0-乳牙萌出前(一般约出生后6个月)口腔保健应从出生时开始。牙齿萌出前,每次给宝宝喂养后,再喂几口白开水,以便把残留食物冲洗干净,如有必要家长可将消毒棉花或纱布套在手指上沾水后将婴儿口腔中的舌头及牙龈处奶渣擦拭干净,减少口腔细菌的孳生,可降低或延缓龋病的发生。6个月---1.5岁家长坐在沙发或床边,让幼儿躺在家长怀中。用一只手固定幼儿的头部和嘴唇,另一只手拿清洁的纱布或婴幼儿专用的指套牙刷,沾温开水为孩子清洁牙齿的外侧面和内侧面。1.5岁---3岁这个时期的儿童可开始使用牙刷,但刷牙主要由成人完成。幼儿可直立或坐在椅凳上,母亲或其他家长在幼儿的背后或一侧,用一只手固定幼儿头部,另一只手持幼儿牙刷沾温开水为幼儿刷牙(不用牙膏),刷牙的顺序是:1.前牙、后牙外侧—握住牙刷,使其与牙齿成45度角,从牙龈线开始,轻柔地、小幅度地来回刷牙;2.后牙内侧—刷牙幅度要小、刷牙动作形成一定弯度;3前牙内侧—保持牙刷与牙齿垂直,用牙刷头上下刷牙;4.咀嚼面—平握牙刷,轻柔地刷牙;每个面要刷15至20次,才能达到清洁牙齿的目的。在此期间,家长应注意培养孩子对刷牙的兴趣,使孩子从小养成良好的口腔卫生习惯,将会终生受益。3岁----6岁儿童应在成人的指导下开始自己刷牙,方法同上,但仍需成人的帮助才能将牙齿刷干净。★除了以上所述牙面清洁的方法之外,还有一点需特别提请家长注意的是宝宝的牙间清洁。乳牙由于具有特有的解剖形态,因此容易嵌塞食物。另外,乳牙存在生理间隙,也容易嵌塞食物。家长和孩子要学会使用牙线,可以很方便地去除嵌塞食物残渣,保持牙间清洁,预防蛀牙。祝各位小朋友们都拥有健康的牙齿!★
Table of Cont entsCleft Lip and PalateCRITICAL ELEMENTS OF CAREINTRODUCTION.................................................................................................................................................................4I. KEY INTERVENTIONS FOR CLEFT LIP/PALATEOverview: Summary of Key Interventions by Age .........................................................................................6Prenatal..................................................................................................................................................................7Birth through 1 Month........................................................................................................................................81 through 4 Months.............................................................................................................................................95 through 15 Months.........................................................................................................................................1016 through 24 Months.......................................................................................................................................112 through 5 Years...............................................................................................................................................126 through 11 Years.............................................................................................................................................1312 through 21 Years...........................................................................................................................................14Overview: Summary of Key Interventions by Specialty...............................................................................15II. APPENDICESI. Standards of Care for Cleft Lip and Palate......................................................................................................17II. Prenatal Diagnosis.............................................................................................................................................20III. Nursing, Coordination of Care and Feeding Issues......................................................................................22IV. Primary Care......................................................................................................................................................24V. Psychosocial and Developmental Issues in Cleft Care..................................................................................27VI. Genetics/Dysmorphology.................................................................................................................................30VII. Plastic Surgery....................................................................................................................................................33VIII. Otolaryngology/Audiology...............................................................................................................................36IX. Speech Problems in Children with Clefts.......................................................................................................39X. Orthodontics/Dental Medicine........................................................................................................................42XI. Oral and Maxillofacial Surgery........................................................................................................................44XII. Ethics and Children with Cleft Lip/Palate......................................................................................................46XIII. Types of Cleft Lip/Palate...................................................................................................................................48XIV. Glossary...............................................................................................................................................................50XV. Washington State Cleft Lip/Palate Teams.......................................................................................................52XVI. References and Resources.................................................................................................................................
Orthodontic ServicesPatients with craniofacial anomalies require orthodontic services as a direct result of the medical condition and as an integral part of the habilitative process. Treatment often takes place in phases which may include treatment in infancy, the primary dentition, the transitional dentition, and the permanent dentition. The skeletal and dental components should therefore be regularly evaluated to see if a malocclusion is present or developing. Diagnosis and treatment planning requires a variety of diagnostic records as well as clinical examination. Records are obtained in a serial fashion to monitor dentofacial growth and development as well as the results of ongoing treatment. When indicated, orthodontic treatment prepares a patient for alveolar bone grafting of the cleft maxilla, for correcting malocclusions and for preparation of jaw surgery. In summary, orthodontic care may include primary orthopedic treatment in infancy and can extend through adulthood. Dental films, cephalometric radiographs, photographs and computer imaging as indicated should be utilized to evaluate and monitor dental and facial growth and development. For patients at risk for developing malocclusion or maxillary-mandibular discrepancy, diagnostic records including properly occluded dental study models should be collected at appropriate intervals. As the primary dentition erupts, each team evaluation should include a dental examination and referral to appropriate providers for caries control, preventive measures and restorative dental treatment, and space management if such services are not being provided. Before the primary dentition is completed, the skeletal and dental components should be evaluated to determine if a malocclusion is present or developing. Depending upon the goals to be accomplished, and also upon the age at which the patient is first seen, orthodontic management of malocclusion may be performed in the primary, mixed or permanent dentition. In some cases, orthodontic treatment may be necessary in all three stages.21 While continuous active orthodontic treatment from early mixed dentition to permanent dentition should be avoided, each stage of therapy may be followed by orthodontic retention and regular observation; the orthodontic retention period for the permanent dentition may extend into adulthood. For some patients with craniofacial anomalies, functional orthodontic appliances may be indicated. For patients with craniofacial anomalies, orthodontic treatment may be needed in conjunction with surgical correction (and/or distraction osteogenesis) of the facial deformity. Congenitally missing teeth may be replaced with a removable appliance, fixed restorative bridgework, or osseointegrated implants. Patients should be closely monitored for periodontal disease. Prosthetic obturation of palatal fistulae may be necessary in some patients. A prosthetic speech appliance may be used to treat velopharyngeal inadequacy in some patients.
什么是隐形矫正?隐形矫正又叫“隐形无托槽矫正”,该技术采用计算机辅助三维诊断、设计、个性定制的口腔正畸技术,只需每两周更换一副,就可以让牙齿悄悄的变整齐。隐形矫治器VS固定矫治器1、美观方面:固定矫治
对于矫正拔牙,特别是拔掉健康的牙齿,很多人都有不解和恐惧。矫正拔牙,其实有理可循,其实没那么可怕。拔牙矫正是很普遍的、很成熟的治疗方式,拔牙不会对患者的功能和健康造成危害的。为什么有的人需要拔牙矫正?需要矫正的人多半存在的问题就是牙齿不整齐,牙齿不整齐多半是因为牙齿萌出空间不足,歪歪扭扭,一团拥挤。拔牙治疗是为了协调牙量与骨量的不一致,在没有明显上下颌骨骨性不调的情况下,错颌畸形的产生,追根究底就是牙槽骨的空间不足以容纳现存所有牙齿的结果,拔牙后腾出来的空隙,正好可以满足正畸过程的需要,以改善牙齿不齐、过大、拥挤等情况,还可以改善面型、提高咀嚼功能。拔牙治疗不但能使牙量与骨量更好的匹配,也能使治疗结果更加稳定。在治疗结束时,缝隙会完全关闭,牙齿下的骨组织也完好存在。很多人认为,拔那么多健康的牙,为什么不拔掉已经坏了,蛀了的牙?其实,医生对于拔那颗牙都是综合各方面因素进行考量的,医生尽量去选择既能解决问题、又相对不那么重要的牙齿。拔哪颗好呢?拔牙一般遵循的原则:1、尽量不拔牙,要拔先拔坏牙、蛀牙、松动牙;2、尽量拔功能小的牙;3、上下左右对称拔牙;4、尽量不拔门牙,门牙是门面担当,除非坏的很严重;5、尽量不拔尖牙,也就是“虎牙”,因为尖牙有撕裂食物和支撑口角的功能,别的牙都不及它威猛;6、尽量不拔第一磨牙和第二磨牙,因为他们承担主要的咀嚼功能,并且正畸难度较大。
什么是矫牙 俗语:矫牙专业术语:口腔正畸研究对象:错颌畸形——不仅指牙齿错位、排列不齐,还包含由牙颌、颌面关系不调而引起的各种畸形。世界卫生组织把错颌畸形定义为“牙面异常”,它不仅影响外貌,还影响功能。不同年龄特点及矫正要求0~3岁,无牙颌—乳牙列形成期不正确的喂养姿势会造成下颌移位而导致错合。从两岁开始,家长应逐步减少直至戒除使用安抚奶嘴,咬手指、咬嘴唇、口呼吸等不良习惯。对不良习惯的纠正应采用奖励安慰的措施,避免粗暴简单的惩罚恐吓。这个时期还要特别注意上门牙的外伤史,部分患儿由于外伤而导致恒牙异位萌出,甚至发育异常而导致萌出困难。3~6岁,乳牙列期这个时期儿童要尽早戒掉使用奶瓶的习惯,对之前发现的不良习惯如通过教育方式仍不能戒除的可在此阶段通过功能矫治器早期治疗,避免错合进一步加重从而对儿童颌面部生长发育造成不良影响。目前较为流行的是MRC矫治系统,但患儿家属千万不要自行在淘宝或者其他途径购买并使用矫治器,错合的诊断及其发生的机理是非常复杂的,且目前产品的种类很多,家长一定不要自行选用以免耽误甚至加重病情。6~12岁,混合牙列期(丑小鸭期)这个时期是小朋友换牙的阶段,新老交替过程中会出现各种各样的问题,也叫做丑小鸭期。有些畸形如上正中门牙间隙,个别牙轻度的扭转错位可暂时观察,不需要进行纠正。但也有一些如多生牙或牙瘤会引起的上正中门牙间隙过大或者是门牙阻生引起的牙齿迟萌则需要早期干预治疗。最新的研究表明如果侧门牙存在先天缺失或者畸形则尖牙有很大几率会出现阻生。另外还有一些颌骨发育异常的患儿也需要在此期进行干预。12~18岁,恒牙列初期这个时期除了智慧牙外恒牙已经全部萌出,是比较理想的进行正畸治疗的阶段,个体到底需不需要矫正要看自身的需要以及专科医生检查后的建议。有一个“个别正常合”的概念,凡轻微的错合畸形,对于生理过程无大碍者,都列入正常合范畴。这种正常范畴内的个体合,彼此之间又有所不同。当然,如果你是一个追求完美的人,轻微的错合畸形也可以通过正畸的方法达到纠18岁以上目前越来越多的成年人进行牙齿矫正,有些是为了排齐牙齿以追求美观,有些是因为镶牙之前所做的必要准备,还有些是因为去除牙周炎导致的牙齿移位引起的咬合创伤。另外有一些严重的颌面部发育畸形通过单纯矫正是不能达到理想的效果的,这时候就需要正畸联合正颌手术才能达到理想的效果。 Q&A Q:等牙齿换完后才做矫正吗?A:不是的,这种做法是错误的,甚至会错过最佳治疗时机。关于错颌的治疗与诊断是非常复杂的,最稳妥的做法是在孩子两岁半左右出齐牙后定期每半年找正畸专科医师检查一次,建立系统完善的病例资料。Q:每个人都需要做矫正吗?A:个体差异很大,具体还需专科医生进行详尽的检查评估后决定。随着社会的发展,食物变得精细,导致咀嚼功能逐步退化,想要一口正常且美观的牙齿越来越难。建议大家定期每半年拜访一次正畸专科医师。
据统计,近半3岁儿童患龋病,由于龋病程度不同会导致幼儿牙痛、牙龈肿痛、无法正常咀嚼、进食、甚至影响睡眠,更严重的影响孩子正常生长发育,可大部分幼儿经行为诱导后仍严重哭闹不能配合常规治疗,这时最适合的方式便是全麻下进行龋坏牙的治疗。关于全麻治疗的方式,很多家长疑虑:全麻对宝宝安全吗?口腔全麻技术,先了解一下:口腔全麻技术指采用麻醉药物让儿童进入无意识的睡眠状态,在严密的心电监护下进行口腔治疗的一种方法。口腔全麻治疗是一种安全、有效,并且已经广泛应用于临床的技术。全麻下舒适化儿牙治疗家长最想知道的问题!Q&A全身麻醉会影响儿童智力吗?答案是:NO!!很多家长最担心这个问题,但可以明确的是,到目前为止全世界没有任何研究数据表明全麻会影响智力。(1)2011-2013年,北京大学口腔医院儿童口腔科调查全麻前后对照资料,患儿在术前一周和术后2-4周各接受一次智力测试,结果表明全身麻醉下牙齿治疗未对患儿智力水平产生任何影响。(2)美国FDA2016年指出:3岁以上孩子接受全麻不会影响大脑智力发育,3岁以下幼儿单次接受3小时内全麻为安全,3岁以下幼儿接受多次和长时间全麻对大脑是否有影响尚没有文献证据。所以家长无需过度担心,现代医疗技术再加上专业的医护团队,能够保障孩子在舒适的状态下接受治疗。儿童口腔全麻治疗的好处?1.可以减轻孩子在治牙中出现的恐惧,避免给孩子造成心理影响;2.可以一次性高效的完成口内所有牙齿的治疗;3.安全,能有效的避免了孩子在治疗过程中乱动、乱叫,而导致的软硬组织损伤、器械折断等。儿童口腔全麻治疗安全吗?现代全身麻醉技术已经是非常成熟的临床技术,术前会进行完善的检查评估,治疗当日全程由专业麻醉医生保驾护航,治疗结束后患儿会在家人的陪伴下逐步恢复至接近术前的状态,符合离院标准后离开,发生全麻医疗意外的风险极低。哪些孩子适合口腔全麻治疗?1.患儿因智力或全身疾病因素,无法清醒状态下配合门诊治疗;2.全口牙大部分龋坏严重,不能常规配合治疗但需尽快治疗的低龄儿童;3.非常恐惧、焦虑、抵抗或不能交流的儿童或青少年,短期内行为无法改善,口腔内有多颗患牙需要治疗;4.患者有多颗患牙,无法多次就诊的;5.患儿有多颗患牙,家长担心束缚下治疗会对患儿心理造成影响,选择全麻下治疗患牙;6.因急性感染、解剖结构变异或者过敏,患儿进行充填治疗或外科手术局麻无效的。美美睡一觉,牙就治好了!舒适化全麻口腔治疗,带孩子看牙不再发愁了:在儿童看牙过程中,医生家长齐上阵、“威逼利诱”等现象屡见不鲜。但不论何种方式,都容易给儿童造成心理阴影。全麻下儿童口腔手术既安全又快,孩子还不遭罪,选择它为孩子治疗一口烂牙,是不错的选择。