The impact of recent changes in the epidemiology of dental caries on guidelines for the use of dental sealants: clinical perspectives.
The impact of recent changes in the epidemiology of dental caries on guidelines for the use of dental sealants: clinical perspectives.
复制标题
龋齿流行病学的最新变化对牙科密封剂使用指南的影响：临床观点。
DOI：
10.1111/j.1752-7325.1995.tb02384.x
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发表时间：
1995
影响因子：
2.3
通讯作者：
Söderholm,KJ
中科院分区：
文献类型：
--
作者：
Söderholm,KJ
如果使用得当，密封剂可以改善牙齿健康。然而，出于预防的原因，它们在所有咬合牙齿表面上的使用将导致浪费牙齿护理资源。为了优化密封剂的预防效果，应启动一种交付模式，使用经过专门培训的牙科医生或牙科助理，他们访问学校解释口腔健康相关问题，对临床口腔健康状况进行目视检查，识别有龋齿风险的患者，并为项目操作生成中央数据库。当识别出高风险患者时，辅助人员可以放置密封剂并在六个月后召回患者进行新的目视检查。若怀疑有蛀牙，可送牙科医生作进一步治疗。为抵销因过度使用封闭剂而引致的不良影响，封闭剂的使用应分为两类。首先，应提供一种预防性备选办法，在这一备选办法中使用密封剂的费用应低于目前使用的费用。由受过特别训练的辅助人员放置这种密封剂，费用可以保持在合理的低水平。其次，还应该提供针对早期病变治疗的封闭剂治疗选项。这种治疗的费用应与传统的咬合修复接近，并应由牙医申请。如果采用这种基于市场力量的收费结构，人们预计早期龋损患者使用密封剂的情况会增加，而预防性密封剂的使用量则会保持不变或减少。牙科密封剂的这种使用模式将有助于提高龋齿治疗中密封剂使用的效率，特别是在龋齿频率下降的时候。效率的提高可以释放牙科保健资源，这些资源应该用于提高牙齿健康教育的目标风险群体。通过使用这种策略，长期效果不仅是减少牙齿的放置，而且还改善了青少年和成年人的牙齿健康。
When used properly, sealants result in improved dental health. However, their use on all occlusal tooth surfaces for preventive reasons will result in wasted dental care resources. To optimize the preventive effects of sealants, a delivery model should be initiated that uses specially trained dental hygienists or dental assistants who visit schools to explain oral health‐related issues, conduct visual inspections of clinical oral health status, identify patients at risk for dental caries, and generate a central database for program operation. When a high‐risk patient is identified, auxiliary personnel could place sealants and recall the patient for a new visual inspection six months later. If caries is suspected at that time, the patient could be sent to a dentist for additional treatment.To offset the negative effects caused by overutilization of sealants, their usage should be divided into two categories. First, a preventive option should be available, and the fee for use of sealants in this option should be lower compared to the fees used today. By using specially trained auxiliary personnel to place such sealants, the fee could be kept reasonably low. Second, a sealant treatment option that targets treatments of incipient lesions also should be available. The fee for such a treatment should be close to that of the traditional occlusal restoration, and the application should be by a dentist.By using such a fee structure based on market forces, one would expect that sealant usage would increase among patients suffering from early carious lesions, while the usage of preventive sealants would remain the same or decline. This utilization pattern for dental sealants would contribute to improved efficiency of sealant usage in the treatment of dental caries, particularly at a time when caries frequency is declining. The improved efficiency could release dental care resources that should be used to target risk groups with improved education in dental health. By using such a strategy, the long‐term effect would be not only the placement of fewer restorations, but an improvement in dental health among adolescents and adults.