• 文章类型: Journal Article
    目标:牙科学生对管理创伤性牙齿损伤(TDI)的知识可能不统一,取决于全球地理位置和牙科教育。这项研究的目的是评估10个国家的10所牙科学校的牙髓学和儿科牙科专业本科生和研究生的知识水平,以了解2020年国际牙科创伤学会(IADT)有关TDI管理的指南。
    方法:本次调查使用了以前发表的问卷。这是一项在线调查,其中包含有关TDI管理的12个问题,并添加了有关参与者的社会人口统计学和专业概况的一些其他问题。该调查已分发给来自10所牙科学校的儿科牙科和牙髓学的最后一年的本科生和研究生。主要使用简单的频率分布和描述性统计来描述数据。使用Kruskal-Wallis测试,然后进行Dwass-Steel-Critchlow-Fligner成对比较,评估了学生类别中的中位数分数差异。
    结果:共有347名本科生,126名牙髓学研究生,来自10所牙科学校的72名儿科牙科研究生参加了这项调查。与本科生相比,研究生的正确回答百分比明显更高。牙髓和儿科牙科研究生之间没有观察到显着差异。
    结论:本科生和研究生所拥有的关于IADT推荐的TDI管理的知识在全球范围内各不相同,发现某些方面存在不足。这项研究强调了重新评估与TDI管理有关的教学和学习活动的至关重要性。
    OBJECTIVE: The knowledge of dental students about managing traumatic dental injuries (TDIs) may not be uniform, depending on global location and dental education. The aim of this study was to evaluate the level of knowledge of undergraduate and postgraduate students specializing in endodontics and pediatric dentistry at 10 dental schools in 10 countries about the 2020 International Association of Dental Traumatology (IADT) guidelines regarding the management of TDIs.
    METHODS: A previously published questionnaire was used in the current survey. It was an online survey with 12 questions regarding the management of TDIs and some additional questions regarding sociodemographic and professional profiles of the participants were added. The survey was distributed to final-year undergraduate students and postgraduate students in pediatric dentistry and endodontics from 10 dental schools. Simple frequency distributions and descriptive statistics were predominantly used to describe the data. Differences in the median percentage scores among the student categories were assessed using the Kruskal-Wallis test followed by Dwass-Steel-Critchlow-Fligner pairwise comparisons.
    RESULTS: A total of 347 undergraduates, 126 postgraduates in endodontics, and 72 postgraduates in pediatric dentistry from 10 dental schools participated in this survey. The postgraduates had a significantly higher percentage score for correct responses compared with the undergraduates. No significant difference was observed between the endodontic and pediatric dentistry postgraduates.
    CONCLUSIONS: The knowledge possessed by undergraduate and postgraduate students concerning the IADT-recommended management of TDIs varied across the globe and some aspects were found to be deficient. This study emphasizes the critical importance of reassessing the teaching and learning activities pertaining to the management of TDIs.
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  • 文章类型: Journal Article
    背景:在英国(UK)的儿科牙科中,龋齿学教学中的现有证据并不一致。许多牙科学校并没有始终如一地教授龋齿管理的生物学方法,过时或复杂的方法被教导超出普通牙科医生的权限。此范围审查旨在绘制有关儿童和年轻人龋齿管理的现行指南。这是工作包的一部分,旨在为英国范围内的儿科牙科龋齿管理课程的共识和开发提供信息。
    方法:使用CochraneLibrary对电子数据库进行了同行评审文献的搜索,MEDLINE通过PubMed,TRIP医学数据库和WebofScience。对灰色文献进行了手工搜索(引用证据来源,全球组织的网站和谷歌网络搜索™(谷歌有限责任公司,加州,美国)。独立筛选数据库的结果,同时由两名审稿人。获得全文,和审稿人开会讨论对数据库和手工搜索的任何分歧。
    结果:本综述确定了16个适合纳入的指南。质量鉴定后,选择了8个进行合成和解释。除非在前牙的特定情况下,否则关键主题包括转向选择性龋齿去除和避免完全龋齿去除。对于有和没有空洞的乳牙和恒牙的“早期病变”,一些指南推荐了生物管理,包括特定地点的预防和裂缝密封剂。
    结论:这篇综述绘制了当前儿童和年轻人的龋齿学指南,发现了文献中的空白,包括早期龋齿病变的分类和早期空化病变的处理。确定进一步探索的领域包括将生物龋齿管理纳入治疗计划,选择性龋齿去除和牙髓切除术是否是专科级别的治疗,需要转介。这些结果将为英国的共识建议提供信息,使用Delphi方法。
    BACKGROUND: Current evidence in cariology teaching is not consistently reflected in paediatric dentistry in the United Kingdom (UK). Many dental schools are not consistently teaching biological approaches to caries management, with outdated or complex methods being taught outwith the purview of general dental practitioners. This scoping review aimed to map current guidelines on the management of caries in children and young people. This is part of a work package to inform the consensus and development of a UK-wide caries management curriculum for paediatric dentistry.
    METHODS: A search of electronic databases for peer reviewed literature was performed using Cochrane Library, MEDLINE via PubMed, TRIP Medical Database and Web of Science. Hand searching was undertaken for grey literature (citations of sources of evidence, websites of global organisations and Google Web Search™ (Google LLC, California, USA). Results from databases were screened independently, concurrently by two reviewers. Full texts were obtained, and reviewers met to discuss any disagreement for both database and hand searching.
    RESULTS: This review identified 16 guidelines suitable for inclusion. After quality appraisal, eight were selected for synthesis and interpretation. Key themes included the shift towards selective caries removal and avoidance of complete caries removal unless in specific circumstances in anterior teeth. For \"early lesions\" in primary and permanent teeth with and without cavitation, several guidelines recommend biological management including site specific prevention and fissure sealants.
    CONCLUSIONS: This review mapping current cariology guidelines for children and young people found gaps in the literature including classification of early carious lesions and management of early cavitated lesions. Areas identified for further exploration include integration of biological caries management into treatment planning, selective caries removal and whether pulpotomy is specialist-level treatment, requiring referral. These results will inform consensus recommendations in the UK, using Delphi methods.
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  • 文章类型: Journal Article
    背景:牙科恐惧和不合作行为会阻碍牙科治疗质量。当超过应对能力时,儿科程序镇静和镇痛(PPSA)用于促进治疗。与在医院环境中使用PPSA相比,院外PPSA与更多的不良后果相关。更新的荷兰PPSA指南增加了成本,并引起了对荷兰儿童获得专门高质量牙科护理的担忧。这项研究旨在调查2017年更新的指南对12家荷兰牙科诊所PPSA期间不良事件发生率的影响。方法:对1997年至2019年在12家牙科诊所接受治疗的25,872名儿童的资料进行分析。使用逻辑两级混合效应模型来估计更新的指南对不良事件的影响。结果:不良事件发生率的OR调整为年龄,体重,实施更新后的指南后,治疗时间为0.75(95%CI0.64-0.89).该结果是显著的,p=0.001,表明保护作用。结论:我们的发现表明,在实施更新的指南后,不良事件显着减少,并强调了在院外牙科诊所坚持循证实践的重要性。
    Background: Dental fear and uncooperative behavior can hinder dental treatment quality. Pediatric Procedural Sedation and Analgesia (PPSA) is used to facilitate treatment when the coping capacity is exceeded. Out-of-hospital PPSA has been associated with more adverse outcomes compared to when it is used in hospital-based settings. The updated Dutch PPSA guidelines have increased costs and raised concerns about the accessibility of specialized high-quality dental care for children in the Netherlands. This study aimed to investigate the impact of the updated 2017 guidelines on the occurrence rate of adverse events during PPSA in twelve Dutch dental clinics. Methods: The data of 25,872 children who were treated at twelve dental clinics between 1997 and 2019 were analyzed. A logistic two-level mixed-effects model was used to estimate the updated guidelines\' impacts on adverse events. Results: The OR of the occurrence rate of an adverse event adjusted for age, weight, and duration of treatment was 0.75 (95% CI 0.64-0.89) after the implementation of the updated guidelines. This outcome was significant with p = 0.001, indicating a protective effect. Conclusions: Our findings demonstrate that there was a significant reduction in adverse events after the implementation of the updated guideline and highlight the importance of adhering to evidence-based practices in out-of-hospital dental clinics.
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  • 文章类型: Journal Article
    背景:临床实践指南(CPGs)可增强医疗保健并帮助临床医生做出决策。
    目的:使用AGREEII工具评估儿科牙科临床指南的质量。
    方法:PubMed,EMBASE,Scopus,LIVIVIVO,丁香花,国际准则网站,科学社会,和灰色文献一直搜索到2021年9月。我们纳入了儿科牙科临床指南,并排除了有特殊需要的患者的草案或指南。两名独立审核员使用《研究与评估指南》II(AGREEII)工具进行了质量评估。我们计算了每个指南的平均总体领域得分(95%置信区间)。我们使用回归分析将总体评估得分和AGREEII的六个领域与指南特征相关联。
    结果:本研究包括44个指南。最高的平均得分是域4(呈现的清晰度;58%,95%CI:50.8-64.9),而最低的是领域5(适用性;16%,95%CI:10.8-21.4)。通过报告清单(p<.001),域1-5中的报告质量得到了提高,而自出版以来,第6域的数量随着年份的减少而得到了改善(p=.047)。
    结论:儿科牙科指南不符合方法学质量标准,特别是在领域5(适用性)。AGREE报告清单应与评估未来指南证据确定性的系统一起实施。
    BACKGROUND: Clinical practice guidelines (CPGs) enhance health care and aid clinicians\' decisions.
    OBJECTIVE: To evaluate the quality of clinical guidelines in paediatric dentistry using the AGREE II tool.
    METHODS: PubMed, EMBASE, Scopus, LIVIVO, Lilacs, international guidelines websites, scientific societies, and gray literature were searched until September 2021. We included paediatric dental clinical guidelines and excluded drafts or guidelines for patients with special needs. Two independent reviewers performed quality assessment using the APPRAISAL OF GUIDELINES FOR RESEARCH & EVALUATION II (AGREE II) instrument. We calculated the mean overall domain scores (95% confidence interval) for each guideline. We used regression analysis to correlate the score of overall assessment and the six domains of AGREE II with guideline characteristics.
    RESULTS: Forty-four guidelines were included in this study. Highest mean score was for Domain 4 (Clarity of Presentation; 58%, 95% CI: 50.8-64.9), whereas the lowest was for Domain 5 (Applicability; 16%, 95% CI: 10.8-21.4). The reporting quality was improved in Domains 1-5 with reporting checklists (p < .001), whereas that of Domain 6 was improved by decreasing years since publication (p = .047).
    CONCLUSIONS: Paediatric dental guidelines do not comply with the methodological quality standard, especially in Domain 5 (Applicability). The AGREE reporting checklist should be implemented with a system to evaluate the certainty of evidence for future guidelines.
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  • 文章类型: Systematic Review
    背景:由美国牙科协会科学事务委员会召集的指南小组,美国牙科协会科学与研究所,匹兹堡大学牙科医学院,和宾夕法尼亚大学综合全球口腔健康中心进行了系统评价和荟萃分析,并为1次或更多次简单和手术拔牙后急性牙痛的药理学管理以及牙痛的临时管理制定了循证建议(即,当无法立即获得明确的牙科治疗时)与牙髓和分叉或儿童根尖疾病(<12岁)有关。
    方法:作者进行了系统评价,以确定镇痛药和皮质类固醇在治疗急性牙痛中的作用。他们使用了建议评估等级,开发和评估方法,以评估证据的确定性和建议的等级评估,制定和评估决策框架的证据,以制定建议。
    结果:小组在不同条件下提出了7项建议和5项良好实践声明。与不提供镇痛治疗相比,存在有利于单独使用非甾体抗炎药或与对乙酰氨基酚组合使用的小的有益净平衡。没有关于糖皮质激素对儿童手术拔牙后急性疼痛的影响的可用证据。
    结论:非阿片类药物,特别是非甾体抗炎药,如布洛芬和萘普生单独或与对乙酰氨基酚联合使用,建议用于治疗1次或多次拔牙后的急性牙痛(即,简单和手术)和儿童牙痛的临时管理(有条件推荐,非常低的确定性)。根据美国食品和药物管理局,儿童使用可待因和曲马多治疗急性疼痛是禁忌的。
    A guideline panel convened by the American Dental Association Council on Scientific Affairs, American Dental Association Science and Research Institute, University of Pittsburgh School of Dental Medicine, and Center for Integrative Global Oral Health at the University of Pennsylvania conducted a systematic review and meta-analyses and formulated evidence-based recommendations for the pharmacologic management of acute dental pain after 1 or more simple and surgical tooth extractions and the temporary management of toothache (that is, when definitive dental treatment not immediately available) associated with pulp and furcation or periapical diseases in children (< 12 years).
    The authors conducted a systematic review to determine the effect of analgesics and corticosteroids in managing acute dental pain. They used the Grading of Recommendations Assessment, Development and Evaluation approach to assess the certainty of the evidence and the Grading of Recommendations Assessment, Development and Evaluation Evidence to Decision framework to formulate recommendations.
    The panel formulated 7 recommendations and 5 good practice statements across conditions. There is a small beneficial net balance favoring the use of nonsteroidal anti-inflammatory drugs alone or in combination with acetaminophen compared with not providing analgesic therapy. There is no available evidence regarding the effect of corticosteroids on acute pain after surgical tooth extractions in children.
    Nonopioid medications, specifically nonsteroidal anti-inflammatory drugs like ibuprofen and naproxen alone or in combination with acetaminophen, are recommended for managing acute dental pain after 1 or more tooth extractions (that is, simple and surgical) and the temporary management of toothache in children (conditional recommendation, very low certainty). According to the US Food and Drug Administration, the use of codeine and tramadol in children for managing acute pain is contraindicated.
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  • 文章类型: Practice Guideline
    背景:由美国牙科协会(ADA)科学事务委员会与ADA科学与研究所的临床和转化研究计划召集的专家小组进行了系统的审查,并提出了建议。非牙髓治疗的乳牙和恒牙。
    方法:作者搜索比较OvidMEDLINE龋齿组织去除(CTR)方法的系统评价,Embase,Cochrane系统评价数据库,和旅行医疗数据库。作者还对比较OvidMEDLINE中直接修复材料的随机对照试验进行了系统的搜索,Embase,Cochrane中央控制试验登记册,ClinicalTrials.gov,和世界卫生组织国际临床试验注册平台。作者使用了建议评估的分级,发展,和评估方法,评估证据的确定性并制定建议。
    结果:小组制定了16项建议和良好实践声明:4项针对病变深度的CTR方法,12项针对涉及牙齿位置和表面的直接修复材料。小组有条件地建议使用保守的CTR方法,尤其是晚期病变。尽管小组有条件地推荐使用所有直接修复材料,在某些临床情况下,他们优先考虑某些材料而不是其他材料。
    结论:证据表明,更保守的CTR方法可能会降低不良反应的风险。所有包括的直接修复材料可能有效治疗中度和晚期龋齿病变,非牙髓治疗的乳牙和恒牙。
    An expert panel convened by the American Dental Association (ADA) Council on Scientific Affairs together with the ADA Science and Research Institute\'s program for Clinical and Translational Research conducted a systematic review and developed recommendations for the treatment of moderate and advanced cavitated caries lesions in patients with vital, nonendodontically treated primary and permanent teeth.
    The authors searched for systematic reviews comparing carious tissue removal (CTR) approaches in Ovid MEDLINE, Embase, Cochrane Database of Systematic Reviews, and Trip Medical Database. The authors also conducted a systematic search for randomized controlled trials comparing direct restorative materials in Ovid MEDLINE, Embase, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform. The authors used the Grading of Recommendations Assessment, Development, and Evaluation approach to assess the certainty of the evidence and formulate recommendations.
    The panel formulated 16 recommendations and good practice statements: 4 on CTR approaches specific to lesion depth and 12 on direct restorative materials specific to tooth location and surfaces involved. The panel conditionally recommended for the use of conservative CTR approaches, especially for advanced lesions. Although the panel conditionally recommended for the use of all direct restorative materials, they prioritized some materials over the use of others for certain clinical scenarios.
    The evidence suggests that more conservative CTR approaches may decrease the risk of adverse effects. All included direct restorative materials may be effective in treating moderate and advanced caries lesions on vital, nonendodontically treated primary and permanent teeth.
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  • 文章类型: Journal Article
    评估各种儿科牙科期刊对作者的伦理要求的指导模式。
    对作者说明的横断面调查,为了分析道德过程的指导方针,已经完成了。对全球儿科牙科期刊上的作者的说明进行了审查,以了解有关十四个关键伦理问题的指南。使用描述性统计数据,结果以百分比和数字表示。
    在18种儿科牙科杂志中,仅有3种期刊的作者指南涵盖了所有14种伦理问题,其中只有50%使用ICMJE指南提供了作者身份的明确性.此外,在大约44%的期刊中,COI声明被认为是强制性的。38.9%的抽样期刊提到了有关研究不当行为的指南,出版问题,如剽窃,重叠/分散的出版物,以及作者原始研究数据的可用性。在选定的儿科牙科职称中,略高于33%的作者提供了有关编辑团队投诉的处理指南,而在16.7%和55.6%的期刊中分别提到了对作者和审稿人投诉的处理。
    相当比例的儿科牙科期刊没有向作者提供关于伦理问题的充分指导。
    To assess the pattern of instructions regarding the ethical requirements given to authors in various Pediatric Dental Journals.
    A cross-sectional survey of \'instructions for authors,\' for analysis of guidelines on ethical processes, was done. Instructions to authors in journals of pediatric dentistry across the globe were reviewed for guidelines with regards to fourteen key ethical issues. Descriptive statistics were used, and results were expressed in percentages as well as numbers.
    Of the 18journals of pediatric dentistry, all 14 ethical issues were covered by the instructions to authors in only three journals with only 50% of these providing clarity about authorship using ICMJE guidelines. Furthermore, COI declaration was found to be present as mandatory in about 44% of the journals. 38.9% of the sampled journals mentioned guidelines on research misconduct, publication issues such as plagiarism, overlapping/fragmented publications, and availability of raw research data from authors. Guidelines on handling of complaints about editorial team was provided to authors by slightly over 33% of the selected pediatric dentistry titles while handling of complaints about authors and reviewers were mentioned in 16.7%and 55.6% of the journals respectively.
    A significant proportion of Journals of Pediatric Dentistry did not provide adequate instructions to authors regarding ethical issues.
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  • 文章类型: Journal Article
    Caries of children under 3 years old has such characteristics as early onset, multiple tooth involvement and rapid development. It may affect the mastication and digestive functions of the children, as well as oral and systemic development, and may become a risk factor for systemic diseases. In order to standardize the prevention and treatment of the caries of the infants and toddlers, to fully utilize the existing medical resources to prevent caries, to reduce the incidence rate and to increase the treatment rate, and to improve the oral health statuses of the infants and toddlers in China, the Society of Pediatric Dentistry and the Society of Preventive Dentistry of the Chinese Stomatological Association convened experts of pediatric dentistry and preventive dentistry from 19 universities and hospitals to conduct profound discussions on this topic, and finally developed the present guideline on diagnosis, prevention, clinical practice and effect evaluation for caries of children under 3 years old suitable to China\'s conditions.
    婴幼儿龋具有发病时间早、龋蚀波及牙数多、龋损发展快及龋坏范围广等特点,影响婴幼儿咀嚼和消化功能,对口腔健康及全身生长发育可产生严重影响,亦可能成为某些全身疾病的危险因素。为统一和规范婴幼儿龋的防治标准,充分利用现有医疗资源防治婴幼儿龋,降低我国婴幼儿龋的患病率,提高治疗率,改善我国婴幼儿口腔健康状况,由中华口腔医学会儿童口腔医学专业委员会和口腔预防医学专业委员会牵头,组织19所医学院校及附属医院的18名儿童口腔医学专家和13名口腔预防医学专家制订适合我国婴幼儿龋的防治指南,包括婴幼儿龋的诊断方法、预防措施、治疗方法和防治效果评价体系。.
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  • 文章类型: Consensus Development Conference
    不同研究设计的报告指南目前可用于准确和透明地报告研究。有必要制定针对儿科牙科领域的补充指南项目。本研究旨在使用预定义的基于专家共识的Delphi流程,为儿科牙科(RAPID)指南的研究开发报告标准。
    RAPID指南的制定是基于《健康研究报告指南开发者指南》。在对文献进行全面搜索之后,执行小组确定了儿科牙科的10个主题,并编制了每个主题下的项目清单草案。主题分类为:一般,口腔医学,病理学和放射学,有特殊医疗保健需求的儿童,镇静和医院牙科,行为指导,龋齿,预防性和恢复性牙科,纸浆疗法,创伤学,和截获性正畸.成立了RAPIDDelphi集团(RDG),由来自六大洲15个国家的69名成员组成。使用9分的李克特量表对项目进行评分。成绩达到7分及以上的项目,以至少70%的RDG成员为标志被纳入快速检查表项目。计算每个项目的加权平均得分。统计显著性设置为p<0.05,并且使用单向ANOVA来计算主题之间的加权平均得分的差异。
    最终的RAPID清单由128个项目组成,这些项目由RDG成员在在线共识会议上最终确定和批准。对于单个项目,高分(7至9分)的百分比范围为69.57至100%。最终项目的总体加权平均得分范围为7.51至8.28(共9个),主题之间的差异具有统计学意义(p<0.05)。
    快速声明为研究人员提供了指导,作者,审稿人和编辑,确保与特定研究相关的所有要素得到充分报告。
    Reporting guidelines for different study designs are currently available to report studies with accuracy and transparency. There is a need to develop supplementary guideline items that are specific to areas within Pediatric Dentistry. This study aims to develop Reporting stAndards for research in PedIatric Dentistry (RAPID) guidelines using a pre-defined expert consensus-based Delphi process.
    The development of the RAPID guidelines was based on the Guidance for Developers of Health Research Reporting Guidelines. Following a comprehensive search of the literature, the Executive Group identified ten themes in Pediatric Dentistry and compiled a draft checklist of items under each theme. The themes were categorized as: General, Oral Medicine, Pathology and Radiology, Children with Special Health Care Needs, Sedation and Hospital Dentistry, Behavior Guidance, Dental Caries, Preventive and Restorative Dentistry, Pulp Therapy, Traumatology, and Interceptive Orthodontics. A RAPID Delphi Group (RDG) was formed comprising of 69 members from 15 countries across six continents. Items were scored using a 9-point rating Likert scale. Items achieving a score of seven and above, marked by at least 70% of RDG members were accepted into the RAPID checklist items. Weighted mean scores were calculated for each item. Statistical significance was set at p < 0.05 and one-way ANOVA was used to calculate the difference in the weighted mean scores between the themes.
    The final RAPID checklist comprised of 128 items that were finalized and approved by the RDG members in the online consensus meeting. The percentage for high scores (scores 7 to 9) ranged from 69.57 to 100% for individual items. The overall weighted mean score of the final items ranged from 7.51 to 8.28 (out of 9) and the difference was statistically significant between the themes (p < 0.05).
    The RAPID statement provides guidance to researchers, authors, reviewers and editors, to ensure that all elements relevant to particular studies are adequately reported.
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  • 文章类型: Journal Article
    In recent years, dental treatments of the outpatient children under general anesthesia has gradually developed as a relatively mature behavior management model. Due to the limited operating time and the large patient flow of children in outpatient clinics, higher requirements of management are proposed both in anesthesia and dental treatment phases. The Society of Sedation and Analgesia of the Chinese Stomatological Association organized experts to formulate a guideline of dental treatments of children under general anesthesia in outpatient clinic. The guideline would provide operable implementing criteria for the entire process including general anesthesia in the dental clinics, basic clinical conditions, types of oral diagnosis and treatment, evaluation and preparation before diagnosis and treatment, anesthesia implementation and monitoring, management during the recovery period, common complications and key points of treatments. This guideline will play an important role in the rapid development of the safe and comfort dental treatments of children under general anesthesia in China.
    近年来,在全身麻醉状态下完成门诊儿童口腔诊疗,已逐渐发展成为一种较成熟的行为管理模式。由于门诊儿童口腔诊治时间短、流动性大、周转快,对麻醉及诊疗期的管理提出更高要求。中华口腔医学会镇静镇痛专业委员会组织专家,制定儿童口腔门诊全身麻醉操作指南,从口腔门诊实施全身麻醉的范围、临床基本条件、口腔诊疗种类、诊治前评估与准备、麻醉实施与监测、恢复和苏醒期管理、常见并发症及处理要点等方面给出具有可操作性的实施规范,对促进我国儿童门诊全身麻醉下口腔诊疗安全性和舒适化的快速发展具有重要意义。.
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