Levine R S, Nugent Z J, Pitts N B
Dental Health Services Researcch Unit, University of Dundee Dental School.
Br Dent J. 2003 Aug 23;195(4):202-6; discussion 197. doi: 10.1038/sj.bdj.4810444.
To provide a pain-predictive model for the non-operative management of carious deciduous teeth from the analysis of data from a retrospective analysis of clinical case notes of children regularly attending two general dental practices and receiving preventive care.
A clearly defined protocol was used to determine the fate of deciduous teeth diagnosed as carious into dentine but symptomless and left unrestored from the sequential examination of the clinical records of 480 children attending at least annually.
The age of the children at the first visit when carious teeth were diagnosed ranged from 008 to 12.3 years, with the majority of children (243/480) presenting by 6 years of age. In all, 250 teeth from 162 children were extracted because of pain or became painful and were treated. The remaining 318 children did not report pain on subsequent visits. The strongest predictor of pain was age on diagnosis, the other factors being tooth type and extent of the cavity when first seen. Data from the present study provides a model that enables a child with deciduous caries to be placed into one of six pain-predictive groups associated with a risk of pain or infection if the teeth are not restored but provided with preventive care only.
In these patients, the majority of unrestored carious deciduous teeth remain symptomless until shed. A higher risk of subsequent pain or infection was associated with the development of caries in younger patients, disease extending beyond single surfaces, and disease in lower deciduous molars. The results provide evidence to aid the treatment planning of carious deciduous teeth in children receiving regular preventive dental care.
通过对定期就诊于两家普通牙科诊所并接受预防性护理的儿童临床病例记录进行回顾性分析，为龋损乳牙的非手术治疗提供疼痛预测模型。
采用明确的方案，通过对至少每年就诊一次的480名儿童的临床记录进行序贯检查，确定诊断为龋坏至牙本质但无症状且未进行修复的乳牙的转归。
首次诊断出龋齿时儿童的年龄范围为0.8岁至12.3岁，大多数儿童（243/480）在6岁时就诊。总共，162名儿童的250颗牙齿因疼痛或变得疼痛而被拔除并接受治疗。其余318名儿童在后续就诊时未报告疼痛。疼痛的最强预测因素是诊断时的年龄，其他因素包括首次就诊时的牙齿类型和龋洞范围。本研究的数据提供了一个模型，该模型能够将患有乳牙龋齿的儿童分为六个疼痛预测组之一，如果牙齿不进行修复而仅接受预防性护理，则与疼痛或感染风险相关。
在这些患者中，大多数未修复的龋损乳牙在脱落前仍无症状。年轻患者龋齿的发生、病变累及多个面以及下颌乳牙的病变与随后疼痛或感染的较高风险相关。这些结果为帮助接受定期预防性牙科护理的儿童龋损乳牙的治疗计划提供了证据。
