DDS, MPH, Boston Children's Hospital, Boston, MA, USA; DDS, MPH, Developmental Biology (Pediatric Dentistry), Harvard School of Dental Medicine, Boston, MA, USA.
DMD, Predoctoral Pediatric Dentistry, Harvard School of Dental Medicine, Boston, MA, USA; DMD, Pediatric Dentistry, Boston Children's Hospital, Boston, MA, USA.
J Evid Based Dent Pract. 2016 Jun;16 Suppl:20-33. doi: 10.1016/j.jebdp.2016.01.015. Epub 2016 Jan 29.
Management of the complex chronic disease of early childhood caries requires a system of coordinated health care interventions which can be led by a dental hygienist and where patient self-care efforts are paramount.
Even after receiving costly surgical treatment under general anesthesia in the operating room, many children develop new and recurrent caries after only 6-12 months, a sequela that can be prevented. This article describes the chronic disease management (CDM) of dental caries, a science-based approach that can prevent and control caries.
In this article, we (1) introduce the concept of CDM of dental caries, (2) provide evidence that CDM improves oral health outcomes, and (3) propose a dental hygienist-led team-based oral health care approach to CDM. Although we will be describing the CDM approach for early childhood caries, CDM of caries is applicable in children, adolescents, and adults.
Early childhood caries disease control requires meaningful engagement of patients and parents by the oral health care team to assist them with making behavioral changes in the unique context of their families and communities. The traditional dentist/hygienist/assistant model needs to evolve to a collaborative partnership between care providers and patients/families. This partnership will be focused on systematic risk assessment and behaviorally based management of the disease itself, with sensitivity toward the familial environment. Early pilot study results demonstrate reductions in the rates of new caries, dental pain, and referral to the operating room compared with baseline rates. Dental hygienists are the appropriate team members to lead this approach because of their expertise in behavior change and prevention.
管理儿童早期龋齿这一复杂的慢性病需要一套协调的医疗干预措施，该措施可以由一名牙科保健员来领导，而患者的自我保健努力则至关重要。
即使在手术室全身麻醉下接受了昂贵的手术治疗，许多儿童在仅 6-12 个月后仍会出现新的、反复的龋齿，这是可以预防的后遗症。本文描述了龋齿的慢性疾病管理（CDM），这是一种基于科学的方法，可以预防和控制龋齿。
在本文中，我们（1）介绍了龋齿的 CDM 概念，（2）提供了证据表明 CDM 可以改善口腔健康结果，以及（3）提出了一种由牙科保健员领导的团队式口腔保健方法来进行 CDM。尽管我们将描述针对儿童早期龋齿的 CDM 方法，但 CDM 对龋齿的应用适用于儿童、青少年和成年人。
儿童早期龋齿的疾病控制需要口腔保健团队与患者和家长进行有意义的互动，以帮助他们在家庭和社区的独特环境中做出行为改变。传统的牙医/保健员/助手模式需要演变为护理提供者和患者/家庭之间的协作伙伴关系。这种伙伴关系将侧重于系统性风险评估和基于行为的疾病管理，并对家庭环境保持敏感性。早期试点研究结果表明，与基线相比，新龋齿、牙痛和转诊手术室的发生率有所降低。由于牙科保健员在行为改变和预防方面的专业知识，他们是领导这种方法的适当团队成员。
