Womack Army Medical Center, 2817 Reilly Road, Fort Bragg, NC 28310.
Uniformed Services University F Edward Hébert School of Medicine Department of Family Medicine, 4301 Jones Bridge Road A1038, Bethesda, MD 20814-4799.
FP Essent. 2021 Feb;501:24-29.
Dental and oral health conditions are widespread in the US population. Among children and teenagers, 46% have dental cavities; among adults, more than 90% have cavities and 46% have periodontal disease. In 2015, more than $117 billion was spent on dental care in the United States, with a significant share delivered in emergency departments (EDs). Common nontraumatic dental conditions seen in EDs include dental pain and infection. Less than one-third of patients seek follow-up dental care. The mildest form of oral disease is dental cavities. Gingivitis is inflammation of the gums. Left unmanaged, it can lead to necrotizing ulcerative gingivitis, periodontitis, and periodontal abscesses. Acute periodontal abscess can be managed by a nondental physician with simple incision and drainage. Rarely, patients will develop orofacial space infections from unrecognized or unmanaged dental infections. These medical emergencies require immediate surgical consultation. Initial management of postextraction bleeding consists of application of constant pressure for more than 30 min at the bleeding site. Dental conditions and their complications are preventable. Family physicians play a role in providing oral health education. The primary areas of needed intervention are continuity of dental care, healthy nutritional habits, oral hygiene education, systemic disease management, and smoking cessation.
美国人群中普遍存在口腔和牙齿健康问题。在儿童和青少年中，46%有龋齿；在成年人中，超过 90%有龋齿，46%有牙周病。2015 年，美国在牙科保健上的支出超过 1170 亿美元，其中很大一部分是在急诊科（EDs）提供的。急诊科常见的非创伤性牙科疾病包括牙痛和感染。不到三分之一的患者寻求后续牙科护理。最轻微的口腔疾病形式是龋齿。牙龈炎是牙龈的炎症。如果不加以治疗，它可能导致坏死性溃疡性牙龈炎、牙周炎和牙周脓肿。急性牙周脓肿可以由非牙科医生通过简单的切开引流来治疗。极少数情况下，未被识别或未得到治疗的牙科感染会导致口腔颌面部间隙感染。这些医疗急症需要立即进行手术咨询。拔牙后出血的初始处理是在出血部位施加超过 30 分钟的持续压力。牙科疾病及其并发症是可以预防的。家庭医生在提供口腔健康教育方面发挥作用。需要干预的主要领域是牙科护理的连续性、健康的营养习惯、口腔卫生教育、系统性疾病管理和戒烟。
