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来自牙科学博士Alan Carr的回答。
标准牙线通常被认为是清洁牙齿之间的狭小空间的最有效工具。 您还可以使用牙线刮擦每个牙齿的侧面。
一个水龙头（冲牙器）是一种瞄准你的牙齿水流的装置。 一个水镐可以帮助从你的牙齿清除食物颗粒，可能有助于减少出血和牙龈疾病 - 但它通常不被视为替代刷牙和牙线。
如果平滑的牙线卡在牙齿的话，使用打蜡的品种。 如果您很难处理牙线，请尝试清洁牙线架。 其他选项可能包括专用刷子，镐或棍子设计用于清洁牙齿之间。
中文翻译：豌豆爸爸
本文地址：http://www.wjbb.com/know/1197
原文出处：http://www.mayoclinic.org/heal ... 58112
来自牙科学博士Alan Carr的回答。
标准牙线通常被认为是清洁牙齿之间的狭小空间的最有效工具。 您还可以使用牙线刮擦每个牙齿的侧面。
一个水龙头（冲牙器）是一种瞄准你的牙齿水流的装置。 一个水镐可以帮助从你的牙齿清除食物颗粒，可能有助于减少出血和牙龈疾病 - 但它通常不被视为替代刷牙和牙线。
如果平滑的牙线卡在牙齿的话，使用打蜡的品种。 如果您很难处理牙线，请尝试清洁牙线架。 其他选项可能包括专用刷子，镐或棍子设计用于清洁牙齿之间。
中文翻译：豌豆爸爸
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来自牙科学博士Alan Carr的回答。
The best way to treat dry mouth — known medically as xerostomia (zeer-o-STOE-me-uh) — depends on what's causing it. You can do some things to relieve dry mouth temporarily. But for the best long-term dry mouth remedy, you need to address its cause.
To relieve your dry mouth:
Chew sugar-free gum or suck on sugar-free hard candies to stimulate the flow of saliva. For some people, xylitol, which is often found in sugar-free gum or sugar-free candies, may cause diarrhea or cramps if consumed in large amounts.Limit your caffeine intake because caffeine can make your mouth drier.Don't use mouthwashes that contain alcohol because they can be drying.Stop all tobacco use if you smoke or chew tobacco.Sip water regularly.Try over-the-counter saliva substitutes — look for products containing xylitol, such as Mouth Kote or Oasis Moisturizing Mouth Spray, or ones containing carboxymethylcellulose (kahr-bok-see-meth-ul-SEL-u-lohs) or hydroxyethyl cellulose (hi-drok-see-ETH-ul SEL-u-lohs), such as Biotene Oral Balance.Try a mouthwash designed for dry mouth — especially one that contains xylitol, such as Biotene Dry Mouth Oral Rinse or ACT Total Care Dry Mouth Rinse, which also offer protection against tooth decay.Avoid using over-the-counter antihistamines and decongestants because they can make your symptoms worse.Breathe through your nose, not your mouth.Add moisture to the air at night with a room humidifier.
Saliva is important to maintain the health of your teeth and mouth. If you frequently have a dry mouth, taking these steps to protect your oral health may also help your condition:
Avoid sugary or acidic foods and candies because they increase the risk of tooth decay.Brush with a fluoride toothpaste. Ask your dentist if you might benefit from prescription fluoride toothpaste.Use a fluoride rinse or brush-on fluoride gel before bedtime.Visit your dentist at least twice yearly to detect and treat tooth decay or other dental problems.
If these steps don't improve your dry mouth, talk to your doctor or dentist. The cause could be a medication or another condition. Medications are one of the most common causes of dry mouth. Long-term relief from your dry mouth may mean stopping or changing your medication or its dosage, or addressing underlying health issues.
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原文出处：http://www.mayoclinic.org/dise ... 58424
来自牙科学博士Alan Carr的回答。
The best way to treat dry mouth — known medically as xerostomia (zeer-o-STOE-me-uh) — depends on what's causing it. You can do some things to relieve dry mouth temporarily. But for the best long-term dry mouth remedy, you need to address its cause.
To relieve your dry mouth:
Chew sugar-free gum or suck on sugar-free hard candies to stimulate the flow of saliva. For some people, xylitol, which is often found in sugar-free gum or sugar-free candies, may cause diarrhea or cramps if consumed in large amounts.Limit your caffeine intake because caffeine can make your mouth drier.Don't use mouthwashes that contain alcohol because they can be drying.Stop all tobacco use if you smoke or chew tobacco.Sip water regularly.Try over-the-counter saliva substitutes — look for products containing xylitol, such as Mouth Kote or Oasis Moisturizing Mouth Spray, or ones containing carboxymethylcellulose (kahr-bok-see-meth-ul-SEL-u-lohs) or hydroxyethyl cellulose (hi-drok-see-ETH-ul SEL-u-lohs), such as Biotene Oral Balance.Try a mouthwash designed for dry mouth — especially one that contains xylitol, such as Biotene Dry Mouth Oral Rinse or ACT Total Care Dry Mouth Rinse, which also offer protection against tooth decay.Avoid using over-the-counter antihistamines and decongestants because they can make your symptoms worse.Breathe through your nose, not your mouth.Add moisture to the air at night with a room humidifier.
Saliva is important to maintain the health of your teeth and mouth. If you frequently have a dry mouth, taking these steps to protect your oral health may also help your condition:
Avoid sugary or acidic foods and candies because they increase the risk of tooth decay.Brush with a fluoride toothpaste. Ask your dentist if you might benefit from prescription fluoride toothpaste.Use a fluoride rinse or brush-on fluoride gel before bedtime.Visit your dentist at least twice yearly to detect and treat tooth decay or other dental problems.
If these steps don't improve your dry mouth, talk to your doctor or dentist. The cause could be a medication or another condition. Medications are one of the most common causes of dry mouth. Long-term relief from your dry mouth may mean stopping or changing your medication or its dosage, or addressing underlying health issues.
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来自口腔外科博士Thomas J. Salinas的回答。
可能使用手动牙刷刷牙更有效。然而，电动牙刷是手动牙刷很好的一种替代品，尤其是在您有关节炎或者其他刷牙有困难的情况时。电动牙刷毛的运动甚至能帮助您去除更多的牙菌斑和改善牙龈的健康状况。
如果您选择使用电动牙刷，确保它方便手握和容易使用。您的牙医可能会建议使用有摇摆旋转刷头或使用超声波驱动刷头的牙刷。其他的一些功能，如可调节强度、时间或充电功能都是可以选择的。请按照生产商提供的说明书替换刷头以确保牙刷能继续有效使用。
不管您是使用电动牙刷或者手动牙刷，谨记最重要的是要每天刷牙和使用牙线。
中文翻译：米小胖
本文地址：http://www.wjbb.com/know/1195
原文出处：http://www.mayoclinic.org/heal ... 58325
来自口腔外科博士Thomas J. Salinas的回答。
可能使用手动牙刷刷牙更有效。然而，电动牙刷是手动牙刷很好的一种替代品，尤其是在您有关节炎或者其他刷牙有困难的情况时。电动牙刷毛的运动甚至能帮助您去除更多的牙菌斑和改善牙龈的健康状况。
如果您选择使用电动牙刷，确保它方便手握和容易使用。您的牙医可能会建议使用有摇摆旋转刷头或使用超声波驱动刷头的牙刷。其他的一些功能，如可调节强度、时间或充电功能都是可以选择的。请按照生产商提供的说明书替换刷头以确保牙刷能继续有效使用。
不管您是使用电动牙刷或者手动牙刷，谨记最重要的是要每天刷牙和使用牙线。
中文翻译：米小胖
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来自医学博士Martha Grogan的回答。
Good oral health is important, but taking care of your teeth isn't a proven way to prevent heart disease.
Poor oral health has been debated as a possible cause of heart disease for many years. In 2012, however, experts from the American Heart Association reviewed the available scientific evidence and concluded that poor oral health hasn't been proved to cause heart disease — and that treating existing gum disease hasn't been proved to reduce the risk of heart disease.
Both gum disease and heart disease involve swelling (inflammation), but swelling of the gums hasn't been proved to contribute to swelling elsewhere in the body. Similarly, the presence of bacteria on the teeth and gums hasn't been shown to directly contribute to heart disease.
Even though oral health isn't a key to heart disease prevention, it's still important to take care of your teeth and gums:
Brush your teeth at least twice a day.Floss your teeth at least once a day.Replace your toothbrush every three to four months — or sooner if the bristles become frayed.See your dentist for regular dental checkups.
If you're concerned about heart disease prevention, ask your doctor about proven ways to reduce your risk — such as stopping smoking and maintaining a healthy weight.
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来自医学博士Martha Grogan的回答。
Good oral health is important, but taking care of your teeth isn't a proven way to prevent heart disease.
Poor oral health has been debated as a possible cause of heart disease for many years. In 2012, however, experts from the American Heart Association reviewed the available scientific evidence and concluded that poor oral health hasn't been proved to cause heart disease — and that treating existing gum disease hasn't been proved to reduce the risk of heart disease.
Both gum disease and heart disease involve swelling (inflammation), but swelling of the gums hasn't been proved to contribute to swelling elsewhere in the body. Similarly, the presence of bacteria on the teeth and gums hasn't been shown to directly contribute to heart disease.
Even though oral health isn't a key to heart disease prevention, it's still important to take care of your teeth and gums:
Brush your teeth at least twice a day.Floss your teeth at least once a day.Replace your toothbrush every three to four months — or sooner if the bristles become frayed.See your dentist for regular dental checkups.
If you're concerned about heart disease prevention, ask your doctor about proven ways to reduce your risk — such as stopping smoking and maintaining a healthy weight.
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来自牙科学博士 Alan Carr的回答。
When you have sensitive teeth, certain activities, such as brushing, flossing, eating and drinking, can cause sharp, temporary pain in your teeth. Sensitive teeth are typically the result of worn tooth enamel or exposed tooth roots. Sometimes, however, tooth discomfort is caused by other factors, such as a cavity, a cracked or chipped tooth, a recently placed filling or a side effect of other dental procedures, such as bleaching.
If you're concerned about sensitive teeth, start by visiting your dentist. He or she can identify or rule out any underlying causes of your tooth pain. Depending on the circumstances, your dentist might recommend:
Desensitizing toothpaste. After several applications, desensitizing toothpaste can sometimes help block pain associated with sensitive teeth.Fluoride. Your dentist might apply fluoride to the sensitive areas of your teeth to strengthen tooth enamel and reduce pain. He or she might also suggest the use of prescription fluoride at home.Desensitizing or bonding. Occasionally, exposed root surfaces can be treated by applying bonding resin to the sensitive root surfaces. Local anesthetic might be needed.Surgical gum graft. If your tooth root has lost gum tissue, a small amount of gum tissue can be taken from elsewhere in your mouth and attached to the affected site. This can protect exposed roots and reduce sensitivity.Root canal. If your sensitive teeth cause severe pain and other treatments aren't effective, your dentist might recommend a root canal — a procedure used to treat problems in the tooth's soft core (dental pulp). While this might seem like a significant treatment, it's considered the most successful technique for eliminating tooth sensitivity.
To prevent sensitive teeth from recurring, your dentist might offer suggestions to help you maintain your oral health. Twice a day, brush your teeth with a soft-bristled toothbrush and fluoride toothpaste. Floss daily. Avoid vigorous or harsh scrubbing, highly abrasive toothpaste, and excessive brushing and flossing. If you grind your teeth, ask your dentist about a mouth guard. Tooth grinding can fracture teeth and cause sensitivity.
You might also consider limiting acidic foods and drinks, such as carbonated drinks, citrus fruits, wine and yogurt — all of which can remove small amounts of tooth enamel over time. When you drink acidic liquids, use a straw to limit contact with your teeth. After eating or drinking an acidic substance, drink milk or water to balance the acid levels in your mouth.
It also helps to avoid brushing your teeth immediately after eating or drinking acidic substances, since acid softens enamel and makes it more vulnerable to erosion during brushing.
中文翻译：
本文地址：http://www.wjbb.com/know/1193
原文出处：http://www.mayoclinic.org/heal ... 57854
来自牙科学博士 Alan Carr的回答。
When you have sensitive teeth, certain activities, such as brushing, flossing, eating and drinking, can cause sharp, temporary pain in your teeth. Sensitive teeth are typically the result of worn tooth enamel or exposed tooth roots. Sometimes, however, tooth discomfort is caused by other factors, such as a cavity, a cracked or chipped tooth, a recently placed filling or a side effect of other dental procedures, such as bleaching.
If you're concerned about sensitive teeth, start by visiting your dentist. He or she can identify or rule out any underlying causes of your tooth pain. Depending on the circumstances, your dentist might recommend:
Desensitizing toothpaste. After several applications, desensitizing toothpaste can sometimes help block pain associated with sensitive teeth.Fluoride. Your dentist might apply fluoride to the sensitive areas of your teeth to strengthen tooth enamel and reduce pain. He or she might also suggest the use of prescription fluoride at home.Desensitizing or bonding. Occasionally, exposed root surfaces can be treated by applying bonding resin to the sensitive root surfaces. Local anesthetic might be needed.Surgical gum graft. If your tooth root has lost gum tissue, a small amount of gum tissue can be taken from elsewhere in your mouth and attached to the affected site. This can protect exposed roots and reduce sensitivity.Root canal. If your sensitive teeth cause severe pain and other treatments aren't effective, your dentist might recommend a root canal — a procedure used to treat problems in the tooth's soft core (dental pulp). While this might seem like a significant treatment, it's considered the most successful technique for eliminating tooth sensitivity.
To prevent sensitive teeth from recurring, your dentist might offer suggestions to help you maintain your oral health. Twice a day, brush your teeth with a soft-bristled toothbrush and fluoride toothpaste. Floss daily. Avoid vigorous or harsh scrubbing, highly abrasive toothpaste, and excessive brushing and flossing. If you grind your teeth, ask your dentist about a mouth guard. Tooth grinding can fracture teeth and cause sensitivity.
You might also consider limiting acidic foods and drinks, such as carbonated drinks, citrus fruits, wine and yogurt — all of which can remove small amounts of tooth enamel over time. When you drink acidic liquids, use a straw to limit contact with your teeth. After eating or drinking an acidic substance, drink milk or water to balance the acid levels in your mouth.
It also helps to avoid brushing your teeth immediately after eating or drinking acidic substances, since acid softens enamel and makes it more vulnerable to erosion during brushing.
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来自牙科学博士Alan Carr的回答。
美国牙科协会推荐每天至少刷牙两次。
刷牙有助于去除食物残渣和牙菌斑-一种包裹在牙齿上的含有细菌的粘性薄膜。当您吃完一餐或包含糖类的点心时，细菌能分解出破坏牙釉质的酸类，持续的破坏能分解牙釉质而导致蛀牙。这种不易移除的薄膜逐渐硬化变成牙石，使得牙齿清洁更为困难。
刷牙时间也和您吃的食物有关，如果食用了酸性食物或饮料，30分钟内应该避免刷牙。这种酸性物质会削弱牙釉质，过早刷牙会去除牙釉质，所以如果您知道您将吃或喝一些酸性物质，请事先刷牙。
除刷牙之外，美国牙科协会建议您：
每天使用牙线健康饮食并限制零食每三到四个月更换一次牙刷，如果刷毛磨损应及早更换；定期检查牙齿
中文翻译：zydj308
本文地址：http://www.wjbb.com/know/1192
原文出处：http://www.mayoclinic.org/heal ... 58193
来自牙科学博士Alan Carr的回答。
美国牙科协会推荐每天至少刷牙两次。
刷牙有助于去除食物残渣和牙菌斑-一种包裹在牙齿上的含有细菌的粘性薄膜。当您吃完一餐或包含糖类的点心时，细菌能分解出破坏牙釉质的酸类，持续的破坏能分解牙釉质而导致蛀牙。这种不易移除的薄膜逐渐硬化变成牙石，使得牙齿清洁更为困难。
刷牙时间也和您吃的食物有关，如果食用了酸性食物或饮料，30分钟内应该避免刷牙。这种酸性物质会削弱牙釉质，过早刷牙会去除牙釉质，所以如果您知道您将吃或喝一些酸性物质，请事先刷牙。
除刷牙之外，美国牙科协会建议您：
每天使用牙线健康饮食并限制零食每三到四个月更换一次牙刷，如果刷毛磨损应及早更换；定期检查牙齿
中文翻译：zydj308
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来自牙科学博士Alan Carr的回答。
美白牙膏可去除牙齿表面由喝咖啡或吸烟导致的污渍，从而可稍微美白牙齿。漂白牙齿后也可使用美白牙膏来巩固治疗效果。
为去除牙齿表面的污渍，美白牙膏里通常含有：
温和地漂白牙齿的特殊研磨剂，破坏或溶解污渍的化学物。
有些美白牙膏含有化学蓝色染料（blue covarine），blue covarin可以附着在牙齿表面，形成一种牙齿更白的视觉错觉。
如果每天刷两次牙，美白牙膏需要2到6周达到美白牙齿的效果。含有blue covarine 的美白牙膏美白效果立显。
虽然每日使用美白牙膏通常是安全的，但是还是要遵循牙膏制造商的建议。长期过度使用美白牙膏可损伤您的牙釉质。
请注意，美白牙膏无法改变牙齿的天然颜色，如果污渍深入到牙齿内部，美白牙膏也无能为力。
如果您正打算使用一款美白牙膏，请寻找一种有声望的牙科机构（美国牙科协会）认可印章的品牌。该印章表明该牙膏可有效去除牙齿表面的污渍。
如果您不满意美白牙膏的美白效果，可向您的牙医资讯其他美白牙齿的方法，例如非处方药物或专业的漂白产品。
中文翻译：豌豆爸爸
本文地址：http://www.wjbb.com/know/1191
原文出处：http://www.mayoclinic.org/heal ... 58411
来自牙科学博士Alan Carr的回答。
美白牙膏可去除牙齿表面由喝咖啡或吸烟导致的污渍，从而可稍微美白牙齿。漂白牙齿后也可使用美白牙膏来巩固治疗效果。
为去除牙齿表面的污渍，美白牙膏里通常含有：
温和地漂白牙齿的特殊研磨剂，破坏或溶解污渍的化学物。
有些美白牙膏含有化学蓝色染料（blue covarine），blue covarin可以附着在牙齿表面，形成一种牙齿更白的视觉错觉。
如果每天刷两次牙，美白牙膏需要2到6周达到美白牙齿的效果。含有blue covarine 的美白牙膏美白效果立显。
虽然每日使用美白牙膏通常是安全的，但是还是要遵循牙膏制造商的建议。长期过度使用美白牙膏可损伤您的牙釉质。
请注意，美白牙膏无法改变牙齿的天然颜色，如果污渍深入到牙齿内部，美白牙膏也无能为力。
如果您正打算使用一款美白牙膏，请寻找一种有声望的牙科机构（美国牙科协会）认可印章的品牌。该印章表明该牙膏可有效去除牙齿表面的污渍。
如果您不满意美白牙膏的美白效果，可向您的牙医资讯其他美白牙齿的方法，例如非处方药物或专业的漂白产品。
中文翻译：豌豆爸爸
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有关宝宝出牙及治疗牙龈肿痛的理论要比儿童的多。医生及专业的健康护理人士一致认为：出牙是童年发育的正常经历，不需要服用处方药或者非处方药。
绝大多数情况下，父母、祖父母还有其他看护者出于好心会给出牙的宝宝在牙龈处擦抹药物，他们使用的却是潜在有害的药物，而非安全无毒的药物。
这就是为什么美国食品药品监督管理局（FDA）警告父母不要给婴儿或者小孩子使用诸如黏性利多卡因等处方药，这些药对他们而言还不安全，有些孩子使用此类药物后出现了问题。
FDA先前曾建议父母和看护人除非在专业的健康护理人士的建议及监督下，否则不要给2岁以下的孩子使用苯唑卡因类药物。苯唑卡因与黏性利多卡因类似是一种局麻药，一些非处方药，诸如Anbesol，Hurricaine，苯佐卡因制剂，宝宝用苯佐卡因制剂和明胶（Orabase），含有苯唑卡因。
用于口腔及牙龈疼痛的胶状及液态的苯唑卡因会引发罕见但严重的，有时甚至是致命的一种状况，叫做高铁血红蛋白症，表现为血液中氧含量急剧减少。这种情况对于2岁以下的孩子而言尤其危险。
建议父母使用安全的替代性药物
一般地，宝宝在6个月大到3岁之间平均每个月长一颗牙，直至长满20颗乳牙。
据美国儿科医生协会（AAP）介绍，出牙的偶然症状有轻度易怒、低热、流口水、控制不住地想咬硬的东西。
宝宝出牙的同时身体各方面都发生很大变化，伴随有睡眠不好、食欲减退、充血、咳嗽、呕吐以及腹泻，对大人们会误以为这些症状是出牙引起的。
如果孩子的牙龈肿胀并且疼痛，
用手指轻轻地抚摸或者按摩牙龈，并且给孩子一个清凉的塑胶牙环或者干净的、湿润的、清爽的毛巾让他们咬。
把塑胶牙环或者毛巾放在冰箱里冷冻一会，确保其清凉而不是像冰块一样凉，如果太凉了会伤到孩子和牙龈。低温可以麻痹神经以缓解牙龈疼痛或者转移疼痛感。
“清凉的物体起着温和的局麻药的作用，”FDA的儿科医生哈里o谢丽尔o萨克斯博士说， “短时间内能极大地缓解孩子的痛苦。”
父母要看好孩子，别让孩子们不小心误食塑胶牙环或者毛巾从而引发窒息。
避免使用局麻药
除非在专业的健康护理人员的建议及监护下，不要给出牙的孩子使用诸如黏性利多卡因或者含有苯唑卡因的药。
黏性利多卡因是一种处方药，一种胶装的糖浆类的局麻药。医生给化疗病人（大人或者孩子）开这种药，这些病人由于化疗引起口腔溃疡而无法进食。牙医在给孩子拍口腔X片时使用黏性利多卡因以减少拍照过程中的咽反应。
如果家里面有人用过粘性利多卡因缓解口腔或者喉部溃疡等引发的疼痛，家长手头可能会有些剩余的粘性利多卡因，但是切记永远不要给出牙的孩子用。
安全用药机构（ISMP），一个致力于预防错误用药的非盈利组织收到过出牙宝宝由于使用过量的黏性利多卡因引起其他问题的报告。这些问题有神经过敏、意识混乱、视力问题、呕吐、嗜睡、摇晃及惊厥等等。
ISMP主席，注册药剂师迈克尔oRo科恩说：“粘性利多卡因也会引发进食中的吞咽困难，增加窒息风险。它能引发药物中毒，影响心脏及神经系统。
科恩说，宝宝一旦烦躁不安家长们就知道该给他们用黏性利多卡因了。家长也学会了给宝宝喝的奶里加入液体胶状的局麻药或者把奶嘴，湿毛巾浸在局麻药里然后再给宝宝咬。科恩说，无法估算宝宝们摄入了多少黏性利多卡因，也许很多很多。基于上述原因，FDA建议不要用黏性利多卡因治疗出牙引起的疼痛。
伊桑o豪斯曼医学博士，一位FDA的儿科医师、病理师说：“出牙是正常的现象，所有的宝宝都要出牙。”“FDA不建议对出牙的儿童使用任何药物，草药或者类似药物及治疗。”
本文刊登在FDA消费者更新页面，该页面刊载FDA所管理所有产品的最新消息。
中文翻译：乐山乐水
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原文出处：http://www.fda.gov/ForConsumer ... 7.htm
有关宝宝出牙及治疗牙龈肿痛的理论要比儿童的多。医生及专业的健康护理人士一致认为：出牙是童年发育的正常经历，不需要服用处方药或者非处方药。
绝大多数情况下，父母、祖父母还有其他看护者出于好心会给出牙的宝宝在牙龈处擦抹药物，他们使用的却是潜在有害的药物，而非安全无毒的药物。
这就是为什么美国食品药品监督管理局（FDA）警告父母不要给婴儿或者小孩子使用诸如黏性利多卡因等处方药，这些药对他们而言还不安全，有些孩子使用此类药物后出现了问题。
FDA先前曾建议父母和看护人除非在专业的健康护理人士的建议及监督下，否则不要给2岁以下的孩子使用苯唑卡因类药物。苯唑卡因与黏性利多卡因类似是一种局麻药，一些非处方药，诸如Anbesol，Hurricaine，苯佐卡因制剂，宝宝用苯佐卡因制剂和明胶（Orabase），含有苯唑卡因。
用于口腔及牙龈疼痛的胶状及液态的苯唑卡因会引发罕见但严重的，有时甚至是致命的一种状况，叫做高铁血红蛋白症，表现为血液中氧含量急剧减少。这种情况对于2岁以下的孩子而言尤其危险。
建议父母使用安全的替代性药物
一般地，宝宝在6个月大到3岁之间平均每个月长一颗牙，直至长满20颗乳牙。
据美国儿科医生协会（AAP）介绍，出牙的偶然症状有轻度易怒、低热、流口水、控制不住地想咬硬的东西。
宝宝出牙的同时身体各方面都发生很大变化，伴随有睡眠不好、食欲减退、充血、咳嗽、呕吐以及腹泻，对大人们会误以为这些症状是出牙引起的。
如果孩子的牙龈肿胀并且疼痛，
用手指轻轻地抚摸或者按摩牙龈，并且给孩子一个清凉的塑胶牙环或者干净的、湿润的、清爽的毛巾让他们咬。
把塑胶牙环或者毛巾放在冰箱里冷冻一会，确保其清凉而不是像冰块一样凉，如果太凉了会伤到孩子和牙龈。低温可以麻痹神经以缓解牙龈疼痛或者转移疼痛感。
“清凉的物体起着温和的局麻药的作用，”FDA的儿科医生哈里o谢丽尔o萨克斯博士说， “短时间内能极大地缓解孩子的痛苦。”
父母要看好孩子，别让孩子们不小心误食塑胶牙环或者毛巾从而引发窒息。
避免使用局麻药
除非在专业的健康护理人员的建议及监护下，不要给出牙的孩子使用诸如黏性利多卡因或者含有苯唑卡因的药。
黏性利多卡因是一种处方药，一种胶装的糖浆类的局麻药。医生给化疗病人（大人或者孩子）开这种药，这些病人由于化疗引起口腔溃疡而无法进食。牙医在给孩子拍口腔X片时使用黏性利多卡因以减少拍照过程中的咽反应。
如果家里面有人用过粘性利多卡因缓解口腔或者喉部溃疡等引发的疼痛，家长手头可能会有些剩余的粘性利多卡因，但是切记永远不要给出牙的孩子用。
安全用药机构（ISMP），一个致力于预防错误用药的非盈利组织收到过出牙宝宝由于使用过量的黏性利多卡因引起其他问题的报告。这些问题有神经过敏、意识混乱、视力问题、呕吐、嗜睡、摇晃及惊厥等等。
ISMP主席，注册药剂师迈克尔oRo科恩说：“粘性利多卡因也会引发进食中的吞咽困难，增加窒息风险。它能引发药物中毒，影响心脏及神经系统。
科恩说，宝宝一旦烦躁不安家长们就知道该给他们用黏性利多卡因了。家长也学会了给宝宝喝的奶里加入液体胶状的局麻药或者把奶嘴，湿毛巾浸在局麻药里然后再给宝宝咬。科恩说，无法估算宝宝们摄入了多少黏性利多卡因，也许很多很多。基于上述原因，FDA建议不要用黏性利多卡因治疗出牙引起的疼痛。
伊桑o豪斯曼医学博士，一位FDA的儿科医师、病理师说：“出牙是正常的现象，所有的宝宝都要出牙。”“FDA不建议对出牙的儿童使用任何药物，草药或者类似药物及治疗。”
本文刊登在FDA消费者更新页面，该页面刊载FDA所管理所有产品的最新消息。
中文翻译：乐山乐水
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Oral health is an integral part of the overall health of children. Dental caries is a common and chronic disease process with significant short- and long-term consequences. The prevalence of dental caries for the youngest of children has not decreased over the past decade, despite improvements for older children. As health care professionals responsible for the overall health of children, pediatricians frequently confront morbidity associated with dental caries. Because the youngest children visit the pediatrician more often than they visit the dentist, it is important that pediatricians be knowledgeable about the disease process of dental caries, prevention of the disease, and interventions available to the pediatrician and the family to maintain and restore health.
Introduction
Dental caries is the most common chronic disease of childhood. Twenty-four percent of US children 2 to 4 years of age, 53% of children 6 to 8 years of age, and 56% of 15-year-olds have caries experience (ie, untreated dental caries, filled teeth, teeth missing as a result of dental caries). For children 5 to 19 years of age, children from poor and racial or ethnic minority families have higher rates of untreated dental caries than do their peers from nonpoor and nonminority families. For some age groups, the incidence of dental caries has decreased or stayed the same, but for the youngest children, it has increased. Among 6- to 8-year-olds and 15-year-olds, caries experience and untreated dental decay remained mostly unchanged between
and . In children 2 to 4 years of age, the caries experience increased significantly, from 19% to 24%, during that same time period. The increase in the caries experience and untreated caries was statistically significant in children from poor families.
The Etiology and Pathogenesis of Dental Caries
A dynamic process takes place at the surface of the tooth that involves constant demineralization and remineralization of the tooth enamel (the caries balance). Multiple factors affect that dynamic process and can be manipulated in ways that tip the balance toward disease (demineralization) or health (remineralization). These factors include bacteria, sugar, saliva, and fluoride. Because these factors can be manipulated, it is possible for pediatricians and families to prevent, halt, or even reverse the disease process.
Different oral structures and tissues have different and distinct microbial communities (microbiomes). The oral microbiome at the surface of the tooth is referred to as dental plaque. During the disease process of dental caries, bacteria that are aciduric and acidogenic predominate in the dental plaque. Streptococcus mutans is most strongly associated with dental caries, although other bacterial species have these capabilities and thus can also be pathogenic. When environmental factors make it possible to select for these pathogenic bacteria in dental plaque, the disease process begins.
A key environmental factor that allows for selection and proliferation of these pathogenic bacteria is dietary sugar intake. Because these pathogenic bacteria have the ability to ferment sugars, produce acid, and decrease the pH of the dental plaque, they make possible the selection of other aciduric, acidogenic bacteria that will contribute to disease. As more bacteria produce more acid, the pH at the surface of the tooth decreases. This process causes the demineralization of the tooth enamel. Unimpeded, these long periods of low pH and demineralization will result in cavitation.
Saliva is an important factor in buffering the low pH and bringing these demineralization pressures back to a balance with remineralization. In addition to acting as a buffering agent, saliva also flushes the oral cavity of food particles and provides an environment rich in calcium and phosphate to aid in remineralization. When salivary flow is impeded, the pH is able to decrease to a lower level, tipping the scales toward demineralization (disease); in addition, the time it takes to buffer back to a normal pH is longer.
Another important factor that can affect the balance of demineralization and remineralization is fluoride. More in-depth reviews of fluoride are available elsewhere. It is important, however, for pediatricians and other child health care providers to understand how fluoride influences the caries balance. Fluoride has 3 key effects on the caries balance: (1) inhibition of demineralization
(2) enhancement of remineralization, which results in a more acid-res and (3) inhibition of bacterial enzymes. The primary effect of fluoride is topical, via fluoridated toothpastes, mouth rinses, and varnishes, although there is still value in systemic fluoride exposures via fluoridated water and supplements.
Preventive Strategies
Caries Risk Assessment
Ideally, primary prevention efforts will anticipate and prevent caries before the first sign of disease. Preventive strategies for this multifactorial, chronic disease require a comprehensive and multifocal approach that begins with caries risk assessment. Assessing each child’s risk of caries and tailoring preventive strategies to specific risk factors are necessary for maintaining and improving oral health. There is no single test that takes into consideration all risk factors and accurately predicts an individual's susceptibility to caries. However, pediatricians can conduct an excellent risk assessment for caries by focusing on the key risk factors for dental caries that are associated with diet, bacteria, saliva, and status of the teeth (both current status and previous caries experience). The American Academy of Pediatrics (AAP)/Bright Futures Oral Health Risk Assessment Tool can be found at http://www2.aap.org/oralhealth ... html.
Sugars (but not sugar substitutes) are a critical risk factor in the development of caries. The risk of caries is greatest if sugars are consumed at high frequency and are in a form that remains in the mouth for long periods of time. Thus, key behaviors that place a child at high risk of caries include continual bottle/sippy cup use (especially with fluids other than water), sleeping with a bottle (especially with fluids other than water), frequent between-meal snacks of sugars/cooked starch/sugared beverages, and frequent intake of sugared medications.
Early acquisition of S mutans is a major risk factor for early childhood caries and future caries experience. Strong evidence demonstrates that mothers are a primary source of S mutans colonization for their children. Thus, an important factor associated with caries risk in young children is the recent or current presence of active dental decay in the primary caregiver. Prevention, diagnosis, and treatment of oral diseases are highly beneficial, can be undertaken, and should be encouraged during pregnancy with no additional fetal or maternal risk compared with the risk of not providing care. The most important and predictive risk factor for caries, however, is previous caries experience. This finding is not surprising, considering that the factors which initiated the disease process often continue to exist over time.
Other caries risk factors are associated with salivary flow and the status of the teeth. Diseases (eg, diabetes mellitus, Sj?gren's syndrome, cystic fibrosis) and medications (eg, antihistamines, anticonvulsants, antidepressants) that result in xerostomia (decreased salivary flow) reduce the availability of saliva to buffer the acid produced by pathogenic bacteria, thus enhancing their ability to cause damage to the teeth. In addition, the teeth of preterm infants, which frequently have enamel defects, are at increased susceptibility for disease. Older children who have deep pits and fissures in their molars are also at increased susceptibility for disease.
Anticipatory Guidance
With a clear understanding of the etiology of dental caries and the risk factors that lead to and facilitate the spread of this disease, pediatricians can target anticipatory guidance to assist families in preventing it. Because the disease of dental caries is multifocal, the anticipatory guidance should also be multifocal. Pediatricians should concentrate their anticipatory guidance on topics that can affect the risk of disease.
Dietary Counseling
Because sugar intake is such an important risk factor for dental caries, pediatricians can incorporate anticipatory guidance associated with preventing dental caries into discussions with families about dietary habits and nutritional intake. Pediatricians should counsel parents and caregivers on the importance of reducing the frequency of exposure to sugars in foods and drinks. To decrease the risk of dental caries and ensure the best possible health and developmental outcomes, pediatricians should recommend that parents do the following:
oExclusively breastfeed infants for 6 months and continue breastfeeding as complementary foods are introduced for 1 year or longer, as mutually desired by mother and infant.
oDiscourage putting a child to bed with a bottle. Establish a bedtime routine conducive to optimal oral health (eg, brush, book, and bed).
oWean from a bottle by 1 year of age.
oLimit sugary foods and drinks to mealtimes.
oAvoid carbonated, sugared beverages and juice drinks that are not 100% juice.
oLimit the intake of 100% fruit juice to no more than 4 to 6 oz per day.
oEncourage children to drink only water between meals, preferably fluoridated tap water.
oFoster eating patterns that are consistent with guidelines from the US Department of Agriculture.
Oral Hygiene
The value of good oral hygiene lies in controlling the levels and activity of disease-causing bacteria in the oral cavity and delivering fluoride to the surface of the tooth. It is important to remember that pathogenic bacteria can be passed from caregiver to child. Thus, anticipatory guidance for both parent and child is important. Key anticipatory guidance points regarding oral hygiene are as follows:
oParents/caregivers should be encouraged to model and maintain good oral hygiene and a relationship with their own dental provider.
oParents/caregivers, especially those with significant history of dental decay, should be cautioned to avoid sharing with their child items that have been in their own mouths.
oThe child’s teeth should be brushed twice a day as soon as the teeth erupt with a smear or a grain-of-rice–sized amount of fluoridated toothpaste. After the third birthday, a pea-sized amount should be used.
oParents/caregivers should help/supervise a child brushing his or her teeth until mastery is obtained, usually at around 8 years of age.
The delivery of fluoride to the teeth includes community-based options (water fluoridation), self-administered modalities (fluoride toothpaste and supplements), and professional applications (fluoride varnish). Each of these delivery mechanisms is useful in preventing dental caries.
Water fluoridation is a community-based intervention that optimizes the level of fluoride in drinking water, resulting in preeruptive and posteruptive protection of the teeth.19 Water fluoridation is a cost-effective means of preventing dental caries, with the lifetime cost per person equaling less than the cost of 1 dental restoration. Most bottled waters do not contain an adequate amount of fluoride.
Fluoride toothpaste is an important way to deliver fluoride to the surface of the tooth. Fluoride toothpaste has been shown to be effective in reducing dental caries in both primary and permanent teeth. It is important to limit the amount of toothpaste used to a smear or a grain-of-rice–sized amount for young children and no more than a pea-sized amount for children older than 3 years. Fluoride supplements should be prescribed for children whose primary source of drinking water is deficient in fluoride.
Fluoride varnish is a professionally applied, sticky resin of highly concentrated fluoride. Two or more applications of fluoride varnish per year are effective in preventing caries in children at high risk of all ages. In most states, pediatricians can apply and be paid for application of fluoride varnish to the teeth of young children. Application of fluoride varnish is even more effective when coupled with counseling. The US Preventive Services Task Force recently published a new recommendation that primary care clinicians apply fluoride varnish to the primary teeth of all infants and children starting at the age of primary tooth eruption (B recommendation). More details and recommendations on fluoride can be found in the AAP clinical report “Fluoride Use in Caries Prevention in the Primary Care Setting.”
Other Important Anticipatory Guidance Topics
A frequent topic of discussion with parents is nonnutritive oral habits, such as use of pacifiers and thumb sucking. AAP policy states that parents consider offering a pacifier at naptime and bedtime because of a protective effect of pacifiers on the incidence of sudden infant death syndrome after the first month of life.27 Both finger- and pacifier-sucking habits will only cause problems with dental structures if they go on for a long period of time. Evaluation by a dentist is indicated for nonnutritive sucking habits that continue beyond 3 years of age.28
Dental injuries are common. Twenty-five percent of all schoolchildren experience some form of dental trauma. Pediatricians can help prevent such trauma by encouraging parents to cover sharp corners of household furnishings at the level of walking toddlers, recommend use of car safety seats, and be aware of electrical cord risk for mouth injury. Pediatricians can also encourage mouthguard use during sports activities in which there is a significant risk of orofacial injury.More information on dental trauma is available in the AAP clinical report “Management of Dental Trauma in a Primary Care Setting.”
Collaboration With Dental Providers
The AAP, the American Academy of Pediatric Dentistry, the American Dental Association, and the American Association of Public Health Dentistry all recommend a dental visit for children by 1 year of age. Although pediatricians have the opportunity to provide early assessment of risk for dental caries and anticipatory guidance to prevent disease, it is also important that children establish a dental home. A dental home is the ongoing relationship between the dentist and the patient, inclusive of all aspects of oral health care delivered in a comprehensive, continuously accessible, coordinated, and family-centered way.
Unfortunately, little is known about pediatric health care providers’ dental referral behaviors and patterns. Although 1 study found that children 2 to 5 years of age who received a recommendation from their health care provider to visit the dentist were more likely to have a dental visit, the US Preventive Services Task Force found no study that evaluated the effects of referral by a primary care clinician to a dentist on caries incidence. It is also noteworthy that preschool-aged children covered by Medicaid who had an early preventive dental visit by 1 year of age were more likely to use subsequent preventive services and to have lower dental expenses.
With early referral to a dental provider, there is an opportunity to maintain good oral health, prevent disease, and treat disease early. Establishing such collaborative relationships between physicians and dentists at the community level is essential for increasing access to dental care for all children and improving their oral and overall health.
Conclusions
Oral health is an integral part of the overall health and well-being of children. A pediatrician who is familiar with the science of dental caries, capable of assessing caries risk, comfortable with applying various strategies of prevention and intervention, and connected to dental resources can contribute considerably to the health of his or her patients. This policy statement, in conjunction with the oral health recommendations of the third edition of the AAP's Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, serves as a resource for pediatricians and other pediatric primary care providers to be knowledgeable about addressing dental caries. Because dental caries is such a common and consequential disease process in the pediatric population, it is essential that pediatricians include oral health in their daily practice of pediatrics.
Suggestions for Pediatricians
1.Administer an oral health risk assessment periodically to all children.
2.Include anticipatory guidance for oral health as an integral part of comprehensive patient counseling.
3.Counsel parents/caregivers and patients to reduce the frequency of exposure to sugars in foods and drinks.
4.Encourage parents/caregivers to brush a child’s teeth as soon as teeth erupt with a smear or a grain-of-rice–sized amount of fluoride toothpaste and a pea-sized amount at 3 years of age.
5.Advise parents/caregivers to monitor brushing until 8 years of age.
6.Refer to the AAP clinical report, “Fluoride Use in Caries Prevention in the Primary Care Setting,” for fluoride administration and supplementation decisions.
7.Build and maintain collaborative relationships with local dentists.
8.Recommend that every child has a dental home by 1 year of age.
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本文地址：http://www.wjbb.com/know/932
原文出处：http://pediatrics.aappublicati ... .full
Oral health is an integral part of the overall health of children. Dental caries is a common and chronic disease process with significant short- and long-term consequences. The prevalence of dental caries for the youngest of children has not decreased over the past decade, despite improvements for older children. As health care professionals responsible for the overall health of children, pediatricians frequently confront morbidity associated with dental caries. Because the youngest children visit the pediatrician more often than they visit the dentist, it is important that pediatricians be knowledgeable about the disease process of dental caries, prevention of the disease, and interventions available to the pediatrician and the family to maintain and restore health.
Introduction
Dental caries is the most common chronic disease of childhood. Twenty-four percent of US children 2 to 4 years of age, 53% of children 6 to 8 years of age, and 56% of 15-year-olds have caries experience (ie, untreated dental caries, filled teeth, teeth missing as a result of dental caries). For children 5 to 19 years of age, children from poor and racial or ethnic minority families have higher rates of untreated dental caries than do their peers from nonpoor and nonminority families. For some age groups, the incidence of dental caries has decreased or stayed the same, but for the youngest children, it has increased. Among 6- to 8-year-olds and 15-year-olds, caries experience and untreated dental decay remained mostly unchanged between
and . In children 2 to 4 years of age, the caries experience increased significantly, from 19% to 24%, during that same time period. The increase in the caries experience and untreated caries was statistically significant in children from poor families.
The Etiology and Pathogenesis of Dental Caries
A dynamic process takes place at the surface of the tooth that involves constant demineralization and remineralization of the tooth enamel (the caries balance). Multiple factors affect that dynamic process and can be manipulated in ways that tip the balance toward disease (demineralization) or health (remineralization). These factors include bacteria, sugar, saliva, and fluoride. Because these factors can be manipulated, it is possible for pediatricians and families to prevent, halt, or even reverse the disease process.
Different oral structures and tissues have different and distinct microbial communities (microbiomes). The oral microbiome at the surface of the tooth is referred to as dental plaque. During the disease process of dental caries, bacteria that are aciduric and acidogenic predominate in the dental plaque. Streptococcus mutans is most strongly associated with dental caries, although other bacterial species have these capabilities and thus can also be pathogenic. When environmental factors make it possible to select for these pathogenic bacteria in dental plaque, the disease process begins.
A key environmental factor that allows for selection and proliferation of these pathogenic bacteria is dietary sugar intake. Because these pathogenic bacteria have the ability to ferment sugars, produce acid, and decrease the pH of the dental plaque, they make possible the selection of other aciduric, acidogenic bacteria that will contribute to disease. As more bacteria produce more acid, the pH at the surface of the tooth decreases. This process causes the demineralization of the tooth enamel. Unimpeded, these long periods of low pH and demineralization will result in cavitation.
Saliva is an important factor in buffering the low pH and bringing these demineralization pressures back to a balance with remineralization. In addition to acting as a buffering agent, saliva also flushes the oral cavity of food particles and provides an environment rich in calcium and phosphate to aid in remineralization. When salivary flow is impeded, the pH is able to decrease to a lower level, tipping the scales toward demineralization (disease); in addition, the time it takes to buffer back to a normal pH is longer.
Another important factor that can affect the balance of demineralization and remineralization is fluoride. More in-depth reviews of fluoride are available elsewhere. It is important, however, for pediatricians and other child health care providers to understand how fluoride influences the caries balance. Fluoride has 3 key effects on the caries balance: (1) inhibition of demineralization
(2) enhancement of remineralization, which results in a more acid-res and (3) inhibition of bacterial enzymes. The primary effect of fluoride is topical, via fluoridated toothpastes, mouth rinses, and varnishes, although there is still value in systemic fluoride exposures via fluoridated water and supplements.
Preventive Strategies
Caries Risk Assessment
Ideally, primary prevention efforts will anticipate and prevent caries before the first sign of disease. Preventive strategies for this multifactorial, chronic disease require a comprehensive and multifocal approach that begins with caries risk assessment. Assessing each child’s risk of caries and tailoring preventive strategies to specific risk factors are necessary for maintaining and improving oral health. There is no single test that takes into consideration all risk factors and accurately predicts an individual's susceptibility to caries. However, pediatricians can conduct an excellent risk assessment for caries by focusing on the key risk factors for dental caries that are associated with diet, bacteria, saliva, and status of the teeth (both current status and previous caries experience). The American Academy of Pediatrics (AAP)/Bright Futures Oral Health Risk Assessment Tool can be found at
Sugars (but not sugar substitutes) are a critical risk factor in the development of caries. The risk of caries is greatest if sugars are consumed at high frequency and are in a form that remains in the mouth for long periods of time. Thus, key behaviors that place a child at high risk of caries include continual bottle/sippy cup use (especially with fluids other than water), sleeping with a bottle (especially with fluids other than water), frequent between-meal snacks of sugars/cooked starch/sugared beverages, and frequent intake of sugared medications.
Early acquisition of S mutans is a major risk factor for early childhood caries and future caries experience. Strong evidence demonstrates that mothers are a primary source of S mutans colonization for their children. Thus, an important factor associated with caries risk in young children is the recent or current presence of active dental decay in the primary caregiver. Prevention, diagnosis, and treatment of oral diseases are highly beneficial, can be undertaken, and should be encouraged during pregnancy with no additional fetal or maternal risk compared with the risk of not providing care. The most important and predictive risk factor for caries, however, is previous caries experience. This finding is not surprising, considering that the factors which initiated the disease process often continue to exist over time.
Other caries risk factors are associated with salivary flow and the status of the teeth. Diseases (eg, diabetes mellitus, Sj?gren's syndrome, cystic fibrosis) and medications (eg, antihistamines, anticonvulsants, antidepressants) that result in xerostomia (decreased salivary flow) reduce the availability of saliva to buffer the acid produced by pathogenic bacteria, thus enhancing their ability to cause damage to the teeth. In addition, the teeth of preterm infants, which frequently have enamel defects, are at increased susceptibility for disease. Older children who have deep pits and fissures in their molars are also at increased susceptibility for disease.
Anticipatory Guidance
With a clear understanding of the etiology of dental caries and the risk factors that lead to and facilitate the spread of this disease, pediatricians can target anticipatory guidance to assist families in preventing it. Because the disease of dental caries is multifocal, the anticipatory guidance should also be multifocal. Pediatricians should concentrate their anticipatory guidance on topics that can affect the risk of disease.
Dietary Counseling
Because sugar intake is such an important risk factor for dental caries, pediatricians can incorporate anticipatory guidance associated with preventing dental caries into discussions with families about dietary habits and nutritional intake. Pediatricians should counsel parents and caregivers on the importance of reducing the frequency of exposure to sugars in foods and drinks. To decrease the risk of dental caries and ensure the best possible health and developmental outcomes, pediatricians should recommend that parents do the following:
oExclusively breastfeed infants for 6 months and continue breastfeeding as complementary foods are introduced for 1 year or longer, as mutually desired by mother and infant.
oDiscourage putting a child to bed with a bottle. Establish a bedtime routine conducive to optimal oral health (eg, brush, book, and bed).
oWean from a bottle by 1 year of age.
oLimit sugary foods and drinks to mealtimes.
oAvoid carbonated, sugared beverages and juice drinks that are not 100% juice.
oLimit the intake of 100% fruit juice to no more than 4 to 6 oz per day.
oEncourage children to drink only water between meals, preferably fluoridated tap water.
oFoster eating patterns that are consistent with guidelines from the US Department of Agriculture.
Oral Hygiene
The value of good oral hygiene lies in controlling the levels and activity of disease-causing bacteria in the oral cavity and delivering fluoride to the surface of the tooth. It is important to remember that pathogenic bacteria can be passed from caregiver to child. Thus, anticipatory guidance for both parent and child is important. Key anticipatory guidance points regarding oral hygiene are as follows:
oParents/caregivers should be encouraged to model and maintain good oral hygiene and a relationship with their own dental provider.
oParents/caregivers, especially those with significant history of dental decay, should be cautioned to avoid sharing with their child items that have been in their own mouths.
oThe child’s teeth should be brushed twice a day as soon as the teeth erupt with a smear or a grain-of-rice–sized amount of fluoridated toothpaste. After the third birthday, a pea-sized amount should be used.
oParents/caregivers should help/supervise a child brushing his or her teeth until mastery is obtained, usually at around 8 years of age.
The delivery of fluoride to the teeth includes community-based options (water fluoridation), self-administered modalities (fluoride toothpaste and supplements), and professional applications (fluoride varnish). Each of these delivery mechanisms is useful in preventing dental caries.
Water fluoridation is a community-based intervention that optimizes the level of fluoride in drinking water, resulting in preeruptive and posteruptive protection of the teeth.19 Water fluoridation is a cost-effective means of preventing dental caries, with the lifetime cost per person equaling less than the cost of 1 dental restoration. Most bottled waters do not contain an adequate amount of fluoride.
Fluoride toothpaste is an important way to deliver fluoride to the surface of the tooth. Fluoride toothpaste has been shown to be effective in reducing dental caries in both primary and permanent teeth. It is important to limit the amount of toothpaste used to a smear or a grain-of-rice–sized amount for young children and no more than a pea-sized amount for children older than 3 years. Fluoride supplements should be prescribed for children whose primary source of drinking water is deficient in fluoride.
Fluoride varnish is a professionally applied, sticky resin of highly concentrated fluoride. Two or more applications of fluoride varnish per year are effective in preventing caries in children at high risk of all ages. In most states, pediatricians can apply and be paid for application of fluoride varnish to the teeth of young children. Application of fluoride varnish is even more effective when coupled with counseling. The US Preventive Services Task Force recently published a new recommendation that primary care clinicians apply fluoride varnish to the primary teeth of all infants and children starting at the age of primary tooth eruption (B recommendation). More details and recommendations on fluoride can be found in the AAP clinical report “Fluoride Use in Caries Prevention in the Primary Care Setting.”
Other Important Anticipatory Guidance Topics
A frequent topic of discussion with parents is nonnutritive oral habits, such as use of pacifiers and thumb sucking. AAP policy states that parents consider offering a pacifier at naptime and bedtime because of a protective effect of pacifiers on the incidence of sudden infant death syndrome after the first month of life.27 Both finger- and pacifier-sucking habits will only cause problems with dental structures if they go on for a long period of time. Evaluation by a dentist is indicated for nonnutritive sucking habits that continue beyond 3 years of age.28
Dental injuries are common. Twenty-five percent of all schoolchildren experience some form of dental trauma. Pediatricians can help prevent such trauma by encouraging parents to cover sharp corners of household furnishings at the level of walking toddlers, recommend use of car safety seats, and be aware of electrical cord risk for mouth injury. Pediatricians can also encourage mouthguard use during sports activities in which there is a significant risk of orofacial injury.More information on dental trauma is available in the AAP clinical report “Management of Dental Trauma in a Primary Care Setting.”
Collaboration With Dental Providers
The AAP, the American Academy of Pediatric Dentistry, the American Dental Association, and the American Association of Public Health Dentistry all recommend a dental visit for children by 1 year of age. Although pediatricians have the opportunity to provide early assessment of risk for dental caries and anticipatory guidance to prevent disease, it is also important that children establish a dental home. A dental home is the ongoing relationship between the dentist and the patient, inclusive of all aspects of oral health care delivered in a comprehensive, continuously accessible, coordinated, and family-centered way.
Unfortunately, little is known about pediatric health care providers’ dental referral behaviors and patterns. Although 1 study found that children 2 to 5 years of age who received a recommendation from their health care provider to visit the dentist were more likely to have a dental visit, the US Preventive Services Task Force found no study that evaluated the effects of referral by a primary care clinician to a dentist on caries incidence. It is also noteworthy that preschool-aged children covered by Medicaid who had an early preventive dental visit by 1 year of age were more likely to use subsequent preventive services and to have lower dental expenses.
With early referral to a dental provider, there is an opportunity to maintain good oral health, prevent disease, and treat disease early. Establishing such collaborative relationships between physicians and dentists at the community level is essential for increasing access to dental care for all children and improving their oral and overall health.
Conclusions
Oral health is an integral part of the overall health and well-being of children. A pediatrician who is familiar with the science of dental caries, capable of assessing caries risk, comfortable with applying various strategies of prevention and intervention, and connected to dental resources can contribute considerably to the health of his or her patients. This policy statement, in conjunction with the oral health recommendations of the third edition of the AAP's Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, serves as a resource for pediatricians and other pediatric primary care providers to be knowledgeable about addressing dental caries. Because dental caries is such a common and consequential disease process in the pediatric population, it is essential that pediatricians include oral health in their daily practice of pediatrics.
Suggestions for Pediatricians
1.Administer an oral health risk assessment periodically to all children.
2.Include anticipatory guidance for oral health as an integral part of comprehensive patient counseling.
3.Counsel parents/caregivers and patients to reduce the frequency of exposure to sugars in foods and drinks.
4.Encourage parents/caregivers to brush a child’s teeth as soon as teeth erupt with a smear or a grain-of-rice–sized amount of fluoride toothpaste and a pea-sized amount at 3 years of age.
5.Advise parents/caregivers to monitor brushing until 8 years of age.
6.Refer to the AAP clinical report, “Fluoride Use in Caries Prevention in the Primary Care Setting,” for fluoride administration and supplementation decisions.
7.Build and maintain collaborative relationships with local dentists.
8.Recommend that every child has a dental home by 1 year of age.
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作者：实习编辑 Hilary Rasch
掉乳牙是儿童的一个“通过礼”，让他们感觉长大了。而碰掉恒牙却不是那么回事了。
美国儿科牙科学会（AAPD）指出，受伤导致牙齿被碰掉会伤害孩子的自我感觉和对外表的感觉。孩子需要应付缺牙这事，或许得好些年，可能还需要进行很多次的牙科约诊直到重新有颗牙齿。
幸运的是，碰掉的恒牙处理恰当迅速的话可以被保住。
如果您的孩子碰掉了一颗牙，尽快打电话去看牙医，或去看急诊。按照美国儿科牙科学会给出的以下步骤可增加保住牙齿的机会：
o 找到牙齿，拿住牙齿上部（牙冠）捡起来。捡的时候不要拿牙根部。
o 如果牙齿弄脏了，用冷鲜奶（如没有冷鲜奶，用水）轻轻地并快速地冲洗。
o 不要刮、擦、刷牙齿，不要把牙齿弄干，不要用酒精或过氧化氢冲洗。
o 将牙齿放回牙槽中，并用大拇指按住。
o 让孩子咬块纱布（或毛巾、衬衫），保持牙齿不动尽快去牙医诊所。
如果过了五分钟您无法将牙齿重装回去，到牙医诊所前将牙齿放入容器里，倒入汉克平衡盐溶液（在很多药店都可买到，牌子为SAVE-A-TOOTH或EMT TOOTH SAVER)或冷鲜奶、孩子唾液，实在没有就放在水杯里倒上水。
如果孩子掉的是乳牙，不用把牙齿装回牙槽，因为乳牙通常不能进行再植。用纱布（或毛巾或衬衫）控制流血，并打电话给牙医。
中文翻译：晴天绿海
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作者：实习编辑 Hilary Rasch
掉乳牙是儿童的一个“通过礼”，让他们感觉长大了。而碰掉恒牙却不是那么回事了。
美国儿科牙科学会（AAPD）指出，受伤导致牙齿被碰掉会伤害孩子的自我感觉和对外表的感觉。孩子需要应付缺牙这事，或许得好些年，可能还需要进行很多次的牙科约诊直到重新有颗牙齿。
幸运的是，碰掉的恒牙处理恰当迅速的话可以被保住。
如果您的孩子碰掉了一颗牙，尽快打电话去看牙医，或去看急诊。按照美国儿科牙科学会给出的以下步骤可增加保住牙齿的机会：
o 找到牙齿，拿住牙齿上部（牙冠）捡起来。捡的时候不要拿牙根部。
o 如果牙齿弄脏了，用冷鲜奶（如没有冷鲜奶，用水）轻轻地并快速地冲洗。
o 不要刮、擦、刷牙齿，不要把牙齿弄干，不要用酒精或过氧化氢冲洗。
o 将牙齿放回牙槽中，并用大拇指按住。
o 让孩子咬块纱布（或毛巾、衬衫），保持牙齿不动尽快去牙医诊所。
如果过了五分钟您无法将牙齿重装回去，到牙医诊所前将牙齿放入容器里，倒入汉克平衡盐溶液（在很多药店都可买到，牌子为SAVE-A-TOOTH或EMT TOOTH SAVER)或冷鲜奶、孩子唾液，实在没有就放在水杯里倒上水。
如果孩子掉的是乳牙，不用把牙齿装回牙槽，因为乳牙通常不能进行再植。用纱布（或毛巾或衬衫）控制流血，并打电话给牙医。
中文翻译：晴天绿海
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来自牙科学博士Alan Carr的回答。
标准牙线通常被认为是清洁牙齿之间的狭小空间的最有效工具。 您还可以使用牙线刮擦每个牙齿的侧面。
一个水龙头（冲牙器）是一种瞄准你的牙齿水流的装置。 一个水镐可以帮助从你的牙齿清除食物颗粒，可能有助于减少出血和牙龈疾病 - 但它通常不被视为替代刷牙和牙线。
如果平滑的牙线卡在牙齿的话，使用打蜡的品种。 如果您很难处理牙线，请尝试清洁牙线架。 其他选项可能包括专用刷子，镐或棍子设计用于清洁牙齿之间。
中文翻译：豌豆爸爸
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来自牙科学博士Alan Carr的回答。
标准牙线通常被认为是清洁牙齿之间的狭小空间的最有效工具。 您还可以使用牙线刮擦每个牙齿的侧面。
一个水龙头（冲牙器）是一种瞄准你的牙齿水流的装置。 一个水镐可以帮助从你的牙齿清除食物颗粒，可能有助于减少出血和牙龈疾病 - 但它通常不被视为替代刷牙和牙线。
如果平滑的牙线卡在牙齿的话，使用打蜡的品种。 如果您很难处理牙线，请尝试清洁牙线架。 其他选项可能包括专用刷子，镐或棍子设计用于清洁牙齿之间。
中文翻译：豌豆爸爸
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来自牙科学博士Alan Carr的回答。
The best way to treat dry mouth — known medically as xerostomia (zeer-o-STOE-me-uh) — depends on what's causing it. You can do some things to relieve dry mouth temporarily. But for the best long-term dry mouth remedy, you need to address its cause.
To relieve your dry mouth:
Chew sugar-free gum or suck on sugar-free hard candies to stimulate the flow of saliva. For some people, xylitol, which is often found in sugar-free gum or sugar-free candies, may cause diarrhea or cramps if consumed in large amounts.Limit your caffeine intake because caffeine can make your mouth drier.Don't use mouthwashes that contain alcohol because they can be drying.Stop all tobacco use if you smoke or chew tobacco.Sip water regularly.Try over-the-counter saliva substitutes — look for products containing xylitol, such as Mouth Kote or Oasis Moisturizing Mouth Spray, or ones containing carboxymethylcellulose (kahr-bok-see-meth-ul-SEL-u-lohs) or hydroxyethyl cellulose (hi-drok-see-ETH-ul SEL-u-lohs), such as Biotene Oral Balance.Try a mouthwash designed for dry mouth — especially one that contains xylitol, such as Biotene Dry Mouth Oral Rinse or ACT Total Care Dry Mouth Rinse, which also offer protection against tooth decay.Avoid using over-the-counter antihistamines and decongestants because they can make your symptoms worse.Breathe through your nose, not your mouth.Add moisture to the air at night with a room humidifier.
Saliva is important to maintain the health of your teeth and mouth. If you frequently have a dry mouth, taking these steps to protect your oral health may also help your condition:
Avoid sugary or acidic foods and candies because they increase the risk of tooth decay.Brush with a fluoride toothpaste. Ask your dentist if you might benefit from prescription fluoride toothpaste.Use a fluoride rinse or brush-on fluoride gel before bedtime.Visit your dentist at least twice yearly to detect and treat tooth decay or other dental problems.
If these steps don't improve your dry mouth, talk to your doctor or dentist. The cause could be a medication or another condition. Medications are one of the most common causes of dry mouth. Long-term relief from your dry mouth may mean stopping or changing your medication or its dosage, or addressing underlying health issues.
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