口腔健康 Oral Health Zeng Huilan（曾慧兰 ）M.D. ,Ph.D. Dept. of Int. Med. e-mail: thlz@jnu.edu.cn

The concept of health（1） 健康不仅仅是没有疾病或衰弱，而是身心健康、社会幸福的完美状态。 Health is a state of complete physical， mental， and social well-being and not merely the absence of disease or infirmity。 ——World Health Organization (1946) Basic Documents， 5th ed. P. 1.

The dimensions of health Personal health （inner circle） Social health （middle circle） Environment health （out circle）

Health starts with Your Teeth You cannot be healthy unless your teeth are healthy

The concept of oral health(1) ※牙齿清洁、无龋洞、无疼痛感、牙龈颜色正常、无出血现象。 Teeth clean no caries cavities No pains Gingiva with normal colure No sign of bleeding. —— WHO 1981

The concept of oral health（2） 牙、牙周组织、口腔临近部位及颌面部均无组织结构与功能性异常。 Functional efficiency not only of the teeth and supporting structures But also the surrounding parts of the oral cavity Various structures related to mastication(咀嚼) and the maxilla-facial（颌面） complex。 —— WHO 1965

中国，平均每个孩子有 4.56 颗坏牙， 成人的恒牙患龋率为 49.88% 儿童的乳牙患龋率为 76.55%。 世界卫生组织把龋病列为仅次于癌症、脑血管疾病的第三大顽疾。

Health education principles口腔健康教育 口腔健康教育纳入综合健康教育计划中。 Oral health education should be built into general health education programmes. (WHO, 1984) 1989年9月20日为 世界爱牙日。 Health promotion 健康促进 运用行政或组织手段，广泛动员和协调，共同维护和促进健康的一种社会行为和社会战略。

健康促进 health promotion The facts: 免费医疗保健没有消除贫富人群的健康差异 the provision of free health care did not in and of itself eliminate the health gap between the wealthy and the poor. 死亡率和发病率与社会经济状态成反比 The mortality & morbidity vs socioeconomic status ---- inversely

健康促进 health promotion The consequence: 医疗费用限制政策出台 推出健康教育措施以促进自我保健，减少就医 Cost containment policy 推出健康教育措施以促进自我保健，减少就医 The role of health education in promoting self-care and reducing utilization of services

健康促进 health promotion 疾病普改变：The major health problems of modern populations, particularly the poor, were and continue to be chronic degenerative diseases Expensive to manage but could not be cured Could be prevented by changes in personal behaviours in social and physical environments

健康的决定因素 Determinants of health 环境因素： 环境因素包括自然环境与社会环境两个方面 行为与生活方式： 行为与生活方式是指因自身行为所产生的影响健康的因素 卫生保健服务因素： 卫生保健服务因素是社会因素中直接与健康有关的一个重要方面，包括预防服务，医疗与康复服务 生物遗传因素： 已知人类的遗传性缺陷和遗传性疾病近三千种，约占人类各种疾病的1／5

口腔健康促进——危险因素策略 Risk Factor Approach Socio-cultural risk factors Health system and oral health services Environmental risk factors Use of oral health services Outcome: Oral health status Impairment Quality of life General health Risk behavior: Oral hygiene Diet Tobacco Alcohol WHO 2003

健康促进的功能——五个工作领域 促进制定有利于健康的政策 building healthy public policy 促进建设和保护物质环境和自然环境 creating supportive environments 促进提高个人和群体保健知识和技能 developing personal skills 促进调整卫生服务方向 reorienting health services 促进发展社区能力 strengthening community action Ottawa Charter for Health Promotion（WHO 1986）

健康促进的原则 Principles of Health promotion 1、The population as a whole in the context of their everyday lives rather than focusing on people who are sick or at risk for specific diseases. 全社会参与，结合日常生活，不仅仅关注处于危险因素中的患病人群 2、 It is directed towards action on the determinants of health and requires close cooperation between many different sectors of society.针对健康决定因素，社会多部门协同行动

3、It combines many different approaches and requires organizational change, community development and local activities to identify and remove health hazards.采取联合措施，进行组织机构调整，通过社区建设和地区行动确定并铲除健康危险因素 4、Aims at effective and concrete public participation and requires that problem-defining and decision-making life skills be developed further in individuals and communities.以公众参与为目标，使个人和社区获得发现健康问题并正确抉择的生存技能。

5、While it is an activity in the health and social fields, it is not a medical service; health professionals have a special contribution to make in the areas of education and advocacy. 尽管不是医疗服务，但这是卫生和社会范畴的活动，卫生专业人员可以在教育和鼓动中发挥特殊作用 —— WHO 1984

WHY? Teeth are anchored in the Socket/ Alveolar Bone, through the Periodontal Ligaments. Teeth Infection, Gum Infection and Bone Infection. Of which, gum infection is mostly ignored, even by dentists, when it is not an acute infection. The Silent Killer: Periodontal Disease is a Chronic Inflammatory Disease: 牙齿在骨头里，外面包着牙龈。牙齿感染,牙龈感染和骨头感染；牙龈感染是最为忽略的；牙周炎是一种慢性炎症:隐形杀手 Acute inflammation is characterized by the redness, heat, swelling and pain that is the immune system's normal response to infection or injury. Immune cells congregate at the site so that they can overwhelm and dispose of infectious organisms or debris from injury.  Thus healing takes place. 18

Acute vs. Chronic Inflammation Acute inflammation is characterized by the redness, heat, swelling and pain. Another kind of inflammation -- low grade, chronic, and "systemic".   This has been getting a lot of attention in the medical community lately. 急性牙周炎：红热肿痛； 慢性牙周炎：轻微的，病程长，进展缓慢,"循序渐进", 

Chronic Inflammation could lead to Diabetic Complications Cardiovascular Diseases Chronic Inflammatory Diseases Neurological Disorders 糖尿病并发症， 心脏病 其他慢性炎症 神经类疾病 Bone, Muscular and Skeletal Diseases Metabolic Disorder Complications Cancer Pre-Term Birth or Infertility 骨骼，肌肉和骨骼疾病 代谢紊乱并发症 癌症，早产 和 不孕

Diabetes Well controlled? How well? Diabetic complications Atherosclerosis Retinopathy Chronic Renal Failure Neuropathy Sepsis Cardiomyopathy 动脉硬化 视网膜病变 慢性肾功能衰竭 神经系统疾病 败血病 心肌病

Cardiovascular Diseases Atherosclerosis Stroke Cerebrovascular Disease Cardiomyopathy Heart Failure 动脉硬化 中风 脑血管病 心肌病 心脏衰竭

Metabolic Disorder Complications Fatty Liver Disease Heart Disease Type II Diabetes Chronic Kidney Disease Sleep Apnea 脂肪肝 心脏疾病 II型糖尿病 慢性肾脏病 睡眠窒息症

Cancer 大肠癌 肺癌 肾癌 胰腺癌 淋巴瘤 胃癌 Colon Cancer Lung Cancer Kidney Cancer Pancreatic Cancer Lymphoma Gastric Cancer 大肠癌 肺癌 肾癌 胰腺癌 淋巴瘤 胃癌

Chronic Periodontitis Treatment subgingival vs Chronic Periodontitis Treatment subgingival vs. supragingival cleaning 慢性牙周炎的治疗 龈下刮治 vs 一般牙齿清洁 龈下刮治术（subgingival scaling) 根面平整术 （root planing),SRP是用比较精细的龈下刮治器刮除位于牙周袋内根面上的牙石和菌斑 25

Obamacare? Don’t Count on it! 别指望奥巴马保健 Advocates for Health hsCRP test HbA1c test Private Third Party Insurance Eg. Aetna 私营牙齿医疗保险： 自救，自醒，看牙，口腔护理 Self Help Self Awareness Dental Visits Oral Home Care

Oral care 　　口腔护理≠口腔擦洗 漱口液漱口 软毛刷刷牙 多漱口，每日多次，晨间、餐后、睡前。 按顺序擦洗

常用漱口液 冷开水

防腐、防臭，适用于口腔感染有溃烂坏死组织者 口腔护理常用漱口液 溶液名称 浓度 作 用 生理盐水 清洁口腔，预防感染 复方硼酸溶液 （朵贝尔氏液） 轻度抑菌、除臭 过氧化氢溶液 1%～3% 防腐、防臭，适用于口腔感染有溃烂坏死组织者 碳酸氢钠溶液 1%～4% 属碱性溶液，适用于真菌感染 洗必泰溶液 0．02% 清洁口腔，广谱抗菌 呋喃西林溶液 醋酸溶液 0．1% 适用于绿脓杆菌感染 硼酸溶液 2%～3% 酸性防腐溶液，有抑制细菌作用 甲硝唑溶液 0．08% 适用于厌氧菌感染 中药漱口液（金银花、 一枝黄花、野菊花） 清热、解毒、消肿、止血、抗菌

Questions： 健康人的口腔有细菌吗？ 一般情况下为什么不会引起口腔感染 ？ 你平时是怎样刷牙？ 存在大量的致病或非致病菌——口腔的温度、湿度、食物残渣适宜微生物生长繁殖 健康人的口腔有细菌吗？ 一般情况下为什么不会引起口腔感染 ？ 机体抵抗强 正常的饮水、进食、刷牙、濑口等可以起到减少和清除病菌的作用 你平时是怎样刷牙？

口腔护理的目的 保持口腔清洁、湿润，预防口腔感染等并发症。 去除口臭、口垢，使患者舒适，促进食欲，保持口腔正常功能。 观察口腔粘膜、舌苔和特殊口腔气味，提供病情变化的动态信息。

口腔卫生习惯 三三制 口腔清洁用具 刷牙方法 上下颤动刷牙法 义齿的清洁护理 牙线剔牙法 每日三次晨、晚、餐后 每次三分钟 餐后三分钟 牙刷：外形较小，刷毛软硬适中、表面光滑 牙膏：无腐蚀性，交替使用 牙线；尼龙线、丝线、涤纶线 口腔卫生习惯 三三制 口腔清洁用具 刷牙方法 上下颤动刷牙法 义齿的清洁护理 牙线剔牙法 将牙刷毛面轻轻放于牙齿及牙龈沟上，刷毛与牙齿成450角，快速环形来回颤动，每次刷2~3个牙 白天清洁法同真牙 不用时，取下用冷水浸泡，一日一换水 不能用乙醇和热水 每日两次，餐后更好

一 、Dental caries 龋病的预防 是慢性进行性破坏的一种疾病。（也可称为牙体硬组织的细菌感染性疾病） 病因：四联因素（细菌+宿主+时间+食物） 基本变化：无机物脱矿和有机物分解 临床特征：色、形、质均 发生变化

初期龋坏部位硬组织发生脱矿，微晶结构改变，牙透明度下降，致使牙釉质呈白垩色。 继之病变部位有色素沉着，局部可呈黄褐色。 随着无机物脱矿，有机物分解，牙釉质牙本质疏松软化，最终发生牙体缺损，形成龋洞。龋洞一旦形成，则缺乏自身修复能力。

龋病是人类的常见病、多发病之一 可引起牙髓病，根尖周病，颌骨炎症等系列并发症，严重形象身体健康。

二、龋病的预防方法 1.牙菌斑的控制 2.糖代替品 3.氟防龋 4.激光防龋 5.窝沟封闭 6.非创伤性修复治疗 （1）机械法清除菌斑 （2）生物学方法 （3）化学方法 （4）免疫方法 1.牙菌斑的控制 2.糖代替品 3.氟防龋 4.激光防龋 5.窝沟封闭 6.非创伤性修复治疗

1.牙菌斑的控制 细菌是致龋的主要因素，而防龋的关键环节 是控制菌斑。 （1）机械性清除菌斑 用牙刷、牙膏、牙线、牙签、牙间清洁器等保健用品，清除口腔内牙菌斑。

2.糖代替品 蔗糖的致龋性最强，但从营养和经济上考虑，目前还没有一种糖可以完全替代蔗糖。现有的糖代替品（山梨醇、甘露醇、木糖醇等）只能起到限制蔗糖食用的辅助作用。目前广泛使用木糖醇防龋。

3.氟防龋 效果肯定，应用广泛 措施：公共饮水氟化（主要） 含氟牙膏使用 氟片、氟凝胶、含氟漱口剂、含氟食 品的使用

4.激光防龋 作用：①激光照射后的釉质，形成抗酸性强的玻璃样物质，减少牙脱钙量。 ②与氟化物结合，可使氟透过牙骨质、牙本质小管，促进钙化封闭牙本质小管，提高抗酸蚀效果。

牙周病预防方法 （1）机械性措施 刷牙、牙线、牙签、牙间刷、橡胶按摩器、龈上洁治术和根面平整术。 （2）药物方法 氯已定、甲硝唑、替硝唑等 （3）控制相关局部因素 改善食物嵌塞、破除不良习惯、预防矫治错颌畸形、制作良好修复体。 （4）提高机体抵抗力

刷 牙

洁牙剂及其作用 牙膏： 洁净剂 摩擦剂 润湿剂 胶粘剂 防腐剂 甜味剂

三、刷牙方法 Bass刷牙法：洗刷唇舌面时，刷毛指向牙龈方向，与牙面呈45度角。使刷毛进入龈沟和邻间区，部分刷毛压于龈缘上做短距离的前后向颤动。刷洗后牙时，刷毛紧压在牙的颌面，使毛端深入沟裂区做短距离的前后向颤动。

窝沟封闭 定义：不去除牙体组织，在牙的点隙裂沟上涂布一层粘结性树脂，保护牙釉质不受细菌及代谢产物侵蚀，达到预防龋病的发生。 适宜年龄：乳磨牙3~4岁；第一恒磨牙6~7岁；第二恒磨牙11~13岁。

窝沟封闭 含氟凝胶

Sudden health problem

High Fever In general, the sudden high fever (38.5°C-40°C) usually means that the in vivo virus infection. However, the long-term sustainability of low-grade fever (37.3°C -38.5°C) , means that the immune system has been destroyed

Home treatment measures First of all, do not rush to cool the hot pack or cold compress selected according to the degree of body temperature . You should pay attention to the regular cleaning of the body Appropriate taking fever medicine. Soak in a warm bath will benefit to the heat distributing.

The preventive measures When the climate change, pay more attention to your dress In the diet, not all of a sudden eat too much cold food and attention to food hygiene(卫生) After strenuous exercise suited to immediately drink lots of water or a cold bath immediately Drink a lot of water in life , pay attention to rest

Stomachache Stomach pain is a chronic disease, usually requires a longer time of treatment, and then obtains good effect or recovery. It is better to take diet therapy, because drug therapy is just for emergency.

Suggestions to stomach trouble patient Correct poor eating habits Eat light, eat less fat , sweet and spicy food Beware of the food in acid, sweet, salty, bitter, spicy. Stop smoking.

Pay attention to nutritional balance, daily diet should supply foods rich in vitamin. Diet should be soft and warm. You’d better make food in mouth full chew.（细嚼慢咽） Prepare some stomach medicine to relieve stomachache when you have a stomachache.

General preventive measures Infection It not only causes health hazards, but also spreads in the crowd, causing the outbreak and great harm to the society as well. General preventive measures to strengthen management about possible pathogens病原体 in the extracellular细胞外 environment ; catch good plan immunity and protect susceptible population ;

Epidemic occurred after the epidemic prevention measures. 1）Control the infectious source； 2）cut off transmission； 3）to protect the susceptible population

Our advices In our opinion, the best way is to go to the hospital and see the doctor!