低龄儿童龋的临床管理专家共识

doi:10.7518/hxkq.2022.05.001

华西口腔医学杂志 ›› 2022, Vol. 40 ›› Issue (5): 495-503.doi: 10.7518/hxkq.2022.05.001

• 专家共识 • 下一篇

低龄儿童龋的临床管理专家共识

张琼¹(), 汪俊², 夏斌³, 赵玮⁴, 陈旭⁵, 蒋备战⁶, 黄洋⁷, 吴礼安⁸, 袁国华⁹, 邹静¹()

^1.口腔疾病研究国家重点实验室国家口腔疾病临床医学研究中心四川大学华西口腔医院儿童口腔科，成都 610041
^2.上海交通大学医学院附属第九人民医院儿童口腔科，上海 200011
^3.北京大学口腔医学院附属口腔医院儿童口腔科，北京 100081
^4.中山大学光华口腔医学院附属口腔医院儿童口腔科，广州 510055
^5.中国医科大学口腔医学院儿童口腔科，沈阳 110002
^6.同济大学附属口腔医院儿童口腔科，上海 200072
^7.吉林大学口腔医院儿童口腔科，长春 130021
^8.第四军医大学口腔医学院儿童口腔科，西安 710032
^9.武汉大学口腔医学院儿童口腔科，武汉 430079

收稿日期:2022-02-14 修回日期:2022-07-06 出版日期:2022-10-01 发布日期:2022-10-17
通讯作者: 邹静 E-mail:zhangqiongdentist@126.com;zoujing@scu.edu.cn
作者简介:张琼，副教授，博士，E-mail：zhangqiongdentist@126.com|张琼，四川大学华西口腔医（学）院儿童口腔科副教授，四级专家，美国阿拉巴马州立大学伯明翰分校牙学院联合培养博士，博士后。现任中华口腔医学会儿童口腔医学专业委员会常务委员、学术秘书，四川省口腔医学会儿童口腔医学专业委员会常务委员，青年委员会主任委员，中华医学会儿科学分会口腔学组青年委员，四川省口腔医学会口腔激光医学专业委员会常务委员，四川省健康管理师协会儿童健康管理分会副主任委员，四川省妇幼保健协会口腔分会常务委员。主持/主研国家自然科学基金4 项，四川省科研基金3 项，发表SCI 及核心期刊文章20 余篇。研究成果荣获中华医学科技奖医学科学技术三等奖，四川省科技厅、成都市科技厅科学技术进步三等奖。E-mail：zhangqiongdentist@126.com|邹静，口腔医学博士，四川大学华西口腔医（学）院教授/主任医师，博士研究生导师，儿童口腔科主任、一级临床专家。擅长儿童口腔健康管理，儿童龋病的综合防治。现任中华口腔医学会儿童口腔医学专业委员会主任委员，中华口腔医学会镇静镇痛专业委员会副主任委员，儿童口腔国家临床重点专科负责人。国际牙医师学院院士，四川省有突出贡献中青年专家，四川省卫健委学术技术带头人。《华西口腔医学杂志》《中华口腔医学杂志》《国际口腔医学杂志》《上海口腔医学》《口腔疾病防治》编委，主笔国家及行业标准6 项；担任第一负责人的“儿童龋病的病因及防治新技术研究”成果获中华医学科技奖三等奖，“儿童口腔疾病防治的基础及临床研究”成果获四川省科技进步奖三等奖及成都市科技进步奖三等奖；担任负责人的《儿童口腔医学（全英文）》课程获教育部本科一流线下课程。担任国家卫生健康委员会“十二五”“十三五”规划教材、全国高等学校教材《儿童口腔医学》副主编，《儿童口腔科诊疗与操作常规》《Pre-clinic Training Guide on Pediatric Dentistry》主编，以及《全国高级卫生专业技术资格考试习题集》副主编。以第一作者或通讯作者发表SCI 及中文核心期刊论文130 余篇，出版《现代龋病学》等学术专著25 部。E-mail：zoujing@scu.edu.cn
基金资助:
国家自然科学基金(82170947);成都市科学技术局技术创新研发项目(2021-YF05-01980-SN)

Expert consensus on clinical management for early childhood caries

Zhang Qiong¹(), Wang Jun², Xia Bin³, Zhao Wei⁴, Chen Xu⁵, Jiang Beizhan⁶, Huang Yang⁷, Wu Li’an⁸, Yuan Guohua⁹, Zou Jing¹()

^1.State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Pediatric Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
^2.Dept. of Pediatric Dentistry, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
^3.Dept. of Pediatric Dentistry, Peking University School and Hospital of Stomatology, Beijing 100081, China
^4.Dept. of Pediatric Dentistry, Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou 510055, China
^5.Dept. of Pediatric Dentistry, School and Hospital of Stomatology, China Medical University, Shenyang 110002, China
^6.Dept. of Pediatric Dentistry, The Affiliated Stomatoloy Hospital of Tongji University, Shanghai 200072, China
^7.Dept. of Pediatric Dentistry, Hospital of Stomatology, Jilin University, Changchun 130021, China
^8.Dept. of Pediatric Dentistry, School of Stomatology, The Fourth Military Medical University, Xi'an 710032, China
^9.Dept. of Pediatric Dentistry, School of Stomatology, Wuhan University, Wuhan 430079, China

Received:2022-02-14 Revised:2022-07-06 Online:2022-10-01 Published:2022-10-17
Contact: Zou Jing E-mail:zhangqiongdentist@126.com;zoujing@scu.edu.cn
Supported by:
The National Natural Science Foundation of China(82170947);The Technological Innovation Research and Development Project of Chengdu Bureau of Science and Technology(2021-YF05-01980-SN);Corres-pondence: Zou Jing, E-mail: zoujing@scu.edu.cn

摘要/Abstract

摘要：

低龄儿童龋（ECC）影响儿童牙齿、牙列、颅颌面和全身健康发育，是目前世界范围内需要面对和解决的重要儿童公共卫生问题之一。ECC的临床管理应以维护儿童口腔健康为中心，从其致病因素入手，以龋病风险评估为基础，早期预防在先，预防和治疗相结合，医护人员、儿童及其监护人相互配合，周期性地持续进行，从而阻止ECC的发生发展。本共识从ECC的风险评估、早期预防管理、临床治疗及术后管理来阐述ECC的临床管理策略。

关键词: 低龄儿童龋, 临床管理, 龋病风险评估, 过渡性充填修复, 间接牙髓治疗, 专家共识

Abstract:

Early childhood caries (ECC) is the most prevalent chronic oral disease and one of the worldwide public health problems of great urgency for children. ECC can affect children's teeth, dentition, craniomaxillofacial, and general health and development. Therefore, through dental caries etiologies and caries risk assessment, patient-centered, personalized planning and a combination of prevention and treatment should be implemented in the clinical management for ECC. Periodic and continuous cycle management can only be accomplished with the cooperation of medical staff, children, and their guardians. This expert consensus will expound the clinical management of ECC in the following aspects: caries risk assessment, early clinical prevention, treatment strategies, and postoperative management.

Key words: early childhood caries, clinical management, caries risk assessment, interim therapeutic restorations, indirect pulp therapy, expert consensus

中图分类号:

R 788

张琼, 汪俊, 夏斌, 赵玮, 陈旭, 蒋备战, 黄洋, 吴礼安, 袁国华, 邹静. 低龄儿童龋的临床管理专家共识[J]. 华西口腔医学杂志, 2022, 40(5): 495-503.

Zhang Qiong, Wang Jun, Xia Bin, Zhao Wei, Chen Xu, Jiang Beizhan, Huang Yang, Wu Li’an, Yuan Guohua, Zou Jing. Expert consensus on clinical management for early childhood caries[J]. West China Journal of Stomatology, 2022, 40(5): 495-503.

参考文献 52

1	American Academy of Pediatric Dentistry. The reference manual of pediatric dentistry[M]. Chicago: American Academy of Pediatric Dentistry, 2021.
2	刘亚琪, 张琼, 王艳, 等. 重度低龄儿童龋儿童全身麻醉与常规门诊下牙病治疗的疗效及卫生经济学评价[J]. 华西口腔医学杂志, 2021, 39(6): 703-708.
	Liu YQ, Zhang Q, Wang Y, et al. Evaluation of therapeutic effect and health economics of general anesthesia and routine outpatient dental treatment in children with severe early child caries[J]. West China J Stomatol, 2021, 39(6): 703-708.
3	Selwitz RH, Ismail AI, Pitts NB. Dental caries[J]. Lancet, 2007, 369(9555): 51-59.
4	Hemadi AS, Huang RJ, Zhou Y, et al. Salivary proteins and microbiota as biomarkers for early childhood caries risk assessment[J]. Int J Oral Sci, 2017, 9(11): e1.
5	Chaffee BW, Featherstone JDB, Zhan L. Pediatric caries risk assessment as a predictor of caries outcomes[J]. Pediatr Dent, 2017, 39(3): 219-232.
6	American Academy of Pediatric Dentistry. Guideline on perinatal and infant oral health care[J]. Pediatr Dent, 2016, 38(6): 150-154.
7	周学东, 程磊, 郑黎薇. 全生命周期的龋病管理[J]. 中华口腔医学杂志, 2018, 53(6): 367-373.
	Zhou XD, Cheng L, Zheng LW. Strategies of caries management in whole life cycle[J]. Chin J Stomatol, 2018, 53(6): 367-373.
8	Fontana M, González-Cabezas C. Noninvasive caries risk-based management in private practice settings may lead to reduced caries experience over time[J]. J Evid Based Dent Pract, 2016, 16(4): 239-242.
9	Ghaffari M, Rakhshanderou S, Ramezankhani A, et al. Oral health education and promotion programmes: Meta-analysis of 17-year intervention[J]. Int J Dent Hyg, 2018, 16(1): 59-67.
10	Fontana M. The clinical, environmental, and behavioral factors that foster early childhood caries: evidence for caries risk assessment[J]. Pediatr Dent, 2015, 37(3): 217-225.
11	Berkowitz RJ. Mutans streptococci: acquisition and trans-mission[J]. Pediatr Dent, 2006, 28(2): 106-109, discussion 192-198.
12	Hartnett E, Haber J, Krainovich-Miller B, et al. Oral health in pregnancy[J]. J Obstet Gynecol Neonatal Nurs, 2016, 45(4): 565-573.
13	Singleton R, Day G, Thomas T, et al. Association of maternal vitamin D deficiency with early childhood caries[J]. J Dent Res, 2019, 98(5): 549-555.
14	Bernabé E, MacRitchie H, Longbottom C, et al. Birth weight, breastfeeding, maternal smoking and caries trajectories[J]. J Dent Res, 2017, 96(2): 171-178.
15	Cui LL, Li X, Tian YL, et al. Breastfeeding and early childhood caries: a Meta-analysis of observational studies[J]. Asia Pac J Clin Nutr, 2017, 26(5): 867-880.
16	Moynihan PJ, Kelly SA. Effect on caries of restricting sugars intake: systematic review to inform WHO guidelines[J]. J Dent Res, 2014, 93(1): 8-18.
17	American Academy of Pediatric Dentistry. Policy on the use of xylitol[J]. Pediatr Dent, 2017, 39(6): 54-56.
18	霍静怡, 苏畅, 刘美延, 等. 儿童3种刷牙方法清除菌斑效果的随机对照试验[J]. 国际口腔医学杂志, 2015, 42(5): 528-530.
	Huo JY, Su C, Liu MY, et al. Randomized controlled comparison of three toothbrushing methods in plaque removal efficacy among children[J]. Int J Stomatol, 2015, 42(5): 528-530.
19	Yaacob M, Worthington HV, Deacon SA, et al. Powered versus manual toothbrushing for oral health[J]. Cochrane Database Syst Rev, 2014(6): CD002281.
20	Corby PM, Biesbrock A, Bartizek R, et al. Treatment outcomes of dental flossing in twins: molecular analysis of the interproximal microflora[J]. J Periodontol, 2008, 79(8): 1426-1433.
21	Li X, Zhong YS, Jiang XJ, et al. Randomized clinical trial of the efficacy of dentifrices containing 1.5% arginine, an insoluble calcium compound and 1 450 ppm fluoride over two years[J]. J Clin Dent, 2015, 26(1): 7-12.
22	Cummins D. The superior anti-caries efficacy of fluoride toothpaste containing 1.5% arginine[J]. J Clin Dent, 2016, 27(2): 27-38.
23	Rozier RG, Adair S, Graham F, et al. Evidence-based clinical recommendations on the prescription of dietary fluoride supplements for caries prevention: a report of the American Dental Association Council on Scientific Affairs[J]. J Am Dent Assoc, 2010, 141(12): 1480-1489.
24	Reynolds EC. Casein phosphopeptide-amorphous calcium phosphate: the scientific evidence[J]. Adv Dent Res, 2009, 21(1): 25-29.
25	Wang Y, Li JL, Sun WB, et al. Effect of non-fluoride agents on the prevention of dental caries in primary dentition: a systematic review[J]. PLoS One, 2017, 12(8): e0182221.
26	Seminario-Amez M, López-López J, Estrugo-Devesa A, et al. Probiotics and oral health: a systematic review[J]. Med Oral Patol Oral Cir Bucal, 2017, 22(3): e282-e288.
27	Zaura E, Twetman S. Critical appraisal of oral pre- and probiotics for caries prevention and care[J]. Caries Res, 2019, 53(5): 514-526.
28	Zhang Q, Cheng L, Zhou X, et al. Small molecule inhibitors for Streptococcus mutans biofilms[J]. Current Organ Chem, 2018, 22(27): 2664-2670.
29	Almaz ME, Sönmez IŞ, Ökte Z, et al. Efficacy of a sugar-free herbal lollipop for reducing salivary Streptococcus mutans levels: a randomized controlled trial[J]. Clin Oral Investig, 2017, 21(3): 839-845.
30	American Academy of Pediatric Dentistry. Policy on the role of dental prophylaxis in pediatric dentistry[J]. Pediatr Dent, 2017, 39(6): 47-48.
31	Gugnani N, Gugnani S. Remineralisation and arresting caries in children with topical fluorides[J]. Evid Based Dent, 2017, 18(2): 41-42.
32	中华口腔医学会儿童口腔医学专业委员会, 中华口腔医学会口腔预防医学专业委员会. 婴幼儿龋防治指南[J]. 中华口腔医学杂志, 2021, 56(9): 849-856.
	Chinese Society of Pediatric Dentistry, Chinese Stomatological Association; Chinese Society of Preventive Dentistry, Chinese Stomatological Association. Guideline on caries prevention and clinical practice for children under three years of age[J]. Chin J Stomatol, 2021, 56(9): 849-856.
33	Bagherian A, Shirazi AS. Flowable composite as fissure sealing material? A systematic review and Meta-analysis[J]. Br Dent J, 2018, 224(2): 92-97.
34	Wright JT, Crall JJ, Fontana M, et al. Evidence-based clinical practice guideline for the use of pit-and-fissure sealants: a report of the American Dental Association and the American Academy of Pediatric Dentistry[J]. J Am Dent Assoc, 2016, 147(8): 672-682.e12.
35	Murdoch-Kinch CA, McLean ME. Minimally invasive dentistry[J]. J Am Dent Assoc, 2003, 134(1): 87-95.
36	Zhao IS, Gao SS, Hiraishi N, et al. Mechanisms of silver diamine fluoride on arresting caries: a literature review[J]. Int Dent J, 2018, 68(2): 67-76.
37	Crystal YO, Marghalani AA, Ureles SD, et al. Use of silver diamine fluoride for dental caries management in children and adolescents, including those with special health care needs[J]. Pediatr Dent, 2017, 39(5): 135-145.
38	Contreras V, Toro MJ, Elías-Boneta AR, et al. Effectiveness of silver diamine fluoride in caries prevention and arrest: a systematic literature review[J]. Gen Dent, 2017, 65(3): 22-29.
39	Allen DN, Fine CM, Newton MN, et al. Resin infiltration therapy: a micro-invasive treatment approach for white spot lesions[J]. J Dent Hyg, 2021, 95(6): 31-35.
40	Dorri M, Martinez-Zapata MJ, Walsh T, et al. Atraumatic restorative treatment versus conventional restorative treatment for managing dental caries[J]. Cochrane Database Syst Rev, 2017, 12: CD008072.
41	Cardoso M, Coelho A, Liam R, et al. Efficacy and patient's acceptance of alternative methods for caries removal—a systematic review[J]. J Clin Med, 2020, 9(11): E3407.
42	Donly KJ, García-Godoy F. The use of resin-based composite in children: an update[J]. Pediatr Dent, 2015, 37(2): 136-143.
43	Rodrigues JA, Casagrande L, Araújo FB, et al. Restorative materials in pediatric dentistry[M]. Cham: Springer, 2019: 161-167.
44	Dhar V, Marghalani AA, Crystal YO, et al. Use of vital pulp therapies in primary teeth with deep caries lesions[J]. Pediatr Dent, 2017, 39(5): 146-159.
45	Coll JA, Seale NS, Vargas K, et al. Primary tooth vital pulp therapy: a systematic review and Meta-analysis[J]. Pediatr Dent, 2017, 39(1): 16-123.
46	Roberts C, Lee JY, Wright JT. Clinical evaluation of and parental satisfaction with resin-faced stainless steel crowns[J]. Pediatr Dent, 2001, 23(1): 28-31.
47	Kupietzky A, Waggoner WE, Galea J. Long-term photographic and radiographic assessment of bonded resin composite strip crowns for primary incisors: results after 3 years[J]. Pediatr Dent, 2005, 27(3): 221-225.
48	张蕴涵, 邓晓宇, 王艳, 等. 乳切牙牙体缺损的修复治疗进展[J]. 口腔疾病防治, 2020, 28(2): 131-136.
	Zhang YH, Deng XY, Wang Y, et al. Progress in restora-tive treatments of primary incisor defects[J]. J Prev Treat Stomatol Dis, 2020, 28(2): 131-136.
49	Innes NP, Evans DJ, Bonifacio CC, et al. The Hall Technique 10 years on: questions and answers[J]. Br Dent J, 2017, 222(6): 478-483.
50	Badar SB, Tabassum S, Khan FR, et al. Effectiveness of hall technique for primary carious molars: a systematic review and Meta-analysis[J]. Int J Clin Pediatr Dent, 2019, 12(5): 445-452.
51	Ajayakumar LP, Chowdhary N, Reddy VR, et al. Use of restorative full crowns made with zirconia in children: a systematic review[J]. Int J Clin Pediatr Dent, 2020, 13(5): 551-558.
52	Choi JW, Bae IH, Noh TH, et al. Wear of primary teeth caused by opposed all-ceramic or stainless steel crowns[J]. J Adv Prosthodont, 2016, 8(1): 43-52.

[1]	陈芸梅, 刘艳, 黄秋雨, 罗姜, 吴红梅, 王烨华, 吴玲, 李秀娥, 毕小琴. 周围性面瘫患者的面神经功能训练专家共识[J]. 华西口腔医学杂志, 2023, 41(6): 613-621.
[2]	刘磊, 向中正, 李一, 郭伟, 杨凯, 王军, 孙志军, 任国欣, 张建国, 孙沫逸, 冉伟, 黄桂林, 唐瞻贵, 李龙江. 头颈部鳞癌免疫检查点抑制剂治疗专家共识[J]. 华西口腔医学杂志, 2022, 40(6): 619-628.
[3]	李煌, 武秀萍, 黄兰, 徐晓梅, 康娜, 韩向龙, 李宇, 赵宁, 江凌勇, 谢贤聚, 郭杰, 李志华, 莫水学, 刘楚峰, 胡江天, 施洁珺, 曹猛, 胡炜, 曹阳, 宋锦璘, 汤旭娜, 白丁. 正畸根尖区牙根外吸收的风险因素及其临床处理建议的专家共识[J]. 华西口腔医学杂志, 2022, 40(6): 629-637.
[4]	祝颂松, 王旭东, 杨学文, 王晓霞, 田磊, 刘曙光, 郑广森, 唐正龙, 吴国民, 李志勇, 白晓峰, 黄旋平, 黄立, 习伟宏, 朱耀旻. 下颌支矢状骨劈开术并发症防治的专家共识[J]. 华西口腔医学杂志, 2022, 40(3): 247-254.
[5]	潘剑, 薛洋, 赵吉宏, 周青, 邹多宏, 陈松龄, 韩冰, 崔念晖, 刘显, 王了, 胡开进. 口服抗栓药物患者门诊拔牙围手术期管理的专家共识[J]. 华西口腔医学杂志, 2022, 40(3): 255-263.
[6]	郭维华, 汪俊, 陈旭, 王小竞, 赵玮, 宋光泰, 吴礼安, 蒋备战, 张琼, 王军, 李宇, 赵宁, 谭家莉, 李煌, 舒睿, 周陈晨, 傅蕾, 陈学鹏, 邹静. 混合牙列期间隙管理的专家共识[J]. 华西口腔医学杂志, 2022, 40(3): 264-270.
[7]	刘亚琪, 张琼, 王艳, 瞿星, 邹静. 重度低龄儿童龋儿童全身麻醉与常规门诊下牙病治疗的疗效及卫生经济学评价[J]. 华西口腔医学杂志, 2021, 39(6): 703-708.
[8]	李小兵, 叶全富, 贺红, 卢海平, 朱敏, 姜若萍, 邹淑娟, 韩向龙, 周力, 陈柯, 袁晓, 张军梅, 谭理军, 尹畅, 贺周, 李昂, 程斌, 阮文华, 黄芳, 刘娟, 马兰, 邹蕊, 杨芳, 张卫兵, 田玉楼, 蒋备战, 邵林琴, 黄洋, 唐丽琴, 高黎, 周陈晨. 中国儿童错𬌗畸形早期矫治专家共识[J]. 华西口腔医学杂志, 2021, 39(4): 369-376.
[9]	张颖, 贾松菠, 李帆, 李姗姗, 张利娟, 谭凯璇, 卢洁, 杨芳. 低龄儿童龋病相关的唾液生化指标研究[J]. 华西口腔医学杂志, 2021, 39(3): 300-305.
[10]	张东升, 郑家伟, 张陈平, 蔡志刚, 李龙江, 廖贵清, 尚政军, 孙沫逸, 韩正学, 尚伟, 孟箭, 龚忠诚, 黄圣运. 口腔癌合并全身系统性疾病患者的多学科协作诊疗模式专家共识[J]. 华西口腔医学杂志, 2020, 38(6): 603-615.
[11]	邓晓宇, 张蕴涵, 邹静, 张琼. 全身麻醉下儿童牙病综合治疗术后反应的调查分析[J]. 华西口腔医学杂志, 2020, 38(3): 284-289.
[12]	邹静. 儿童口腔健康管理[J]. 华西口腔医学杂志, 2018, 36(5): 465-468.
[13]	吴偲, 刘映伶, 邹静, 周学东, 郑黎薇. 乳牙深龋的间接牙髓治疗[J]. 华西口腔医学杂志, 2018, 36(4): 435-440.
[14]	孙同正, 滕飞, 贾松菠, 唐永平, 姜明, 黄适, 袁晓, 李晓岚, 杨芳. 与重症低龄儿童龋病相关的唾液微生物群落研究[J]. 华西口腔医学杂志, 2018, 36(2): 150-155.
[15]	张瑞涵, 李小兵, 王丽萍, 刘奕杉. 新疆维吾尔族和汉族儿童龋病与人类白细胞抗原-DQB1等位基因多态性的相关性研究[J]. 华西口腔医学杂志, 2018, 36(1): 4-8.

低龄儿童龋的临床管理专家共识

Expert consensus on clinical management for early childhood caries

RichHTML

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

参考文献 52

相关文章 15

编辑推荐

Metrics

本文评价