学龄前儿童全口龋齿的手术治疗

美国——在西雅图儿童医院儿童牙科中心的外科侧楼里，两岁半的DevonKoester上个月在他母亲的怀中静止不动，麻醉师用泡泡糖香味的面罩遮住他的面部，将其麻醉。

医生随后拍摄X-线片，显示20颗乳牙中有11颗已经龋坏。

然后，他的儿童牙医拔出两颗切牙，在1颗磨牙上进行根管治疗，其他牙齿进行充填治疗和冠修复。

在5年前的一项研究中，疾病控制和预防中心注意到患有龋齿的学龄前儿童增长数字在40年里列于首位。

但是美国牙医表示他们看到各个收入水平的学龄前儿童患有6-10颗或更多龋齿的数量都有所增加。

他们还表示，龋坏水平十分严重，以至于他们经常会建议使用全身麻醉，因为儿童不可能在清醒时坐下来接受如此大范围的治疗。

PreschoolersinSurgeryforaMouthfulofCavitiesSEATTLE—InthesurgicalwingoftheCenterforPediatricDentistryatSeattleChildren’sHospital,DevonKoester,2½yearsold,wasrestinglastmonthinhismother’sarmsasananesthesiologistheldabubble-gum-scentedmaskoverhisfacetoputhimunder.ThedoctorsthentookX-rays,whichshowedthat11ofhis20babyteethhadcavities.Thenhispediatricdentistextractedtwoincisors,performedarootcanalonamolar,andgavetherestfillingsandcrowns.Devon’smother,MelodyKoester,ahomemakerfromStanwood,Wash.,andherhusband,Matthew,aninformationtechnologymanager,saidtheybeganworryingaboutbrushingDevon’steethonlyafterMrs.Koesternoticedtheywerediscoloredwhenhewas18monthsold.“Ihadalotonmymind,andbrushinghisteethwasanextrathingIdidn’tthinkaboutatnight,”shesaid.Thenumberofpreschoolersrequiringextensivedentalworksuggeststhatmanyotherparentsmakethesamemistake.TheCentersforDiseaseControlandPreventionnotedanincrease,thefirstin40years,inthenumberofpreschoolerswithcavitiesinastudyfiveyearsago.Butdentistsnationwidesaytheyareseeingmorepreschoolersatallincomelevelswith6to10cavitiesormore.Thelevelofdecay,theyadded,issoseverethattheyoftenrecommendusinggeneralanesthesiabecauseyoungchildrenareunlikelytositthroughsuchextensiveprocedureswhiletheyareawake.Thereisnocentralclearinghousefordataonthenumberofyoungchildrenundergoinggeneralanesthesiatotreatmultiplecavities,butinterviewswith20dentistsandothersinthefieldofdentalsurgerysuggestthattheproblemiswidespread.“Wehavehadahugeincreaseinkidsgoingtotheoperatingroom,”saidDr.JonathanShenkin,apediatricdentistinAugusta,Me.,andaspokesmanfortheAmericanDentalAssociation.“We’retreatingmorekidsmoreaggressivelyearlier.”Butsuchoperationsarelargelypreventable,hesaid.“Ihaveparentstellmeallthetime,‘Noonetolduswhentogotothedentist,whenweshouldstartusingfluoridetoothpaste’—allthisbasicinformationtocombattheNo.1chronicdiseaseinchildren.”Dentistsofferanumberofreasonssomanypreschoolerssufferfromsuchextensivedentaldecay.Thoughtheyarenotnecessarilynew,theyhavecombinedtocreateagrowingproblem:endlesssnackingandjuiceorothersweetdrinksatbedtime,parentswhochoosebottledwaterratherthanfluoridatedtapwaterfortheirchildren,andalackofawarenessthatinfantsshould,accordingtopediatricexperts,visitadentistbyage1tobeassessedforfuturecavityrisk,eventhoughtheymayhaveonlyafewteeth.Andbecausesometoddlersdisliketooth-brushing,someparentsdonotenforceit.“Let’ssayachildis1½,andthechildscreamswhentheygettheirteethcleaned,”saidDr.JedBest,apediatricdentistinManhattan.“Someparentssay,‘Idon’twantmylittledarlingtobetraumatized.’ThemetaphorIgivethemis,‘I’dmuchratherhaveakidcrywithasofttoothbrushthanwhenIhavetodrillacavity.’”Dentaldecayoftenstartswithadullachethatmaybemistakenforteething.Thatiswhyparentsdonotrealizetheirchild’steethareinfecteduntiltheybreakorthepainbecomessoacutethatthechildcannotsleep,saidDr.JoelBerg,directoroftheCenterforPediatricDentistry,ajointventuresince2010betweentheUniversityofWashingtonandSeattleChildren’sHospital,whichbuiltasurgicalwingbecauseofthedemandfororalsurgeryforpreschoolers.Withacooperativechild,acavity—orevenmany—canbetreatedinadentist’sofficewithaninjectionoflocalanesthesiaandanepisodeof“TheBackyardigans”todistractpatients.Butdentistsroutinelyrecommendgeneralanesthesiaforpreschoolerswithextensiveproblems,particularlyiftheywillnotevenletX-raysbetaken.Thecosttoparentsfordentalrestorationundergeneralanesthesiaforachildrangesfrom$2,000to$5,000ormore,dependingoninsurancecoverageandtheamountofwork,severaldentistssaid.Dr.MegannSmiley,adentist-anesthesiologistatNationwideChildren’sHospitalinColumbus,Ohio,isusedtohearingparentsquestiontheneedforgeneralanesthesiatofixtheirchildren’sinfectedteeth.“Itseemslikeputtingamatchoutwithafirehydrant,”Dr.Smileysaid.“Butifanyofustriedtoget12teethtreated,wewouldn’tthinkthat’ssmall.”ThedentalsurgerycenteratNationwidehasthreeoperatingrooms,whichstaffmembersandlocaldentistsusedtotreatroughly2,525childrenin2011,6percentmorethanin2010.Theaverageageofpatientsis4,andmosthavedecayinsixtoeightteeth,shesaid.“Themostseverecaseshave12or16,whichisseenseveraltimesaweek,”Dr.Smileyadded.Usinggeneralanesthesiaonhealthychildrenhasrisks,includingvomitingandnausea,and,inveryrarecases,braindamageordeath.Usinganti-anxietydrugstorelaxachildcoupledwithlocalanesthesiaforpainhasrisks,too,includinganoverdosethatcouldsuppressbreathing.。