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1、UnitSeventeen ORALDISEASES:PREVENTIONISBETTERTHANCURE Oraldiseasessuchascariesandperiodontaldisease(infectionsofthegumsandofthetoothsupporttissues)areamongthemostwidespreaddiseasesintheworld.Theyaffectallpopulationstovaryingdegrees. Dentalcariesintheworld:asituationofcontrast Theindexformeasurin

2、gtheextenttowhichapopulationisaffectedbycariesisthemeanDMFT,whichinagroupofindividualscountstheaveragenumberofteeththatareDecayed,Missing(onaccountofcaries)andFilled.Itisasimple,rapidanduniversallyapplicablemeasurementthathasbeenwidelyusedforseveraldecades. Wehavedrawnupascaleforseverityofinvolveme

3、ntatvariouskeyages:12,35-44,65andover. Atage12the5levelscalevariesfrom0.0to6.6ormore:aDMFTbetween0.0and1.1isconsideredverylow,afigureof6.6ormoreisveryhigh,whileamoderateDMFTisbetween2.7and4.4decayed. AnycountryundertakingananalysisofitsoralhealthsituationcancomparetheresultswithWHO*sworldwideobjec

4、tive:bytheyear2000nomorethanthreedecayed,missingandfilledteethatage12.Byrepeatingtheanalysisatregularintervals(WHOrecommendsanevaluationeveryfiveyears)itispossibletomonitorthetrendincariesprevalence,toestimatetheneedsforcareandpreventionandtoadjustpersonneltrainingandservicesaccordingly.Itshouldbepo

5、intedoutthatthesimplifiedoralhealthsurveymethoddevelopedbyWHOisreliable,veryinexpensive,canbeusedanywhereandprovidescomparabledatabothintherichestcountriesandinthepoorest. WHO*sOralHealthUnitprovidestechnicalsupportfbrepidemiologicalsurveysandprocessescountrydatafreeofchargeonrequest. Theinformati

6、oncollectedisstoredintheGlobalOralDataBank(GODB)systeminthecatalogueofUnitedNationsdatabanks,wherebyitispossibletofollowtheworldwidetrend.Everyyearsince1969,WHOhascompiledaworldmapofcariesatage12.In1969theoverallpictureshowedsharpcontrasts:theDMFTwasveryhigh,highoratleastmoderate(between2.7and4.4)in

7、theindustrializedcountries,whereasitwasgenerallyverylow,lowandoccasionallymoderateinthedevelopingcountries. Overthenexttwodecadestherewasadownwardmovementandsometimesaspectacularfallintheprevalenceofcariesinvirtuallyalltheindustrializedcountries. Inthedevelopingcountriesthegeneraltrendisforcariesp

8、revalencetoincreaseexceptwherepreventionprogrammeshavebeensetup. Everyyearsince1980theWHOOralHealthUnithascalculatedthemeanglobalDMFTatage12,weightedforpopulation.Theresultinggraphsdisplaythetrendsindentalcariesintheindustrializedcountries,inthedevelopingcountriesandformankindasawhole. Thetrendint

9、hemeansince1980justifiesmeasuredoptimismforthenext10years,althoughthesituationisstilldelicateinasmuchasasmallincreaseinveryhighlypopulatedcountriesisallthatisneededtotakethemeanabove3. Whatistheexplanationfbrthespectaculardropincariesprevalenceinsomecountries?Howcanitbepreventedfromrisingagain?Howc

10、antheworseningofthesituationinothercountriesbehalted? Thereplytothesethreequestionsisoneandthesame:prevention,morepreventionandstillmoreprevention. Intheindustrializedcountriesthepromotionoforalhygiene,thewidespreaduseoffluoridetoothpaste,theintroductionoffluorideintodrinkingwaterorsaltinsomecount

11、ries,adviceonnutrition(nosweetsbetweenmealsandetc.)arethefactorsbehindanunprecedentedpublichealthsuccessstory! Wherevercommunitypreventionprogrammesaresetup,cariesstopadvancing.Forexample,thishashappenedinBulgaria,FrenchPolynesiaandThailand.Apartfromthefluoridaiionofwater,sahandmilk,whichrequiresmo

12、readvancedtechnologyandsupervisedcentraladministration,allthemethodsoforalhygienemakeuseofsimpletechniques,costlittleandareperfectlysuitedtoimplementationatprimaryhealthcarelevel. Asaresultof(heprogressmadeinthelast25years,thedevelopingcountriesnowhavetheknowledgeandmeansofpreventionthatwillenablet

13、hemtoavoidtheproblemstheindustrializedcountrieshavehadloface,andindeedstillarefacingataveryhighprice! Inmostindustrializedcountriestheoralhealthservicesstillabsorbbetween5%and11%ofthenationalhealthbudget. Thereisnoreasonatalltocontinuedevotingsubstantialresourcestotreatingaconditionthatcanbepreven

14、tedbysimple,variedandinexpensivemeasures.Butthereneedstobethepoliticalwilltogiveprioritytoprevention. **** Whataboutthe"periodontaldisease"? Towardstheendofthe1960smostdentalepidemiologistssharedtheviewthatperiodontaldiseases,unlikecaries,weremorecommoninthedevelopingcountriesthanin(heindustriali

15、zedcountries.However,theavailabledatawereveryfragmentaryanddifficultorimpossibletocomparesincetherewerenofewerthanfivedifferentindicesincommonuse.Thisplethoraofmethodswascompoundedbythedifficultyofcollectingdatafromadults;aproblemthatislessseriousinthecaseofcaries,wherethekeyageis12years. Withthede

16、finitionofaperiodontalindex,whichveryquicklyachievedwideinternationalacceptance,theepidemiologyofperiodontaldiseaseshasmadegreatstrides.TheCPITN(CommunityPeriodontalIndexofTreatmentNeeds)wasproposedbyaWHOscientificgroupandrecommendedintheearly1980sbyajointworkinggroupfromWHOandtheFDI(InternationalDe

17、ntalFederation). Thisindexrecordstheperiodontaldiseasesintermsoffourclinicalsigns: 1. Bleedingfromthegum 2. Presenceofcalculus 3. Presenceofshallowperiodontalpockets 4. Presenceofdeepperiodontalpockets A"periodontalpocket"isconsideredtobepresentwhen'thegum,undertheeffectofinflammationand/orinf

18、ection,retracts,formsapocketandnolongeradherestothetooth.Theligamentsbecomeimpairedandthetoothbecomesincreasinglyloose. Tomeasureperiodontalstatus,themouthisdividedintosixpartsorsextants.Aspeciallydesignedprobeisusedtotestthecondition(1,2,3or4)ofthegumaroundthetoothselectedastheindextoothforeachsex

19、tant. Ifseveralclinicalsignsarepresentsimultaneously,(hemostsevereisselected. WHOhascompileddataonoverIOOsurveyscarriedoutintheagegroup35-44years.Thesedatashouldbetreatedwithcaution,sinceveryfewofthemprovideanationalestimate. Neverthelesstheyareofgreatinterestbecausetheyconsistentlyshowasimilarpa

20、tternfrequencyandseverityofinvolvement,whichchallengessomegenerallyacceptedideasaboutthedistributionandtheetiologicalprocessofperiodontaldisease. Thedatashowthatthepercentageofpeoplewhohavedeeppocketsandthemeannumberofsextantsperpersonalsodisplayingdeeppocketsarelowioverylow.Thismeansthattheseveref

21、ormsofperiodontaldisease,thoserequiringcomplicatedsurgeryarefarfromcommon. Moreover,(hereseemstobenodifferenceinfrequencybetweenindustrializedcountriesanddevelopingcountriesforthesevereformsofperiodontaldisease. Ontheotherhand,theinitialforms(bleedingandcalculus)aremuchmoreprevalentinthedeveloping

22、countries. Inthelightofthesedataitmaybestatedthatgeneralizedperiodontaldestructionisrarein40-year-oldadults.Somepeopleshowsomesignsofsuchdestruction,butonlyalimitedpartoftheirdentitionisaffected.Itseemsthattheinitialforms(bleedingandcalculus)donotnecessarilyleadon(olheadvancedstagesofthedisease,exc

23、eptincertainminoritygroups. Howcanthesediseasesbeprevented? Afterafewdaysofcarefulcleaningoftheteeth,thebleedingstopsinthevastmajorityofcasesandtheinflammation,thecauseofmuchdiscomfort,alsoregresses. Therearevariouspossiblepreventionpolicies:hygienef8rthemostcommonandleastseriousforms;development

24、ofproductsthatactagainstthedestructivetypesofperiodontitis.Awholefieldofresearchloprotect(heriskgroupsisopeningup. 1. gum.gingivacalculus,tartar 2. FooddebrisDentalplaque 3. index,indicesmeanDMFT 4. D-DecayedM-Missing(onaccountofCaries) 5. F-FilledKeyages(indexagegroups) 6. oralhealthsituati

25、onregularintervals 7. monitorcariesprevalence 8. simplifiedreliable 9. epidemiologicalsurveyVOCABULARY 牙齦牙結(jié)石食物殘渣牙菌斑指數(shù)，索引斌（牙）均 失 補 指數(shù)年齡組口腔健康狀況定期，間隔一定時間監(jiān)測，監(jiān)督 患融簡化的可靠的流行病學(xué)調(diào)查 10. preventiveprogrommeonrequest 11. databankcompile(d) 12. Sharpcontrast(s)downward 13. upwardspectacularfall 14. v

26、irtuallyweightedforpopulation 15. Justify,justifiesoptimism 16. graphworsening 17. halt(ed)unprecedented 18. supervisedfluoridation 19. administrationoralhygiene 20. primaryhealthcarehealthbudget 21. devotesubstances 22. priorityinexpensivemeasures 23. share(d)periodontaldiseases 24. fragm

27、entaryplethora 25. periodontalindexinternationalacceptance 26. strides(s)CPITN(CommunityPeriodontalindexofTreatmentNeeds) 27. FDI(InternationalDentalFederation)bleedinggum 28. shallowperiodontalpocketsdeepperiodontalpockets 29. retract(s)adhere(s) 30. ligament(s)impaired 31. loosesextant(s)

28、32. speciallydesignedprobeindextooth 33. simultaneouslycaution 34. similarpatternfrequency 預(yù)防項目（計劃）根據(jù)要求 資料庫（數(shù)據(jù)瘁）編制 鮮明對比向下的，下降的 向上的，上升的引人注目的下降 事實上，實際上： 加權(quán)人口證明（認(rèn)為）……有道理，為?….-提供依據(jù)樂觀（主義） 座標(biāo)圖，曲線圖（使）惡化、變壞 停止、止步，休息空前的，無先例的 在監(jiān)督指導(dǎo)下的氟化 管理口腔（清洗）衛(wèi)生 初級衛(wèi)生保健衛(wèi)生預(yù)算 獄（身），貢獻，專心致力于實質(zhì)的，有價值，有實力的 重點，優(yōu)先廉價措施

29、分享，分擔(dān)牙周疾病 片斷的，殘缺不全的過多（剩） 牙周指數(shù)國際承認(rèn)（接受） 邁進，進步社區(qū)牙周治療需要指數(shù) 國際牙科聯(lián)盟牙齦出血 淺牙周袋深牙周袋 退縮，萎縮附著，吸附韌帶受損傷的（牙淞動（牙周）區(qū)段專門設(shè)計的探針指數(shù)牙同時，一齊小心、慎重類似方式（模式、形式）頻數(shù) 68. etiological 69. display 70. prevalent 71. initialform 72. regress(es) 73. riskgroup 病因果的展現(xiàn)，展示流行的早期階段(形式)消退；退回 危險人群Notes 1. 長句分析(課文第二段第一句)： 1) towh

30、ich引入?個定語從句"apopulationisaffectedbycaries"。這里的which是指Theindexo 2) 下面一個Which指themeanDMFT,又引入一個定語從句“inagroupofindividualscountstheaveragenumberofteeth." 3) that也是一個關(guān)系代詞，代表事物較多見，在從句中作.主語thataredecayed,missing(onaccountofcaries),filled. 2. keyages.又可稱in山xages(groups),指有代表性的年齡(組)，又稱指數(shù)年齡(組)。 3. 5level

31、ScaleofDMFT 世界衛(wèi)生組織(WHO)規(guī)定的以12歲兒童?恒牙患炳狀況為基準(zhǔn)的5個水平，如下： 0.0—1.1verylow,很低1.2—2.6low,低 2.7—4.4moderate,中等—6.5high,高 6.5 >veryhigh,很高 4. WHO：WorldHealthorganization世界衛(wèi)生組織成立于1948年，中國是發(fā)起國之一。 5. WHO*soralHealthUnit：世界衛(wèi)生組織口腔衛(wèi)生處“Unit”相當(dāng)于我國衛(wèi)生部內(nèi)的一個“處級”水平。 6. GlobalOralDataBank(GODB)：全球口腔資料(數(shù)據(jù))庫，從屬于聯(lián)合國(UN)資料庫內(nèi)。 7. Overthenexttwodecades=inlasttwodecades在過去的2()年中 8. Except除XXX之外 besides除XXX之外(還有) 例如：besidesfluorides>pitandfissuresealantarealsoimportantforcariesprevention. 9. EPITN現(xiàn)已常用CPI,作為牙周健康狀況調(diào)查的記分標(biāo)準(zhǔn)，通常用WHO推薦的帶有刻度的標(biāo)淮探針進行檢查。