Tap chi THONG TIN Y DlfOC So ndm 2012 KIBIA SOAT HANH VI TRE EM TRONG DIED TR) NHA KHOA DANG PHUONG PHAP KHONG DUNG THUOC Vd TruVng Nhu" Ngpc Mot nhuhg van de quan nhat dieu trj cho t)enh nhan (BN) tre em la kiem soat hanh vl Niu khong co si/ hdp tac cua tre thi dieu tri nha khoa rat kho thut hien Hau hit cac tre tdi phong kham nha deu cd mot vai cam xuc lo lang hoae sd hai hoc dddc tCfbo me, nhuhg ngudi than, ban be hoae ehi ddn glan la tudng titdng Do vay, eae nha sy can phai ed nhutig klin thut chuyen sau ve tam ly tre em died nhOhg bien phap tlip can tre phu hcfp I CAT VAN DE Hlnh vi nha khoa tre em dupe djnh nghia la nhihig phan xa hinh tif cac yeu td tam li, xa hdi, kinh nghiem thu dupe sau mic loi tre edn nhd ho3e tudi thieu nien cd lien quan tdi eae tinh hudng nha khoa [2,3] Do vay, viec chan doin loai hanh vi eiia tre rat phifc tap va eung la van de can thiet trUde lus chpn ky thuat tiep can tre Kiem soat hanh vi cd the la khach quan nhU: tao mdi trudng giao tiep hieu qui vdi tre va cha me chung, tao dupe Idng tin vdi ca tre va cha me de hp chap nhan dUpc thu thuat nha khoa, tuyen truyen cho tre va cha me mat tich cUc ciia dU phdng sii'c khde rang mieng, tao mdi trUdng thU gian, thoal mai eho dpi ngu nhan vien lam viec hieu qua I I TRE LAN OAU DEN PHONG NHA Nen dua tre di tdi phdng kham rSng khoang tir 3-4 tudi [1] Mii'c dp bleu hien sU hdp tac cua tre miu giao rat cao d lan gap dau tien SU lo ling eiia me ddng vai trd quan trpng phan ifhg ciia tre d phdng kham Co nhieu nhan td khac anh hUdng tdi hlnh vi ciia tre d lan gap dau tien Lan dau tdi thudng chi khim, dlnh gii X-quang v l neu can du phdng thi bdi fluoride trif phi tre cd cic benh qua cap b'nh Tre cang nhd tudi cang de sp hai nen cd the giy lo sp ehup X-quang, dan tdi hanh vi khdng hpp tae eua tre Cha me nen giu" may ehup mieng tre de chiing elm thay an toin hdn Tre nhd tudi khdng nen tach rdi khdl tid me ho3e phai nam tren ghe rang mdt minh Khdng nen thut hien bat ki thii thuat nha khoa nao tir lan dau tien cho dil tre rat hdp tic tru" tnrdng hdp cap eifU I I I KIEM SOAT HANH V I Kiem soat hanh vi ciia tre la van de rat phut tap ddi hdi su" phdi hpp ciia ea cha me "TS., Vien Oao tao RSng Ham M3t - Tnrdng Dai hoc Y Ha Npi nhan vien nha khoa va tham chi ca thay cd giao Cd the kiem soit hlnh vi bing hai each cd bin: each khdng diing thuoc va each diing thude Cach khdng diing thude ed nhieu kl thuat khac nhU: - Hinh hanh vi trUde tdi khim benh - Giao tiep - Hinh hanh vi: ky thuat Ndi - Diln Lam, gay cam iitig, lay tam gUdng cho tre hoc theo, ludng trUdc tinh hudng bat ngd Hinh hanh vi tntdc tdi khambenh Cach cd mue dich chuan bj tam li cho tre trUdc di kham bing nhieu each nhu nghe nhin, viet thU, xem phim, xem eae doan video Giai thich cho tre hieu 6\i(ic tam quan trpng ciia viec gID' gin sifc khde rang mieng NhChig doan video ve cic tre khac da tutig dieu trj r3ng mieng nhu the nao tao cho tre ed cam xiic va hanh vi tUdng tu nhu the Oieu ehinh hlnh vi cho tre trUdc budi hen od the tien hlnh bing cich eho tre gap gd vdi nhihig BN kieu miu nhu anh chj, ban eung liila hoae chinh cha me nhutig ngUdi da tifng trii qua van de rang mieng Nen gifi thU ndi ngan gpn ve nhutig thu thuat se lam cho tre biet Cich gpi la phUdng phip chuan bi bang thU tin Cha me cung nen dUa cho tre nhihig Idi khuyen de chiing chuan bi t i m li trUdc tdi dieu trj Giao dep Dau hieu xac nhan nha sT odng kiem soat hlnh vi cua BN nhi la ning giao tiep va ehinh phue dupt sU tin tUdng eiia tiB SU sp hai va tinh hieu ki bam sinh ciia tre giiip ehung ta biet tn/dc la phai giai thfeh rat tdt cho chiing t n j & tien hanh mpt kf tiiuat mdi hoae khac Sir giao tiep dupc tao tir nhfhig diem ttiiet yeu eua ki tiiuat Ndi - Dien - Lam Tinh khich quan ciia giao tiep: Tap chi THdNG TIN Y DlfOC 2.1 Hinh si/giao dip: Ndi chuyen giiip nha sT tim hieu rat nhieu dieu ve fre va lam chung thay thoai mai, thu glan nhUng khdng nen di qui gidi han Mdt vai tre nhan ring bing cicli kiem soat cudc ddi thoai chung cd the cd ging tao nhutig anh hudng dang ke len mdi trudng (Lim bic sT phai theo tre nhieu hdn) 2.2 Hinh ngudi trao thong tin: NgUdi tiuyen dat od tiie la bat ki al tai phdng kham neu biet ttidng tin SU giao tiep dau tien chi'nh la l l tan tiep ddn tre va cha me chung vdi net m3t vul ve Cude trd chuyen rat quan trpng vi nd xay dutig ttiai dp va niem tin ciia BN vdi nhan vien y te Trp thii nen ndi chuyen vdi tre tren dudng tij" phdng tiep ddn tdi khu dieu tri va chuan bj tie len ghe r3ng Khi nha sT tdi, vai trd giao tiep ciia trp thii bj md nhat, dd tre od tiie ling nghe mdt ngUdi tal mdt thdi diem 2.3 Thong dlep ro rang: Bao gdm ca nhihig Idi chao hdi, viec giai thfeh vdi BN eho tdi Idi elm dn NhChig cau ndi vdi trd nen ddn glan va de hieu Cd the diing cich ndi lai Khi ndi chuyen vdi tre nen ghi nhd mdt vai diem quan trpng sau: - Tre em khdng the phin ifng lai vdi cac cau hdi, chung can nhieu thdi glan de thau hieu chung hdn ngUdi Idn Nen dUa nhihig yeu cau ddn gian va n3ng thuc hien ciia tre - T i t ca nhu'ng yeu cau nen dUde dUa bing ngdn ngC? tfch cUc vi each tiep can tieu cUc cd the khien tre sp hai Vf du: nen trinh ndi "Nim yen" ma nen thay bing "Chu khdng the chu'a rang eho chiu tdi chau ngdl yen vj trf" Nen gpi ten tre bing ten than mat hay dupc sir dung d nha Hinh hanh vl Hinh hlnh vl dim tren tren thuyet kfch thfch - phin ifng v l ngudn gdc eiia nhan thifc xa hdl, tre dUpe day each img xif nhU the nao Cae ki thuat cd the sir dung de hinh hlnh vi eho tre bao gdm: - Ki thuat Ndi - Diln - Lam - Giy d m ifng bing dch kfchttifehdau nhe - Lay tam gUdng eho fre hpe theo - LUdng bT/dc tinh hudng bat ngd Nguyen tic ciia kiem soat hlnh vi bao gom: bit dau vdi nhihig yeu d u ddn gian d l ttiut hien, giai thfch nhChig quy trinh d n ttiiet cho tre hieu va phdi hpp, giai thfch eho tiftig phan cu ttie, giai ttifeh that d l hieu cho tie, giup tie ttie hien nhutig hlnh vi tdt cho dieu trj So nam 2012 3.1 KI thuat Ndi - Dien - Lam: KT thuat dUpe Addleston tim nam 1959 Trong do, tre se diitic ndi qua ve d e thao tac dieu trj, dUpc tiep xiic vdi dung cu de biet chung se lam nhChig gi va sau dd tien hanh lam ttiu ttiuat Khi dd diici tre se dude ndi la rang ciia chung d n dUpc chai viia hoae lam sach Tre se nhin thay tay khoan, xem ehung quay trdn nhU the nao va se dupe gidi thieu mdt kT thuat danh rang dae biet, rang dUpc lam sach vdi nUdc Viec nen lam tiep sau ki thuat la khen ngpl tre de tang eUdng nhuhg hanh vi tdt ciia chiing Khi duS tre di ehup phim X-quang, nen gidi ttiieu cho chiing biet la mdt may anh de ehup rang va de tre tin chic chan ring may dd se khdng lam dau ma chi di gan tdi ma eiia tre thdi Phdng ehup nen cd d c thij nhoi bdng hoae cac dd chdi ma tre thfeh de giam d m giic sp hai KT thuat nen dUpc lam trUde moi lan cd dung CU mdi tiep xuc vdi tre ICi thuat Ndi Diln - Lam can dupe sifa ddi ap dung eho tre cd thj lUc kem Khi se diing kT thuat Ndi - Sd - Lam ho3c Ndi - Ngifi - Lam Tre se dUpe cham, ngin, cam giac dupe vat lieu hoae dung eu (trir vat sic nhpn) 3.2 ky thuat gay cam uhg: Ky thuat cdn dupe gpi la ky thuat ifc che tUdng tac Dd la qua trinh tap luyen hoae thUc hien eae bUdc lam giam nhay d m ciia BN vdi nhutig lo lang xuat hien d c vat the hoae nhu'ng hoan canh dac biet Vdi moi tinh hudng hoae vat the se dupc gidi thieu vdi dp gay sp hai tang dan bit dau tif mifc thap nhat de tao nhieu mifc gay lo sp KT thuat gdm ba giai doan: - HUdng dan BN thU gian - Xay dutig cac mifc dp sp hai tang dan de tao nhihig kfch thfch cd lien quan tdi noi sp chfnh eiia BN - Cho BN thay d c mifc dp lo sp eac kfch thfch dx) hS BN thay de chju, bit dau vdi ddng tac gay sU lo sp tiiap nhat eho BN Chi bit dau thut hien dpng tae tiep tiieo BN thay khdng k) sp nuci Vi du: neu diiS tre sp tiam rang, phudng phip giy d m utig od tiie ttiut hien odng bao gdm d e yeu td la khautiepddn, nha s, ghe rang, kham lim sang, dch phdng benh rang mieng, trim phuc hoi bat ki cho nao d n thiel, ki thuat yeu d u d n hen kham lai nhieu Sn 3.3 Lay tam gudng eho tre hgc theo: PhUdng phap keo theo viec cho phep tre quan sat mdt hoae mdt vai ngUdi (tam gUdng), nhihig ngUdi se the hien d c hanh vi thfch hpp dch tinh hudng die biet BN se thudng Tap chi THONG TIN YDlfOC xuyen bat chude nhutig hanh vi kieu miu dd d c tinh hudng tUdng tU Hinh mau dd cd the la ngUdI that (la nhChra tre khac cung cd mat tai phdng khim) Hinh mau eung ed the la phim anh (ed tinh chat tUpng frutig hoae thay the) Hinh miu od ttie diing nhan vat khdng cd that Vi du nhu anh hoae doan video quay dnh chupt Mickey dang dieu fri rang d phdng kham Cac budc d n thut hien diing dch lay hinh mau cho tre hpe theo: - Gay dupe sU chu y ciia tre - Hanh vi mono mudn lam miu dUpc - Can hudng dan nhutig ddng tae eiia hanh vi nha sl mong mudn liic dau tien tre bit ehudc - Ciing ed dch hanh vi d n thue hien Hinh miu la phUdng phap dem lai Ipi fch dang ke cdng sii'c bd rat it Thay vi thdi gian chd dpi tre cd the bj anh hUdng xau bdi tam ly lo ling ciia ngUdi me thi tdt hdn chung ta nen dua tre vao phdng dieu trj neu d cung ed nhutig tam gUdng cho tre hpe theo dang 6\i(ic dieu trj Khi anh chj ciia tre cd the lam hinh miu 6\iiic, ehung ta nen lUa chpn de cho tre thafy ring khdng ed gi phai sp d va "Em cung lam dupe ma" 3.4 Kiim soat dnh huong bat ngd: SU mat di nhutig hanh vi da 6\Jl(ic thiet lap ho3c xuat hien nhChig yeu td lam thay ddi hanh vi ciia tre d n dUde han die bang deh kiem soit d e tinh hudng xay khd ludng tn/dc SU ciing ed bing deh nhae lai ludn lam tSng tfnh thuc CLia hanh vi Chung dUpc phan hai loai: cung cd dUdng tinh va ciing ed am tinh Ciing ed dUdng tinh la su eiing cd cua nhutig hlnh vi xuat hien bat ngd se lam tang tinh tiiuan thyc ciia hanh vi Cung cd am tinh la sU ciing cd cua nhutig hanh vi da bj lu md cung lam tang ti'nh thuan thuc ciia hanh vi Cung cd qua nhutig vat the, xa hdl va d c hoat ddng NhChig BN sp hai od the d n dutfc cung cd hanh vi nhieu lan Ciing cd xa hpi nen dutfc thut hien mdt deh chan sau mdi lan tdi kham theo ljch hen de BN cd nhihig hanh vi thfch hdp tUdng ifhg vdi yeu d u bic si thao tic lim viec Cac ky thuat kiem soat hanh vikhac 4.1 Diing am nhae diglam dau: Hay edn dUde gpi l l "nhilu trang" - dd la loai am hon hpp lim BN rat khd de chu y vao bat ki d i gi Cd hieu utig niy II BN bj xao lang, phan tan ehu y va cd d m giac hUng phan qua trinh dieu trj ciia nha si 4.2 Kiim soat am ludng: Khi sU truyen dat va dien ta that bai, kiem soit I m lupng la yeu td ehu ehdt de cd the dat So ndm 2012 dupc sU chap thuan eiia tre SU thay ddi nhanh ve gipng dieu va d c h dien dat la mdt bien phap hieu qua de kiem soat nhutig hanh vi tieu cut ciia tre Kiem soat am lupng ehIng han nhu dot nhien lenh "ni'n va tap trung vio day" bao gid eung cd ket qua hdn la ed phdi hpp nhieu deh truyen dat khac 4.3 Giao tlip bang nhieu glae quan: NhChig thdng diep khdng diing Idi ndi nhu ngdn ngu" hinh the cung od ttie tao dupe nhChig hanh vi tfch cut ctio tne Cach dat tay len vai tre ndi cung lam cho tre d m giac than thien, am ap Giao tiep bing anh mat cung quan ttpng khdng kem Ling nghett'ehcut eung quan dae biet vdi tre d tudi ttiieu nien Do hay lam de hieu dude d m xuc ciia tte 4.4 Tholmien nha khoa: Thdi mien &\iriz djnh nghia la mdt trang thai dac biet cua tinh than d mpt ngUdi ngUdi khic tao Mdt tinh trang ciia tinh than gpi y rang khdng chi d l chap nhan lam theo hPn luc tinh tao ma edn hanh ddng rat manh me hdn cd the lam binh thudng Jame Braid (Anh) la ngUdi dau tien sif dung thuat ngii' thdi mien va md ta hien tUpng bf an dd la trang thai thdi mien than kinh Bdn dSc diem eiia trang thai thdi mien dd la: - Khdng ndi tiep vdi cudc sdng thUe nhutig khac vdi viec ngii Bj bit budc phai lam theo nhihig gi ma ngUdi thdi mien yeu cau va sau trang thii thdi mien - Cd tiem n3ng de thut hien sU viec hdn la vdi thUc tai khach quan ed nhu'ng bien ddi ve nhan thifc, tri nhd, d m xuc dUa tren nhihig Idi gdi y cua nha thdi mien - Cd kha n3ng chju dutig nhutig mau thuin ma binh thudng thi bj rdi loan 4.5 Doi dau: BN khdng diap thuan khdng nhuhgtiJ"nhan thiit v l phan litig lai vdi cdn dau ml cdn dch hp giai quyet va ddi mat vdi nhihig sbess dc cdn dau tnTct day giy Cic kltiiuatddi dau la: - Lam xao nhang hoae chuyen ddi sU chu y vao cii de dpa II y tUdng chii dao ciia phUdng phip ddi dau Chung ta cd the lam dupe bing deh ndi chuyen thudng xuyen va dat nhutig d u hdi thu vj vdi tre - Cho phep tre ndi noi lo sp vdi nha si de tao eho tre d m giic an toan hdn - Cho phep bd me tre d phdng dieu trj de tre thay an toan hdn Tap chi THdNG TIN Y DlfOC 4.6 Tht/glan: PhUdng phap tiiu gian thudng bao gom mdt chuoi d c bai tap phai hpe va yeu d u BN phai tap luyen thudng xuyen d nha it nhat 15 phiit moi Muc dich ciia d c bai tap giup giam dng tiling va phat huy tiem nang chdng lai dau 4.7 ue ehi hanh vl: LTC ehe hanh vi cd ba each: - Bjt mieng tre - Han che cif ddng eiia tre - Kiem soit am lupng LTC che hlnh vi thUdng dupe lUa chpn cudi ciing cho nhutig fre qua nhd tudi, bj tat nguyen ho3c nhutig tre od van d i khdng binh thudng ve d m xuc va than kinh Mdt vai nha sT diing dch nhU mdt bien phap de dpa nat tre va mdt sd cha me khdng tan vdi deh lam va cung d n sU thdng qua ciia luat phip Ngay viec giam dau y thifc cd the giup han che d e trUdng hpp phai ifc ehe hanh vi hdn Til lap hinh vi Ap dung cho nhutig tre the hien dang ve lo ngai, run sd hoSc nhChig hanh vi gay can trd SU xuat hien nhihig hanh vi cd the la du am ciia lan th3m kham nha khoa trUdc day, anh hudng hlnh vi khdng thich hpp tif bd me ho3c mdi trUdng sdng Trong sudt qua trinh tai lap lai, muc tieu la xay dung mdt chuoi nhChig lien ket trf nao tre Neu tre da cd nhChig So nam 2012 an tupng khdng tdt ve phdng khim nha trUdc day va dUde dUa tdi mdt phdng kham nha khac thi nhin chung tre vin cd xu hUdng ap dat suy nghl nhCitig dieu tdi te tUdng tU se xay d phdng kham mdi Hinh thifc tam If gpi la "khai quat kfch thfeh" £)e loal bd dieu nay, dpi ngu nhan vien nha khoa d n phai tao sU khac biet va tao nen nhu'ng tic ddng mdi lam hai Idng va thay the cai eu IV KET LUAN Kiem soat hanh vl eiia tre ttong can tiilep nha khoa hang la dieu khdng ttie thieu de dam bao ca dieu tri edng Kiem soat hanh vi bing dch khdng diing thude la phUdng phap dupc lu^ chpn dau tien PhUdng phap cd nhieu kl thuat khac nhU: hinh hanh vl trUdc tdi kham benh, giao tiep, hinh ttianh hanh vi, Tiiy theo tijtig ddi tUdng ml chung ta nen luS chpn ky tiiuat hpp ly Thdi mien nha khoa la mdt khai niem tUdng ddi mdi nha khoa tre em nhuhg cung la mdt ky ttiuat cd the cho la ddn glan va hieu qua TAI LIEU THAM KHAO Courson P.: Odontologie pediatrique au quotidien Deuxieme edition, 2005 McDonald E.R.: Dentistry for child and Adolescent 2004 Rao A.: Behavior management in dental practices Principles and practice of pedodondcs, 2008, Jaypee, pp.91-121.iS' UC CHE CALCINEURIN (TACROUMUS) - MOT DOOC TIEN MOI TRONG DIBJ TR| VIEM DA 0! UNG Nguyen Thi Van", Cat Van Anh" Nhihig nSm gan day, nhitng din bo qua trinh nghien euV ve dieu tn eae benh ly da da dan din si/ehap nhan cae san pham mdi dieu tri Nhuhg san pham mdi dddc thifa hudng nhuhg din bo mdi nghien euV ve mien dich benh ly Mgt nhuhg din t>g dd la diing de ehi calelneurin (tacrolimus) brong dieu tri viem da di dhg I DAT VAN DE Dieu til viem da dj irhg da dUdc dlnh dau bing mdt bUdc ngoSt vio n3m 2001 bdi sU ddi aJa d c thude dieu hda miln djch dieu trj tai eho va toan thin Mdt ttong nhuhg sin pham dd la tacrolimus (Protopic) va picrollmus (Elidel) Dly la nhihig hoat chat cd cd ehe tac dpng nhU dcrosporin: ut ehe d c ealdneurin lam kim ham qui trinh sin xuat d e cytokin NhChig chi dinh dill yeu eiia nd dieu tri tai dio la d c benh "PGS.TS., 0?i hpe Y Ha Npi; "ThS., Benh vien M3t Tmng uHng ly viem da v l dac biet viem da dj utig NgUpc lai vdi cortieoid, nd khdng gay teo da, thim da Cung sau nhieu cdng trinh nghien cuU tuWng ti/ nhu vdi Protopic, ngUdi ta da duS ttij trUdng san pham Aldara cd vai trd kfch thi'di dip utig mien djch qua tmng glan thymus-1 Trong dd vai trd ciia lympho T (LT) ddng vj tri quan trpng cd die benh sinh d c bdnh ly da ke d ton tiiUdng vay nen LTc che hoat hda d c te bao LT hoSe d e cytokin S\i(ic giai phdng tij" ... nay, dpi ngu nhan vien nha khoa d n phai tao sU khac biet va tao nen nhu'ng tic ddng mdi lam hai Idng va thay the cai eu IV KET LUAN Kiem soat hanh vl eiia tre ttong can tiilep nha khoa hang la... tijtig ddi tUdng ml chung ta nen luS chpn ky tiiuat hpp ly Thdi mien nha khoa la mdt khai niem tUdng ddi mdi nha khoa tre em nhuhg cung la mdt ky ttiuat cd the cho la ddn glan va hieu qua TAI... gay can trd SU xuat hien nhihig hanh vi cd the la du am ciia lan th3m kham nha khoa trUdc day, anh hudng hlnh vi khdng thich hpp tif bd me ho3c mdi trUdng sdng Trong sudt qua trinh tai lap lai,