tag:blogger.com,1999:blog-29665116128094121442024-03-19T01:24:37.655-07:00NetENDO : Endodontists We ConnectAnonymoushttp://www.blogger.com/profile/07108752172963983832noreply@blogger.comBlogger7125tag:blogger.com,1999:blog-2966511612809412144.post-91196901520427313822013-08-02T17:18:00.001-07:002013-08-02T17:18:54.069-07:00Do You Hear The People Sing? <iframe allowfullscreen="" frameborder="0" height="270" src="//www.youtube.com/embed/PTLwzuQuRsw" width="480"></iframe>Chang WenHsinhttp://www.blogger.com/profile/14350841415994901546noreply@blogger.com1tag:blogger.com,1999:blog-2966511612809412144.post-63119149468614494782013-07-04T07:49:00.001-07:002013-08-12T21:09:24.468-07:00Isolation with Temporary Crown in Root Canal Treatment<p><br></p><p><font size="5">No rubber dam, no endodontics.是現今的共識。如果沒有rubber dam的根管治療,就如同未鋪無菌單的開刀房手術,治療結果將大打折扣。甚至有文獻指出,非專科醫師治療成功率低至五成,和無菌設備應當有直接的關係(專科醫師成功率可高達94%)。</font></p><p><font size="5">但臨床上,牙齒破壞程度不一,總是有蛀牙到難以隔溼隔菌的狀況。若在rubber dam isolation不能完全時,其中一種選擇就是製作temporary crown,再reentry 重新開始open chamber,完成access opening。</font></p><p><font size="5">Temporary crown輔助之isolation,臨床治療水平相當要求。為避免遺留感染源,<span style="-webkit-tap-highlight-color: rgba(26, 26, 26, 0.292969); -webkit-composition-fill-color: rgba(175, 192, 227, 0.230469); -webkit-composition-frame-color: rgba(77, 128, 180, 0.230469); ">事前</span>需將已經蛀開的齒質做完整的清除,初步的open chamber,找到根管開口後並加以保護,再修型製作temporary crown。</font></p><p><font size="5">這樣的方式需要專門的假牙科醫師協助,所有環節都要小心。若有以下的狀況都會導致失敗:</font></p><p><font size="5">1,蛀牙沒有清除乾淨,遺留感染源。</font></p><p><font size="5">2,coronal sealing沒有紮實,周邊滲漏。</font></p><p><font size="5">3,coronal sealing選擇失當,材料崩解。</font></p><p><font size="5">4,臨時牙冠空隙過大或不合,或黏著劑脫膠,導致沖洗液流出。</font></p><p><font size="5">5,臨時牙冠修型不良,固持力不佳,療程(常需數次)中脫落。</font></p><p><font size="5">若有以上狀況發生,幾乎就是要從頭開始。說會讓療程功虧一簣,進度歸零,其實也不為過。</font></p><p><br></p><p><font size="4" color="#ffdc4f">[以下照片經患者同意,分享於豐采牙醫相關]</font></p><img src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjnrSZrvfRvKL_o0t-iySBitvHVaUFWttKL4as6v6_AhEvTmzFcWHzstz7Km3B7ZyTBfd-5mU32Qxu1bvPUIb1ZnWMm3TBM_uK6OegL5c-_VPfw7ymFM0ww5XZ89KlYjCtTT1OEtx8ZRo8/" width="650" height="650"><p><img src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiUWiWA2J4rpDgbuoQwMhLNIZS_M1ZDER-1-aD_HQ448WK2P4xXb3Qzif4CWB8BchpiiV7cHnJK9wFQWo5Kzo55kZ8A3Zqt5ul5yP21LJeLkAOnUngm-pYgrKiv0U82uKz1cuzOhrQJcBk/" width="650" height="650" title="" alt=""><img src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi_tG7hy7cuTRR3wUpCrWupwOd_DWot5THUQQTLXavlCPSMfpFLalf4TC1ry4gugX14DAuIa0K7gESOV_R6dXuU5RTrFXiAX_wbUgB4-c59_PkOaArS4jS93jmjHJaclt9u5uJ8KPWIytA/" width="650" height="650"></p><p><img src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhZ-NKNxq6nThVQbnx-s7VZLTQCgt2eaAtWRj3PwfKW1EGklI3rh1ts52a4qPSmW7f-2W8bmSSrVpZl30poisjfo1_3RF9KExXBfRCxKEN4lSQn1OvcwsOb3-J8qyE4M6aSvbanOZyEAl4/" width="650" height="650"><br></p><p><font size="5">上圖箭頭可見,臨時假牙與齒質交接處。製作十分精密,完全貼合。看了真是敲感動的。</font></p><p><img src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhr0dbJcQDlvwR0J2-PBd-o_CXRlUQ8mnIy_7N7YWWbFstGa6U3Ov9FwJv6bw4Epyws9QXrD2tbAeh3NCcXqs0Ej8eyfwFKKOsG2wY2Ru2PmN5dkGdeYhRWWY7Ls2cG_XWgB8rOZjqTzvg/" width="650" height="650"><br></p><p><font size="5">上圖箭頭可見,之前coronal sealing遺留的材料。完整留置,未崩潰鬆脫。</font></p><p><br></p><p><font size="5" color="#ffdc4f">我只能說,有這麼好的假牙科醫師作為醫療團隊,真的是三生有幸阿~~</font></p>Anonymoushttp://www.blogger.com/profile/07108752172963983832noreply@blogger.com1tag:blogger.com,1999:blog-2966511612809412144.post-21564619912544636542013-03-23T01:08:00.001-07:002016-07-16T01:47:45.981-07:00《悲惨世界》Les Misérables : Why Fantine sells her tooth? <div class="separator" style="clear: both;">
<span style="font-size: large;">在悲慘世界裡,Fantine 為了他的女兒的珂塞特 (Cosette) 賣頭髮,賣牙齒。有一對女兒的我,看了都好想掉眼淚 T_T</span></div>
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<span style="font-size: large;">但是,為什麼要賣牙齒呢? </span><span class="Apple-style-span" style="font-size: large;">買了別人的牙齒,要做什麼?</span></div>
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<span style="font-size: large;"><i>我們要來回顧一下 "悲慘世界" 的年代。Wiki 上面是這樣寫的 : </i></span><br />
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<span style="font-size: large;"><i>"《<a href="http://zh.wikipedia.org/wiki/%E6%82%B2%E6%83%A8%E4%B8%96%E7%95%8C">悲慘世界</a>》(法語:Les Misérables,另有中文譯名《孤星淚》,原意為「悲慘的人們」,「可憐的人們」),是法國作家維克多-雨果(Victor-Marie Hugo)於<span style="color: yellow;">1862年</span>所發表的一部長篇小說。....."</i></span><br />
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<span style="font-size: large;"><span style="font-family: "arial" , "helvetica" , sans-serif;"><span class="s2">1771年,解剖學家 John Hunter</span></span></span><span style="font-family: "arial" , "helvetica" , sans-serif; font-size: large;"><span class="s2">出版了</span></span><span class="s2" style="font-family: "arial" , "helvetica" , sans-serif; font-size: large;">著作 "</span><span class="s3" style="font-family: "arial" , "helvetica" , sans-serif; font-size: large;"><i>Natural history of the human teeth",</i>整理了當時的牙齒贋復方式。</span><span class="s3" style="font-family: "arial" , "helvetica" , sans-serif; font-size: large;">包括貝殼,象牙,骨頭,或是死人牙</span><span style="font-family: "arial" , "helvetica" , sans-serif; font-size: large;">。</span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-size: large;">貝殼,象牙或骨頭,並沒有咬合形態與解剖構造,而且大小不合。不好種也不好用。</span></span><span style="font-family: "arial" , "helvetica" , sans-serif; font-size: large;">而口內植入死屍的牙齒,大家心裡都覺得相當不蘇胡。</span><br />
<span style="font-size: large;">因此,異體牙齒移植,從活人 (窮人) 身上摘取新鮮牙齒,成為大家較能接受的方式。</span><br />
<span style="font-size: large;">而John Hunter 更發表了一個驚人案例,把剛摘下人齒種入活雞的雞冠(Living cock's comb)中,牙齒竟然沒有脫落。既然種植在雞上都成功了,這種療法就倍受肯定,並流行了起來。</span><br />
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<tr><td class="tr-caption" style="text-align: center;">John Hunter 的<i>"Natural History of the Human teeth"</i> 插圖。</td></tr>
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<tr><td class="tr-caption" style="text-align: center;">種在雞冠裡的人齒。John Hunter, 1771</td></tr>
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<span style="font-size: large;">因此,在1862年的"悲慘世界"裡,Fantine 賣牙齒,作為醫療贋復用途,是行之於當時社會的治療之一。</span><br />
<span style="font-size: large;"><br /></span><span style="font-size: large;">下圖是另一張更有趣的繪畫,更栩栩如生的描述賣牙齒的場面。</span><br />
<span style="font-size: large;">最右方綠色的富人,正端詳老婆剛完成的手術。稍靠左側,後方站著一個男人,拿著方鏡,檢視著自己的牙齒。</span><span style="font-size: large;">再往左邊,一個三人手術組合。</span><br />
<span style="font-size: large;">最左邊的窮女人,一手摀著臉,剛被拔完牙。另一手拿了幾個銅板,是賣牙齒的錢。</span><br />
<span style="font-size: large;">富人都是亮的,而窮人就是暗的了。</span><br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj3N3duXNykThlWNrDIe8v0q4bDv33sWjTcXnWsJ_PfpML5ANZvmEPzVZJIJ8H9V1zOZDl2VjMonzuP0-Iell6jkhwRoHSACIY_nPqDkkygDU4irUcAdNDNbv4xb1A2MnWM-0L4JJe8Jf4/s1600/%E8%9E%A2%E5%B9%95%E5%BF%AB%E7%85%A7+2013-03-22+%E4%B8%8A%E5%8D%884.12.33.png" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="396" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj3N3duXNykThlWNrDIe8v0q4bDv33sWjTcXnWsJ_PfpML5ANZvmEPzVZJIJ8H9V1zOZDl2VjMonzuP0-Iell6jkhwRoHSACIY_nPqDkkygDU4irUcAdNDNbv4xb1A2MnWM-0L4JJe8Jf4/s640/%E8%9E%A2%E5%B9%95%E5%BF%AB%E7%85%A7+2013-03-22+%E4%B8%8A%E5%8D%884.12.33.png" width="640" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Thomas Rowlandson, 1781. National Library of Medicine, Bethesda.<br />
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<span style="font-size: large;">下方最後這張圖,左後方背景處,擺放了很多牙齒的模型,也顯示了Fantine不是在路邊作處理,而是在一個dental clinic 裡面。</span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEicsRw6yJYGT973ehDG5B1ehojrKo454BzHmOEVZBbKjIA8Us112d7IfilJ8G-DeAyQHoRmJVUOMvti6X-SPBkjHEs_rjqlcgdJ9HlKhGlufx2vnf09Q9HpvbCQR8S8_pbePlRRAVaQNmw/s1600/%E8%9E%A2%E5%B9%95%E5%BF%AB%E7%85%A7+2013-03-01+%E4%B8%8B%E5%8D%883.42.08.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="346" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEicsRw6yJYGT973ehDG5B1ehojrKo454BzHmOEVZBbKjIA8Us112d7IfilJ8G-DeAyQHoRmJVUOMvti6X-SPBkjHEs_rjqlcgdJ9HlKhGlufx2vnf09Q9HpvbCQR8S8_pbePlRRAVaQNmw/s640/%E8%9E%A2%E5%B9%95%E5%BF%AB%E7%85%A7+2013-03-01+%E4%B8%8B%E5%8D%883.42.08.png" width="640" /></a></div>
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<span style="font-size: large;">不過,還是要提醒各位訪客,這種異體牙齒移植,<span style="color: yellow;"><u><b>不能</b></u></span>被視做一種牙科治療。別人的牙齒不會穩定存活在其他人的口內,更有細菌感染以及疾病傳染的風險。畢竟在1771年,當時連細菌和免疫觀念,都還沒有建立,也沒有術前消毒的做法。和當今的現代醫療及要求,是完全不同的世界的。</span><br />
<br />Anonymoushttp://www.blogger.com/profile/07108752172963983832noreply@blogger.com1tag:blogger.com,1999:blog-2966511612809412144.post-10623881721916827082013-02-25T19:42:00.003-08:002013-03-25T18:45:47.957-07:00Possible Limitation of NSRCT :Extra-radicular Infection<div class="separator" style="clear: both; text-align: center;">
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjUaZfPwTBAiey9TldHi46AY6zS-MLb5yCcYlcLFHi8ktLYqFGw1qEKqBApglzBWDD7JduvpciAeXOK9oNZYutRtGAm0kBV2r7KR-oh8POBKagQeN8Po-9THhCvbHgZtAkQqpXn6F9Nhs0/s1600/photo.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjUaZfPwTBAiey9TldHi46AY6zS-MLb5yCcYlcLFHi8ktLYqFGw1qEKqBApglzBWDD7JduvpciAeXOK9oNZYutRtGAm0kBV2r7KR-oh8POBKagQeN8Po-9THhCvbHgZtAkQqpXn6F9Nhs0/s1600/photo.jpg" width="240" /></a><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEifsVxaolpPmKrLcJjIWUaEB0i_DBV_AJQHCqr2XkVFoj9VKEXIdrA5k9ubBOgLQ5BPKmKhnovJ2fx_ZyJ63_S0FWq6QrX4aXyu2sZCD2jD4u6C9_dKo4FtZoFeLAwBjTkeNeeb66Cockc/s1600/DSC00838.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEifsVxaolpPmKrLcJjIWUaEB0i_DBV_AJQHCqr2XkVFoj9VKEXIdrA5k9ubBOgLQ5BPKmKhnovJ2fx_ZyJ63_S0FWq6QrX4aXyu2sZCD2jD4u6C9_dKo4FtZoFeLAwBjTkeNeeb66Cockc/s1600/DSC00838.JPG" width="240" /></a></div>
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<span style="font-size: large;">上圖是同一顆牙齒,上頷側門牙。牙冠部缺損嚴重,在口內時約可見到1mm的齒質,並有個大lesion。因為症狀不消,久治不癒 (好吧,我只換過幾次藥。不過經我換過藥,幾乎會有大幅度的好轉。沒有任何改善的並不多見,我眉頭一皺,懷疑內情並不單純),所以討論過後決定拔除。</span><span class="Apple-style-span" style="font-size: large;">從根尖處看去,<span class="Apple-style-span" style="color: yellow;">extra-radicular </span>infection 明確。甚至calculus 都已經成形了。</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><span class="Apple-style-span" style="color: yellow;">N</span>on <span class="Apple-style-span" style="color: yellow;">S</span>urgical <span class="Apple-style-span" style="color: yellow;">R</span>oot <span class="Apple-style-span" style="color: yellow;">C</span>anal <span class="Apple-style-span" style="color: yellow;">T</span>reatment (<span class="Apple-style-span" style="color: yellow;">NSRCT</span>) 可能的極限之一,就是extra-radicular infection。或者該說,extra-radicular infection之後,伴隨而來的Biofilm,或是貼附上來的一些阿力不達像 Actinomycotic colonies 之類的東西。</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">如果這些感染物已經結寨築城,並且<span class="Apple-style-span" style="color: yellow;">extra</span>-radicular infection 已經從dependent 變成independent (of the intra-radicular infection),那就算你將根管內處理成金光閃閃,變成無菌狀態,恢復到上帝起初創造它時的樣子,依然是沒用的。因為人家就是獨立了嘛,再也不需要外來的養分支援。這時,<strike>不求人的Biofilm已經無欲則剛,</strike>根管治療已經無法消滅甚至削弱他的力量了。</span><br />
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<span style="font-size: large;">這時我曾想起某個名師,在某本interdisciplinary相關的名書上,曾經提到 : 因為所有failure case都有unfilled POE, 所以如果3D緻密充填,完全封住複雜的根尖開口,成功率可達100%。 我覺得邏輯很像無誤 (..."若A為B 非B則非A" 沒錯吧?),但是現實是不對的。就像若已經有extra-radicular infection, Independent (of Intra-radicular infection) 的話,就算根管內處理得超完美,依然會失敗的。</span><br />
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<br />Anonymoushttp://www.blogger.com/profile/07108752172963983832noreply@blogger.com0tag:blogger.com,1999:blog-2966511612809412144.post-14947452701251495812013-02-20T22:41:00.000-08:002013-02-21T21:19:04.037-08:00Informed Consent<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEggpMEUWovlvxG-h6j2KODiUN9Ssi9E40RzVOAJS8nwY61cWlx_72CvwuD3y0tvMMCKxalVrpnIPoPm2eVLvK9C2m0trYFs0xE9xBcR5j-0_-WDywUoLN2nN2F60iKeWwd2ai-PuyqQaWU/s1600/%E8%9E%A2%E5%B9%95%E5%BF%AB%E7%85%A7+2013-02-20+%E4%B8%8A%E5%8D%8811.22.45.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEggpMEUWovlvxG-h6j2KODiUN9Ssi9E40RzVOAJS8nwY61cWlx_72CvwuD3y0tvMMCKxalVrpnIPoPm2eVLvK9C2m0trYFs0xE9xBcR5j-0_-WDywUoLN2nN2F60iKeWwd2ai-PuyqQaWU/s640/%E8%9E%A2%E5%B9%95%E5%BF%AB%E7%85%A7+2013-02-20+%E4%B8%8A%E5%8D%8811.22.45.png" width="572" /></a></div>
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<span style="font-size: large;">~ From Pathways of the Pulp, 10 ed. </span></div>
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<span style="font-size: large;">治療同意書,在現今大部份的醫療行為裡,都已經是不可或缺的一環。</span></div>
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<span style="font-size: large;">民眾在購買各種服務與商品,並價金給付,都是瞭解後才下決定。</span></div>
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<span style="font-size: large;">因此</span><span style="font-size: large;">患者在接受各種醫療行為,</span><span style="font-size: large;">知情/同意 是理所當然,理應做到。沒有什麼爭議。</span></div>
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<span style="font-size: large;">不過,醫療牽涉到的決定,都更為複雜。即便單就牙科而言,通常也不是只有金錢的代價,還包括部分結構的處理與犧牲; 可能漫長的治療時間; 身體的侵入風險與留置醫療材料; 以及往後的機會性, 包括機會成本。而這些還有成功率的考量。</span></div>
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<span style="font-size: large;">逐項列清並逐條說明,是醫師的義務,也是對醫師的保護。是患者的權利,也同樣是對患者的保護。</span></div>
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<span style="font-size: large;">說成保護,這個用詞似乎就是醫病相互小心,防禦防備。</span></div>
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<span style="font-size: large;">另一方面,其實同意書也有令人舒服的性質,就是跟患者的善意溝通。</span></div>
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<span style="font-size: large;">正如教科書的同意書所言,我們除了治療項目之外,更尊重身為一個患者的權利。能夠選</span><span style="font-size: large;">擇,而不只是被決定 - 的權利。</span></div>
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<span style="font-size: large;">現實裡,其實我挺享受跟患者說明,討論,及決定這個過程。</span></div>
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<span style="font-size: large;">看著患者越來越知道自己的狀況,了解代價(身體,時間,金錢,機會成本),最後斟酌自身條件,作出合宜的選擇,整個過程是很正向,並且愉悅的。</span></div>
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<span style="font-size: large;">醫病的本質是信任。</span></div>
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<span style="font-size: large;">任何能去除雙方疑慮的動作,讓醫療回歸純粹的醫療專業,或進一步放心地給予善意的建議,都是件好事。</span></div>
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<span style="font-size: large;">目前衛生署要求的牙科治療同意書/ 說明書,包括:</span></div>
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<span style="font-size: large;">牙周手術,人工植牙植入手術,齒切除術 (拔智齒),以及上列手術的麻醉同意書。</span></div>
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<span style="font-size: large;">雖然官方並沒有要求根管治療必須填寫同意書。但是專科醫師執業中,很大部份是高階的根管治療療程,其中隱含了更高的風險和專業度,因此建議事前常規填寫手術同意書,尤其是自費項目。</span></div>
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<span style="font-size: large;">所以,引述了一份同意書內容,給各位做個參考參考。</span></div>
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Anonymoushttp://www.blogger.com/profile/07108752172963983832noreply@blogger.com1tag:blogger.com,1999:blog-2966511612809412144.post-39588510676682347322013-02-13T07:27:00.001-08:002013-04-01T22:49:51.894-07:00牙髓病專科醫師的漫漫長路。<div class="separator" style="clear: both; text-align: left;">
<a href="http://4.bp.blogspot.com/-F3PIlAnfURM/URshrYCCCHI/AAAAAAAAAJA/K7mPED78Qt4/s1600/%E5%9C%96%E7%89%87+14.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><span class="Apple-style-span" style="font-size: large;"></span></a></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjONfOMziRt7ypY48E7zcKxxO7MLL9Q-HCCUKEvCgT-TOxtfLQ2lrmN7hwIB6MjqEb3Dohkl2PRDcNAyCe3sY57-M9uazNQZ5jkvZL_eoWbBGrhO6SV-nPUp4DjtPLup1TrJrt6E2kw2gQ/s1600/%25E5%259C%2596%25E7%2589%2587+13.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="420" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjONfOMziRt7ypY48E7zcKxxO7MLL9Q-HCCUKEvCgT-TOxtfLQ2lrmN7hwIB6MjqEb3Dohkl2PRDcNAyCe3sY57-M9uazNQZ5jkvZL_eoWbBGrhO6SV-nPUp4DjtPLup1TrJrt6E2kw2gQ/s640/%25E5%259C%2596%25E7%2589%2587+13.png" width="640" /></a></div>
<span class="Apple-style-span" style="font-size: large;"> ~ from AAE, <a href="http://www.aae.org/" target="_blank">http://www.aae.org/</a></span><br />
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<span class="Apple-style-span" style="font-size: large;"><br /></span>
<span class="Apple-style-span" style="font-size: large;">美國牙髓病學會(American Association of Endodontists,AAE)</span><br />
<div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;">
<span class="Apple-style-span" style="font-size: large;">是全球牙髓病專科領域裡,最權威性與專業性的學術組織。</span></div>
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<span class="Apple-style-span" style="font-size: large;"><br /></span>
<span class="Apple-style-span" style="font-size: large;">美國的牙髓專科醫師的培訓,正如上方文字敘述 :</span><br />
<span class="Apple-style-span" style="font-size: large;">"at least two additional years of advanced specialty education in diagnosis and root canal treatment"</span><br />
<span class="Apple-style-span" style="font-size: large;"><br /></span>
<span style="font-size: large;">台灣的牙髓病專科醫師與專科訓練,大幅度的參考美國的制度。</span><br />
<span class="Apple-style-span" style="font-size: large;">不只是牙髓病科,幾乎大部分的牙科學制與專科,都與美國有深厚的關連性。</span><br />
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<span class="Apple-style-span" style="font-size: large;">我們的專科醫學會名稱叫做 <a href="http://www.aeroc.org.tw/" target="_blank">中華民國牙髓病學會</a>。</span><br />
<span class="Apple-style-span" style="font-size: large;"> ( 髓,ㄙㄨㄟˇ )</span><br />
<span class="Apple-style-span" style="font-size: large;"><br /></span><span class="Apple-style-span" style="font-size: large;">如果一位牙醫師想要成為牙髓病專科醫師,首先,需任職於 "中華民國牙髓病學會 <u>專科醫師訓練機構</u>" 認證之醫療院所。</span><br />
<span class="Apple-style-span" style="font-size: large;">這些有資格的醫院,幾乎都是等級很高的教學醫院。</span><br />
<span class="Apple-style-span" style="font-size: large;">(另有一個甄審辦法,開放給非任職此類醫院的醫師。但目前尚未有醫師經此管道考取。)</span><br />
<span class="Apple-style-span" style="font-size: large;"><br /></span>
<span class="Apple-style-span" style="font-size: large;">其次,醫師專科訓練的時限至少兩年。這兩年大都局限於牙髓專科門診。</span><br />
<span class="Apple-style-span" style="font-size: large;">當一個牙醫師每天每週每月....看同一類型的患者,手上的靈敏度,對解剖與結構的熟悉感,相關知識的完整性,思考的深入,甚至隱約的直覺,都遠遠超越一般的牙醫師。</span><br />
<span class="Apple-style-span" style="font-size: large;">而專科病歷討論,文獻閱讀,專題討論,跨科協同治療會議....也都是不分科牙醫師不一定會涉足的基礎學習。</span><br />
<span class="Apple-style-span" style="font-size: large;"><br /></span>
<span class="Apple-style-span" style="font-size: large;">而且你知道嗎? 超過80%的牙醫系學生,畢業後直接進入診所任職。也就是說,許多牙醫師真正學習臨床牙髓專科的時間,可能僅僅在大六實習的那一年,通常佔了兩個月。如果還想再接觸學習,就要之後自己花錢聽專業的演講了。</span><br />
<span class="Apple-style-span" style="font-size: large;"><br /></span>
<span class="Apple-style-span" style="font-size: large;">而且,漫長的專科路並非每個人都能走完。醫科的專科是醫師的必然,牙科的專科卻是額外的,必須是燃燒熱情才會去選擇的路。我必須要給這些完成牙科專科訓練,完成住院醫師訓練,以及國內外研究所進修的牙醫師們鼓鼓掌,因為你們的堅持努力,現今台灣牙科的水準,因此幾乎能和歐美並駕齊驅。</span><br />
<span class="Apple-style-span" style="font-size: large;"><br /></span>
<span class="Apple-style-span" style="font-size: large;">歐,講遠了。</span><br />
<span class="Apple-style-span" style="font-size: large;"><br /></span>
<span class="Apple-style-span" style="font-size: large;">這些牙髓專科受訓醫師的起點,可都不是初出茅廬的菜鳥,剛畢業的牙醫師是沒資格選擇專科的,選科通常是在後兩年。在R2結束後,R3開始進入專科受訓。因為要看其他牙醫師搞不定的高難度專科患者,沒有三兩三是不行的。雖然剛進入專科,但是在牙科一般治療上,一定都是熟手了。</span><br />
<span class="Apple-style-span" style="font-size: large;"><br /></span>
<span class="Apple-style-span" style="font-size: large;">牙髓專科門診,轉診而來的病例通常有以下三種之一,或複選,或以下皆是。包括 : </span><br />
<span class="Apple-style-span" style="font-size: large;">很嚴重。久治不癒,疑難雜症,上通鼻竇下達神經,範圍通透涵蓋三五齒位.. </span><br />
<span class="Apple-style-span" style="font-size: large;">很困難。根管鈣化,找不到洞,細小變異,斷針穿孔,張不開嘴,舌頰肥厚...</span><br />
<span class="Apple-style-span" style="font-size: large;">很危險。帶錄音錄影機,帶眾家屬,帶律師,幹醮前醫師,帶一疊google資料...</span><br />
<span class="Apple-style-span" style="font-size: large;"><br /></span>
<span style="font-size: large;">一位熟手的牙醫師,即使在少林武當接受扎實訓練,但實際遇到的案例,可是撲天蓋地的困難case。加上三不五時有人來踢館挑戰,即便後面有專科主治醫師或主任可以支援,但是終究是硬戰兩年。這兩年完成後,雖然有時會上上法院,回回投訴單,但不論是拳腳外功,或是<strike>嘴炮心法,趨吉避兇</strike>醫病溝通,都幾乎能獨當一面,已經能夠處理整個城市裡,差不多是最困難的根管案例了。</span><br />
<span class="Apple-style-span" style="font-size: large;"><br /></span>
<span class="Apple-style-span" style="font-size: large;">所以當考專科醫師的時刻來臨,經過這麼漫長的路,考生常常都早已是醫院的主治醫師,碩士醫師,區域名醫,甚至牙科演講的名嘴或名師了。在專審委員會時,有時看到來的考生名單大有來頭,心理還會暗自想: 喔~他也來考阿....</span><br />
<span class="Apple-style-span" style="font-size: large;"><br /></span>
<span class="Apple-style-span" style="font-size: large;">不過,就算都是頂尖高手,但我考過的那一年,錄取率為六成多。</span><br />
<span class="Apple-style-span" style="font-size: large;"><br /></span>
<span class="Apple-style-span" style="font-size: large;">還真的是漫漫長路阿。</span></div>
Anonymoushttp://www.blogger.com/profile/07108752172963983832noreply@blogger.com0tag:blogger.com,1999:blog-2966511612809412144.post-86822962598493298152013-02-09T19:18:00.000-08:002013-02-09T21:50:58.802-08:00新年恭喜新上架~!<div class="separator" style="clear: both; text-align: left;">
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgaTKu_PO8WtY1gd3Vk1ZajwcbPrur8QpAmnS7AjzRxtVCcjVcbSdHETOs1S_CKdbDTLxBtivyEg28OTfxBR_9PkBSvMaAu-Tw-5kJwbd3jtXvHB2_wkBwhbhK6Io3w1qFa7DqsOuUIT7k/s1600/filebox+Daisy+Shih.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgaTKu_PO8WtY1gd3Vk1ZajwcbPrur8QpAmnS7AjzRxtVCcjVcbSdHETOs1S_CKdbDTLxBtivyEg28OTfxBR_9PkBSvMaAu-Tw-5kJwbd3jtXvHB2_wkBwhbhK6Io3w1qFa7DqsOuUIT7k/s400/filebox+Daisy+Shih.jpg" width="305" /></a></div>
<span class="Apple-style-span" style="font-size: large;"><br /></span>
<span class="Apple-style-span" style="font-size: large;"><br /></span>
<span class="Apple-style-span" style="font-size: large;">新年恭喜!</span><br />
<span class="Apple-style-span" style="font-size: large;">在這小龍年的大年初一,</span><br />
<span class="Apple-style-span" style="font-size: large;">祝各位新年快樂,事事如意~</span><br />
<span class="Apple-style-span" style="font-size: large;"><br /></span>
<span class="Apple-style-span" style="font-size: large;">NetENDO 團隊將於今天出發。</span><br />
<span class="Apple-style-span" style="font-size: large;"><br /></span>
<span class="Apple-style-span" style="font-size: large;">NetENDO 由兩個字組成,Net and ENDO</span><br />
<br />
<span class="Apple-style-span" style="font-size: large;">Endo 是 Endodontics</span><br />
<span class="Apple-style-span" style="font-size: large;">指的是牙髓病科 或根管治療科</span><br />
<span class="Apple-style-span" style="font-size: large;"><br /></span>
<span class="Apple-style-span" style="font-size: large;">Net-代表我們將專注於專科,聯結於專科,</span><br />
<span class="Apple-style-span" style="font-size: large;">並將根管治療向外拓展,結合各專科協同治療與General Practice.</span><br />
<span class="Apple-style-span" style="font-size: large;"><br /></span>
<br />
<div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;">
<span class="Apple-style-span" style="font-size: large;">NetENDO成員皆為牙髓病專科醫師</span></div>
<div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;">
<span class="Apple-style-span" style="font-size: large;">而團隊成員資歷包括 : </span></div>
<div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;">
<span class="Apple-style-span" style="font-size: large;"><br /></span></div>
<div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;">
<span class="Apple-style-span" style="font-size: large;">醫學中心主治醫師,</span><span class="Apple-style-span" style="font-size: large;">牙醫學系講師</span></div>
<div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;">
<span class="Apple-style-span" style="font-size: large;">教學醫院牙科主任 牙髓病科主任 </span></div>
<div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;">
<span class="Apple-style-span" style="font-size: large;">專科醫師甄審委員會委員</span></div>
<div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;">
<span class="Apple-style-span" style="font-size: large;">專科訓練機構 負責醫師</span></div>
<div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;">
<span class="Apple-style-span" style="font-size: large;">國立龍頭牙醫學院 碩士/博士</span></div>
<div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;">
<span class="Apple-style-span" style="font-size: large;"><br /></span></div>
<div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;">
<span class="Apple-style-span" style="font-size: large;">深入參與並活躍於 </span></div>
<div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;">
<span class="Apple-style-span" style="font-size: large;">專科醫學會 </span></div>
<div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;">
<span class="Apple-style-span" style="font-size: large;">國內專科演講</span></div>
<div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;">
<span class="Apple-style-span" style="font-size: large;">牙科醫療器械研發 </span></div>
<div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;">
<span class="Apple-style-span" style="font-size: large;">國內外牙材公司顧問與講師 </span></div>
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<span class="Apple-style-span" style="font-size: large;">以及ptt。</span></div>
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<span class="Apple-style-span" style="font-size: large;"><br /></span>
<span class="Apple-style-span" style="font-size: large;"><br /></span></div>
<span class="Apple-style-span" style="font-size: large;">希望光臨此處的朋友</span><br />
<span class="Apple-style-span" style="font-size: large;">可以更瞭解牙醫的執業與職業的背後。</span><br />
<span class="Apple-style-span" style="font-size: large;"><br /></span>
<span class="Apple-style-span" style="font-size: large;">來這裡的牙醫同仁</span><br />
<span class="Apple-style-span" style="font-size: large;">都能組成您心中的夢幻專科團隊</span><br />
<span class="Apple-style-span" style="font-size: large;">如果需要endodontist, 請讓我們提供協助。</span><br />
<span class="Apple-style-span" style="font-size: large;"><br /></span>
<span class="Apple-style-span" style="font-size: large;">來這裡的endodontist</span><br />
<span class="Apple-style-span" style="font-size: large;">都能獲取您所想要的資源,並且加入我們。</span><br />
<span class="Apple-style-span" style="font-size: large;">因為您需要的,您想要的</span><span class="Apple-style-span" style="font-size: large;">,我們最知道。</span><br />
<span class="Apple-style-span" style="font-size: large;"><br /></span>Anonymoushttp://www.blogger.com/profile/07108752172963983832noreply@blogger.com1