1、1高雄醫學大學牙醫學系高雄醫學大學牙醫學系牙醫學系主任 陳玉昆KMU 國際學術研究大樓國際學術研究大樓2牙醫學系課程內容牙醫學系課程內容1.通識博雅課程2.基礎教育-醫學、牙醫學3.臨床教育-醫學、牙醫學4.4.需修畢四年級學科才能需修畢四年級學科才能見習見習5.5.需修畢五年級學科才能需修畢五年級學科才能實習實習 實習前需通過臨床技能臨床技能OSCE測驗測驗 畢業前需通過全民英檢中高級初試全民英檢中高級初試課程設計課程設計課程設計目標課程設計目標：整合基礎科學與臨床應用，重視團隊關懷，培養學生終身學習精神與專業創新的能力。基礎教育：著重將來從事基礎或臨床醫學之科目。實驗課程：配合課程安排進行
2、分組練習臨床技能分組練習臨床技能。臨床見習：五年級時安排至本校附院牙科部學習 臨床技術的運用及醫病溝通的技巧臨床技術的運用及醫病溝通的技巧。臨床實習：六年級時依照成績分發至本校附院牙科部 或其他教學醫院之牙科部實習。45基礎教育基礎教育 著重未來相關基礎或臨床醫學科目物理化學微積分生物化學免疫學心理學解剖學 神經解剖學生理學組織學病理學藥理學 基礎牙醫學 口腔胚胎及組織學 口腔微生物及免疫學 應用口腔解剖學 口腔病理學 牙體形態學 牙科放射線影像學（I）牙科器材學 咬合學 6臨床牙醫學課程臨床牙醫學課程牙體復形學 牙科放射影像學(II)口腔病理學 固定補綴學 全口補綴學牙周病學 牙科公共衛生學
3、 家庭牙醫學 口腔外科學 牙科麻醉學局部補綴學 齒顎矯正學 兒童牙科學7牙醫學臨床八大專科牙醫學臨床八大專科1.1.口腔病理診斷及口腔病理診斷及X X光科光科2.2.家庭牙醫科家庭牙醫科3.3.牙周病科牙周病科4.4.齒顎矯正科齒顎矯正科5.5.保存科保存科(牙體復形科、牙髓病科牙體復形科、牙髓病科)6.6.口腔顎面外科口腔顎面外科7.7.兒童牙科兒童牙科(特殊需求者牙科特殊需求者牙科)8.8.補綴科補綴科牙科放射線學(1)陳玉昆教授陳玉昆教授:高雄醫學大學高雄醫學大學 口腔病理口腔病理科科 07-31211012755 yukkwakmu.edu.twCommunicationCommuni
4、cation skills in dentistryskills in dentistry with emphasis on oral radiography with emphasis on oral radiography接受接受X X光影像攝影的溝通技巧光影像攝影的溝通技巧學 習 目 標-認識牙科X光影像攝影-了解牙醫師與病患 (含X光影像攝影)溝通技巧2.Eric Whaites:Essentials of dental radiography&radiology 1st edition,Chapter 8,p.59-771.Eric Whaites:Essentials of den
5、tal radiography&radiology 3rd edition,Chapter 8-10,p.75-116References:3.Kaohsiung Medical University,Oral Pathology Department4.高雄市牙醫師公會資料高雄市牙醫師公會資料Intraoral Radiography Periapical Radiography Bitewing Radiography Occlusal Radiography根尖片根尖片u 平行法平行法u 分角線法分角線法u 難題解決難題解決u牙科口內放射線攝影牙科口內放射線攝影根尖片根尖片咬翼片咬翼片咬
6、合片咬合片Ref.3UpperLeftPremolarsLowerIncisorsIncisors CanineCanineCanineCaninePremolarsMolarsMolarsMolarsMolarsVertical BitewingVerticalBitewingVerticalBitewingVerticalBitewing Premolars PremolarsRightFull mouth X-ray filmsPosterior tooth橫橫 放放橫橫 放放左上左上、右下、右下 象限象限右上、右上、左下左下 象限象限Anterior tooth直直 放放upperAn
7、terior tooth直直 放放lowerRef.3Paralleling technique(平平 行行 法法)Positioning上上 顎顎 門門 齒齒AnteriorPosteriorMetal supportingindicator rodWhite locator ringBite blockBite blockPatient positioning上上 顎顎 門門 齒齒 平平 行行 法法 Ref.1,2,3上上 顎顎 犬犬 齒齒PositioningAnteriorPosteriorMetal supportingindicator rodWhite locator ringB
8、ite blockBite blockPatient positioning上上 顎顎 犬犬 齒齒 平平 行行 法法 Ref.1,2,3Positioning上上 顎顎 小小 臼臼 齒齒AnteriorPosteriorMetal supportingindicator rodWhite locator ringBite blockBite blockPatient positioning上上 顎顎 小小 臼臼 齒齒 平平 行行 法法 Ref.1,2,3上上 顎顎 大大 臼臼 齒齒PositioningAnteriorPosterior Metal supporting indicator r
9、odWhite locator ringBite blockBite blockPatient positioning上上 顎顎 大大 臼臼 齒齒 平平 行行 法法 Ref.1,2,3AnteriorPosteriorMetal supportingindicator rodWhite locator ringBite blockBite block下下 顎顎 門門 齒齒Patient positioningPatient positioning下下 顎顎 門門 齒齒 平平 行行 法法 Ref.1,2,3下下 顎顎 犬犬 齒齒PositioningAnteriorPosteriorMetal
10、supportingindicator rodWhite locator ringBite blockBite blockPatient positioning下下 顎顎 犬犬 齒齒 平平 行行 法法 Ref.1,2,3下下 顎顎 小小 臼臼 齒齒PositioningAnteriorPosteriorMetal supportingindicator rodWhite locator ringBite blockBite blockPatient positioning下下 顎顎 小小 臼臼 齒齒 平平 行行 法法 Ref.1,2,3Positioning下下 顎顎 大大 臼臼 齒齒Ante
11、riorPosteriorMetal supportingindicator rodWhite locator ringBite blockBite blockPatient positioning下下 顎顎 大大 臼臼 齒齒 平平 行行 法法 Ref.1,2,3正確正確錯誤錯誤 平平 行行 法法 Ref.4Periapical Radiography Paralleling technique Bisecting angle technique Positioning difficultiesRef.1Vertical angulation too smallImageshortenedVe
12、rtical angulation too largeImageelongatedVertical angulationBisecting lineLong axis of toothLong axis of film2-3mm of filmvisible beyond theincisal edgeCentral ray ofX-ray beam aimed throughtooth apexAlveolar bone levelis not accurateAnterior teeth2-3mm beyondthe incisal edgeLong axisof thefilmpacke
13、t verticalLong axis of the filmpacket horizontalPosterior teeth2-3mm beyondthe occlusal edgeRef.1Bisecting angle techniqueHorizontal angle正正 照照 想想 要要 照照 的的 牙牙 齒齒Upper archLower archPosterior toothAnterior toothBite fork鱷鱷 魚魚 夾夾Ref.3Bisecting angle technique 上上 顎顎 犬犬 齒齒 Vertical angle 上上 顎顎 門門 齒齒 Ver
14、tical anglePatient positioningPatient positioning 分分 角角 線線 法法 Ref.1,2,3Patient positioningPatient positioning 上上 顎顎 小小 臼臼 齒齒 上上 顎顎 大大 臼臼 齒齒 分分 角角 線線 法法 Ref.1,2,3 分分 角角 線線 法法 Patient positioningPatient positioning 下下 顎顎 犬犬 齒齒 下下 顎顎 門門 齒齒 Ref.1,2,3Patient positioningPatient positioning 分分 角角 線線 法法 下下
15、顎顎 小小 臼臼 齒齒 下下 顎顎 大大 臼臼 齒齒 Ref.1,2,3u 下顎第三大臼齒下顎第三大臼齒u 嘔嘔 吐吐 感感u 根管治療根管治療u 無牙區域無牙區域u 小孩子小孩子u 身心障礙病患身心障礙病患 難難 題題 解解 決決 1.The dentistpatient relationship is a crucial factor that has an influence on the viability of the average dental practice2.Dental students should be educated about the importance of
16、 developing and mastering sound communication skills with patients.Importance of patients communication for dentists3.Little emphasis was placed on the development of sound communication skills because dental students cognitive and clinical development have always been emphasized4.It has been noted
17、that the ability to communicate skillfully and with purpose rarely occurs as a gift,but is learned,the reality is that the term communication skills is perceived as an intrinsic part of an individuals personality,his/her cognitive functioning and social experienceImportance of patients communication
18、 for dentistsA.Opening the interview(creates safe environment):1.Greets patient2.Obtains patients name3.Introduces self4.Attends to patients physical comfort(here and throughout interview)5.Identifies and confirms patients chief complaintSteps for patients communication for dentistsB.Gathering infor
19、mation:structuring the interview (explains interview process):1.Negotiates an agenda for consultation2.Attends to timingSteps for patients communication for dentistsC.Gathering information:exploration of problems (determines chief complaint):1.Encourages patient to give history of chief complaint2.U
20、ses open questioning technique(s)3.Uses closed questioning technique(s)4.Listens attentively(no interruptions;allow time for patient to think before answering)Steps for patients communication for dentists5.Facilitates patients responses(use of encouragement,silence,repetition,paraphrasing,interpreta
21、tion)6.Clarifies patients statements which are vague and need amplification7.Summarizes at end of a specific line of inquiry to verify own interpretation of what patient has said to ensure no important data was omittedSteps for patients communication for dentistsD.Understanding the patients perspect
22、ive (determines expectations,psychosocial issues&emotions):1.Determines patients expectations regarding each problem2.Picks up verbal cues(patients need to contribute information/ask questions;information overload;distress)3.Encourages expressions of feelings4.Encourages patient to contribute ideas/
23、suggestions/preferences/beliefs5.Accepts legitimacy of patients views/beliefs(non-judgmental)Steps for patients communication for dentistsE.Sharing information(presents treatment plan):1.Discusses treatment options2.Discusses consequences of not proceeding with treatment plan(in non-threatening mann
24、er)3.Provides information about procedures,processes,benefits&advantages,value&purpose4.Uses easily understood language(avoids or adequately explains technical terminology)5.Shares own thoughts&ideasSteps for patients communication for dentistsF.Reaching an agreement on treatment plan(s)(treatment p
25、lan acceptance):1.Obtains patients view of need for action (perceived benefits)2.Negotiates mutually acceptable treatment plan(encourages patient to make choices;address concerns)Steps for patients communication for dentists3.Elicits patients understanding about treatment plan(s)4.Takes patients lif
26、estyle,beliefs,cultural background and abilities into consideration5.Encourages patient to be involved in implement-ing treatment plan(to take responsibility and be self-reliant)6.Asks about patients support network for decision-makingSteps for patients communication for dentistsG.Closing the interv
27、iew:1.Summarizes session briefly2.Contracts with patient regarding next step(s)for patient and dentist3.Explains possible unexpected outcomes and safety-nets appropriatelySteps for patients communication for dentistsH.Nurturing the relationship(employs relationship building blocks):1.Demonstrates in
28、terest2.Demonstrates respect3.Communicates warmth4.Demonstrates appropriate non-verbal behavior (for example eye contact,posture&position,movement,facial expression,use of voice)5.Reading,writing,use of computer do not interfere with dialogue/rapport6.Shows empathy with patient7.Deals sensitively wi
29、th embarrassing&disturbing topicsSteps for patients communication for dentists當病患現有懷孕時：當病患現有懷孕時：A.在放射線照射前，應告知她的法律權益在放射線照射前，應告知她的法律權益B.應警告她有流產的可能性應警告她有流產的可能性C.應告知她絕不可拍攝牙科應告知她絕不可拍攝牙科X X光片光片D.視情況在適當的防護下可拍攝牙科視情況在適當的防護下可拍攝牙科X X光片光片 (上列何者最正確上列何者最正確)http:/www.scmh.org.tw/dental/dental_information/dental_x-
30、ray.htmSteps for patients communication for dentists1.The culture of dentistry places a high premium on technology.Dental schools should ensure a balanced approach in their training of dentists to ensure that the focus on technology is not at the expense of the dentistpatient relationshipSummaries2.
31、Since dental care occurs in the context of relationships amongst patients and dentists,dental schools should complement students cognitive and clinical development by teaching the human dimensions of dental care by means of the development and implementation of courses in communication skillsSummari
32、es3.Standardized patient(SP):a professional actress was trained as SP to portray the case study (clinical scenario)in a consistent,reproducible and measurable manner)4.To assist the SP in understanding the nature of the dental scenario and its presenting signs and symptoms,written case notes were prepared for the SP to reviewSummaries
