《齲臨床特征和診斷》

1、整理課件整理課件Chapter 3 Clinical Manifestations and Diagnosis of Dental Caries整理課件整理課件Histophathology of Caries Enamel Caries整理課件整理課件The early enamel lesion consists of four zones of alternating levels of mineralisation. It illustrates the dynamic nature of the caries process. The surface zone blocks the

2、passage of calcium ions into the body of the lesion and may have to be removed to allow the lesion to become arrested (After Kidd & Joyston-Bechal, 1987). 整理課件整理課件Dentinal Caries整理課件整理課件Dentine caries comprises two main layers.In the outer layer, the dentine is heavily infected with bacteria. Bo

3、th organic matrix and mineral have been lost and the dentine is beyond repair. In the deeper layer, the dentine has been affected by plaque acids and demineralised. The number of colony forming units (CFU) of bacteria decreases (about 100 times) as cavity preparation proceeds into affected dentine.

4、The damage in this layer is reversible if bacterial metabolism can be halted. A barrier of translucent (well mineralised) dentine may be formed ahead of the advancing lesion. Reactionary (secondary ) dentine forms to protect the pulp from acid irritation (After Kidd & Joyston-Bechal, 1987整理課件整理課

5、件整理課件整理課件Root caries lesions Early : Appears as radiolucent zone in the root cementum 整理課件整理課件Steps in the formation of an arrested lesion in dentinea) high concentration of dissolved mineral salts. b)If bcterial acidproduction is reduced, and the pH increases, the salts precipitate into large cryst

6、als of tricalcium phosphate which temporally block the tubule. c) If further bacterial activity is suppressed, the odontoblast secretes collagen and calcium salts. Crystals of hydroxyapatite then form and block the tubule more effectively (After Daculsi et al, 1987) 整理課件整理課件The Process of Deminerali

7、zation and Remineralization Caries is a dynamic process. Teeth are subjected to an ongoing cycle of demineralization and remineralization determined by the balance of factors. 整理課件整理課件Demineralization Demineralization is the process of removing minerals, in the form of mineral ions, from dental enam

8、el. A substantial number of mineral ions can be removed from hydroxyapatite latticework without destroying its structural integrity 整理課件整理課件Remineralization Remineralization is the process of restoring minerals - again, in the form of mineral ions - to the hydroxyapatites latticework structure. 整理課件

9、整理課件促進(jìn)再礦化阻止齲病發(fā)展 齲損的形成是脫礦與再礦化的連續(xù)性動力過程。整理課件整理課件 1、 除去致齲底物：木糖醇取代蔗糖， 減少碳水化合物攝入頻率 Diet counseling : To identify the sources of sucrose and acidic foodstuffs in the diet To reduce the frequency of ingestion of both To use xylitol as sugar substitute.整理課件整理課件 2、 仔細(xì)刷牙，牙面不形成厚的牙菌斑 Oral hygiene : Plaque free t

10、ooth surface do not decay. Dental flossing Tooth brushing Rinsing 整理課件整理課件 3、 在牙齒發(fā)育的再礦化期間，結(jié)合氟 離子，可形成更具抗齲能力的釉質(zhì)Use of fluoride整理課件整理課件整理課件整理課件Clinical classification of caries 整理課件整理課件Classification according to progression rate Acute caries: progress fast, often in children and teenagers, light color

11、ed cavity.整理課件整理課件Rampant caries, many tooth involved at same time acute caries feature often accompanied by systematic disorder. Such as sjogren syndrome or saliva reduction after radiation. Caries in a patient with impaired salivary function as result of radiation therapy(courtesy of Drs Jansma an

12、d Vissink, RUG, the Netherlands). 整理課件整理課件 整理課件整理課件Chronic caries progress slowly, black or brown colored cavity hard remaining dentine Arrested caries caries stop progressing because of the local etiological change整理課件整理課件Secondary caries (recurrent caries) caries recurred after treatment. Often at

13、 the margin the filling materials restoration or beneath The shadow located on the mesiolingual cusp adjacent to the larger occlusal amalgam restoration on the maxillary right first molar indicates the presence of carious dentin 整理課件整理課件整理課件整理課件Classification according to the involving site Occlusal

14、 caries Root caries Smooth surface caries 整理課件整理課件Classification according to the deepness Superfacial caries(淺齲) white spot lesions, visibly frosted surface brown spot Dentin caries (中齲) cavitated lesion involving the up part of dentin Deep caries (深齲) cavitated lesion involving the pupal third of

15、dentin整理課件整理課件Diagnosis Visual change Probing: rough surface or trapping point pain upon probing Temperature test X-ray examination Transillumination整理課件整理課件Visual change Matte, white, active cervical lesions 整理課件整理課件整理課件整理課件Probing: rough surface or trapping point pain upon probing The explorer tip

16、 can easily damage white spot lesions 整理課件整理課件整理課件整理課件整理課件整理課件Temperature test 整理課件整理課件X-ray examination 整理課件整理課件Transillumination（FOTL,FOTL,光纖透照法光纖透照法）： Proximal caries lesion is detected in an anterior tooth with the use of transillumination 整理課件整理課件LAF（激光熒光法（激光熒光法)整理課件整理課件The hardware of the intr

17、a-oral system includes a measurement probe, a control unit, and a computer fitted with a framegrabber. The control unit consists of an illumination device and imaging electronics. The light source is a special arc-lamp based on Xenon氙氙 technology. The light from this lamp is filtered by a blue-trans

18、mitting filter. A liquid light guide transports the blue light to the teeth in the mouth. Quantitative Light-induced Fluorescence整理課件整理課件QLF technical specifications整理課件整理課件QLF theoryThe QLF method is based on the auto-fluorescence熒光熒光 of teeth. When teeth are illuminated with high intensity blue li

19、ght they will start to emit light in the green part of the spectrum. The fluorescence of the dental material has a direct relation with the mineral content of the enamel. Quantitative Light-induced Fluorescence 整理課件整理課件 DIAGNOdent pen (齲齒探測筆 )整理課件整理課件DIAGNOdent pen整理課件整理課件DIAGNOdent整理課件整理課件整理課件整理課件S

20、tandard of diagnosis整理課件整理課件Superfacial caries(淺齲) White spot or brown, dark lesion, rough upon probing No complaint, no hypersensitivity整理課件整理課件Dentin caries (中齲) Cavity, hypersensitivity upon probing, hot or cold stimulus. 整理課件整理課件Deep caries (深齲) Deep cavity, very sensitive and some pain upon sti

21、mulus, however the pain disappear as soon as the stimulus is taken away. 整理課件整理課件Treatment Strategy整理課件整理課件Treatment Strategy Preventive(casual,noninvasive) treatment Restorative (operative,invasive) treatment 整理課件整理課件Preventive treatment chemical therapy: use of fluoride with a regular daily admini

22、stration or professional applied. pit and fissure sealing 整理課件整理課件一、一、 chemical therapy（化學(xué)療法化學(xué)療法 ） 1藥物治療藥物治療 適應(yīng)證適應(yīng)證（1）恒牙早期釉質(zhì)齲未形成齲洞者， 自潔作用較好的區(qū)域； （2）一年內(nèi)將被替換的乳牙大面積淺齲； （3）靜止齲。 藥物藥物 氟化物 硝酸銀整理課件整理課件藥物治療 氟化物氟化物 (fluorence) 75氟化鈉甘油糊劑 8氟化亞錫溶液 酸性磷酸氟化鈉（APF）溶液 含氟凝膠（1.5APF凝膠） 含氟涂料 原理：氟與HA作用，形成氟磷灰石； 沉積氟化物，促進(jìn)再礦化。

23、氟化物對軟組織無腐蝕性，不使牙變色， 安全有效，前后牙均可使用。整理課件整理課件藥物治療 硝酸銀硝酸銀 10硝酸銀 氨硝酸銀 原理: 蛋白銀沉淀 還原銀或碘化銀滲入牙釉質(zhì)牙 本質(zhì)，殺滅細(xì)菌，封閉病變區(qū) 對軟組織有強的腐蝕性，不可用于牙頸部齲，并使牙變黑，只用于乳牙和后牙。整理課件整理課件應(yīng)用方法應(yīng)用方法： 用石尖磨除牙表面淺齲，暴露病變部位 清潔牙面 隔濕吹干 涂布藥物整理課件整理課件 2Remineralization (再礦化療法 ) 再礦化液：主要為含有不同比例的鈣、磷和氟。 適應(yīng)癥 平滑面早期釉質(zhì)齲 齲易感者預(yù)防 應(yīng)用方法應(yīng)用方法： 漱口液每日含漱 局部應(yīng)用 整理課件整理課件pit a

24、nd fissure sealing（窩溝封閉) 適應(yīng)證適應(yīng)證：窩溝可疑齲；與充填窩洞相鄰的牙合面無齲深溝裂，應(yīng)用方法應(yīng)用方法：清潔牙面、隔濕、酸蝕、涂布及固化封閉劑。 整理課件整理課件 Operative dentistry is the art and science of the diagnosis, treatment, and prognosis of defects of teeth which do not require full coverage restorations for correction. 整理課件整理課件Such treatment should result

25、 in the restoration of proper tooth form, function, and esthetics while maintaining the physiological integrity of the teeth in harmonious relationship withthe adjacent hard and soft tissues; all of which enhance the general health and welfare of the patient. 整理課件整理課件 Caries Malformed, discolored, o

26、r fractured teeth Restoration replacement 整理課件整理課件 Patient assessment Examination and diagnosis Treatment planning 整理課件整理課件 The mechanical alteration of a defective , injured, or diseased tooth in order to best receive a restorative material which will re-establish a healthy state for the tooth incl

27、uding esthetic corrections where indicated, along with normal form and function. 整理課件整理課件整理課件整理課件整理課件整理課件 Class Class Class Class Class Class G.V.Black in 1908 整理課件整理課件 All pit and fissure cavities are Class I. Cavities on occlusal surface; Cavities on occlusal two-thirds of the facial and lingual s

28、urfaces of molars; Cavities on lingual surface of maxillary incisor.整理課件整理課件 A cavity occurring on the proximal surface of posterior teeth are Class II. MO mesial and occlusal DO distal and occlusal MOD mesial, occlusal and dista 整理課件整理課件 Cavities on the proximal surfaces of anterior teeth that do n

29、ot involve the incisal angles are Class III.整理課件整理課件 Cavities on the proximal surfaces of anterior teeth that do involve the incisal angles are Class IV.整理課件整理課件 Cavities on the gingival third of the facial or lingual surfaces of all teeth ( not pit and fissure cavities ) are Class V.整理課件整理課件整理課件整理課

30、件 Cavities on the incisal edge of anterior teeth or the occlusal cusp heights of posterior teeth are Class VI.整理課件整理課件整理課件整理課件洞型分類 一類洞：根據(jù)發(fā)生于所有牙齒的發(fā)育窩，溝內(nèi)的一類洞：根據(jù)發(fā)生于所有牙齒的發(fā)育窩，溝內(nèi)的 齲損所制備的洞型。齲損所制備的洞型。 二類洞：后牙鄰面的齲損所制備的洞型。二類洞：后牙鄰面的齲損所制備的洞型。 三類洞：前牙鄰面未損及切角的齲損所制備的洞三類洞：前牙鄰面未損及切角的齲損所制備的洞 型。型。 四類洞：前牙鄰面損及切角的齲損所制備的洞型。

31、四類洞：前牙鄰面損及切角的齲損所制備的洞型。 五類洞：所有牙齒頰（唇），舌（腭）面齦五類洞：所有牙齒頰（唇），舌（腭）面齦1/3 牙面的齲損制備的洞型。牙面的齲損制備的洞型。 六類洞：所有牙齒牙尖，牙脊或冠軸交界的軸角六類洞：所有牙齒牙尖，牙脊或冠軸交界的軸角 區(qū)的齲損所制備的洞型。區(qū)的齲損所制備的洞型。整理課件整理課件整理課件整理課件 walls angles cavity 整理課件整理課件整理課件整理課件 Internal walls: a prepared cavity surface that does not extend to the external tooth surface. Axial walls: an internal wall parallel with the long axis of the tooth and occlusal of the tooth. Pulpal walls: an internal