口腔專業(yè)英語2011電子版

Lesson1DentalAnatomyTheclassificationoftheteethHumaninhiswholelifehastwoseriesofteethincluding20deciduousteethasthefirstseriesand32permanentteethasthesecondseries.Deciduousteethcanbeclassifiedtothreekinds:deciduousincisor,deciduouscanineanddeciduousmolor.Permanentteethcanbeclassifiedtoincisor,canine,premolarandmolar.Theincisorsandcaninesarecalledanteriorteethbecausetheyareinthefrontofthecornerofthemouthandthepremolarsandmolarsarecalledposteriorteethbecausetheyarebehindthecornerofthemouth.ThefunctionoftheteethMastication.Afterthefoodiseateninthemouth,itundergoesaseriesofmechanicalprocessessuchascuttingbytheincisor,laniatingbythecanine,poundingtopiecesbypremolarandmillingbymolar.Meanwhilethefoodwillbemixedwithsalivaanddigestedpartiallybytheenzyme.Pronunciationandspeech:Teeth,lipsandtonguehavetightrelationshipwithpronunciationandspeech.Thecorrectnessofthepronunciationandtheclearanceofthespeechareseriouslyinfluencedbythepositionoftheteethandthepositionalrelationshipbetweentongue,lipsandteeth.Itisveryimportanttomaintainthefacialharmonyandbeauty.TherecordoftheclinicteethpositionRecentlytherearefouroftenusedmethodstorecordtheteethpositionsuchaspositionrecordingmethod,palmerrecordingsystem,universalnumberingsystemandFederationDentaireInternationalsystem.WithpositionrecordingmethodthedentalarchcanbedividedintoA,B,CandDquadrantsbytwoperpendicularlines.Theuprightlinerepresentsthecentrallineusedtoidentifytheleftandright.Thehorizontallinerepresentstheocclusalsurface.Themaxillaryteethareabovethelineandthemandibularteethareundertheline.ThedeciduousteethcanberepresentedbyRomannumberI-VandthepermanentteethArabiannumber1-8.VwmiiIVwmiiIIiimwVVwmiiIIiimwVThefollowingaretherecordingoftheclinicdeciduousteeth.ple,I|Forexamrepresentsthefirstdeciduousincisorintherightpartofthemaxillaryteeth.Thefollowingaretherecordingoftheclinicpermanentteeth.8 7 6 5 4 3 2 11 2 3 4 5 6 7 88 7 6 5 4 3 2 1 1 2 3 4 5 6 7 8Forexample,6representsthefirstmolarpermanentteethintheleftpartofthemandibularteeth.LandmarksoftheteethThecrownsoftheincisorsandcanineshavefoursurfacesandaridge.Thecrownsofthepremolarsandmolarshavefivesurfaces.Thosesurfacesoftheincisorsandcaninesfacingtowardthelipsarecalledlabialsurfaces,thosesurfacesofthepremolarsandmolarsfacingtowardthecheek,buccalsurfaces.Allsurfacesfacingtowardthetonguearecalledlingualsurfaces.Thesurfacesoftheteethwhichcomeincontactwiththoseintheoppositejawduringtheactofclosurearecalledocclusalsurfaces.61Thesurfacesoftheteethwhicharepresentedtowardorlieagainstadjoiningteethinthesamedentalarcharecalledproximalorproximatesurfaces.Thoseproximalsurfaceswhicharefacedtowardthemedianlinearecalledmesialsurfaces,andthosemostdistantfromthemedianlinearecalleddistalsurfaces.OtherlandmarksAcuspisanelevationormoundonthecrownportionofatoothmakingupadivisionalpartoftheocclusalsurface.Atubercleisasmallerelevationonsomeportionofthecrownproducedbyanovercalcificationofenamel.Acingulumisthelinguallobeofananteriortooth.Aridgeisanylinearelevationonthesurfaceofatoothandisnamedaccordingtoitslocationorform:buccalridge,incisalridge,marginalridge,etc.Marginalridgearethoseroundedelevationsoftheenamelwhichformthemarginsoftheocclusalsurfacesofpremolarsandmolars,mesiallyanddistally,andthemesialanddistalmarginsoftheincisorsandcanineslingually.Triangularridgesarethoseridgeswhichdescendfromthetipsofthecuspsofmolarsandpremolarstowardthecentralpartoftheocclusalsurfaces.Whenabuccalandalingualtriangularridgejoin,theyformatransverseridge,theunionoftwotriangularridgescrossingtransverselythesurfaceofaposteriortooth.Theobliqueridgeisavariableridgecrossingobliquelytheocclusalsurfacesofuppermolars;itresultsfromthejunctionoftwotriangularridges.Afossaisanirregular,roundeddepressionorconcavityfounduponthesurfaceofatooth.Lingularfossaearefounduponthelingualsurfaceofincisors.Centralfossaearefoundupontheoccluusalsurfaceofmolars,andareformedbytheconvergingofridgesterminatingatacentralpointinthebottomofthedepressionwherethereisajunctionofgrooves.Triangularfossaearefoundonmolarsandpremolarsontheocclusalsurfacesmesialordistaltomarginalridges.Asulcusisanotablylongdepressionorvalleyinthesurfaceofatoothbetweenridgesandcusps,theinclinesofwhichmeetatanangle.Adevelopmentalgrooveisashallowgrooveorlinedenotingevidenceofcoalescencebetweentheprimarypartsofthecrownorroot.Fissuresarelinearfaultsintheenamelcoveringofcrowns.61NewWordsandExpressionsdeciduous[2興同?興2守"■"?^?]adj.每年落葉的，非永久性的incisor[為■同?公興并列n.門牙canine[同此我興■公興■]n.[解剖]犬齒adj.犬的，似犬的，犬科的，犬齒的molar[同。號(hào)*?號(hào)]adj.磨碎的，臼齒的n.臼齒，磨牙premolar[息口□為且息。號(hào)*,號(hào)]n.前臼齒mastication口.咀嚼laniate['?盟■陟虱陟8v.撕裂，撕開saliva[?學(xué)息?公興?和n.口水，唾液quadrant[同此?器2口號(hào)?6]n.象限，四分儀perpendicular隆口號(hào)以口號(hào)■息2為此時(shí)??利adj.垂直的，正交的n.垂線occlusal尸口法?曲以?號(hào)?]adj.[醫(yī)]（上下齒）咬合（面）的occlusalsurface牙合面maxillary[O盟法口?陟?號(hào)門陟三口。盟此?陟①]adj.上頜骨的n.上頜骨mandibular[。盟■息2興皿"??q]adj.下頜〔骨〕ridgen.嵴，脊labial[息?虱興皿興號(hào)?]adj.唇的，嘴唇的，[語音]唇音的n.唇音，風(fēng)琴管labialsurface唇面buccal[圾>此號(hào)?]adj.（面）頰的，口的，口腔的lingual[息?陟具丫?麓學(xué)③叫adj.舌的，舌狀的;語言的lingualsurfaces舌面proximal['pr器此?為（□??]（proximate['pr器ksimeit]）adj.最接近的median['m興且dj?n]adj.中央的，中線的n.中部，當(dāng)中，[數(shù)學(xué)]中線，中值mesial['mHHzj?l]adj.中央的，中間的distal['distl]adj.末梢的，遠(yuǎn)中的elevation[eli'veie?口]隆突mound[maund]聳起,小丘divisional[di'vie?n]adj.分割的，分區(qū)的tubercle「tj?且b?（:）kl]結(jié)節(jié)overcalcification[ou?:??此盟??興彳興'keie?n]過度鈣化cingulum['s諼gjul?m]帶，扣帶;舌面隆突mesially['m興且zj?li]近中地distally['dist?li]遠(yuǎn)中地oblique[?'bl為且k]斜的fossa[儲(chǔ)s?]（復(fù)fossae['償s興且]）窩，凹converge[k?n'v?且d曹]v.聚合,會(huì)聚，集中于一點(diǎn)groove[gr由H>v]溝sulcus['s>lk?s]溝coalescence[kou?'lesns]n.合并，接合，聯(lián)合linear['lini?]adj.線的，直線的，線性的61參考譯文牙的分類人一生有兩副牙齒，第一副為乳牙，第二副為恒牙。乳牙共20個(gè)，恒牙共32個(gè)。乳牙分為乳切牙、乳尖牙和乳磨牙三類；恒牙分為切牙、尖牙、前磨牙和磨牙四類。切牙和尖牙位于口角之前，稱之為前牙；前磨牙和磨牙位于口角之后，故稱為后牙。牙的功能咀嚼：食物進(jìn)入口腔后，經(jīng)過切牙的切割、尖牙的撕裂、前磨牙的搗碎和磨牙的磨細(xì)等一系列機(jī)械加工過程，同時(shí)與唾液混合，唾液中的酶對(duì)食物起部分消化作用。發(fā)音和言語：牙、唇和舌與發(fā)音和言語的關(guān)系密切。牙的位置以及舌與唇、牙之間的位置關(guān)系，對(duì)發(fā)音的準(zhǔn)確性與言語的清晰程度有著重要的影響。保持面部的協(xié)調(diào)美觀。臨床牙位記錄目前最常用的牙位記錄方法有四：部位記錄法，palmer記錄系統(tǒng)，通用編號(hào)系統(tǒng)及國(guó)際牙科聯(lián)合會(huì)系統(tǒng)。部位記錄法以兩條相互垂直的直線將牙弓分為A、B、C、D4個(gè)象限，豎線代表中線，區(qū)分左右；橫線表示牙面，橫線以上為上頜牙，以下為下頜牙。乳牙用羅馬字I—V表示；恒牙用阿拉伯字1一8表示。乳牙臨床牙位記錄如下：VWmiiiiiimwVVWmiiiiiimwV例如I|表示右上第一乳切牙。恒牙臨床牙位記錄如下：876543211234567887654321 12345678例如|"6-表示左下第一恒磨牙。牙冠表面解剖標(biāo)志切牙和尖牙的牙冠有四個(gè)面和一個(gè)切嵴，前磨牙和磨牙的牙冠有五個(gè)面。切牙和尖牙向著唇部的面叫唇面，前磨牙和磨牙向著頰部的面叫頰面。所有向著舌部的各個(gè)面都叫做舌面。上下頜牙齒的接觸面叫牙面。在同一牙弓中，牙齒面向或緊靠鄰牙的面叫鄰面?？拷芯€的鄰接面叫近中面，遠(yuǎn)離中線的叫遠(yuǎn)中面。其他標(biāo)志：牙尖：是牙冠高起的部分，它構(gòu)成牙面的一部分。結(jié)節(jié)：是牙冠一些部分的較小突起，由于釉質(zhì)的過度鈣化所形成。舌面隆突：是前牙的舌葉。嵴：是牙面上任何一種長(zhǎng)條形的突起部分，按照它的位置和形狀來命名：頰嵴、切嵴、邊緣嵴等等。邊緣嵴：是釉質(zhì)的圓形隆起，它形成前磨牙和磨牙牙合面的近遠(yuǎn)中邊緣，切牙和尖牙舌面的近遠(yuǎn)中邊緣。61三角嵴：起于磨牙和前磨牙牙尖頂部，向牙合面的中央部分延伸。當(dāng)頰尖三角嵴和舌尖三角嵴相連，就形成一個(gè)橫嵴；二個(gè)三角嵴的連接部分橫貫于后牙的表面。斜嵴：是斜向橫貫上頜磨牙牙面的變異性嵴；它由二個(gè)三角嵴連接而成。窩：牙面上呈不規(guī)則圓形的凹下部分叫窩。切牙在舌面有舌窩。磨牙在牙合面有中央窩，這是由嵴的末端在凹下部分底部中央聚集而成，并有溝連接。磨牙和前磨牙牙面邊緣嵴的近中側(cè)或遠(yuǎn)中側(cè)可有三角窩。溝：是牙面上嵴與牙尖間的長(zhǎng)條形凹陷或谷，斜面集合成角。發(fā)育溝：是一線性溝或線，顯示牙冠和牙根發(fā)育期連接的痕跡。裂隙：是牙冠面上釉質(zhì)呈細(xì)條狀的斷裂層。SupplementarymaterialUsefulQuestionstoPatientsIsitgettingworseatnightorbyday? Howlonghaveyouhadthepain?Haveyouhadanypaininthetempleortheear? Wheredoyoufeelthepainmost?Doyoufeelthepainwhenyoutouchyourtoothwithyourtongue?Doyougetmorepainwithcoldorwarmwater?Doyoubleedalotafterextraction?IsthepainmoreseverewhenIpresshereorhere?Howlongdoesthepainlast?Doyourgumsbleedwhenyoubrushyourteeth?Haveyouafeelingofweightinyourtooth?Haveyoubeeninhospitalforanything? Areyoutakinganymedicine?Haveyoueverhadrheumaticfever,kidneydisease,chestorlungdiseases?Haveyouanyallergies--particularlypenicillinallergy?TermsUsedinDentistryToapplyaclamp.Toarrestbleeding.Tobrushteeth.Tocapatooth.Tocauterize.Todrill.Toextractatooth(pullout,remove).Tofile.Tofill.Tokillanerve.Toplugatooth.Topolish.Toputagaginthemouth.Toremovethesalivabyapump.Torinsethecavity.Toscale.Animpactedtooth.Toscrape.Prematureteeth.Dentures/artificialteetharenotmyownteeth.Totakeanimpression.Totakethebite.Togrindofftheartificialtoothuntilthereisaperfectfit.Youmusthaveafull/top/bottomset.61Lesson2OralandMaxillofacialHistologyThemucousmembranesurroundingthenecksoftheteethisthegingivaorgum.Thegingivaisfirmlyattachedtothetoothinacuff-shapedmanner,butthearrangementofthetissuesissuchthatashallowsulcusformed.Thisgingivalsulcustendstocollectfoodanddebris,particularlyintheabsenceofadequateoralhygiene,andthisprovidesafavourablesituationforbacterialgrowth.Eveningingivaethatappearcompletelynormalclinically,atleastasparseinfiltrationofmacrophagesandlymphocytescanbenotedinthesubepithelialconnectivetissueinregionofthegingivalsulcus.Theepitheliumisnormallykeratinised,thoughofteninotherwisenormaltissueskeratinsationislacking,ortheremaybeparakeratosis.Themucousmembranecoveringthejawsfartherawayfromthegingivaconstitutesthealveolarmucosa.Heretheepitheliumlacksastratumcorncumandepithelialpegsarepoorlydevelopedorabsent.Themucousmembraneelsewhereinmouthshowssomevariationsinthedifferentareas.Theepitheliumofthehardpalateiswellkeratinisedandhasnumerouslongpegs.Mucousglandsarepresentinthesubepithelialconnectivetissueposteriorly.Thepalatinepapillacontainstheblindendingsofthenasopalatineducts,whicharelinedbycolumnarepitheliumwithnumerousgobletcells.Smallisletsofcartilagearesometimesfoundinthisarea,derivedfromtheparaseptalcartilages.Isletsofepitheliummaybepresent,usuallyclosetothepapillabutalsoelsewhereinthemidlineofthepalate.Thesemayshowcornification.Theyaretheremnantsoftheepitheliumthatcoveresthelineoffusionofthepalatalprocess.Theoralaspectofthesoftpalateiscoveredbynon-keratinisedsquamousepithelium.Thefreebordersofthenasalsurfacearealsocoveredbysqumousepitheliumbuttheremainderofthissurfaceiscoveredbyciliatedcolumnarepithelium.Numerousmucousglandsarepresentinthesubmucosa.Theepitheliumoftheskinofthelipisnormallywellkeratinised.Theepithelialpegsarefewandshort,andnumeroussebaceousglands,hairfolliclesandsweatglandsarepresentinthesubepithelialconnectivetissue.Theepitheliumoftheredzoneofthelipisalsokeratinised,butheretheepithelialpegsarelongandnumerous.Thecorrespondinglylongandnumerousdermalpapillaecarrytherichcapillarysupplythatgivesthiszoneitsredcolour.Hairfolliclesareabsentherethoughoccasionalsebaceousglandsareseen.Themucousmembraneproperofthelipisnotkeratinised.Theepithelialpegsareshortandblunt,andthelabialmucousglandsarepresentinthesubepithelialconnectivetissue.Theepitheliumofthecheeklackskeratinisation.Mucousarepresentinthesubmucosa,sebaceousglandsarealsonotinfrequentlyfound,Inthearealateraltothecornerofthemouth.Theseappeartothenakedeyesassmallyellowspots(Fordycespots).Themucosaofthefloorofthemouthisnotkeratinised.Theepithelialpegsareshort.Mucousglandsarepresentinthesubmucosa.Thegreaterpartofthetoothconsistsofdentine.Therootdentineiscoveredbyathinlayerofcementumanddentineofthecrowniscoveredbyenamel.Internally,thedentinecontainsthedentalpulpinthepulpchamber.Therootofthetoothoccupiesasocketinthealveolarbonetowhichitisattachedbytheconnectivetissuefibresoftheperiodontalmembrane.Thepulpconsisitsoflooseconnectivetissueandcarriestheblood,lymphaticandnervesupplytothetooth.Thedentineconsistsof30percentorganicmaterialandwater,and70percentinorganicmaterial.Theinorganicmaterialofenamelisanapatiteandsmallorganicfractionismainly61ofkeratinousnature.Enamelconsistsofrodsorprismsinaninterprismaticsubstancethatisslightlylessmineralizedthantherodsthemselves.Therodshavea“fish-scale”appearanceincross-section.Thecemetumcoversthedentineofthetoothrootinathinlayer.Theprincipalfunctionofcementumistogiveattachmenttofibresoftheperiodontalmembrane.NewWordsandExpressionshistology[his't器??◎曹興]n.組織學(xué)remark[ri'm赳且k]n.陳述cuff-shaped「k+f首eipt]a.呈袖套狀的sulcus['s+lk+s]n.溝debris['debri:]n.碎片,殘骸sparse[sp赳且s]a.稀少的，稀疏的macrophage「m盟kr+feid曹]n.巨噬細(xì)胞subepithelial[s+bepi冷興且li+l]a.上皮下的keratinise['ker+tinaiz]丫匕角化keratinisation[ker+tinai'zei^+n]比角化parakeratosis[p盟r+ker+'tousis]n.角化不全pegn.釘dermala.皮膚的,真皮的papilla[p+'pil+]n.乳頭stratum['streit+m]n.層corneum['k群且ni+m]n.角質(zhì)層palatine['p掰l+tain]n.腭blindendingsn.盲端columnar[k+'l+mn+]a.柱形的，筒形的goblet['g器blit]n.高腳玻璃杯，酒杯islet['ailit]n.小島paraseptal[p盟r+'septl]a.中隔旁的cornification[k器H>nifi'kei首+n]n.角（質(zhì)）化fusion[修?且曹+n]n.熔化，熔解，熔合squamous['skweim+s]a.有鱗片的，鱗片狀的sebaceous[si'bei首+s]a.皮脂腺的，分泌脂質(zhì)的follicle['fMikl]n.小囊，濾泡，卵泡nakedeyesn.肉眼cementum[si'ment+m]n.牙骨質(zhì)，水門汀dentine['dentin]牙本質(zhì)socket['s器kit]n.窩,穴，孔，插座，牙糟v.給…配插座periodontalmembranen.牙周膜61apatite['盟p?tait]n.磷灰石keratinous[kQr盟tin?s]a.角質(zhì)的，角（質(zhì)）蛋白的interprismatic[int?priz'm掰tik]a.棱柱間的mineralize['min?t?laiz]vt.使礦物化，使含無機(jī)化合物vi.采集礦物fish-scale[fieskeil]a.魚鱗狀的cross-section（transversesection）n.橫切面參考譯文口腔頜面部組織學(xué)圍繞牙頸部的粘膜是牙齦。牙齦呈袖套狀緊緊的附著于牙齒，但是與牙齒之間有一淺溝。牙齦溝容易積聚食物及各種碎屑，特別是在口腔衛(wèi)生差的情況下，便提供了易于細(xì)菌生長(zhǎng)的環(huán)境。甚至臨床上完全正常的牙齦，在牙齦溝的上皮下結(jié)締組織中均能發(fā)現(xiàn)少量巨噬細(xì)胞和淋巴細(xì)胞。雖然在其他部位的正常組織，上皮常常沒有角化，但是牙齦上皮在正常情況下有角化和不全角化。上皮釘和真皮乳頭長(zhǎng)而狹窄。覆蓋在離牙齦遠(yuǎn)一點(diǎn)頜骨上的粘膜為牙槽粘膜。這里的上皮缺乏角質(zhì)層，上皮釘較少或無?？谇黄渌课坏恼衬ぴ诓煌膮^(qū)域表現(xiàn)不同。硬腭的上皮有較好的角化及許多長(zhǎng)的上皮釘。在后部上皮下結(jié)締組織中許多粘液腺。腭乳頭內(nèi)包含有鼻腭管的盲端，此管內(nèi)襯柱狀上皮，其中有大量杯狀細(xì)胞。在此區(qū)內(nèi)有時(shí)可見起源于中隔旁軟骨的軟骨小島。在靠近腭乳頭處常常有上皮小島。但此小島也可見于腭中縫的任何部位。這些小島可能出現(xiàn)角化。它們是覆蓋在腭突融合線上的上皮殘余。軟腭的口腔面覆蓋著無角化的鱗狀上皮。鼻腔面的游離緣也覆蓋著鱗狀上皮，但鼻腔面的其他地方覆蓋著纖毛柱狀上皮。在內(nèi)膜下層有許多粘液腺。唇的皮膚上皮正常時(shí)角化較好。上皮釘少而短。在皮下結(jié)締組織中有大量皮脂腺、毛囊和汗腺。唇紅的上皮也有角化，但這里的上皮釘長(zhǎng)而多。真皮乳頭也相應(yīng)的長(zhǎng)而多，并含有豐富的毛細(xì)血管，因此使該區(qū)呈紅色。雖然偶爾可見到一些皮脂腺，但是沒有毛囊。唇部的固有粘膜沒有角化。上皮釘短而寬，在上皮下結(jié)締組織中有唇粘液腺。頰上皮沒有角化。在粘膜下層有粘液腺。口角旁區(qū)的皮脂腺并非罕見。肉眼觀為小的黃色斑（福代斯氏斑）?？诘渍衬]有角化。上皮釘較短。粘膜下層有粘液腺。牙齒的大部分由牙本質(zhì)構(gòu)成。根部牙本質(zhì)外面覆蓋著薄層的牙骨質(zhì)。冠部牙本質(zhì)外面覆蓋著釉質(zhì)。在內(nèi)部，牙本質(zhì)含有牙髓腔，內(nèi)有牙髓。牙根位于牙槽窩內(nèi)，借牙周膜的結(jié)締組織附于牙槽骨。牙髓由疏松結(jié)締組織構(gòu)成，給牙齒帶來血液、淋巴和神經(jīng)。牙本質(zhì)含有30%的有機(jī)物和水，70%的無機(jī)物。釉質(zhì)的無機(jī)物是磷灰石，少量的有機(jī)物主要是角質(zhì)性的。釉質(zhì)由釉柱和釉間質(zhì)組成，后者的鈣化程度比釉柱本身稍低。釉柱橫切面呈“魚鱗狀”。牙骨質(zhì)薄薄的覆蓋在牙本質(zhì)表面，其主要功能是于牙周膜的原纖維附著。61SupplementarymaterialInstructionstoPatientsandExplanationsofProceduresLeanback.Spitout.Pleasedon'tswallow.Unclenchyourteeth.Takeoutyourplate/dentures.Leanback.Spitout.Pleasedon'tswallow.Unclenchyourteeth.Takeoutyourplate/dentures.Yourtoothisdecayed.Takecarenottotouchthewound.Thismaymakeyoufeelalittleunpleasant.Yourteetharecrowded.I'llhaveto...Openyourmouthwide.Rinseyourmouthwell.Pleasekeepstillforamoment.Clenchyourteeth.Pleasedon'tcloseyourmouth.Thiswon'thurtyou.Iwantyoutopaintthegumswith...Thistoothisdecayed.Itneedsfilling.Youmustgargleeveryhour.Thistoothwillhavetohaveatemporary/permanentfilling.Anabscesshasformed.I'llhavetoopenitup.I'mgoingtoremovethetartarfromyourteethnow.I'mgoingtoscrapeyourteethandthenpolishthem.Itmustcomeout/beextracted.(Itmustbeextracted.)“Yourgumsareinpoorcondition.Iwantyoutomassagethemandusedentalflossorsticks.”“Pleasedon'thaveanysolidfoodforthreeorfourdays.Youmustcomeeverysixmonthsforacheck-upandremovaloftartar.”LanguageneededforanaesthesiaLocalanaesthesiaGenerallycalled:needleinthegum/prickinthegum.You'lljustfeelalittleprickinthegum.GeneralanaesthesiaGenerallycalled:gas(inhalationanaesthesia).prickinthearm(intravenousanaesthesia).Sometimesreferredtoas"go-to-sleepanaesthesia."61Lesson3DIAGNOSISANDTREATMENTPLANNING(1)Diagnosisandtreatmentplanningareactivitiesthatseparateanddistinguishprofessionalfromauxiliarypersonnel.Expanded-dutypersonnelhavebeentrainedtoperformroutineendodontictechnicalprocedures.However,onlythethedentisthastraininginbasicandclinicalsciences;thisentitlesthedentistalonetofirst,performalldiagnostictests;second,interpretdifferentiallythetestresults;third,psychologicallymanagethepatientduringtestingprocedures;andfourth,formulateanappropriatediagnosisandtreatmentplan.Differentialdiagnosisoforofacialdisordersisdemandingandmayconfusebothpatientandclinicianbecausethereisatendencytoequateacomplaintofpainwithanendodonticproblem.Inadditiontoteeth,otherstructuresandorganssuchastheperiodontium,jaws,sinuses,ears,temporomandibularjoints,masticatorymusculaturenose,eyes,andbloodvesselscaninducepainthatmaymimicdentalpain.Otherpathologicconditionssuchasneuralgiarmultiplesclerosis,myocardialischemia,orpsychiatricdisordersmayproducethesamesymptoms.Toavoidmisdiagnosisandtoruleoutorofacialpainofnonpulpalorperiapicalorigin,astep-by-stepsystematicapproachtodiagnosisandtreatmentplanningmustbefollowed:Ascertainthechiefcomplaint.Takepertinentinformationrelatedtothepatient'smedicalanddentalhistory.Conductthorough(butnotunnecessary)subjective,objective,andradiographicexaminations.Analyzethedataobtained.Formulateanappropriatediagnosisandtreatmentplan.Thischaptersuggestsasystematicapproachtodiagnosisandtreatmentplanningprimarilyasrelatedtorootcanaltreatment..ChiefComplaintThechiefcomplaintisgenerallythefirstinformationobtained.Thesearesymptomsorproblemsexpressedbythepatientinhisorherownwordsrelatingtotheconditionthatpromptsthepatienttoseektreatment.Thechiefcomplaintshouldberecordedinnontechnicallanguage;forexample,"Ihaveaninfectedtoothandagumboil,"orIhaveatoothachethatmaybecausingmysinusinfection.".HealthHistoryTakingacomprehensivehealthhistoryfornewpatientsandreviewingandupdatingthedataofpriorpatientsaremandatoryandconstitutethefirststepindiagnosis.Acompletehealthhistoryforanewpatientconsistsofroutinedemographicdata,medicalhistory,dentalhistory,chiefcomplaintandpresentillness..SubjectiveExamination.PresentConditionSomeroutineinformationrelatedtopersonaldata,medicalhistory,anddentalhistoryaswellasthechiefcomplaintmaybeobtainedbystaff.However,thedentistshouldreviewandbefamiliarwiththedatabeforeproceedingfurther.Often,thefirstcontactbetweenpatientanddentisttakesplaceduringcollectionofdataaboutthepresentillness.Mostpatientswithendodonticpathosesareasymptomaticorhavemildsymptoms.Ifpulpor61periradicularpathosisissuspectedbecauseofotherfindings,thedentistnotestheabsenceofsignificantsymptomsandmovesontoobjectivetests.However,oftenpatientsdoexpressnotablelevelsofpainanddistress.Thesepatientsrequireacareful,systematicsubjectiveexaminationwithpointed,probingquestions.Aninterestingandoftenconfusingentityistooth-relatedpainexperiencedwithchangesinambientpressure.Thisphenomenonisknownasbarodontalgiaandaffectspatientswhoexperienceapressureincreaseordecrease.Ithasbeendescribedinhigh-altitudeflyingaswellasscubadiving.Painanddiscomfortassociatedwithpulpalandperiradiculardiseasesdonotusuallyaffectapatient'sphysicalstateandhavelittleornoeffectonvitalsigns,skincolor,ormuscletone.However,severepulpalorperiradicularpainmayaffectapatient'sphysicalconditionandvitalsigns.Regardlessofdegree,dentalpainsignificantlyalterspsychologicalmake-upandemotionalstatus.Becauseofapprehensionandemotionalaswellasoccasionalphysicalinstability,endodonticpatientsarehandledwithextracare.Professionalappearance,attitude,andaproperatmospherearethemainfactorsneededinestablishinggooddentist-patientrapport.Inafriendlyandcompassionateenvironment,patientsexpressproblemsopenly.Withsuchathoroughapproachpatientsoftenvolunteermanydetailsaboutthelocation,onset,characterandseverityofthepain.Afterlisteningwithkeeninterest;thedentist,inasympatheticandunhurriedmanner,shouldaskfurtherquestionsaboutthespontaneityanddurationofthepainandthestimulithatinduceorrelieveit.Theseverityofthepainandthemedicationstakenforpainreliefandtheireffectivenessareveryimportant..SignificantAspectsofpainPainofhighintensityisusuallyintermittent,whereaslow-intensitypainisoftencontinuousandprotracted.Incontrasttoprotractedpain,whichissteadyanddull,paroxysmalpainconsistsofavolleyofbrightjabs.Painmayalsobedescribedaspricking,stinging,burning,aching,orthrobbing.Often,severepulpalorperiapicalpainhasathrobbingqualityandissynchronizedwithcardiacsystole.Myofascialpainisusuallydull,whereasthepainofneuralgiaisbrightandparoxysmal.Identificationofthenatureofthepainhelpstodifferentiatedentalpainfrompaininothertissues.Painisaverycomplexentity.Manyaspectsofpainarenotparticularlydiagnosticanddonotdifferentiateendodonticfromnonendodonticproblemsorindicatetheseverityoftheproblem.However,someaspectsofpainarestronglyindicativeofirreversibleendodonticpathosisandthusofthetreatmentrequired.Thesearethe(1)intensity,(2)spontaneity,and(3)continuityofthepain.IntensityofPain.Themoreintensethepain(i.e.,themoredisruptivethepainistothepatient'slifestyle),themorelikelyitisthatirreversiblepathosisispresent.Intensepainislikelytobeofrecentduration,isunrelievedbyanalgesics,andhasinducedthepatienttoseektreatment.Long-standingpainisusuallynotintense.Painofamildormoderatenatureoflongdurationisnotbyitselfparticularlydiagnostic.Intensepainmayarisefromirreversiblepulpitisorfromacuteapicalperiodontitisorabscess.SpontaneousPain.Spontaneouspainoccurswithoutanelicitingstimulus.Ifpainawakensthepatientorbeginswithoutanyreason,itisspontaneous.Asdescribedpreviously,spontaneouspaincombinedwithintensepainusuallyindicatesseverepulpalorperiradicularpathosis.Aninterestingandverydiagnosticoccurrenceisintense,continuouspainisrelievedonlybycold.These61

patientsoftenappearfortreatmentclutchingaglassoficewaterthattheysiptoretaincoldontheachingtooth.Thisispathognomicofirreversiblepulpitis.ContinuousPain.Thislingeringtypeofpaincontinuesandmayevenincreaseinintensityafterthestimulusisremoved.Forexample,thepatientreportsprolongedpainafterdrinkingcoldliquids.Anotherdescribesintensecontinuouspainafterchewing.Ifthepulpisvital,continuouspainwiththermalstimulususuallyindicatesirreversiblepulpitis.Ifthepulpisnecrotic,continuouspainafterapplicationofpressuretoatoothindicatesperiradicularpathosis.Aftertakingthemedicalanddentalhistoriesandidentifyingthemainsubjectivesignsandsymptomsofthepatient’sprdnent(aisldescribedpreviously),thedentistfrequentlyarrivesatatentativediagnosis..TentativeDiagnosisByexpandingonthepresentillnessandaskingcarefulsubjectivequestionsaboutthepatient'sproblem,thedentistcanfrequentlydeterminethepresenceofpathologicchangesinpulporperiapicaltissues.Thequalityandquantityofpresentandpastpainaswellasotherimportantsubjectivefindingsoftenruleoutconfusingnonendodonticentities.Theurgencyoftreatmentisalsodetermined.Carefulquestioningandinterpretationofthepatient'sresponsesoftenofferstrongcluestoatentativepulpalorperiradiculardiagnosis.Thetentativediagnosisisthenconfirmedordeniedbyhands-onoralexaminationandclinicaltests.Newwordsandexpressionsabscess膿腫 acuteapicalperiodontitis 急性根尖周炎ambientpressure環(huán)境壓力 analgesics鎮(zhèn)痛藥apprehension理解，領(lǐng)會(huì)，焦慮不安，懼怕 ascertain查明，確定asymptomatic無癥狀的 chewing咀嚼，嚼服（法）,嚼auxiliary輔助,輔助的，補(bǔ)助，輔助品,附屬的clinician臨床醫(yī)師barodontalgia航空牙痛，氣壓牙痛，氣壓性牙痛cardiacclutch心的；強(qiáng)心藥，恢復(fù)藥；心臟病患者；賁門的窩,離合器，夾緊裝置,聯(lián)軸器，扳手，套管cardiacclutchcompassionatea.慈悲的，富于同情心的，斟酌情況的;丫.憐憫，同情complaint 陳述，癥狀，疾病，complaint 陳述，癥狀，疾病，不適demographicdata人口數(shù)據(jù)diagnosis（鑒別）診斷disruptive破裂的，裂開，分裂distress不良應(yīng)激,不舒適的應(yīng)激，痛苦，苦惱，窮困，危難，使苦惱，損壞，事故dull愚鈍的，不鋒利的,呆滯的duration持續(xù)，持續(xù)時(shí)間，期間，耐久，持久，延續(xù)時(shí)間,延續(xù)期elicitingstimulus誘發(fā)刺激gumboil齦膿腫highintensity高強(qiáng)度induce elicitingstimulus誘發(fā)刺激gumboil齦膿腫highintensity高強(qiáng)度induce 感生，誘發(fā)，誘導(dǎo)，感應(yīng)endodontichands-on牙髓的現(xiàn)成的indicativeof .指示的,預(yù)示的irreversible不可逆的61jabn.刺進(jìn);jabn.刺進(jìn);v捅；忽刺lingeringa.延遲的；逗留不去的low-intensity低強(qiáng)度的masticatory 咀嚼的，咀嚼劑mimic 擬態(tài)的，模仿的，模仿疾病的long-standing長(zhǎng)期的mandatoryadj.強(qiáng)制性的，義務(wù)的,命令的medication藥療法，給藥方法，附加藥物multiplesclerosis多發(fā)性硬化癥，軸周性硬化性腦炎，多發(fā)性硬化muscletone肌緊張，肌肉緊張度 moveon multiplesclerosis多發(fā)性硬化癥，軸周性硬化性腦炎，多發(fā)性硬化muscletone肌緊張，肌肉緊張度 moveon 繼續(xù)前進(jìn)musculature肌肉（系統(tǒng)）,肌組織，肌肉系統(tǒng)myocardialischemia心肌缺血myofascialpain肌盤膜痛 necrotic 壞死的neuralgia神經(jīng)痛 neuralgic 神經(jīng)痛的objective接物鏡，物鏡,目的,目標(biāo),目標(biāo)的,賓位的，客觀的,客觀的,（接）物鏡paroxysmalpain陣痛paroxysmal發(fā)作的，陣發(fā)的pathognomonic特異病征性的pathosis病態(tài)Periapicaltissue 根尖周組織periradicular根周phenomenon現(xiàn)象pricking穿刺術(shù)，穿刺，放液穿刺protracted （拉protractus）伸展的，延長(zhǎng)的psychological心理的,心理學(xué)的pulpitis牙髓炎rapport情感協(xié)調(diào)，感通ruleout排除，除外，拒絕sinuses竇,竇房結(jié)，竇道（復(fù)數(shù)）sip啜飲stinginga.刺人的，刺一般的，激烈的symptoms癥狀systematicapproach 系統(tǒng)化處理方法pathologic病理學(xué)的periapical根尖周的periodontium牙周組織,牙周膜pertinentinformation相關(guān)信息physicalstate 身體狀態(tài)，體格狀況prompt瞬發(fā)的，迅速的psychiatric精神病的，精神病學(xué)的psychologicallyad.心理上地；心理學(xué)地radiographic放射照相的rootcanaltreatment根管療法significant顯著的，有效的，有意義的,重要的sinusinfection 竇感染，鼻竇感染spontaneity n.自然發(fā)生，自生，自發(fā)subjective主觀的,自覺的synchronized使同步的volley 排放,沖動(dòng)排，一列沖動(dòng)systole收縮（期），收縮（期）的,心縮期,收縮期temporomandibularjoint顳下頜關(guān)節(jié)，顳頜關(guān)節(jié)tentativediagnosis暫時(shí)的（假定的）診斷，試驗(yàn)性診斷thermalstimulus溫?zé)岽碳の?熱刺激throbbing搏動(dòng)的 TreatmentPlanning治療計(jì)劃vital生病的，生機(jī)的,致命的，極其重要的 vitalsigns生命征象61Lesson4DIAGNOSISANDTREATMENTPLANNING(2)4.ObjectiveExamination(1)Duringthisstage,extraoralandintraoraltissuesareexaminedandcomparedbilaterallyforthepresenceorabsenceofpathosis..ExtraoralExaminationGeneralappearance,skintone,facialasymmetry,swelling,discoloration,redness,extraoralscarsorsinustracts,andtenderorenlargedfacialorcervicallymphnodesareindicatorsofphysicalstatus.Acarefulextraoralexaminationhelpstoidentifythecauseofthepatient'sc