《齲臨床特征和診斷》

Chapter3

ClinicalManifestationsandDiagnosisofDentalCaries編輯pptHistophathologyofCariesEnamelCaries編輯pptTheearlyenamellesionconsistsoffourzonesofalternatinglevelsofmineralisation.Itillustratesthedynamicnatureofthecariesprocess.Thesurfacezoneblocksthepassageofcalciumionsintothebodyofthelesionandmayhavetoberemovedtoallowthelesiontobecomearrested(AfterKidd&Joyston-Bechal,1987).編輯pptDentinalCaries編輯pptDentinecariescomprisestwo

mainlayers.Intheouterlayer,thedentineisheavilyinfectedwithbacteria.Bothorganicmatrixandmineralhavebeenlostandthedentineisbeyondrepair.Inthedeeperlayer,thedentinehasbeenaffectedbyplaqueacidsanddemineralised.Thenumberofcolonyformingunits(CFU)ofbacteriadecreases(about100times)ascavitypreparationproceedsintoaffecteddentine.Thedamageinthislayerisreversibleifbacterialmetabolismcanbehalted.Abarrieroftranslucent(wellmineralised)dentinemaybeformedaheadoftheadvancinglesion.Reactionary(secondary)dentineformstoprotectthepulpfromacidirritation(AfterKidd&Joyston-Bechal,1987編輯ppt編輯pptRootcarieslesionsEarly:Appearsasradiolucentzoneintherootcementum編輯pptStepsintheformationofanarrestedlesionindentinea)highconcentrationofdissolvedmineralsalts.b)Ifbcterialacidproductionisreduced,andthepHincreases,thesaltsprecipitateintolargecrystalsoftricalciumphosphatewhichtemporallyblockthetubule.c)Iffurtherbacterialactivityissuppressed,theodontoblastsecretescollagenandcalciumsalts.Crystalsofhydroxyapatitethenformandblockthetubulemoreeffectively(AfterDaculsietal,1987)

編輯pptTheProcessofDemineralizationandRemineralizationCariesisadynamicprocess.Teetharesubjectedtoanongoingcycleofdemineralizationandremineralizationdeterminedbythebalanceoffactors.編輯pptDemineralizationDemineralizationistheprocessofremovingminerals,intheformofmineralions,fromdentalenamel.Asubstantialnumberofmineralionscanberemovedfromhydroxyapatitelatticeworkwithoutdestroyingitsstructuralintegrity編輯pptRemineralizationRemineralizationistheprocessofrestoringminerals-again,intheformofmineralions-tothehydroxyapatite'slatticeworkstructure.編輯ppt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(dòng)力過(guò)程。編輯ppt1、除去致齲底物：木糖醇取代蔗糖，減少碳水化合物攝入頻率Dietcounseling:ToidentifythesourcesofsucroseandacidicfoodstuffsinthedietToreducethefrequencyofingestionofbothTousexylitolassugarsubstitute.編輯ppt2、仔細(xì)刷牙，牙面不形成厚的牙菌斑Oralhygiene:Plaquefreetoothsurfacedonotdecay.DentalflossingToothbrushingRinsing編輯ppt3、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)Useoffluoride編輯ppt編輯pptClinicalclassificationofcaries

編輯pptClassificationaccordingtoprogressionrateAcutecaries:progressfast,ofteninchildrenandteenagers,lightcoloredcavity.編輯pptRampantcaries,manytoothinvolvedatsametimeacutecariesfeatureoftenaccompaniedbysystematicdisorder.Suchassjogrensyndromeorsalivareductionafterradiation.

Cariesinapatientwithimpairedsalivaryfunctionasresultofradiationtherapy(courtesyofDrsJansmaandVissink,RUG,theNetherlands).

編輯ppt

編輯pptChroniccaries

progressslowly,blackorbrowncoloredcavityhardremainingdentine

Arrestedcaries

cariesstopprogressingbecauseof

thelocaletiologicalchange編輯pptSecondarycaries(recurrentcaries)cariesrecurredaftertreatment.Oftenatthemarginthefillingmaterialsrestorationorbeneath

Theshadowlocatedonthemesiolingualcuspadjacenttothelargerocclusalamalgamrestorationonthemaxillaryrightfirstmolarindicatesthepresenceofcariousdentin

編輯ppt編輯pptClassificationaccordingtotheinvolvingsiteOcclusalcaries

RootcariesSmoothsurfacecaries編輯pptClassificationaccordingtothedeepnessSuperfacialcaries(淺齲)whitespotlesions,visiblyfrostedsurfacebrownspotDentincaries(中齲)cavitatedlesioninvolvingtheuppartofdentinDeepcaries(深齲)cavitatedlesioninvolvingthepupalthirdofdentin編輯pptDiagnosisVisualchangeProbing:roughsurfaceortrappingpointpainuponprobingTemperaturetestX-rayexaminationTransillumination編輯pptVisualchange

Matte,white,activecervicallesions編輯ppt編輯pptProbing:roughsurfaceortrappingpointpainuponprobing

Theexplorertipcaneasilydamagewhitespotlesions編輯ppt編輯ppt編輯pptTemperaturetest

編輯pptX-rayexamination

編輯pptTransillumination（FOTL,光纖透照法）：

Proximalcarieslesionisdetectedinananteriortoothwiththeuseoftransillumination編輯pptLAF（激光熒光法)

編輯pptThehardwareoftheintra-oralsystemincludesameasurementprobe,acontrolunit,andacomputerfittedwithaframegrabber.Thecontrolunitconsistsofanilluminationdeviceandimagingelectronics.Thelightsourceisaspecialarc-lampbasedonXenon氙technology.Thelightfromthislampisfilteredbyablue-transmittingfilter.Aliquidlightguidetransportsthebluelighttotheteethinthemouth.

QuantitativeLight-inducedFluorescence編輯pptQLF?technicalspecifications編輯pptQLF?theoryTheQLF?methodisbasedontheauto-fluorescence熒光ofteeth.Whenteethareilluminatedwithhighintensitybluelighttheywillstarttoemitlightinthegreenpartofthespectrum.Thefluorescenceofthedentalmaterialhasadirectrelationwiththemineralcontentoftheenamel.QuantitativeLight-inducedFluorescence

編輯pptDIAGNOdentpen(齲齒探測(cè)筆)DIAGNOdenthttp:///products/handpieces_accessories/special_instruments/diagnodent/tutorial.asp?navid=500019&lan=Us&znavid=311000編輯pptDIAGNOdentpen編輯pptDIAGNOdent編輯ppt編輯pptStandardofdiagnosis編輯pptSuperfacialcaries(淺齲)Whitespotorbrown,darklesion,roughuponprobingNocomplaint,nohypersensitivity編輯pptDentincaries(中齲)Cavity,hypersensitivityuponprobing,hotorcoldstimulus.編輯pptDeepcaries(深齲)Deepcavity,verysensitiveandsomepainuponstimulus,howeverthepaindisappearassoonasthestimulusistakenaway.編輯pptTreatmentStrategy編輯pptTreatmentStrategyPreventive(casual,noninvasive)treatmentRestorative(operative,invasive)treatment

編輯pptPreventivetreatmentchemicaltherapy:

useoffluoridewitharegulardailyadministrationorprofessionalapplied.

pitandfissuresealing編輯ppt一、chemicaltherapy

（化學(xué)療法

）

1．藥物治療適應(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。藥物氟化物硝酸銀編輯ppt藥物治療氟化物(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（1.5％APF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。氟化物對(duì)軟組織無(wú)腐蝕性，不使牙變色，安全有效，前后牙均可使用。編輯ppt藥物治療硝酸銀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(duì)軟組織有強(qiáng)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。編輯ppt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編輯ppt2．Remineralization(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：漱口液每日含漱局部應(yīng)用

編輯pptpitandfissuresealing

（窩溝封閉)

適應(yīng)證：窩溝可疑齲；與充填窩洞相鄰的牙合面無(wú)齲深溝裂，應(yīng)用方法：清潔牙面、隔濕、酸蝕、涂布及固化封閉劑。

編輯pptDefinitionofOperativeDentistry

Operativedentistryistheartandscienceofthediagnosis,treatment,andprognosisofdefectsofteethwhichdonotrequirefullcoveragerestorationsforcorrection.

編輯pptSuchtreatmentshouldresultintherestorationofpropertoothform,function,andestheticswhilemaintainingthephysiologicalintegrityoftheteethinharmoniousrelationshipwiththeadjacenthardandsofttissues;allofwhichenhancethegeneralhealthandwelfareofthepatient.

編輯pptIndicationofOperativeDentistry

Caries

Malformed,discolored,orfracturedteethRestorationreplacement

編輯pptProgramofOperativeTreatment

PatientassessmentExaminationanddiagnosisTreatmentplanning編輯pptCavityPreparation

Themechanicalalterationofadefective,injured,ordiseasedtoothinordertobestreceivearestorativematerialwhichwillre-establishahealthystateforthetoothincludingestheticcorrectionswhereindicated,alongwithnormalformandfunction.

編輯ppt編輯ppt編輯ppt

Classificationofcavity

ClassⅠClassⅡClassⅢClassⅣClassⅤClassⅥ—G.V.Blackin1908

編輯pptClassI

AllpitandfissurecavitiesareClassI.

Cavitiesonocclusalsurface;Cavitiesonocclusaltwo-thirdsofthefacialandlingualsurfacesofmolars;Cavitiesonlingualsurfaceofmaxillaryincisor.編輯pptClassII

AcavityoccurringontheproximalsurfaceofposteriorteethareClassII.MOmesialandocclusal

DOdistalandocclusalMODmesial,occlusalanddista

編輯pptClassIIICavitiesontheproximalsurfacesofanteriorteeththatdo

notinvolvetheincisalanglesareClassIII.編輯pptClassIV

Cavitiesontheproximalsurfacesofanteriorteeththatdo

involvetheincisalanglesareClassIV.編輯pptClassVCavitiesonthegingivalthirdofthefacialorlingualsurfacesofallteeth(notpitandfissurecavities)areClassV.編輯ppt編輯pptClassVICavitiesontheincisaledgeofanteriorteethortheocclusalcuspheightsofposteriorteethareClassVI.編輯ppt編輯ppt洞型分類(lèi)一類(lèi)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。二類(lèi)洞：后牙鄰面的齲損所制備的洞型。三類(lèi)洞：前牙鄰面未損及切角的齲損所制備的洞型。四類(lèi)洞：前牙鄰面損及切角的齲損所制備的洞型。五類(lèi)洞：所有牙齒頰（唇），舌（腭）面齦1/3牙面的齲損制備的洞型。六類(lèi)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。編輯ppt編輯pptCavityStructure

wallsanglescavity編輯ppt編輯pptWalls

Internalwalls:apreparedcavitysurfacethatdoesnotextendtotheexternaltoothsurface.

Axialwalls:aninternalwallparallelwiththelongaxisofthetoothandocclusalofthetooth.Pulpalwalls:aninternalwallthatisbothperpe