金教案2 3
TRANSCRIPT
General Hospital Tianjin Medical University Sherry Jin Yan-
jiao(TEL:60362418)
March 2009
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CHAPTER 2. Dental caries-Endodontics-Periapical disease 2.1 Dental caries
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Definition of dental cariesDental caries can be defined as progressive
and irreversible bacterial damage to hard
tissue of teeth exposed to the oral environment. It is characterized by demineralization of these tissues followed by disintegration of their organic material. The disease can result in bacterial invasion and death of the pulp and spread of infection into the periapical tissues, causing pain
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Traditional Caries Model
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Factor 1:dental plaque
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Factor 2: Host—teeth and saliva
TEETH
Be Associatedwith
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Factor 3:sugar
All these must be present for a sufficient length
of time
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Current Concept of the Caries Process
Important things to note are:A natural phenomenonSpread over timeNot have to progressDepend on the modifying factors
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Caries RiskMalnourished childrenSocially deprivedSome of the wealthyThose who snack on sugary products
Medically compromised/handicapped
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Caries RiskInfants who demand on breast feeding beyond 42 months or are fed with sugary fluids
Residents of non-fluoridated water
Clinical evidence
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High –risk Teeth Position
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High –risk Tooth Surfaces
Pits,grooves and fissureInterproximal areasCervical areas
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Pits,grooves and fissure
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Pits,grooves and fissure
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Interproximal areas
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Cervical Caries
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Caries diagnosis
Requirement Good lightingDry and plaque free teethBlunt probeMouth mirrorSharp eyes
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Visual /tactile criteriaOpacity or discolouration: chalky white
Opacity or discolouration: brown or black
Enamel breakdownObvious cavitation
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Progression of Dental CariesA)Enamelcaries
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Progression of Dental CariesB)Dentinecaries
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Progression of Dental CariesC)Pulpinvolved
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Progression of Dental CariesD)Periapicalabscess
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Classification of caries1.Based on development of the lesion
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Classification of caries 2.Based on severity of the lesion
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Based on severity of the lesion Superfacial caries
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Based on severity of the lesion Intermediate caries
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Based on severity of the lesion Deep caries
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Clinical manifestation of caries
Tooth painBad breathFoul taste
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InquirySpectationTouchProbeCold and warm testX-ray
Diagnosis of dental caries:
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Spectation
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Probe
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Cold test
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Warm test
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Mechanical measure for caries control
ToothbrushingMouth RisingDental FlossFissure and pits
sealants
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Operative Treatment for Caries
For superfacial and intermediate cariesRestoration of teeth
with amalgam, composite resin, glass ionomer
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Operative Treatment for Caries
For deep caries
Remove caries and place a Calcium Hydroxide base
Then a temporary filling
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Operative Treatment for Caries
For deep caries
In the case of irreversible pulpitis, root canal treatment(RCT) is necessary
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Operative Treatment for Caries
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Main topics
Definition of dental caries
Four principal factors of causes for caries
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Take a rest
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2-2 Endodontics (pulp diseases)
1.Pulpitis Acute pulpitis Chronic pulpitis Retropulpitis and residual pulpitis2.Pulp degeneration3.Pulp necrosis
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The main causes of pulpitisDental cariesTraumatic exposureFracture of the crownThermal effectsChemical irritation
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Acute pulpitis
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Chronic pulpitisPain is not prominent featureThe reaction to the thermal change is dramatically reduced
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2-3.Periradicular lesionsAcute apical periodontitis Acute periradicular abscessChronic apical periodontitis Chronic periradicular abscess Chronic periradicular granuloma Radicular cyst
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Acute apical periodontitis
Exhibit normal periradicular structure but painful to percussion
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Acute periradicular abscess
Pain ,rapid onset, tenderness to percussionThe exudates can be confined to the alveolar
bone, causing localized swelling of soft tissue, or extend into facial space (cellutis)
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Chronic apical periodontitis The development of an asymtomatic periradicular
lesion at the periapex1.Chronic periradicular abscess2.Chronic periradicular granuloma3. Radicular cyst
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Treatment for pulp diseases and periradicular lesions
Root canal treatment
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Take a rest
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