牙體牙髓病學(xué)概論(NXPowerLite)ppt課件

1、Cariology Cariology and and EndodonticsEndodonticsA discipline to study the etiology, pathogenic mechanism, pathology, pathology-physiology,clinical expression,treatment and favorable turn etc. of the disease on dental hard tissue and pulp tissue. The content of the textbook Cariology Non-cariogenic

2、 disease of dental hard tissue Endodontics Operative dentistryHistoryIn 50s yearsOral medicineCariologyOperative dentistryEndodonticsNon-cariogenic disease of dental hard tissueDisease of Oral mucosaPreventive dentistryPeriodontologyPaediatrics for dentistryStomatology in ancient timesBefore Christ

3、(B.C.)There were some record about cariesImage liking character (script) worm + toothThe chinese were known to have treated dental ills with knife, cautery, and acupuncture, a technique whereby they punctured different areas of the body with a needle.In Dynasty Han (A.D.215282)There are some record

4、about periodontologyAnno DominiPulpitisIn Han, Mr. Zhang Zhong Jing Jin Gui Yao luewas a very famous writings in which there was a record about arsenicArsenic is a toxicant medicine which has been generally used for killing pulp In Dynasty Tang (A.D.710 era)the people use silver paste to fill tooth

5、decay In Tang, tooth brush with willow twig a toothbrush with hair planted was invented in A.D.911 century from a tomb of an emperors son-in-law of Liao from Chi Fong city3 events above describedreflected ancient civilization of our countryDentistry development in West countryThe first known dentist

6、 was an Egyptian named Hesi-re (3000 B. C.). He was chief toothist to the pharaohs, he was also a physician, indicating an association between medicine and dentistry.The GreeksHippocrates (500 B. C.) appreciated the importance of teeth. He accurately described the technique for reducing a fracture o

7、f the jaw and also replacing a dislocated mandible. He was familiar with extraction forceps for this is mentioned in one of his writings.Aristotle (384 B.C.) also stated figs and soft sweets produce decay.Galen (200A. D. Romans)was first to recognize that toothache could be:Pulpitis or pericementiti

8、sHe also classified teeth into centrals,cuspids and molars.However, credit has been given to Dr. Nathaniel Highmore of England (1650).D. Leeuwenhoek (17th Century) - invented the microscope. He described the dental tubuli and was the first to see organisms of the mouth Anton van leeuwenhoekK. John G

9、reenwood (1789) - dentures for George Washington were made by him.a red laser scansGeorge Washingtons false teeth not woodenLaser scans find gold, ivory, lead, human and animal teeth L. Pierre Fauchard (18th Century - 1728) - Father of Scientific Dentistry. Wrote a great text Surgeon Dentist. He als

10、o wrote a complete work on Odontology in two volumes, 843 pages. He recognized the intimate relationship between oral conditions and general health. He advocated the use of lead to fill cavities. He removed all decay and if the pulp was exposed, he used the cautery. Musee dArt Dentaire Pierre Faucha

11、rdat the Academie Nationale de Chirurgie Dentaire22 Rue Emile Menier, 75116, Paris FranceHe prescribed oil of cloves and cinnamon for pulpitis. He described partial dentures and full dentures in his text. He constructed dentures with springs and used human teeth. Gold dowels were used in root canals

12、 filled with lead. He was also known as Father of Orthodontics. Fauchard died in 1768 at the age of 83. 1763 A.DJohn Baker, M.D. Surgeon Dentist. The earliest qualified dentist to practice in Boston and in America. 1836 A.D.Arsenic introduced for the killing of pulps, by Spooner.1840 A.D.The America

13、n Society of Dental Surgeons, first national dental organization. The Baltimore College of Dental Surgery, the first school in the world for the training of dentists was founded by Harris and Harden.Founded by Harris and Harden1891 A.D.Extension for prevention and scientific cavity preparation promu

14、lgated by G.V. Black. 1892 A.D. The establishment of a three-year course in dental colleges.1906 A.D.Einhorn recommends novacaine and adrenalin combination for local anesthesia.1915 A.D.McKay and Black publish results of investigation of fluoride in drinking water.1956 A.D.Air-rotor drill, 250,000 R

15、PM Dr. Robert Borden.Stomatology in China before 1949 West China University (1910) Shanghai Second University(1920) 4th Military Medical University(1935) Beijing University(1943)Shanghai Second UniversityWest China University 1918(School 1910)The first dental school in China was founded in West Chin

16、aMedical University in 1917. A.W. LindsayA. W. Lindsay was teachingAfter 1949Hubei Medical College 1960 Founder Prof. Xia Liang Cai In recent 20 years, the science and techniques got great progressThere are 12 faculties or dental schools in each province Caries researchCaries VaccineEtiology & preve

17、ntion Pulp diseaseModern root canal traitment Pulp biologyStem cell final targetAchievementsCraniofacial-oral-dental research in the century21stWhere we are (strengths, weaknesses, opportunities and threats)Where we want to go (e.g., mission and vision)How we plan to get there (strategic plan)Severa

18、l scientific areas will be concerned in century 21stFrom molecular biology to clinical investigations; etiology, pathogenesis, epidemiology, prevention, diagnosis and treatment of inherited craniofacial-oral-dental diseases and disorders. e.g., ectodermic, dysplasia, cleft lip and palate, amelogenes

19、is imperfect, dentin genesis imperfect, osteogenesis imperfect, and other inherited diseases.Inherited disease and disordersHereditary hypoplasiaHereditary aplasia of the enamel dental caries Periodontitis Oral candidiasis Herpes Hepatitis,HIV/AIDSInfections diseasesViral, bacterial, fungal and para

20、sitic such asDiseased PeriodontiumPrimary herpetic stomatitisCandidal stomatitisNeoplastic diseaseSupports basic, patient oriented, and community-based research on the etiology, pathogenesis and metastasis, epidemiology, prevention, diagnosis, treatment of oral and pharyngeal neoplastic diseases Chr

21、onic disabling diseasesThe full range of research involving chronic disabling disease associated with the craniofacial-oral-dental complexThis includes osteoporosis, osteoarthritis and related bone disorders, temporo-mandible joint diseases and disorders, neuropathies and neuro-degenerative diseases

22、 including those involving oral sensory and motor functions and autoimmune diseases such as sjgrens syndrome. Chronic diseases of cran-oral-dental complex and other systemic diseases (e.g., diabetes)Biomaterials, biomimetics and tissue engineering Biomaterials used for the repair, regeneration, rest

23、oration and reconstruction of craniofacial-oral-dental molecules,cells, tissues and organs The study of computer aid design (CAD) computer aid manufacture (CAM) for dentureBehavior, health promotion and environment aimed at assessing the interactive roles of sociological, behavior, economic, environ

24、mental, genetic, and biomedical factors in craniofacial-oral-dental diseases and disorders 2019 Diet and Oral HealthCariology is a discipline within Stomatology which deals with the complex interplaying between the oral fluids and the microbial deposits in relation to subsequent changes in the denta

25、l hard tissues. Several index have been used in dental caries Prevalence= No of the patients with caries No of the specific population in an area at risk of getting caries at that time Prevalence of caries: the total caries experience of a population in existence at a certain time in a designated ar

26、ea.Caries incidence is usually expressed as the number of new decayed teeth or surfaces per-a period in a individual,group, or population. Incidence of cariesDMF=Decayed teeth+Missing teeth+Filled teeth/Number of subjects examined DMFTvIf surface have been counted, then we refer to the score as DMF-

27、SvIf the teeth have been counted, then it is refer to as DMF-TvThe DMF-S or DMF-T are often referred to as an “index”The distribution of dental caries in oral cavityReducing tendency in developed country The DMFT prevalence of 12-year-old children in the Nordic countries in the period 1974-91.Denmar

28、k,Finland ,Norway and Sweden seem to follow the same downward trend, whereas Iceland has started a more rapid decline somewhat later. Increasing tendency in developing country958498959892959813Romania China Fuji Tonga Jordanian45627883858662DMFTs for 12 Years-old in Part of developing countryThe car

29、ies prevalence of China Time Population people with caries prevalence Before 1949 32469 19258 59.3019501959 219312 106781 48.7019601969 544708 217774 40.0019701979 3766290 1356362 36.00 131340 40.54 permanent teethCities 25080Countryside 20636 29.70 Cities 19683 79.55Countryside 16253 58.48Deciduous

30、 teethThe DMFT prevalence of 12-year-old children in 11 provinces of ChinaBeijing 1.41 0.98Shanghai 1.17 0.95Tianjing 1.41 1.02Gansu 0.36 0.8Shandong 0.69 0.59Yunnan 0.46 0.88Liaoning 0.76 1.29Zhejiang 1.22 1.46Hubei 0.98 0.51Guangdong 0.91 1.65Sichuan 0.57 0.37Account 0.67 0.88 Province DMFT(1983)

31、DMFT(2019) Age DMFT 12 1.03 15 1.42 18 1.60 3544 2.11 6574 2.49 (DFT) The DMFT prevalence in 2019Current concept of caries etiologyDental caries is a multifactorial disease in which there is an interplay of three principal factors: the host (primarily the saliva and teeth), the microflora, and the s

32、ubstrate, or diet. A fourth factor time must be considered in any discussion of the etiology of caries. Diagrammatically,these factors can be portrayed as four overlapping circles. Micro-organismshost & toothSub-strateThe four circles diagrammatically represent the factors involved in the carious pr

33、ocess.all four factors must act concurrently (overlapping of the circles)for caries to occurtimeno cariesno cariesno cariesno cariescariesCaries requires a susceptible host, a cariogenic oral flora and a suitable substrate that must be present for a sufficient length of timeSalivathe term saliva ref

34、ers to the mixture of secretions in the oral carityvSaliva is produced day and night and it is constantly swallowed vSaliva is present as a proteinaceous film covering all surfaces of oral cavityThis mixture consists of fluids derived from the major salivary glands minor glands of oral mucose traces

35、 from gingival exudateEffect of desalivation on incidence and extent caries in animals Effect of desalivation on caries in hamstersGruopNo. hamstersAvg. no. carious teethAvg. caries scoreIntact Salivary glands202.34.0Desalivated*1010.539.0*Parotid, submandibular, and sublingual glands.Decreased sali

36、vary flow and caries in humansvSarcoidosisvSjogrens syndromevTharapeutic radiationHydrogen ionBuffering abilityCalciumInorganic phosphateFluoricle Inorganic componentsOrganic componentsmucinsGlycoproteinsStatherin and acidic proline-rich proteinsamylaseAntrmicrobial proteinsSaliva and dental cariest

37、he quantity of saliva associated with caries experienceRelationship between salivary characteristics and caries prevalencePropertyRelationshipPropertyRelationshipFlow ratepHCa-Buffer capacity+PO4NH3AmylaseViscosityUrea-Salivary composition and cariesAntibacterial factors of glandular origin could pr

38、otect oral mucosal and hard surfaces by helping to regulate the quantity and species distribution of oral microbesOral Microorganisms and dental plaqueIn contrast to mucosal surfaces, the surfaces of teeth are not constantly renewed by shedding of colonized epithelial cells. Surfaces of teethSome sp

39、ecial sites occlusal fissues Approximal surfaceDental depositsBiofilms on dental surface-matrix-embedded microbial population, adherent to each other and/or to surface or interfacesAcquired pellicleAcellular, homogeneous organic film that forms on enamel and other hard surface by selective adsorptio

40、n of salivary proteins. adsorption of salivary proteins or glycoproteinsOrigin Immediately after cleaning and polishing, salivary secrete deposit in the defects of enamel.v Surface pelliclev Subsurface pellicleHistological appearanceThe surface pellicle appears acellular and faintly granular under T

41、EM Surface PelliclePellicles of unknown age may vary in thickness from 501000nm.globular fibrillar granular Different morphological typesA subsurface pellicleconsisting of dendritic processes that spread into the intercrystalline spaces and extend to 3m into the enamel.90% water 10% solid material c

42、ompositionAccording to chemical analysesamino acids account for 45% to 50% carbohydrates amount 10% to 15% of the dry weight lipidFunctionvhealing, repairing, or protecting the enamel surfacevimparting selective permeability to the enamelvinfluencing the adherence of specific oral microorganisms to

43、the tooth surfacevserving as a substrate or nutrient for the organismssummaryvOrganic depositvNaturally forms by selective adsorptionvOrigin of protein from salivavAfter polishing, reforms rapidlyvBacteria settle on the pellicle as soon as it forms vformation of dental plaqueDental Plaque In the fou

44、rth century B. C. Aristotle related soft, adhere food deposits to tooth decay, but it was not until the advent of the microscope in the seventeenth century that “animalcules (microorganism) were seen in these dental deposits.Anton van leeuwenhoek, a draper and sheriffs chamberlain in Delft recognize

45、d the limitation of mechanical oral hygiene in removing these deposits. Anton Van leeuwenhoek saw large numbers of living cells in scrapings from teeth:I judge from myself that all the people living in our united Netherlands are not as many as the living animalcules that I carry in my own mouth this

46、 very day.Terminology1847 Ficinus a slime coating denticulate Williams demonstrated the presence of a mass of microorganisms 1895 G.V. Black gelatinous microbial plaqueDental plaque Most figurative description: a bacterial aspic with millions of organisms standing shoulder to shoulder More formal de

47、finition by Le: plaque is the soft, non-mineralized, bacterial deposit which forms on teeth and dental prosthesis that are not adequately cleanedMorphology of dental plaque A white or off-white accumulation Variable thicknessThree main typies of organisms coccoid rod-shaped filamentous classificatio

48、nvSupragingival plaque vSubgingival plaque vDental calculus (calcified plaque)Supragingival plaquevSmooth surface plaque vFissure plaque Supragingival smooth surface plaqueDivided into 4 areas: plaque/tooth interfacecondensed microbial layerbody of the plaque plaque surfaceplaque/tooth interfaceIn s

49、ome locations no pelicleHigher magnification of plaque-enamel border. Microorganisms that divide in horizontal planes are in direct contact with enamel (1 30,000). Condensed microbial layer a layer of very densely packed coccoid organisms, from 320 cells thickPart of a 7-day-old interdental plaque g

50、rown on enamel. The enamel matrix (bottom), appearing as a fine meshwork, is covered by a thin electron-dense and discontinuous pellicle. Immediately above this is the condensed microbial layer which is covered by a layer of coccoid and filamentous micro-organisms and probably Neisseria. The intermi

51、crobial space is electron-lucent and reveals cell remnants ( 1 6,500).vBody of the plaquev this occupies by far the largest portion of the plaque Thin section of plaque made of different bacterial species-predominantly coccoidal.Dense aggregation of microorganisms at the enamel surface (lower left)v

52、Plaque surfacev loosely arrangement vGreat variety: coccoid, rod like, “corncob”In the surface layer of plaque some microorganisms co-aggregate with other species, as visualized by the presence of so-called corn cob structuresMagnified view of “corncob”Free surface of plaque composed of unidentified

53、 organismsFree surface of plaque composed of coccoid gram-positive (heavily stained cell walls ) and unidentified gram-negative microorganismsFissure plaque Gram-positive cocci and short rods predominate in a homogeneous,matrix, with occasional yeast cells Palisade and branching filaments are absent

54、 within the fissuresA: survey of dental plaque situated within a deep, narrow fissure of a premolarB: the upper half of the fissure is filled with dark material, the lower half is les dense C: Higher magnification reveals a plaque consisting of mostly ghostlike membrane and cell wall structures Subg

55、ingival plaque The matrix is sparse Organisms:filamentous organisms, bacilli, cocci, spirochetes Gram negative bacteriaThe filamentous nature of plaque associated with gingivitis. Note attachment of smaller bacteria to filamentsCalcified plaqueSupragingival calcucus white chalky yellowSub gingival c

56、alculus greenish blackDental calculus is plaque in which mineralization has involved both the plaque matrix and the microorganisms.Formation and development of dental plaques vUneven tooth surface vCarious lesions vill-filling margins of restorationsvIrregularities in positioning of the teeth the lo

57、cation favoring plaque formation:vPellicle formationvMicrobial colonization Process of formationPlaque formation can be considered as three phasesvInitial colonizationvRapid bacterial growthvRemodeling Bacteria are thought to be unspecifically associated with the tooth surface under the influence of

58、 Van der walls attractive forces as well as repulsive negative electrostatic forcesInitial microbial colonizationVan der walls forcesThere is a weakness forces between the molecules to be equal to 1/101/100 energe of chemical bondDepend on the cause and character of producing the forces:vOrientation

59、 forcevInduction force vDispersion forceOrientation forceInduction forceDispersion forceA firm attachment may subsequently be achieved by specific mechanismsLigands theoryRecognized system “adhesions” ”receptors”Simplified explanation of the principle of selective adherence of bacteria to enamel. Su

60、ccessful attachment is achieved when the surface characteristics of a bacterium fit with a component in the pellicle (P)Two-reaction process for S.mutans initial weak attachment occurs between bacterial cell proteins and salivary glycoproteins of the acquired pellicle and is followed by cellular acc