口腔預(yù)防醫(yī)學(xué)：第四章 齲病的預(yù)防

1、1Pathogenic Factors in Dental Caries2Keyess diagramMicroorganismToothFoodTime 3Four factorsBacteria: S. mutans, LB, ActFood: CarbonhydrateHost: teeth, saliva, acitivity and habitTime4Dental cariesMicrobiology in CariologyDental Plaque Dental plaque is the prime aetiological agent of the two main ora

2、l diseases, dental caries and periodontal disease. http:/www.delftoutlook.tudelft.nl/info/indexe0ee.html?hoofdstuk=Article&ArtID=51167Major cariologic bacteriaMutans streptococciLactobacillus spActinimyces sp(Newbrun, Cariology, Chapter 3, 1989) 8Mutans streptococciNonmotile Gram-posotive cocci in s

3、hort or medium chainsWindows of infectivityhttp:/www.irishscientist.ie/2001/01images/01p2080102.jpg9Oral lactobacilliRepresent about 1% of the oral floraConstitute only a minor fraction (1/10,000) of the plaque floraAre both acidogenic and aciduric http:/www.irishscientist.ie/2001/01images/01p208010

4、2.jpg10Oral ActinomycesGram-positive Nonmotile Ferment glucose and produce lactic acid(Newbrun, Cariology, chapter3, 1989)11A. naeslundii: Gram stain (1,000)Actinomyces: scanning electron micrograph (18,000)(Prescott L et al. Dental infection. In Microbiology. New York: Von Hoffmann Press, 2002)12Lo

5、cation of the oral flora related to cariesThe different organisms display some selectivity as to which tooth surface they attack 13 Types of dental caries in animal model systemType of caries Etiological organismPossible significance in human diseasePit and fissureS mutansVery significamt Lactobacil

6、lus spVery significant Actinimyces spMay be significant S sanguisNot very significant Other streptococciNot very significant Smooth surfaceS mutans Very significant S salivariusProbably not significant Root surface A viscosusVery significant A naeslundiiVery significantOther filamentous rodsVery sig

7、nificantS mutans significantS sanguisMay be significant S salivariusProbably not significant Deep dentinal caries Lactobacillus spVery significantA naeslundiiVery significantA viscosusSignificantOther filamentous rodsVery significantS mutansMay be significant (Newbrun, Cariology, Chapter 3,1989) 14P

8、roperties of cariogenic potentialAciduricity at pH levels observed in cariogenic plaqueStrong acidogenicity Ability to synthesize water-insoluble glucan polymers in the presence of dietary sucroseAttachment to the tooth pellicle (Newbrun, Cariology, chapter 3, 1989) 15SummaryBacteria are essential f

9、or the development of a carious lesionThe microflora associated with pit and fissure caries, smooth surface caries, root caries, deep dentinal caries are not the same The early and mature plaques are not the same16Risk factor-bacteriaNumber of S. mutans is increasedNumber of LB is increasedpH of pla

10、que is acid (5.5)Number of cariogenic and acid-producing bacteria is increased17Factor-hostTeethSalivaActivity and life style18Risk factor-hostTeethdental defects1)defects of teeth enamel 2)pit and fissure3)irregular teeth alignment 4)impacted wisdom teeth5)contacting points of gear teeth surfaces 1

11、9Risk factor-hostTeeth20 Medical source 1)Secondary caries2)Crown3)Orthodontic appliance4)Nonstandard pit&fissure seal21Local pathological source 1)Exposure of root2)Abrasion of tooth3)Turners tooth22Problem of saliva secretionXerostomiaSjogrens syndromeSalivary gland destroyed by X-xayMedicineAging

12、 change of salivary gland 23Past medical history and environmentsIllness of the whole bodyDisabilitySocial and economical status24Factor-foodCarbohydrate: Sucrose, glucose, starchFrequencyOverdose飲食控制 Diet Control 控制蔗糖及精制碳水化合物的攝入頻率26Risk factor- FoodToo much or too often usage of carbonhydrate pH is

13、 decreased Teeth are demineralizedAcid beverageBad habit27Cariogram - the five sectorsThe dark blue sector Diet is based on a combination of diet contents and diet frequency. The red sector Bacteria is based on a combination of amount of plaque and mutans streptococci. The light blue sector Suscepti

14、bility is based on a combination of fluoride program, saliva secretion and saliva buffer capacityThe yellow sector Circumstances is based on a combination of past caries experience and related diseasesThe green sector shows an estimation of the Actual chance to avoid new cavities. The green sector i

15、s what is left when the other factors have taken their share! Caries Prognosis and Early DiagnosisCaries Prognosissusceptible group Past medical historyCariologic bacteriaSalivaIllness of the whole bodySocial and economical statusClinical prognosis乳牙齲數(shù)量多牙根面外露釉質(zhì)發(fā)育不全早產(chǎn)兒和低出生體重兒干燥綜合征菌斑滯留重度氟牙癥阻生牙口腔衛(wèi)生不良不合

16、理飲食習(xí)慣Laboratory prognosis齲活性試驗(yàn)（caries activity test）致齲菌檢測(cè)酸性產(chǎn)物檢測(cè)唾液緩沖能力檢測(cè)caries activity testDentocult SM testDentocule LB testCariostat testDentobuff strip testResazurin disc test定量PCR法caries activity test細(xì)菌因素：Number of S. mutans is increasedNumber of LB is increasedpH of plaque is acid (5.5)Number o

17、f cariogenic and acid-producing bacteria is increasedCaries Early Diagnosis臨床檢查X線片檢查特殊儀器檢查脫礦, 小齲洞和齦炎幾周后 : 發(fā)生再礦化，齦炎愈合常規(guī)臨床檢查 齲病的早期診斷 （一）臨床診斷 齲病的預(yù)測(cè)與早期診斷光滑面早期齲-齲白斑窩溝早期齲-變黑、粗糙鄰面早期齲-粗糙、X線 常規(guī)臨床檢查（視覺、觸覺）齲病早期診斷X線法儀器檢測(cè)：激光熒光法；定量光導(dǎo)熒光法；電阻法；光纖透照法；數(shù)字成像光纖透照法等。齲病的早期診斷 X線診斷 特殊儀器檢查 齲病的預(yù)測(cè)與早期診斷齲病的三級(jí)預(yù)防Three Levels of Pre

18、vention for Dental Caries 一級(jí)預(yù)防 Primary Prevention 1. 進(jìn)行口腔健康教育 2. 控制及消除危險(xiǎn)因素 二級(jí)預(yù)防 Secondary Prevention 早期診斷早期處理，定期臨床檢查，X線片等輔助診斷，在檢查診斷基礎(chǔ)上做早期充填等治療三級(jí)預(yù)防 Tertiary Prevention 1. 防止齲病的并發(fā)癥 2. 恢復(fù)功能（一）Plaque Control致齲細(xì)菌存在于牙菌斑, 粘附在牙面上牙菌班的控制是防齲的主要途徑之一。目前尚缺乏長(zhǎng)期高效而且安全的對(duì)致齲菌斑的控制方法。1. 機(jī) 械 法用牙刷、牙膏、牙線、牙間清潔器等保健用品，清除口腔內(nèi)菌斑。但無法完全清除所有的菌斑，尤其是存在于牙齒點(diǎn)隙裂溝位置的菌斑，牙刷無法進(jìn)入，而這些部位正是齲病的好發(fā)部位。2、化學(xué)方法chlorhexidine：抑菌作用， 變形鏈球菌、放線菌triclosan：抑菌殺菌效果3. 生物學(xué)方法（1）天然植物抗菌劑（黃芩、厚樸、五倍子、金銀花等）（2）生物方法：酶類（特異性及非特異性酶）（3）抗菌斑附著劑（茶多酚 ，甲殼素，一些無機(jī)離子等）（4） 替代療法從常駐細(xì)菌獲得無害的突變株，作為效應(yīng)菌(effector strain)接種于齲