牙体牙髓病学概论.pptx

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1、A 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.第1页/共291页The content of the textbookCariology Non-cariogenic disease of dental hard tissue EndodonticsOpera

2、tive dentistry第2页/共291页History第3页/共291页In 50s yearsOral medicinevCariologyvOperative dentistr yvEndodonticsvNon-cariogenic disease of dental hard tissuevDisease of Oral mucosavPreventive dentistr yvPeriodontologyvPaediatrics for dentistr y第4页/共291页Stomatology in ancient timesBefore Christ(B.C.)There

3、 were some record about caries第5页/共291页Image liking character(script)worm +tooth第6页/共291页The 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.第7页/共291页In Dynasty Han(A.D.215282)There are som

4、e record about periodontologyAnno Domini第8页/共291页PulpitisIn 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第9页/共291页 In Dynasty Tang(A.D.710 era)the people use sil

5、ver paste to fill tooth decay 第10页/共291页In Tang,tooth brush with willow twigtooth 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 city第11页/共291页3 events above describedreflected ancient civilization of

6、our country第12页/共291页Dentistry development in West country第13页/共291页The first known dentist 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.第14页/共291页The GreeksHippocrates(500 B.C.)appreci

7、ated the importance of teeth.He accurately described the technique for reducing a fracture of the jaw and also replacing a dislocated mandible.He was familiar with extraction forceps for this is mentioned in one of his writings.第15页/共291页Aristotle(384 B.C.)also stated figs and soft sweets produce de

8、cay.第16页/共291页Galen(200A.D.Romans)was first to recognize that toothache could be:Pulpitis or pericementitisHe also classified teeth into centrals,cuspids and molars.第17页/共291页B.Leonardo da Vinci (end of 15th Century)-he described the anatomy of the jaws,teeth and maxillary sinus.These drawings are t

9、he first to accurately describe the maxillary sinus.However,credit has been given to Dr.Nathaniel Highmore of England(1650).第18页/共291页D.Leeuwenhoek(17th Century)-invented the microscope.He described the dental tubuli and was the first to see organisms of the mouth 第19页/共291页Anton van leeuwenhoek第20页

10、/共291页K.John Greenwood(1789)-dentures for George Washington were made by him.第21页/共291页a red laser scansGeorge Washingtons false teeth not woodenLaser scans find gold,ivory,lead,human and animal teeth 第22页/共291页L.Pierre Fauchard(18th Century-1728)-Father of Scientific Dentistry.Wrote a great text Su

11、rgeon Dentist.He also 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.第23页/共291页Musee dAr

12、t Dentaire Pierre Fauchardat the Academie Nationale de Chirurgie Dentaire22 Rue Emile Menier,75116,Paris France第24页/共291页He 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 do

13、wels were used in root canals filled with lead.He was also known as Father of Orthodontics.Fauchard died in 1768 at the age of 83.第25页/共291页1763 A.DJohn Baker,M.D.Surgeon Dentist.The earliest qualified dentist to practice in Boston and in America.第26页/共291页1836 A.D.Arsenic introduced for the killing

14、 of pulps,by Spooner.第27页/共291页1840 A.D.The American 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.第28页/共291页Founded by Harris and Harden第29页/共291页1859

15、A.D.Organization of American Dental Association on a representative basis.第30页/共291页1890 W.D.Miller propose a chemical-bacteria Paraorganism theory to explain the mechanism of caries第31页/共291页1891 A.D.Extension for prevention and scientific cavity preparation promulgated by G.V.Black.1892 A.D.The es

16、tablishment of a three-year course in dental colleges.第32页/共291页1906 A.D.Einhorn recommends novacaine and adrenalin combination for local anesthesia.第33页/共291页1915 A.D.McKay and Black publish results of investigation of fluoride in drinking water.第34页/共291页1956 A.D.Air-rotor drill,250,000 RPM Dr.Rob

17、ert Borden.第35页/共291页Stomatology in China before 1949 West China University(1910)Shanghai Second University(1920)4th Military Medical University(1935)Beijing University(1943)第36页/共291页Shanghai Second UniversityWest China University 1918(School 1910)第37页/共291页The first dental school in China was foun

18、ded in West ChinaMedical University in 1917.A.W.Lindsay第38页/共291页A.W.Lindsay was teaching第39页/共291页After 1949Hubei Medical College 1960 Founder Prof.Xia Liang Cai 第40页/共291页In recent 20 years,the science and techniques got great progressThere are 12 faculties or dental schools in each province 第41页/

19、共291页 Caries researchCaries VaccineEtiology&prevention Pulp diseaseModern root canal traitment Pulp biologyStem cell final targetAchievements第42页/共291页Craniofacial-oral-dental research in the century21st第43页/共291页The leadership team of NIDR initiated a strategic planning process in 1999 to identifyW

20、here 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)第44页/共291页Several scientific areas will be concerned in century 21st第45页/共291页From molecular biology to clinical investigations;etiology,pathogenesis,epidemi

21、ology,prevention,diagnosis and treatment of inherited craniofacial-oral-dental diseases and disorders.e.g.,ectodermic,dysplasia,cleft lip and palate,amelogenesis imperfect,dentin genesis imperfect,osteogenesis imperfect,and other inherited diseases.Inherited disease and disorders第46页/共291页第47页/共291页

22、Hereditary hypoplasia第48页/共291页Hereditary aplasia of the enamel第49页/共291页 dental caries Periodontitis Oral candidiasis Herpes Hepatitis,HIV/AIDSInfections diseasesViral,bacterial,fungal and parasitic such as第50页/共291页Diseased Periodontium第51页/共291页Primary herpetic stomatitis第52页/共291页Candidal stomat

23、itis第53页/共291页Neoplastic diseaseSupports basic,patient oriented,and community-based research on the etiology,pathogenesis and metastasis,epidemiology,prevention,diagnosis,treatment of oral and pharyngeal neoplastic diseases 第54页/共291页第55页/共291页第56页/共291页Chronic disabling diseasesThe full range of re

24、search involving chronic disabling disease associated with the craniofacial-oral-dental complex第57页/共291页This includes osteoporosis,osteoarthritis and related bone disorders,temporo-mandible joint diseases and disorders,neuropathies and neuro-degenerative diseases including those involving oral sens

25、ory and motor functions and autoimmune diseases such as sjgrens syndrome.第58页/共291页第59页/共291页Chronic diseases of cran-oral-dental complex and other systemic diseases(e.g.,diabetes)第60页/共291页Biomaterials,biomimetics and tissue engineering Biomaterials used for the repair,regeneration,restoration and

26、reconstruction of craniofacial-oral-dental molecules,cells,tissues and organs 第61页/共291页The study of computer aid design(CAD)computer aid manufacture(CAM)for denture第62页/共291页第63页/共291页第64页/共291页Behavior,health promotion and environment aimed at assessing the interactive roles of sociological,behavi

27、or,economic,environmental,genetic,and biomedical factors in craniofacial-oral-dental diseases and disorders 第65页/共291页1996 Diet and Oral Health第66页/共291页第67页/共291页第68页/共291页Cariology is a discipline within Stomatology which deals with the complex interplaying between the oral fluids and the microbia

28、l deposits in relation to subsequent changes in the dental hard tissues.第69页/共291页第70页/共291页Several index have been used in dental caries 第71页/共291页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

29、 caries experience of a population in existence at a certain time in a designated area.第72页/共291页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 caries第73页/共291页DMF=Decayed teeth+Missing teeth+Filled t

30、eeth/Number of subjects examined DMFT第74页/共291页If surface have been counted,then we refer to the score as DMF-SIf the teeth have been counted,then it is refer to as DMF-TThe DMF-S or DMF-T are often referred to as an“index”第75页/共291页The distribution of dental caries in oral cavity第76页/共291页第77页/共291

31、页第78页/共291页Reducing tendency in developed country 第79页/共291页第80页/共291页The DMFT prevalence of 12-year-old children in the Nordic countries in the period 1974-91.Denmark,Finland,Norway and Sweden seem to follow the same downward trend,whereas Iceland has started a more rapid decline somewhat later.第81

32、页/共291页Increasing tendency in developing country第82页/共291页958498959892959813Romania China Fuji Tonga Jordanian45627883858662DMFTs for 12 Years-old in Part of developing country第83页/共291页The caries prevalence of China Time Population people with caries prevalence Before 1949 32469 19258 59.3019501959

33、 219312 106781 48.7019601969 544708 217774 40.0019701979 3766290 1356362 36.001983 131340 40.54 permanent teethCities 25080Countryside 20636 29.70 Cities 19683 79.55Countryside 16253 58.48Deciduous teeth第84页/共291页The DMFT prevalence of 12-year-old children in 11 provinces of ChinaBeijing 1.41 0.98Sh

34、anghai 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)DMFT(1995)第85页/共291页 Age DMFT 12 1.03 15 1.42 18 1.60 3544 2.11 6574 2.49(DFT)The DMFT prevale

35、nce in 1995第86页/共291页Current concept of caries etiology第87页/共291页Dental 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 substrate,or diet.第88页/共291页A fourth factor time must be considered in

36、any discussion of the etiology of caries.Diagrammatically,these factors can be portrayed as four overlapping circles.第89页/共291页Micro-organismshost&toothSub-strateThe four circles diagrammatically represent the factors involved in the carious process.all four factors must act concurrently(overlapping

37、 of the circles)for caries to occurtimeno cariesno cariesno cariesno cariescaries第90页/共291页Caries requires a susceptible host,a cariogenic oral flora and a suitable substrate that must be present for a sufficient length of time第91页/共291页第92页/共291页Salivathe term saliva refers to the mixture of secret

38、ions in the oral carity第93页/共291页Saliva is produced day and night and it is constantly swallowed Saliva is present as a proteinaceous film covering all surfaces of oral cavity第94页/共291页This mixture consists of fluids derived from the major salivary glands minor glands of oral mucose traces from ging

39、ival exudate第95页/共291页Effect 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.第96页/共291页Decreased

40、salivary flow and caries in humansSarcoidosisSjogrens syndromeTharapeutic radiation第97页/共291页第98页/共291页第99页/共291页Hydrogen ionBuffering abilityCalciumInorganic phosphateFluoricle Inorganic components第100页/共291页Organic componentsmucinsGlycoproteinsStatherin and acidic proline-rich proteinsamylase第101页

41、/共291页Antrmicrobial proteins第102页/共291页Saliva and dental caries第103页/共291页the quantity of saliva associated with caries experience第104页/共291页Relationship between salivary characteristics and caries prevalencePropertyRelationshipPropertyRelationshipFlow ratepHCa-Buffer capacity+PO4NH3AmylaseViscosity

42、Urea-Salivary composition and caries第105页/共291页Antibacterial factors of glandular origin could protect oral mucosal and hard surfaces by helping to regulate the quantity and species distribution of oral microbes第106页/共291页Oral Microorganisms and dental plaque第107页/共291页In contrast to mucosal surface

43、s,the surfaces of teeth are not constantly renewed by shedding of colonized epithelial cells.Surfaces of teeth第108页/共291页Some special sites occlusal fissues Approximal surface第109页/共291页第110页/共291页Dental depositsBiofilms on dental surface-matrix-embedded microbial population,adherent to each other a

44、nd/or to surface or interfaces第111页/共291页Acquired pellicleAcellular,homogeneous organic film that forms on enamel and other hard surface by selective adsorption of salivary proteins.第112页/共291页adsorption of salivary proteins or glycoproteinsOrigin 第113页/共291页Immediately after cleaning and polishing,

45、salivary secrete deposit in the defects of enamel.第114页/共291页v Surface pelliclev Subsurface pellicleHistological appearance第115页/共291页The surface pellicle appears acellular and faintly granular under TEM Surface Pellicle第116页/共291页Pellicles of unknown age may vary in thickness from 501000nm.第117页/共2

46、91页globular fibrillar granular Different morphological types第118页/共291页第119页/共291页第120页/共291页A subsurface pellicleconsisting of dendritic processes that spread into the intercrystalline spaces and extend to 3m into the enamel.第121页/共291页90%water 10%solid material composition第122页/共291页According to c

47、hemical analysesamino acids account for 45%to 50%carbohydrates amount 10%to 15%of the dry weight lipid第123页/共291页Functionhealing,repairing,or protecting the enamel surfaceimparting selective permeability to the enamelinfluencing the adherence of specific oral microorganisms to the tooth surfaceservi

48、ng as a substrate or nutrient for the organisms第124页/共291页summaryOrganic depositNaturally forms by selective adsorptionOrigin of protein from salivaAfter polishing,reforms rapidlyBacteria settle on the pellicle as soon as it forms formation of dental plaque第125页/共291页Dental Plaque 第126页/共291页第127页/共

49、291页第128页/共291页第129页/共291页In the fourth 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.第130页/共291页Anton van leeuwenhoek,a draper and

50、sheriffs chamberlain in Delft recognized the limitation of mechanical oral hygiene in removing these deposits.第131页/共291页第132页/共291页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