牙周病学医学英语课件

Unit 10 Periodontal DiseaseUnit 10 Periodontal Disease Zeng sujuan Dental Hospital of Guangzhou Medical College 1 The characteristic feature of The characteristic feature of periodontitisperiodontitis is is a loss of the connective tissue and ala loss of the connective tissue and alv veolar eolar stucturestucture, termed a loss of attachment., termed a loss of attachment. periodontitis牙周炎 the connective tissue 结缔组织 alveolar 牙槽的 2 Gingival inflammation is a common concurrent feature. Gingival inflammation：牙龈炎 concurrent feature：伴发症状 3 This loss will be evidenced by an apical This loss will be evidenced by an apical migration of the migration of the junctionaljunctional epithelium ,which epithelium ,which can result in a periodontal pocket (and/or can result in a periodontal pocket (and/or gingival recession ) coingingival recession ) coinc cides with that apical ides with that apical mimig gration.ration. evidence：表现 apical migration：根向迁移 the junctional epithelium：结合上皮 periondontal pocket：牙周袋 coincides with:coincides with:与与一致一致 4 GingiGingiv vitis is usually a preitis is usually a prec cursorursor to to periodontitisperiodontitis, but not all gingivitis , but not all gingivitis progresses to progresses to periodontitisperiodontitis. . Precursor:先兆、前兆 5 Periodontitis results from a host response to microbial plaque; however, mechanisms for its initiation and progression are still being studied. Result from :起因于 Host; 大量的 mechanism：机制 initiation 6 The term of periodontal disease activity refers to The term of periodontal disease activity refers to the stage of the disease the stage of the disease c characterized by loss of haracterized by loss of periodontal attachment.periodontal attachment. Propose:提议 Progression：进展 periodontal attachment：牙周附着 7 It implies that the natural history of periodontal It implies that the natural history of periodontal disease has periods of active destruction and disease has periods of active destruction and periods of relative inactivity, although chronicperiods of relative inactivity, although chronic inflammation persists. inflammation persists. Destruction:破坏、消灭 8 Coton(1989) summarizes the three theories of periodontal disease activity as : the continuous paradigms that implies a low, constant progression of periodontal degeneration summarizes：总结 paradigm：范例 degeneration：退化、恶化 Three models have been proposed to explain Three models have been proposed to explain the progression of the progression of periodontitisperiodontitis. . 9 The random burst theory that implies that short periods of destruction are followed by periods of no destruction ,occurring randomly destruction：消灭 randomly：随机地 10 The asynchronous multiple burst theory that implies that periodontal disease activity, and resultant destruction occurs within a specific period of life and is followed by remission. asynchronous：不同时存在性，异步的 resultant：必然产生的 remission：减轻、平息 11 LoeLoe and coworker(1986)assert that the and coworker(1986)assert that the rate of progress varies in different sites,rate of progress varies in different sites, at different ages, and between individuals at different ages, and between individuals and groups.and groups. 12 The periodontitis lesion progresses steadily over time, even though there may be periods of slow progress and destructive processes. Destructive：毁灭性的 13 The facts remains, however ,that in the The facts remains, however ,that in the absence of treatment or interference, the lesion absence of treatment or interference, the lesion will continue until the entire will continue until the entire perioperiod dontiumontium is is involved and tooth loss result.involved and tooth loss result. Interference：干预、干涉 in the absence of:in the absence of:缺乏、没有缺乏、没有 14 LoeLoe and coworker (1986) emphasize that a and coworker (1986) emphasize that a steady, continuous progression does no rule steady, continuous progression does no rule out periods of exacerbation.out periods of exacerbation. rule out：划去、排除可能 exacerbation：恶化 15 Classification systems are necessary in order Classification systems are necessary in order to provide a framework in which the etito provide a framework in which the etio ology,logy, pathopathog genesis ,and treatment of disease can be enesis ,and treatment of disease can be scienscient tifically studied in an orderly fashion.ifically studied in an orderly fashion. etiology：病因学 pathogenesis：发病机制 ScientificallyScientifically：合乎科学的：合乎科学的 FashionFashion：方式、样子：方式、样子 16 In addition, such systems give clinicians In addition, such systems give clinicians a way to organize the health care needs a way to organize the health care needs of their patient.of their patient. OrganizeOrganize：组织、管理：组织、管理 health carehealth care：卫生保健：卫生保健 17 The last time the scientists and cliThe last time the scientists and clin nicians in icians in the field of the field of periodonperiodont tologyology and related areas and related areas agreed upon a classification system for agreed upon a classification system for periodontal diseases was in 1989 at the world periodontal diseases was in 1989 at the world workshop in clinical workshop in clinical periodonticsperiodontics. . periodontology ：牙周病学 18 Subsequently, a simpler Subsequently, a simpler classficationclassfication was was agreed upon at the 1agreed upon at the 1 st st European Workshop European Workshop in in periodontologyperiodontology. . SubsequentlySubsequently：后来、随后：后来、随后 19 These classification systems have been These classification systems have been widely used by clinicians and research widely used by clinicians and research scientists throughout the world.scientists throughout the world. 20 There were four major forms of There were four major forms of periodontitisperiodontitis: adult, early-onset, : adult, early-onset, reref fractory,ractory, and and periodontitisperiodontitis associated with sys associated with syst temic emic diseases.diseases. early-onset：早发型 refractory：难治性 21 Each of these major forms hasEach of these major forms has subclassificationssubclassifications. . subclassification：亚型 22 DiagDiagn nosis was made on the basis of clinical osis was made on the basis of clinical parameters documented in a thorough parameters documented in a thorough periodontal assessment, as well as consideration periodontal assessment, as well as consideration of the age of onset, rapidity of progression, and of the age of onset, rapidity of progression, and extendpatternextendpattern of alveolar bone loss. of alveolar bone loss. parameter:parameter:因素特征因素特征 documentdocument：证明、记录：证明、记录 assessmentassessment：评估：评估 23 Unfortunately, the 1989 classification had many Unfortunately, the 1989 classification had many shortcomings including: shortcomings including: considerable overlap in considerable overlap in disease categories,disease categories, absence of gingival disease absence of gingival disease comcomp ponent,onent, ina inap ppropriate emphasis on age of propriate emphasis on age of onset of disease and rates of progress, andonset of disease and rates of progress, and inina adequate or unclear classification cridequate or unclear classification crit teria.eria. considerable：相当大的 overlap：重叠 inappropriate：不适当的、不合适的 criteria：标准 24 The need of a revised classification The need of a revised classification system for periodontal disease was system for periodontal disease was emphasized during the 1996 world emphasized during the 1996 world workshop in workshop in perioperiod donticsontics. . 25 In 1997 the American AIn 1997 the American Ac cademy of ademy of PeriodontonogyPeriodontonogy responded to the need responded to the need and formed a coand formed a commmittee to plan and mittee to plan and organize an international workshop to organize an international workshop to revise the classification system for revise the classification system for periodontal diseases.periodontal diseases. 26 On OcOn Oct tober 30-November 2,1999,the ober 30-November 2,1999,the International Workshop for a Classification International Workshop for a Classification of Periodontal Diseases and Conditions of Periodontal Diseases and Conditions was held and a new classification was was held and a new classification was agreed upon.agreed upon. 27 1 1、Changing the Classification System Changing the Classification System for Periodontal Diseasefor Periodontal Disease 28 1.1 Addition of a Section on “Gingival 1.1 Addition of a Section on “Gingival Disease”Disease” As mentioned above, the 1989 classification did not include a section gingival diseases 29 This has been remedied by the This has been remedied by the development of a detailed classification development of a detailed classification of gingival diseases and lesion that are of gingival diseases and lesion that are either dental plaque either dental plaque induced or not induced or not primarily associated with dental plaque.primarily associated with dental plaque. Remedy:Remedy:改正，纠正改正，纠正 30 An important feature of the section on An important feature of the section on dental plaque-induced diseases is dental plaque-induced diseases is ackackn nowledgement that the clinical owledgement that the clinical expression of gingivitis can be substantially expression of gingivitis can be substantially modified bymodified by Acknowledgement:Acknowledgement:承认、认可承认、认可 SubstantiallySubstantially：本质上、实质上：本质上、实质上 ModifyModify：修改、更改：修改、更改 31 syssyst temic factors such as perturemic factors such as perturb bations ations in the in the e endocrines systemndocrines system medications medications malnu malnut tritionrition perturbation：扰乱、混乱 endocrines：内分泌 medication：药物 malnutrition：营养不良 32 The section on non-plaqueThe section on non-plaque induced gingival lesions includes induced gingival lesions includes a wide range of disa wide range of diso orders that rders that affactaffact the the gingivagingiva. . Disorders:Disorders:紊乱、障碍紊乱、障碍 33 Many of these disorders are Many of these disorders are f frequently enrequently enc countered in clinical ountered in clinical practicepractice EncounterEncounter：遇到、遭遇：遇到、遭遇 34 1.2 Replacement of “Adult 1.2 Replacement of “Adult PeriodontitisPeriodontitis” ” with “Chronic with “Chronic PeriodontitisPeriodontitis” ” 35 From the outset, the term “Adult From the outset, the term “Adult periodontitisperiodontitis” created a diagnostic ” created a diagnostic dilemma for clinicians.dilemma for clinicians. Outset：开始 Diagnostic：诊断上的 Dilemma:左右为难、窘境 36 Epidemiologic data and clinical Epidemiologic data and clinical experience suggest that the form of experience suggest that the form of periodontitisperiodontitis commonly found in commonly found in adults can also be seen in adults can also be seen in adoadol lescents.escents. Epidemiologic:流行病学的 Adolescent：青少年 37 If this is true, how can non-adultsIf this is true, how can non-adults ( (e.ge.g, , adolescents) with this type of adolescents) with this type of periodontitisperiodontitis be said to have be said to have “ adult “ adult periodontitisperiodontitis ” ” ？ 38 Clearly, the age-Clearly, the age-dependmentdependment nature of nature of the adult the adult periodontitisperiodontitis desig design nation ation created problems.created problems. DesignationDesignation：称号：称号 39 Therefore, workshop parTherefore, workshop part ticipants icipants concluded that it would be more accurate concluded that it would be more accurate to adopt a nonspecific term such as to adopt a nonspecific term such as “Chronic “Chronic PeriodontitisPeriodontitis” to ” to c characterize haracterize this constelthis constell lation of destructive periodontal ation of destructive periodontal disease.disease. ConstellationConstellation：一群（相关的）人：一群（相关的）人 DestructiveDestructive：破坏性的：破坏性的 40 A great deal of diA great deal of dis scussion centeredcussion centered round what words should be used to round what words should be used to replace the Adult replace the Adult PeriodontitisPeriodontitis term term ？ 41 SubSubs stitudetitude terminology such as terminology such as “ “ PeriodontitisPeriodontitis-common form” and “Type -common form” and “Type PeriodontitisPeriodontitis” were considered and ” were considered and eventually rejected by the maeventually rejected by the maj jority of the ority of the groupgroup TerminologyTerminology：术语、专门用于：术语、专门用于 RejectReject：拒绝：拒绝 SubSubs stitudetitude：取代：取代 42 The term “ Chronic The term “ Chronic PeriodontitisPeriodontitis” was criticized by some ” was criticized by some participants, since “chronic” might participants, since “chronic” might be inbe int terpreted as “ erpreted as “ noncurablenoncurable” by ” by some people.some people. 43 Nevertheless, “Chronic Nevertheless, “Chronic PeriodontitisPeriodontitis” ” was eventually agreed upon as long as it was eventually agreed upon as long as it was understood that it did not imply that was understood that it did not imply that this disease was nonresponsive to this disease was nonresponsive to treatment.treatment. 44 Traditionally, this form of Traditionally, this form of periodontitisperiodontitis has been characterized has been characterized as a slowly progressive diseaseas a slowly progressive disease 45 Indeed data from many sources confirm that patients with this form of periodontitis usually exhibit slow rates of progression. 46 However ,there are also data indicating However ,there are also data indicating that some patients may experience short that some patients may experience short periods of rapid progression.periods of rapid progression. 47 Therefore, workshop participants Therefore, workshop participants concluded that rates of progression concluded that rates of progression should not be used to exshould not be used to exc clude people lude people from receiving the diagnosis of from receiving the diagnosis of Chronic Chronic PeriodontitisPeriodontitis. . ExcludeExclude：排除：排除 48 1.3 Replacement of “Early-Onset 1.3 Replacement of “Early-Onset PeriodontitisPeriodontitis” With “Aggressive ” With “Aggressive PeriodontitisPeriodontitis”. ”. 49 The term “Early-Onset The term “Early-Onset PeriodontitisPeriodontitis” ” (EOP) was used in the 1989 AAP and in 1993 (EOP) was used in the 1989 AAP and in 1993 EuopeanEuopean classifications as a collective classifications as a collective designation for a group of dissimilar destructive designation for a group of dissimilar destructive periodontal periodontal deseasedesease that affect young that affect young patients(i.epatients(i.e prepubertalprepubertal, , juvenile,andjuvenile,and rapidly rapidly progressive progressive periodontitisperiodontitis). ). collective designationcollective designation：共同的称号：共同的称号 dissimilar destructivedissimilar destructive：不同的损害：不同的损害 PrepubertalPrepubertal: :青春期前的青春期前的 JuvenileJuvenile：青少年：青少年 50 It was logically assumed that these It was logically assumed that these diseases all had an early onset becausediseases all had an early onset because they affected young people they affected young people . . 51 Unfortunately, the “early-onset”Unfortunately, the “early-onset” designation implies that one has designation implies that one has temporal knowledge of when the temporal knowledge of when the disease started.disease started. DesignationDesignation：指定、指名：指定、指名 52 However, in clinical practice and However, in clinical practice and most other situation this is rarely most other situation this is rarely casecase . . 53 In addition, there is considerable In addition, there is considerable uncertainty about arbitrarily setting uncertainty about arbitrarily setting an upper age limit for patients with an upper age limit for patients with so called so called early-onset early-onset periodontitisperiodontitis considerableconsiderable ：相当多的 ArbitrarilyArbitrarily：任意地：任意地 UpperUpper：上边的、上层的：上边的、上层的 54 For example, how does one classify the type of periodontal disease in a 21- year-old patient with classical incisor- first molar pattern of Localized Juvenile Periodontitis (LJP ) ？ Localized Juvenile Periodontitis：局限型青少 年牙周炎 55 Since the patient is not a juvenile ,Since the patient is not a juvenile , should the age of the patients be should the age of the patients be ignored and the disease classifiedignored and the disease classified as LJP anywayas LJP anyway？ 56 This type of problem stems from the This type of problem stems from the age-dependent nature of the 1989 age-dependent nature of the 1989 classification system.classification system. StemStem：拦住、阻挡：拦住、阻挡 57 Because of these similar problems, Because of these similar problems, workshop participants decided that it workshop participants decided that it was wise to discard classification was wise to discard classification termitermin nologies that were age-dependentologies that were age-dependent or required knowledge of rates of or required knowledge of rates of gression. DiscardDiscard：抛弃：抛弃 Terminology:Terminology:专业用语、术语专业用语、术语 58 Accordingly, highly destructive forms of Accordingly, highly destructive forms of periodontitisperiodontitis formerly considered under formerly considered under the umbrella of “ Early-Onset the umbrella of “ Early-Onset PeriodontitisPeriodontitis” were renamed using the ” were renamed using the term “Aggressive term “Aggressive PeriodontitisPeriodontitis” ” 59 In general, patients who meet the In general, patients who meet the clinical criteria for LJP or GJP are said to clinical criteria for LJP or GJP are said to have “Localized Aggressive have “Localized Aggressive PeriodontitisPeriodontitis” ” or “General Aggressive or “General Aggressive PeriodontitisPeriodontitis”, ”, respectively.respectively. 60 Patients who were Patients who were formlyformly classified classified as having RPP will ,depending on a as having RPP will ,depending on a variety of other clinical criteria, be variety of other clinical criteria, be assigned to either the “General assigned to either the “General Aggressive Agg