【临床医学】牙体牙髓病学概论(NXPowerLite)

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. Concept第一页，共二百九十五页。The content of the textbookCariology Non-cariogenic disease of dental hard tissue E

2、ndodonticsOperative dentistry第二页，共二百九十五页。History第三页，共二百九十五页。In 50s yearsOral medicineCariologyOperative dentistryEndodonticsNon-cariogenic disease of dental hard tissueDisease of Oral mucosaPreventive dentistryPeriodontologyPaediatrics for dentistry第四页，共二百九十五页。Stomatology in ancient timesBefore Chri

3、st (B.C.)There were some record about caries第五页，共二百九十五页。Image liking character (script) worm + tooth第六页，共二百九十五页。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.第七页，共二百九十五页。In Dynasty

4、 Han (A.D.215282)There are some record about periodontologyAnno Domini第八页，共二百九十五页。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第九页，共二百九十五页。 In Dynas

5、ty Tang (A.D.710 era)the people use silver paste to fill tooth decay 第十页，共二百九十五页。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 city第十一页，共二百九十五页。3 events above describedreflected ancient

6、 civilization of our country第十二页，共二百九十五页。Dentistry development in West country第十三页，共二百九十五页。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.第十四页，共二百九十五页。The Gre

7、eksHippocrates (500 B. C.) appreciated 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.第十五页，共二百九十五页。Aristotle (384 B.C.) al

8、so stated figs and soft sweets produce decay.第十六页，共二百九十五页。Galen (200A. D. Romans)was first to recognize that toothache could be:Pulpitis or pericementitisHe also classified teeth into centrals,cuspids and molars.第十七页，共二百九十五页。B. Leonardo da Vinci (end of 15th Century) - he described the anatomy of th

9、e jaws, teeth and maxillary sinus. These drawings are the first to accurately describe the maxillary sinus. However, credit has been given to Dr. Nathaniel Highmore of England (1650).第十八页，共二百九十五页。D. Leeuwenhoek (17th Century) - invented the microscope. He described the dental tubuli and was the firs

10、t to see organisms of the mouth 第十九页，共二百九十五页。Anton van leeuwenhoek第二十页，共二百九十五页。K. John Greenwood (1789) - dentures for George Washington were made by him.第二十一页，共二百九十五页。a red laser scansGeorge Washingtons false teeth not woodenLaser scans find gold, ivory, lead, human and animal teeth 第二十二页，共二百九十五页。L

11、. Pierre Fauchard (18th Century - 1728) - Father of Scientific Dentistry. Wrote a great text Surgeon 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 fil

12、l cavities. He removed all decay and if the pulp was exposed, he used the cautery. 第二十三页，共二百九十五页。Musee dArt Dentaire Pierre Fauchardat the Academie Nationale de Chirurgie Dentaire22 Rue Emile Menier, 75116, Paris France第二十四页，共二百九十五页。He prescribed oil of cloves and cinnamon for pulpitis. He described

13、 partial dentures and full dentures in his text. He constructed dentures with springs and used human teeth. Gold dowels 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. 第二十五页，共二百九十五页。1763 A.DJohn Baker, M.D. Surgeon Denti

14、st. The earliest qualified dentist to practice in Boston and in America. 第二十六页，共二百九十五页。1836 A.D.Arsenic introduced for the killing of pulps, by Spooner.第二十七页，共二百九十五页。1840 A.D.The American Society of Dental Surgeons, first national dental organization. The Baltimore College of Dental Surgery, the fir

15、st school in the world for the training of dentists was founded by Harris and Harden.第二十八页，共二百九十五页。Founded by Harris and Harden第二十九页，共二百九十五页。1859 A.D.Organization of American Dental Association on a representative basis.第三十页，共二百九十五页。1890 W.D. Miller propose a chemical-bacteria Paraorganism theory to

16、 explain the mechanism of caries第三十一页，共二百九十五页。1891 A.D.Extension for prevention and scientific cavity preparation promulgated by G.V. Black. 1892 A.D. The establishment of a three-year course in dental colleges.第三十二页，共二百九十五页。1906 A.D.Einhorn recommends novacaine and adrenalin combination for local a

17、nesthesia.第三十三页，共二百九十五页。1915 A.D.McKay and Black publish results of investigation of fluoride in drinking water.第三十四页，共二百九十五页。1956 A.D.Air-rotor drill, 250,000 RPM Dr. Robert Borden.第三十五页，共二百九十五页。Stomatology in China before 1949 West China University (1910) Shanghai Second University(1920) 4th Milit

18、ary Medical University(1935) Beijing University(1943)第三十六页，共二百九十五页。Shanghai Second UniversityWest China University 1918(School 1910)第三十七页，共二百九十五页。The first dental school in China was founded in West ChinaMedical University in 1917. A.W. Lindsay第三十八页，共二百九十五页。A. W. Lindsay was teaching第三十九页，共二百九十五页。Af

19、ter 1949Hubei Medical College 1960 Founder Prof. Xia Liang Cai 第四十页，共二百九十五页。In recent 20 years, the science and techniques got great progressThere are 12 faculties or dental schools in each province 第四十一页，共二百九十五页。 Caries researchCaries VaccineEtiology & prevention Pulp diseaseModern root canal trait

20、ment Pulp biologyStem cell final targetAchievements第四十二页，共二百九十五页。Craniofacial-oral-dental research in the century21st第四十三页，共二百九十五页。The leadership team of NIDR initiated a strategic planning process in 1999 to identifyWhere we are (strengths, weaknesses, opportunities and threats)Where we want to go

21、(e.g., mission and vision)How we plan to get there (strategic plan)第四十四页，共二百九十五页。Several scientific areas will be concerned in century 21st第四十五页，共二百九十五页。From molecular biology to clinical investigations; etiology, pathogenesis, epidemiology, prevention, diagnosis and treatment of inherited craniofac

22、ial-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第四十六页，共二百九十五页。第四十七页，共二百九十五页。Hereditary hypoplasia第四十八页，共二百九十五页。Hereditary a

23、plasia of the enamel第四十九页，共二百九十五页。 dental caries Periodontitis Oral candidiasis Herpes Hepatitis,HIV/AIDSInfections diseasesViral, bacterial, fungal and parasitic such as第五十页，共二百九十五页。Diseased Periodontium第五十一页，共二百九十五页。Primary herpetic stomatitis第五十二页，共二百九十五页。Candidal stomatitis第五十三页，共二百九十五页。Neoplast

24、ic diseaseSupports basic, patient oriented, and community-based research on the etiology, pathogenesis and metastasis, epidemiology, prevention, diagnosis, treatment of oral and pharyngeal neoplastic diseases 第五十四页，共二百九十五页。第五十五页，共二百九十五页。第五十六页，共二百九十五页。Chronic disabling diseasesThe full range of resea

25、rch involving chronic disabling disease associated with the craniofacial-oral-dental complex第五十七页，共二百九十五页。This includes osteoporosis, osteoarthritis and related bone disorders, temporo-mandible joint diseases and disorders, neuropathies and neuro-degenerative diseases including those involving oral

26、sensory and motor functions and autoimmune diseases such as sjgrens syndrome. 第五十八页，共二百九十五页。第五十九页，共二百九十五页。Chronic diseases of cran-oral-dental complex and other systemic diseases (e.g., diabetes)第六十页，共二百九十五页。Biomaterials, biomimetics and tissue engineering Biomaterials used for the repair, regenerat

27、ion, restoration and reconstruction of craniofacial-oral-dental molecules,cells, tissues and organs 第六十一页，共二百九十五页。The study of computer aid design (CAD) computer aid manufacture (CAM) for denture第六十二页，共二百九十五页。第六十三页，共二百九十五页。第六十四页，共二百九十五页。Behavior, health promotion and environment aimed at assessing t

28、he interactive roles of sociological, behavior, economic, environmental, genetic, and biomedical factors in craniofacial-oral-dental diseases and disorders 第六十五页，共二百九十五页。1996 Diet and Oral Health第六十六页，共二百九十五页。第六十七页，共二百九十五页。caries第六十八页，共二百九十五页。Cariology is a discipline within Stomatology which deals

29、with the complex interplaying between the oral fluids and the microbial deposits in relation to subsequent changes in the dental hard tissues. 第六十九页，共二百九十五页。Epidemiology in dental caries第七十页，共二百九十五页。Several index have been used in dental caries 第七十一页，共二百九十五页。Prevalence= No of the patients with carie

30、s 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 area.第七十二页，共二百九十五页。Caries incidence is usually expressed as the number of new decayed teeth or surfaces p

31、er-a period in a individual,group, or population. Incidence of caries第七十三页，共二百九十五页。DMF=Decayed teeth+Missing teeth+Filled teeth/Number of subjects examined DMFT第七十四页，共二百九十五页。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-TT

32、he DMF-S or DMF-T are often referred to as an “index”第七十五页，共二百九十五页。The distribution of dental caries in oral cavity第七十六页，共二百九十五页。第七十七页，共二百九十五页。第七十八页，共二百九十五页。Reducing tendency in developed country 第七十九页，共二百九十五页。第八十页，共二百九十五页。The DMFT prevalence of 12-year-old children in the Nordic countries in the pe

33、riod 1974-91.Denmark,Finland ,Norway and Sweden seem to follow the same downward trend, whereas Iceland has started a more rapid decline somewhat later. 第八十一页，共二百九十五页。Increasing tendency in developing country第八十二页，共二百九十五页。958498959892959813Romania China Fuji Tonga Jordanian45627883858662DMFTs for 12

34、 Years-old in Part of developing country第八十三页，共二百九十五页。The caries 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 2

35、0636 29.70 Cities 19683 79.55Countryside 16253 58.48Deciduous teeth第八十四页，共二百九十五页。The 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 0.5

36、1Guangdong 0.91 1.65Sichuan 0.57 0.37Account 0.67 0.88 Province DMFT(1983) DMFT(1995)第八十五页，共二百九十五页。 Age DMFT 12 1.03 15 1.42 18 1.60 3544 2.11 6574 2.49 (DFT) The DMFT prevalence in 1995第八十六页，共二百九十五页。Current concept of caries etiology第八十七页，共二百九十五页。Dental caries is a multifactorial disease in which t

37、here is an interplay of three principal factors: the host (primarily the saliva and teeth), the microflora, and the substrate, or diet. 第八十八页，共二百九十五页。A fourth factor time must be considered in any discussion of the etiology of caries. Diagrammatically,these factors can be portrayed as four overlappi

38、ng circles. 第八十九页，共二百九十五页。Micro-organismshost & toothSub-strateThe four circles diagrammatically represent the factors involved in the carious process.all four factors must act concurrently (overlapping of the circles)for caries to occurtimeno cariesno cariesno cariesno cariescaries第九十页，共二百九十五页。Cari

39、es requires a susceptible host, a cariogenic oral flora and a suitable substrate that must be present for a sufficient length of time第九十一页，共二百九十五页。Etiology of Caries第九十二页，共二百九十五页。Salivathe term saliva refers to the mixture of secretions in the oral carity第九十三页，共二百九十五页。Saliva is produced day and nigh

40、t and it is constantly swallowed Saliva is present as a proteinaceous film covering all surfaces of oral cavity第九十四页，共二百九十五页。This mixture consists of fluids derived from the major salivary glands minor glands of oral mucose traces from gingival exudate第九十五页，共二百九十五页。Effect of desalivation on incidenc

41、e 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.第九十六页，共二百九十五页。Decreased salivary flow and caries in humansSarcoidosisS

42、jogrens syndromeTharapeutic radiation第九十七页，共二百九十五页。第九十八页，共二百九十五页。第九十九页，共二百九十五页。Hydrogen ionBuffering abilityCalciumInorganic phosphateFluoricle Inorganic components第一百页，共二百九十五页。Organic componentsmucinsGlycoproteinsStatherin and acidic proline-rich proteinsamylase第一百零一页，共二百九十五页。Antrmicrobial proteins

43、第一百零二页，共二百九十五页。Saliva and dental caries第一百零三页，共二百九十五页。the quantity of saliva associated with caries experience第一百零四页，共二百九十五页。Relationship between salivary characteristics and caries prevalencePropertyRelationshipPropertyRelationshipFlow ratepHCa-Buffer capacity+PO4NH3AmylaseViscosityUrea-Salivary co

44、mposition and caries第一百零五页，共二百九十五页。Antibacterial factors of glandular origin could protect oral mucosal and hard surfaces by helping to regulate the quantity and species distribution of oral microbes第一百零六页，共二百九十五页。Oral Microorganisms and dental plaque第一百零七页，共二百九十五页。In contrast to mucosal surfaces, t

45、he surfaces of teeth are not constantly renewed by shedding of colonized epithelial cells. Surfaces of teeth第一百零八页，共二百九十五页。Some special sites occlusal fissues Approximal surface第一百零九页，共二百九十五页。第一百一十页，共二百九十五页。Dental depositsBiofilms on dental surface-matrix-embedded microbial population, adherent to e

46、ach other and/or to surface or interfaces第一百一十一页，共二百九十五页。Acquired pellicleAcellular, homogeneous organic film that forms on enamel and other hard surface by selective adsorption of salivary proteins. 第一百一十二页，共二百九十五页。adsorption of salivary proteins or glycoproteinsOrigin 第一百一十三页，共二百九十五页。Immediately a

47、fter cleaning and polishing, salivary secrete deposit in the defects of enamel.第一百一十四页，共二百九十五页。 Surface pellicle Subsurface pellicleHistological appearance第一百一十五页，共二百九十五页。The surface pellicle appears acellular and faintly granular under TEM Surface Pellicle第一百一十六页，共二百九十五页。Pellicles of unknown age ma

48、y vary in thickness from 501000nm.第一百一十七页，共二百九十五页。globular fibrillar granular Different morphological types第一百一十八页，共二百九十五页。第一百一十九页，共二百九十五页。第一百二十页，共二百九十五页。A subsurface pellicleconsisting of dendritic processes that spread into the intercrystalline spaces and extend to 3m into the enamel.第一百二十一页，共二百九十

49、五页。90% water 10% solid material composition第一百二十二页，共二百九十五页。According to chemical analysesamino acids account for 45% to 50% carbohydrates amount 10% to 15% of the dry weight lipid第一百二十三页，共二百九十五页。Functionhealing, repairing, or protecting the enamel surfaceimparting selective permeability to the ename

50、linfluencing the adherence of specific oral microorganisms to the tooth surfaceserving as a substrate or nutrient for the organisms第一百二十四页，共二百九十五页。summaryOrganic depositNaturally forms by selective adsorptionOrigin of protein from salivaAfter polishing, reforms rapidlyBacteria settle on the pellicle

51、 as soon as it forms formation of dental plaque第一百二十五页，共二百九十五页。Dental Plaque 第一百二十六页，共二百九十五页。第一百二十七页，共二百九十五页。第一百二十八页，共二百九十五页。第一百二十九页，共二百九十五页。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 c

52、entury that “animalcules (microorganism) were seen in these dental deposits.第一百三十页，共二百九十五页。Anton van leeuwenhoek, a draper and sheriffs chamberlain in Delft recognized the limitation of mechanical oral hygiene in removing these deposits. 第一百三十一页，共二百九十五页。第一百三十二页，共二百九十五页。Anton Van leeuwenhoek saw larg

53、e 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 very day.第一百三十三页，共二百九十五页。Terminology1847 Ficinus a slime coating denticulate Williams demonstrated th

54、e presence of a mass of microorganisms 1895 G.V. Black gelatinous microbial plaque第一百三十四页，共二百九十五页。Dental plaque Most figurative description: a bacterial aspic with millions of organisms standing shoulder to shoulder 第一百三十五页，共二百九十五页。More formal definition by Le: plaque is the soft, non-mineralized, b

55、acterial deposit which forms on teeth and dental prosthesis that are not adequately cleaned第一百三十六页，共二百九十五页。Morphology of dental plaque A white or off-white accumulation Variable thickness第一百三十七页，共二百九十五页。Three main typies of organisms coccoid rod-shaped filamentous 第一百三十八页，共二百九十五页。第一百三十九页，共二百九十五页。第一百

56、四十页，共二百九十五页。第一百四十一页，共二百九十五页。classificationSupragingival plaque Subgingival plaque Dental calculus (calcified plaque)第一百四十二页，共二百九十五页。Supragingival plaqueSmooth surface plaque Fissure plaque 第一百四十三页，共二百九十五页。Supragingival smooth surface plaqueDivided into 4 areas: plaque/tooth interfacecondensed microb

57、ial layerbody of the plaque plaque surface第一百四十四页，共二百九十五页。plaque/tooth interfaceIn some locations no pelicle第一百四十五页，共二百九十五页。Higher magnification of plaque-enamel border. Microorganisms that divide in horizontal planes are in direct contact with enamel (1 30,000).第一百四十六页，共二百九十五页。 Condensed microbial

58、layer a layer of very densely packed coccoid organisms, from 320 cells thick第一百四十七页，共二百九十五页。Part of a 7-day-old interdental plaque grown 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

59、condensed microbial layer which is covered by a layer of coccoid and filamentous micro-organisms and probably Neisseria. The intermicrobial space is electron-lucent and reveals cell remnants ( 1 6,500).第一百四十八页，共二百九十五页。Body of the plaque this occupies by far the largest portion of the plaque第一百四十九页，共

60、二百九十五页。 Thin section of plaque made of different bacterial species-predominantly coccoidal.Dense aggregation of microorganisms at the enamel surface (lower left)第一百五十页，共二百九十五页。Plaque surface loosely arrangement Great variety: coccoid, rod like, “corncob”第一百五十一页，共二百九十五页。In the surface layer of plaque