《龋临床特征和诊断》

Chapter3

ClinicalManifestationsandDiagnosisofDentalCaries编辑pptHistophathologyofCariesEnamelCaries编辑pptTheearlyenamellesionconsistsoffourzonesofalternatinglevelsofmineralisation.Itillustratesthedynamicnatureofthecariesprocess.Thesurfacezoneblocksthepassageofcalciumionsintothebodyofthelesionandmayhavetoberemovedtoallowthelesiontobecomearrested(AfterKidd&Joyston-Bechal,1987).编辑pptDentinalCaries编辑pptDentinecariescomprisestwo

mainlayers.Intheouterlayer,thedentineisheavilyinfectedwithbacteria.Bothorganicmatrixandmineralhavebeenlostandthedentineisbeyondrepair.Inthedeeperlayer,thedentinehasbeenaffectedbyplaqueacidsanddemineralised.Thenumberofcolonyformingunits(CFU)ofbacteriadecreases(about100times)ascavitypreparationproceedsintoaffecteddentine.Thedamageinthislayerisreversibleifbacterialmetabolismcanbehalted.Abarrieroftranslucent(wellmineralised)dentinemaybeformedaheadoftheadvancinglesion.Reactionary(secondary)dentineformstoprotectthepulpfromacidirritation(AfterKidd&Joyston-Bechal,1987编辑ppt编辑pptRootcarieslesionsEarly:Appearsasradiolucentzoneintherootcementum编辑pptStepsintheformationofanarrestedlesionindentinea)highconcentrationofdissolvedmineralsalts.b)Ifbcterialacidproductionisreduced,andthepHincreases,thesaltsprecipitateintolargecrystalsoftricalciumphosphatewhichtemporallyblockthetubule.c)Iffurtherbacterialactivityissuppressed,theodontoblastsecretescollagenandcalciumsalts.Crystalsofhydroxyapatitethenformandblockthetubulemoreeffectively(AfterDaculsietal,1987)

编辑pptTheProcessofDemineralizationandRemineralizationCariesisadynamicprocess.Teetharesubjectedtoanongoingcycleofdemineralizationandremineralizationdeterminedbythebalanceoffactors.编辑pptDemineralizationDemineralizationistheprocessofremovingminerals,intheformofmineralions,fromdentalenamel.Asubstantialnumberofmineralionscanberemovedfromhydroxyapatitelatticeworkwithoutdestroyingitsstructuralintegrity编辑pptRemineralizationRemineralizationistheprocessofrestoringminerals-again,intheformofmineralions-tothehydroxyapatite'slatticeworkstructure.编辑ppt促进再矿化阻止龋病发展龋损的形成是脱矿与再矿化的连续性动力过程。编辑ppt1、除去致龋底物：木糖醇取代蔗糖，减少碳水化合物摄入频率Dietcounseling:ToidentifythesourcesofsucroseandacidicfoodstuffsinthedietToreducethefrequencyofingestionofbothTousexylitolassugarsubstitute.编辑ppt2、仔细刷牙，牙面不形成厚的牙菌斑Oralhygiene:Plaquefreetoothsurfacedonotdecay.DentalflossingToothbrushingRinsing编辑ppt3、在牙齿发育的再矿化期间，结合氟离子，可形成更具抗龋能力的釉质Useoffluoride编辑ppt编辑pptClinicalclassificationofcaries

编辑pptClassificationaccordingtoprogressionrateAcutecaries:progressfast,ofteninchildrenandteenagers,lightcoloredcavity.编辑pptRampantcaries,manytoothinvolvedatsametimeacutecariesfeatureoftenaccompaniedbysystematicdisorder.Suchassjogrensyndromeorsalivareductionafterradiation.

Cariesinapatientwithimpairedsalivaryfunctionasresultofradiationtherapy(courtesyofDrsJansmaandVissink,RUG,theNetherlands).

编辑ppt

编辑pptChroniccaries

progressslowly,blackorbrowncoloredcavityhardremainingdentine

Arrestedcaries

cariesstopprogressingbecauseof

thelocaletiologicalchange编辑pptSecondarycaries(recurrentcaries)cariesrecurredaftertreatment.Oftenatthemarginthefillingmaterialsrestorationorbeneath

Theshadowlocatedonthemesiolingualcuspadjacenttothelargerocclusalamalgamrestorationonthemaxillaryrightfirstmolarindicatesthepresenceofcariousdentin

编辑ppt编辑pptClassificationaccordingtotheinvolvingsiteOcclusalcaries

RootcariesSmoothsurfacecaries编辑pptClassificationaccordingtothedeepnessSuperfacialcaries(浅龋)whitespotlesions,visiblyfrostedsurfacebrownspotDentincaries(中龋)cavitatedlesioninvolvingtheuppartofdentinDeepcaries(深龋)cavitatedlesioninvolvingthepupalthirdofdentin编辑pptDiagnosisVisualchangeProbing:roughsurfaceortrappingpointpainuponprobingTemperaturetestX-rayexaminationTransillumination编辑pptVisualchange

Matte,white,activecervicallesions编辑ppt编辑pptProbing:roughsurfaceortrappingpointpainuponprobing

Theexplorertipcaneasilydamagewhitespotlesions编辑ppt编辑ppt编辑pptTemperaturetest

编辑pptX-rayexamination

编辑pptTransillumination（FOTL,光纤透照法）：

Proximalcarieslesionisdetectedinananteriortoothwiththeuseoftransillumination编辑pptLAF（激光荧光法)

编辑pptThehardwareoftheintra-oralsystemincludesameasurementprobe,acontrolunit,andacomputerfittedwithaframegrabber.Thecontrolunitconsistsofanilluminationdeviceandimagingelectronics.Thelightsourceisaspecialarc-lampbasedonXenon氙technology.Thelightfromthislampisfilteredbyablue-transmittingfilter.Aliquidlightguidetransportsthebluelighttotheteethinthemouth.

QuantitativeLight-inducedFluorescence编辑pptQLF™technicalspecifications编辑pptQLF™theoryTheQLF™methodisbasedontheauto-fluorescence荧光ofteeth.Whenteethareilluminatedwithhighintensitybluelighttheywillstarttoemitlightinthegreenpartofthespectrum.Thefluorescenceofthedentalmaterialhasadirectrelationwiththemineralcontentoftheenamel.QuantitativeLight-inducedFluorescence

编辑pptDIAGNOdentpen(龋齿探测笔)DIAGNOdenthttp:///products/handpieces_accessories/special_instruments/diagnodent/tutorial.asp?navid=500019&lan=Us&znavid=311000编辑pptDIAGNOdentpen编辑pptDIAGNOdent编辑ppt编辑pptStandardofdiagnosis编辑pptSuperfacialcaries(浅龋)Whitespotorbrown,darklesion,roughuponprobingNocomplaint,nohypersensitivity编辑pptDentincaries(中龋)Cavity,hypersensitivityuponprobing,hotorcoldstimulus.编辑pptDeepcaries(深龋)Deepcavity,verysensitiveandsomepainuponstimulus,howeverthepaindisappearassoonasthestimulusistakenaway.编辑pptTreatmentStrategy编辑pptTreatmentStrategyPreventive(casual,noninvasive)treatmentRestorative(operative,invasive)treatment

编辑pptPreventivetreatmentchemicaltherapy:

useoffluoridewitharegulardailyadministrationorprofessionalapplied.

pitandfissuresealing编辑ppt一、chemicaltherapy

（化学疗法

）

1．药物治疗适应证（1）恒牙早期釉质龋未形成龋洞者，自洁作用较好的区域；（2）一年内将被替换的乳牙大面积浅龋；（3）静止龋。药物氟化物硝酸银编辑ppt药物治疗氟化物(fluorence)

75％氟化钠甘油糊剂8％氟化亚锡溶液酸性磷酸氟化钠（APF）溶液含氟凝胶（1.5％APF凝胶）含氟涂料原理：氟与HA作用，形成氟磷灰石；沉积氟化物，促进再矿化。氟化物对软组织无腐蚀性，不使牙变色，安全有效，前后牙均可使用。编辑ppt药物治疗硝酸银10％硝酸银氨硝酸银原理:蛋白银沉淀

还原银或碘化银渗入牙釉质牙本质，杀灭细菌，封闭病变区对软组织有强的腐蚀性，不可用于牙颈部龋，并使牙变黑，只用于乳牙和后牙。编辑ppt应用方法：用石尖磨除牙表面浅龋，暴露病变部位清洁牙面隔湿吹干涂布药物编辑ppt2．Remineralization(再矿化疗法)

再矿化液：主要为含有不同比例的钙、磷和氟。适应症平滑面早期釉质龋龋易感者预防应用方法：漱口液每日含漱局部应用

编辑pptpitandfissuresealing

（窝沟封闭)

适应证：窝沟可疑龋；与充填窝洞相邻的牙合面无龋深沟裂，应用方法：清洁牙面、隔湿、酸蚀、涂布及固化封闭剂。

编辑pptDefinitionofOperativeDentistry

Operativedentistryistheartandscienceofthediagnosis,treatment,andprognosisofdefectsofteethwhichdonotrequirefullcoveragerestorationsforcorrection.

编辑pptSuchtreatmentshouldresultintherestorationofpropertoothform,function,andestheticswhilemaintainingthephysiologicalintegrityoftheteethinharmoniousrelationshipwiththeadjacenthardandsofttissues;allofwhichenhancethegeneralhealthandwelfareofthepatient.

编辑pptIndicationofOperativeDentistry

Caries

Malformed,discolored,orfracturedteethRestorationreplacement

编辑pptProgramofOperativeTreatment

PatientassessmentExaminationanddiagnosisTreatmentplanning编辑pptCavityPreparation

Themechanicalalterationofadefective,injured,ordiseasedtoothinordertobestreceivearestorativematerialwhichwillre-establishahealthystateforthetoothincludingestheticcorrectionswhereindicated,alongwithnormalformandfunction.

编辑ppt编辑ppt编辑ppt

Classificationofcavity

ClassⅠClassⅡClassⅢClassⅣClassⅤClassⅥ—G.V.Blackin1908

编辑pptClassI

AllpitandfissurecavitiesareClassI.

Cavitiesonocclusalsurface;Cavitiesonocclusaltwo-thirdsofthefacialandlingualsurfacesofmolars;Cavitiesonlingualsurfaceofmaxillaryincisor.编辑pptClassII

AcavityoccurringontheproximalsurfaceofposteriorteethareClassII.MOmesialandocclusal

DOdistalandocclusalMODmesial,occlusalanddista

编辑pptClassIIICavitiesontheproximalsurfacesofanteriorteeththatdo

notinvolvetheincisalanglesareClassIII.编辑pptClassIV

Cavitiesontheproximalsurfacesofanteriorteeththatdo

involvetheincisalanglesareClassIV.编辑pptClassVCavitiesonthegingivalthirdofthefacialorlingualsurfacesofallteeth(notpitandfissurecavities)areClassV.编辑ppt编辑pptClassVICavitiesontheincisaledgeofanteriorteethortheocclusalcuspheightsofposteriorteethareClassVI.编辑ppt编辑ppt洞型分类一类洞：根据发生于所有牙齿的发育窝，沟内的龋损所制备的洞型。二类洞：后牙邻面的龋损所制备的洞型。三类洞：前牙邻面未损及切角的龋损所制备的洞型。四类洞：前牙邻面损及切角的龋损所制备的洞型。五类洞：所有牙齿颊（唇），舌（腭）面龈1/3牙面的龋损制备的洞型。六类洞：所有牙齿牙尖，牙脊或冠轴交界的轴角区的龋损所制备的洞型。编辑ppt编辑pptCavityStructure

wallsanglescavity编辑ppt编辑pptWalls

Internalwalls:apreparedcavitysurfacethatdoesnotextendtotheexternaltoothsurface.

Axialwalls:aninternalwallparallelwiththelongaxisofthetoothandocclusalofthetooth.Pulpalwalls:aninternalwallthatisbothperpe