同济大牙体牙髓病学教案07牙髓病病因

同济大学口腔医学院教案编号：课程名称牙体牙髓病学授课日期09-03-20学时2授课章节或题目牙髓病和根尖周病病因及发病机制授课教师赵守亮技术职称教授教师资格证号专业年级06级口腔专业授课方式理论（幻灯）；实验(习)：（操作）授课内容方法、手段、时间病原刺激与机体抵抗力失衡病原刺激物机体状况毒性作用机体抵抗力作用方式防御修复能力持续时间剩余牙本质厚度细菌因素致病菌炎症牙髓：无特异性髄腔完整：龋坏深层菌髄腔开放：需氧菌为主感染根管：以厌氧菌为主的混合感染Anaerobicbacteria某些细菌与临床症状相关普氏菌：肿胀、叩痛、窦道形成放线菌：顽固性根尖周病根尖周组织：无特异性感染途径牙本质小管：龋病、磨损、创伤牙髓暴露：龋病、磨损、创伤牙周途径：侧副根管、根尖孔血源感染：罕见致病机制pathogenesis荚膜、纤毛和膜泡荚膜capsule远程破坏膜泡vesicle运载工具内毒素endotoxinG一细菌胞壁脂多糖lipopolysaccharide致炎因子酶enzyme溶解、感染扩散代谢产物有机酸、氨宿主对细菌感染的反应炎症反应免疫反应3．物理因素创伤trauma非医源性：外伤、咬合创伤医源性：牙体预备、正畸、拔牙温度：牙体预备充填材料和抛光产热电流：少见激光：与能量有关4．化学因素充填材料主要是垫底材料：磷酸锌水门汀游离磷酸释放氧化锌水门汀安抚作用氢氧化钙强碱性酸蚀剂和粘接剂酸蚀剂与酸度、时间有关粘接剂毒性较强消毒药物免疫因素5．检查和诊断方法1）收集病史主诉ChiefComplaint主要症状、部位和持续时间现病史PresentDentalIllness发作方式、部位、程度、影响症状的因素、已接受的治疗和效果系统病史MedicalHistory患病史、心脏、血压、血糖用药史其他凝血状况生理、精神状态2）临床检查一般检查口镜镊子探针特殊检查牙髓活力测试温度测试ThermalTest牙髓的耐受阈20-50冷诊法coldtest冷水冰棒氯乙烷热诊法Hottest热压胶、加热金属临床意义无反应牙髓坏死短暂轻度不适牙髓正常刺激去除不适消除可复性牙髓炎刺激去除不适延续不可复性牙髓炎电活力测试ElectricPulpTest方法临床意义必须有参照牙数值低敏感数值高迟钝无反应坏死影响准确性的原因：电流直接经牙周形成短路未形成有效电流回路液化性坏死根尖未发育完成刚外伤后的患牙禁忌症装有心脏起搏器咬诊主要针对隐裂牙染色法主要针对隐裂牙透照法主要针对隐裂牙选择性麻醉AnestheticTest判定牙位试验性备洞TestCavity判断牙髓活力最有效的方法X线检查重要的辅助诊断手段龋坏部位髄腔、牙根情况、窦道来源根充结果局限性龋坏范围病变程度在X线片上的延迟表现X线片可能出现的伪影Ingeneral,theclinicalexaminationshouldfollowalogicalsequencefromthegeneraltothespecific,fromthemoreobvioustothelessobvious,fromtheexternaltotheinternal.Theresultsoftheexamination,alongwiththeinformationfromthepatient’shistory,willbecombinedtoestablishthediagnosis,formulateatreatmentplan,anddeterminetheprognosis.Althoughnoabsolutecorrelationhasbeenmadebetweenanyspeciesofbacteriaandseverityofendodonticinfections,severalspecieshavebeenimplicatedwithsomeclinicalsignsandsymptoms.ThosespeciesincludeFusobacterium,andActinomycesTheclinicalconditionofthepulpcanbeevaluatedbythermalstimuli,percussion,palpation,andvitalitytests.Whentestingwithacoldstimulus,onemustbeginwiththemostposteriortoothandadvancetowardtheanteriorteeth.Suchasequencewillpreventmeltingicewaterfromdrippinginaposteriordirectionandpossiblyexciteatoothnotyettested,givingafalseresponseWhentestingwithacoldstimulus,onemustbeginwiththemostposteriortoothandadvancetowardtheanteriorteeth.Suchasequencewillpreventmeltingicewaterfromdrippinginaposteriordirectionandpossiblyexciteatoothnotyettested,givingafalseresponse.Thermaltesting,hotorcold,canbeusedfortestingteethwithfullcoverage,todifferentiatebetweenvitalandnecroticpulps,andrequiresonlya“yes”or“no”response:isthestimulusperceivedornotTestCavity.Thistestisoftenalastresortintestingforpulpvitality.Itisimportanttoexplaintheproceduretothepatientbecauseitmustbedonewithoutanesthesia.Makeapreparationthroughtheenamelortheexistingrestorationuntilthedentinisreached.ElectricPulpTestingProcedures.Toachieveconsistentresultswithanelectricpulptester,onemustfollowastandardprocedure.Drytheteethtobetestedandisolatethemwithcottonrolls.Coverthetipoftheelectrodewithtoothpasteorasimilarelectricalconductor.幻灯2min幻灯、图解25min幻灯、图解5min5min幻灯、图解、示范8min第一学时结束30min幻灯、图片典型病例幻灯15min同济大学口腔医学院教案2006年2月制授课内容（续）方法、手段、时间教学重点、难点细菌学病因复习思考题牙髓病和根尖周病的致病因素有哪些?主要参考书牙体牙髓病学（第三版）樊明文主编人民卫生出版社，20042．现代口腔内科学（第二版）史俊南主编高等教育出版社，20043．Endodonticpractice(