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Main textbooksPaul Coulthard, Keith Horner, Philip Sloan, et al. Master Dentistry. Volume 1,2, Oral and Maxillofacial Surgery, Radiology, Pathology, and Oral Medicine. Churchill Livingstone 2003
Updated knowledge from library and Website.
Dental Caries
Tooth loss is common health problem. What can cause tooth loss?
Reasons of tooth loss
Microbial tooth loss (dental caries, periodontitis)Non microbial tooth loss (trauma, congenital loss)
Dental caries
An chronic infectious disease with progressive destruction of tooth.
Prevalence and incidence http://www.wrongdiagnosis.com/d/dental_caries/stats-country.htm(2004)
Almost everyone is affected by dental caries.
Etiology of Dental CariesMicro-organismshost & toothsugartimeno cariesno cariesno cariesno cariescaries1889, Miller: chemocoparasitic theory
MAJOR FACTORS
3 necessary requirements: 1) Microorganismsbacteria, plaque 2) sugar --- carbohydrates 3) host & tooth---saliva, tooth ( and) 4) time.
Role of bacteriaThere are many kinds of bacteria in normal oral cavity.
Mainly the bacteria causing caries are Streptococcus Mutans (MS).
Microorganisms:
Role of plaquePlaque is a biofilm on the surface of the tooth (enamel).EnamelCrownRootgum Microorganisms
Role of Tooth Quality
Position
Structure
arrangement
host & tooth
Role of saliva:
It plays role in remineralization on the teeth.
Saliva has the buffering action and cleansing effect.
host & tooth
Role of carbohydrates:
the most important cause;refined carbohydrates are directly proportional with dental caries.
Sugar:
MINOR FACTORS:
Enamel compositionMorphology of the toothHabit of brushing teethImmunity
Clinical classification of cariesAccording to three basic factors : severity and rate of progression anatomical site(involving site) age patterns at which lesions predominate
Tooth anatomyRoot
Acute caries Chronic cariesArrested cariesRampant cariesClassification according to the developing speed
Classification according to the involving siteOcclusal caries
Root caries
Smooth surface caries
Linear enamel caries
Clinical Manifestation and Symptoms
Visible pits or holes in the tooth
Colour changing
Soften
Pain
changes in tissue color, texture, and structure
ABCDA Early caries may have no symptoms B be sensitive to sweet foods or to hot and cold temperatures C very sensitive to stimulatorD the acute pain
ExaminationClinical observations (Visual change)
ProbingThe explorer tip can easily damage white spot lesions
ExaminationTemperature test
X-ray
Transillumination
Diagnosis Clinical signs visual color, texture, shape, location, cavitation, Clinical symptoms
Diagnostic test--examination
TreatmentNon-surgical - remineralizationSurgical - restorationThe different ways of treatment depend on the size and depth of the cavity, and how much structure has been lost.Calcium hydroxide pulp-capping material lining material filling material
Prevention is the most important for dental caries.
Problem for reviewWhat is the etiology of dental caries? Be familiar with the definitions of dental caries and classification.Simply describe clinical manifestation and symptoms of dental caries.
Endodontics
Etiology of Pulpitis 1-bacterial cause: caries, fracture, bacteremia, periodontal pocket caries irreversible pulpitis
pulp
2-physical cause: sever thermal change (cavity preparation), large metallic restoration
5. Other cause: internal resorption
Possible Pulpal DiagnosesNormalReversible pulpitisIrreversible pulpitisacute, chronic, polypNecrosisPrevious endodontic treatment
Reversible pulpitis Clinically sharp pain & respond to sudden changes in temperaturepain disappear as the stimuli removed last less than 20 sec3. easily localized & unaffected by body position
Irreversible Pulpitis
Reversible pulpitis are left untreated.
Symptoms of Irreversible PulpitisThermal:Hypersensitive-moderate to severe
Sweets:Moderately to severely sensitive Biting Pressure:Usually sensitive in later stages (periapical symptom)spontaneous pain: Moderate to severe
DiagnosisIrreversible Pulpitis
Hypersensitive to hot or cold that is prolonged.
A history of spontaneous pain.
Vital or partially vital pulp.
may occur as a sequel of focal reversible pulpitis or occur due to acute exacerbation of chronic pulpitis. clinically 1- big cavity or margin of a restoration 2- sleep pain 3- spontaneous pain 4- pain lasts 5- difficult to localized Acute pulpitis:
a result of acute pulpitis, or develops as chronic one.Clinically1-spontaneous dull, itching pain2-increased pain threshold (need strong stimuli) due to degeneration of the nerve fibers3- the pain lasts for about 2 h. Chronic pulpitis
Chronic hyperplastic pulpitis(polyp)Clinically: 1- polyp2- occurs in a tooth with large carious lesion 3- not sensitivity 4- bleed easily 5- may confused with hypertrophic gingival polyp
Treatment of Irreversible Pulpitis
Root canal treatment or extraction
Necrotic PulpPulp continued degeneration.no reparative potential.
Commonly have apical radiolucent lesion.
Maxillary first molar with large amalgam restoration and periapical radiolucencies around all three roots. The tooth was unresponsive to electrical and thermal testing.
Symptoms of Necrotic PulpThermal:No response
Sweets:No response
Biting Pressure:Usually moderate to severe pain (not symptom of necrotic pulp, but rather periapical inflammation)
Moderate to severe spontaneous pain
Diagnosis of Necrotic PulpDistinguishing features:No response to cold.No response to EPT.
CaveatsDecreased sensitivity Periapical radiolucency is strong but not conclusive evidence that pulp is necrotic.
Necrotic Pulp(additional considerations)Antibiotic coveragePain Management
Occlusal Reduction
Root Canal TreatmentThe procedure involves removing inflamed or damaged tissue from inside a tooth and cleaning, filling and sealing the remaining space, to prevent re-infection.
Pre-operative film
Access and Working length
Completed RCT
case
Points you must know:What is root canal treatment?Simply describe the clinical manifestation of pulpitis.
The oral manifestation of HIV Infection
human immuno-deficiency virus (HIV)retroviruses acquired immune deficiency syndrome, AIDS
Oral manifestations are often the first clinical feature of HIV infection. The first AIDS case, worldwide1981, AIDS China 1985, AIDS, Beijing,Argentina Shanghai 1987, AIDS Hangzhou: 1985, AIDS--hemophila 2009, 1272/236 (HIV/AIDS)Epidemiology
Oral Manifestations observed in HIV
FungalNeoplasticViralBacterialOther
Fungal Manifestations ----candidiasisCan manifest in 4 different ways Pseudomembraneous candidiasisErythematous candidiasisHyperplastic candidiasisAngular chilitis
Pseudomembraneous Candidiasis
Hyperplastic Candidiasis
Angular chilitis
Neoplastic Oral Manifestations
There are two types of neoplasms associated with oral manifestations in HIV individualsKaposis Sarcoma (KS)Non-Hodgkins Lymphoma
Kaposis Sarcoma
Non-Hodgkins Lymphoma
Viral Manifestations
Herpes Simplex Virus (HSV) lesionsHerpes ZosterHairy leukoplakiaCytomegalovirus (CMV) ulcersHuman Papillomavirus (HPV) lesions
Leukoplakia
Herpes Simplex Virus (HSV) lesions
Cytomegalovirus (CMV) ulcersCombination of HSV and CMV
HPV
Bacterial ManifestationsLinear Gingival Erythema Necrotizing Ulcerative PeriodontitisTuberculosis
Linear Gingival Erythema(red-band gingivitis)
Necrotizing Ulcerative Periodontitis
Necrotizing Ulcerative
TuberculosisOral lesions in people with tuberculosis are seen rarely.
They have been reported as ulcers on the tongue secondary to pulmonary tuberculosis.
Other Oral Manifestations
Aphthous Ulcerations (canker sores)MinorMajorSalivary Gland DiseaseXerostomia
Aphthous Ulcerations
minormajor
Salivary Gland Disease
Xerostomia
Conclusions
Lesions or other manifestations in the mouth may be the initial indicator of a persons HIV status or it may indicate a further decrease or worsening of an infected individuals immune system.
You must know:What is the main oral manifestation of HIV infection?List the four categories of oral manifestations that may present in HIVBe familiar with fungal oral manifestation that may present in HIV infected individuals
******May be confused with aphthous ulcers, NUP, and lymphoma*Warts tend to recur after treatment (2)*Mostly associated with anterior teeth (2)Treatment: Debridement by a dental professional, oral rinses for 2 weeks, an improved home oral hygiene (2)*Very painful, especially when eating salty, spicy or acidic foods and beverages or hard, rough foods (2)*Usually nontenderCan be unilateral or bilateral (1)*Surgery only for cosmetic reasons (1)