金教案2 3

General Hospital Tianjin Medical University Sherry Jin Yan-

jiao(TEL:60362418)

March 2009

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CHAPTER 2. Dental caries-Endodontics-Periapical disease 2.1 Dental caries

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Definition of dental cariesDental caries can be defined as progressive

and irreversible bacterial damage to hard

tissue of teeth exposed to the oral environment. It is characterized by demineralization of these tissues followed by disintegration of their organic material. The disease can result in bacterial invasion and death of the pulp and spread of infection into the periapical tissues, causing pain

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Traditional Caries Model

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Factor 1:dental plaque

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Factor 2: Host—teeth and saliva

TEETH

Be Associatedwith

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Factor 3:sugar

All these must be present for a sufficient length

of time

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Current Concept of the Caries Process

Important things to note are:A natural phenomenonSpread over timeNot have to progressDepend on the modifying factors

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Caries RiskMalnourished childrenSocially deprivedSome of the wealthyThose who snack on sugary products

Medically compromised/handicapped

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Caries RiskInfants who demand on breast feeding beyond 42 months or are fed with sugary fluids

Residents of non-fluoridated water

Clinical evidence

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High –risk Teeth Position

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High –risk Tooth Surfaces

Pits,grooves and fissureInterproximal areasCervical areas

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Pits,grooves and fissure

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Pits,grooves and fissure

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Interproximal areas

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Cervical Caries

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Caries diagnosis

Requirement Good lightingDry and plaque free teethBlunt probeMouth mirrorSharp eyes

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Visual /tactile criteriaOpacity or discolouration: chalky white

Opacity or discolouration: brown or black

Enamel breakdownObvious cavitation

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Progression of Dental CariesA)Enamelcaries

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Progression of Dental CariesB)Dentinecaries

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Progression of Dental CariesC)Pulpinvolved

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Progression of Dental CariesD)Periapicalabscess

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Classification of caries1.Based on development of the lesion

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Classification of caries 2.Based on severity of the lesion

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Based on severity of the lesion Superfacial caries

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Based on severity of the lesion Intermediate caries

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Based on severity of the lesion Deep caries

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Clinical manifestation of caries

Tooth painBad breathFoul taste

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InquirySpectationTouchProbeCold and warm testX-ray

Diagnosis of dental caries:

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Spectation

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Probe

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Cold test

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Warm test

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Mechanical measure for caries control

ToothbrushingMouth RisingDental FlossFissure and pits

sealants

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Operative Treatment for Caries

For superfacial and intermediate cariesRestoration of teeth

with amalgam, composite resin, glass ionomer

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Operative Treatment for Caries

For deep caries

Remove caries and place a Calcium Hydroxide base

Then a temporary filling

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Operative Treatment for Caries

For deep caries

In the case of irreversible pulpitis, root canal treatment(RCT) is necessary

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Operative Treatment for Caries

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Main topics

Definition of dental caries

Four principal factors of causes for caries

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Take a rest

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2-2 Endodontics (pulp diseases)

1.Pulpitis Acute pulpitis Chronic pulpitis Retropulpitis and residual pulpitis2.Pulp degeneration3.Pulp necrosis

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The main causes of pulpitisDental cariesTraumatic exposureFracture of the crownThermal effectsChemical irritation

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Acute pulpitis

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Chronic pulpitisPain is not prominent featureThe reaction to the thermal change is dramatically reduced

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2-3.Periradicular lesionsAcute apical periodontitis Acute periradicular abscessChronic apical periodontitis Chronic periradicular abscess Chronic periradicular granuloma Radicular cyst

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Acute apical periodontitis

Exhibit normal periradicular structure but painful to percussion

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Acute periradicular abscess

Pain ,rapid onset, tenderness to percussionThe exudates can be confined to the alveolar

bone, causing localized swelling of soft tissue, or extend into facial space (cellutis)

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Chronic apical periodontitis The development of an asymtomatic periradicular

lesion at the periapex1.Chronic periradicular abscess2.Chronic periradicular granuloma3. Radicular cyst

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Treatment for pulp diseases and periradicular lesions

Root canal treatment

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Take a rest

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