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Main textbooks. Paul 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. - PowerPoint PPT Presentation

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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

  • Clinical Examination in reversible pulpitisThermal:Hypersensitive with mild pain
  • Treatment of Reversible PulpitisRemove irritant if present If no pulp exposure: direct restoreIf pulp exposure:Carious: initiate RCTMechanical: >1 mm: initiate RCT
  • 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)