General Hospital Tianjin Medical University Sherry Jin Yan-jiao(TEL:60362418) March 2009 06/10/09

General Hospital

Tianjin Medical University

Sherry Jin Yan-jiao(TEL:60362418)

March 2009

CHAPTER 2. Dental caries-Endodontics-Periapical disease 2.1 Dental caries 06/10/09

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Definition of dental caries Dental 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 06/10/09 1

Dental 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 06/10/09 1

Factor 1:dental plaque 06/10/09 1

Factor 2: Host—teeth and saliva TEETH Be Associated with 06/10/09 1

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Factor 3:sugar All these must be present for a sufficient length of time 06/10/09 1

All these must be present for a sufficient length of time

Current Concept of the Caries Process Important things to note are: A natural phenomenon Spread over time Not have to progress Depend on the modifying factors 06/10/09 1

Important things to note are:

A natural phenomenon

Spread over time

Not have to progress

Depend on the modifying factors

Caries Risk Malnourished children Socially deprived Some of the wealthy Those who snack on sugary products Medically compromised/handicapped 06/10/09 1

Malnourished children

Socially deprived

Some of the wealthy

Those who snack on sugary products

Medically compromised/handicapped

Caries Risk Infants who demand on breast feeding beyond 42 months or are fed with sugary fluids Residents of non-fluoridated water Clinical evidence 06/10/09 1

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

Residents of non-fluoridated water

Clinical evidence

High –risk Teeth Position 06/10/09 1

High –risk Tooth Surfaces Pits,grooves and fissure Interproximal areas Cervical areas 06/10/09 1

Pits,grooves and fissure

Interproximal areas

Cervical areas

Pits,grooves and fissure 06/10/09 1

Pits,grooves and fissure 06/10/09 1

Interproximal areas 06/10/09 1

Cervical Caries 06/10/09 1

Caries diagnosis Requirement Good lighting Dry and plaque free teeth Blunt probe Mouth mirror Sharp eyes 06/10/09 1

Requirement

Good lighting

Dry and plaque free teeth

Blunt probe

Mouth mirror

Sharp eyes

Visual /tactile criteria Opacity or discolouration: chalky white Opacity or discolouration: brown or black Enamel breakdown Obvious cavitation 06/10/09 1

Opacity or discolouration: chalky white

Opacity or discolouration: brown or black

Enamel breakdown

Obvious cavitation

Progression of Dental Caries A) Enamel caries 06/10/09 1

A)

Enamel

caries

Progression of Dental Caries B) Dentine caries 06/10/09 1

B)

Dentine

caries

Progression of Dental Caries C) Pulp involved 06/10/09 1

C)

Pulp

involved

Progression of Dental Caries D) Periapical abscess 06/10/09 1

D)

Periapical

abscess

Classification of caries 1.Based on development of the lesion 06/10/09 1

1.Based on development of the lesion

Classification of caries 2.Based on severity of the lesion 06/10/09 1

Based on severity of the lesion Superfacial caries 06/10/09 1

Superfacial caries

Based on severity of the lesion Intermediate caries 06/10/09 1

Intermediate caries

Based on severity of the lesion Deep caries 06/10/09 1

Deep caries

Clinical manifestation of caries Tooth pain Bad breath Foul taste 06/10/09 1

Tooth pain

Bad breath

Foul taste

Inquiry Spectation Touch Probe Cold and warm test X-ray Diagnosis of dental caries: 06/10/09 1

Inquiry

Spectation

Touch

Probe

Cold and warm test

X-ray

Spectation 06/10/09 1

Probe 06/10/09 1

Cold test 06/10/09 1

Warm test 06/10/09 1

Mechanical measure for caries control Toothbrushing Mouth Rising Dental Floss Fissure and pits sealants 06/10/09 1

Toothbrushing

Mouth Rising

Dental Floss

Fissure and pits sealants

Operative Treatment for Caries For superfacial and intermediate caries Restoration of teeth with amalgam, composite resin, glass ionomer 06/10/09 1

For superfacial and intermediate caries

Restoration of teeth with amalgam, composite resin, glass ionomer

Operative Treatment for Caries For deep caries Remove caries and place a Calcium Hydroxide base Then a temporary filling 06/10/09 1

For deep caries

Remove caries and place a Calcium Hydroxide base

Then a temporary filling

Operative Treatment for Caries For deep caries In the case of irreversible pulpitis, root canal treatment(RCT) is necessary 06/10/09 1

For deep caries

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

Operative Treatment for Caries 06/10/09 1

Main topics Definition of dental caries Four principal factors of causes for caries 06/10/09 1

Definition of dental caries

Four principal factors of causes for caries

Take a rest 06/10/09 1

2-2 Endodontics (pulp diseases) 1.Pulpitis Acute pulpitis Chronic pulpitis Retropulpitis and residual pulpitis 2.Pulp degeneration 3.Pulp necrosis 06/10/09 1

1.Pulpitis

Acute pulpitis

Chronic pulpitis

Retropulpitis and residual pulpitis

2.Pulp degeneration

3.Pulp necrosis

The main causes of pulpitis Dental caries Traumatic exposure Fracture of the crown Thermal effects Chemical irritation 06/10/09 1

Dental caries

Traumatic exposure

Fracture of the crown

Thermal effects

Chemical irritation

Acute pulpitis 06/10/09 1

Chronic pulpitis Pain is not prominent feature The reaction to the thermal change is dramatically reduced 06/10/09 1

Pain is not prominent feature

The reaction to the thermal change is dramatically reduced

2-3.Periradicular lesions Acute apical periodontitis Acute periradicular abscess Chronic apical periodontitis Chronic periradicular abscess Chronic periradicular granuloma Radicular cyst 06/10/09 1

Acute apical periodontitis

Acute periradicular abscess

Chronic apical periodontitis

Chronic periradicular abscess

Chronic periradicular granuloma

Radicular cyst

Acute apical periodontitis Exhibit normal periradicular structure but painful to percussion 06/10/09 1

Exhibit normal periradicular structure but painful to percussion

Acute periradicular abscess Pain ,rapid onset, tenderness to percussion The exudates can be confined to the alveolar bone, causing localized swelling of soft tissue, or extend into facial space (cellutis) 06/10/09 1

Pain ,rapid onset, tenderness to percussion

The 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 periapex 1.Chronic periradicular abscess 2.Chronic periradicular granuloma 3. Radicular cyst 06/10/09 1

The development of an asymtomatic periradicular lesion at the periapex

1.Chronic periradicular abscess

2.Chronic periradicular granuloma

3. Radicular cyst

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Treatment for pulp diseases and periradicular lesions Root canal treatment 06/10/09 1

Root canal treatment

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Take a rest 06/10/09 1