第一章 Intruction (NXPowerLite)

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第一章 Intruction (NXPowerLite)

  1. 1. Pediatric Dentistry
  2. 2. Introduction Chapter 1
  3. 3. 1 Definition <ul><li>What is Pediatric Dentistry </li></ul>
  4. 4. Definition <ul><li>An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs </li></ul>
  5. 5. Who ? <ul><li>infants and children through adolescence </li></ul><ul><li>including those with special health care needs </li></ul>
  6. 6. What? <ul><li>provides both primary and comprehensive preventive oral health care </li></ul><ul><li>provides both primary and comprehensive therapeutic oral health care </li></ul>
  7. 7. 2 key elements <ul><li>“ age-defined ” </li></ul><ul><li>“ primary and comprehensive...care ” </li></ul><ul><li>&quot; infants and children through adolescence &quot; </li></ul><ul><li>&quot; special health care needs &quot; </li></ul>
  8. 8. age-defined <ul><li>Most specialties: procedure defined </li></ul><ul><ul><li>PD: no limitation to </li></ul></ul><ul><ul><li>treatment they provide </li></ul></ul>
  9. 9. <ul><li>Pediatric dentists are primary providers. There is no need for a referral of patients </li></ul>
  10. 10. <ul><li>Pediatric dentists see patients at any age from birth up to their late teens </li></ul>
  11. 11. <ul><li>Pediatric dentists have the training and experience to evaluate and treat patients being medically compromised. </li></ul>
  12. 12. key elements <ul><li>“ age-defined ” </li></ul><ul><li>“ primary and comprehensive...care ” </li></ul><ul><li>&quot; infants and children through adolescence &quot; </li></ul><ul><li>&quot; special health care needs &quot; </li></ul>
  13. 13. 3 Structure of the dental consultation
  14. 14. <ul><li>Greeting </li></ul><ul><li>Preliminary chat </li></ul><ul><li>Examination </li></ul><ul><li>Preliminary explanation </li></ul><ul><li>Business </li></ul><ul><li>Health education </li></ul><ul><li>Dismissal </li></ul>
  15. 15. 3.1 Greeting <ul><li>3.1.1 in a friendly way </li></ul><ul><li>3.1.2 by name </li></ul><ul><li>Don’t proceed too quickly </li></ul>
  16. 16. <ul><li>Begin with non-dental topics </li></ul><ul><li>Ask an open qustion </li></ul><ul><li>L isten to the answer </li></ul>3.2 Preliminary chat
  17. 17. 3.3 Examination <ul><li>Should be pain-free </li></ul><ul><li>Should be adequate </li></ul><ul><li>Should not be totally tooth-centered </li></ul>
  18. 18. 3.4 Preliminary explanation <ul><li>The aim: to explain what the clinical or preventive objectives are </li></ul>
  19. 19. <ul><li>In terms parents and children will understand. </li></ul><ul><li>This is a vital part of any visit </li></ul>
  20. 20. 3.5 Business <ul><ul><li>3.5.1 Remain in verbal contact </li></ul></ul><ul><ul><li>3.5.2 Check the patient not in pain </li></ul></ul>
  21. 21. <ul><ul><li>a) Discuss what you are doing </li></ul></ul><ul><ul><li>b) Use the patient’s name to </li></ul></ul><ul><ul><li>show a personal interest </li></ul></ul><ul><ul><li>c) Clarify misunderstandings </li></ul></ul>
  22. 22. <ul><li>3.5.3 Summarize what has been done at the end </li></ul><ul><li>3.5.4 Offer aftercare advice </li></ul>
  23. 23. 3.6 Health education <ul><li>Give advice on maintaining a healthy mouth </li></ul><ul><li>The final part is goal setting </li></ul><ul><li>Goal setting must be used sensibly . </li></ul>
  24. 24. 3.7 Dismissal <ul><li>The final part of a visit </li></ul><ul><li>Should be clearly signposted </li></ul><ul><li>Should be ensured the patient and parents leave with a sense of goodwill. </li></ul>
  25. 25. Structure of the dental consultation <ul><li>Greeting </li></ul><ul><li>Preliminary chat </li></ul><ul><li>Examination </li></ul><ul><li>Preliminary explanation </li></ul><ul><li>Business </li></ul><ul><li>Health education </li></ul><ul><li>Dismissal </li></ul>
  26. 26. 4 Anxious and uncooperative children
  27. 27. <ul><li>4.1 Dental anxiety is a common problem all over the world, especially in pediatric dentistry </li></ul>
  28. 28. <ul><li>It not only prevents patients from seeking care but also cause stress to the dentists </li></ul>
  29. 29. <ul><li>Dental anxiety is a problem that we as a profession must take seriously </li></ul>
  30. 30. 4.2 How does the dental anxiety develop?
  31. 31. <ul><li>4.2.1 Be afraid of pain or imaginary pain </li></ul>
  32. 32. <ul><li>4.2.2 Uncertainty about what is to happen is certainly a factor </li></ul>
  33. 33. <ul><ul><li>4.2.3 A poor past experience with a dentist could upset a patient </li></ul></ul>
  34. 34. <ul><li>4.2.4 Learn anxiety response from parents, relations, friends, or books,TV show </li></ul>
  35. 35. 4.3 The extent of dental anxiety
  36. 36. <ul><li>it is no easy task to measure dental anxiety and pinpoint aetiological agents </li></ul>
  37. 37. <ul><li>5 Helping anxious patients to copy with dental care </li></ul>
  38. 38. <ul><li>Establish an effective preventive programme </li></ul><ul><li>Establish good dentist-patient relationship </li></ul>
  39. 39. <ul><li>Ensure any treatment is pain-free </li></ul><ul><li>Manage time effectively </li></ul><ul><li>Behavior Management </li></ul>
  40. 40. Behavior Management <ul><li>Traditional Techniques </li></ul><ul><ul><li>Tell-show-do </li></ul></ul><ul><ul><li>Distraction </li></ul></ul><ul><ul><li>Modeling </li></ul></ul><ul><ul><li>Positive Reinforcement </li></ul></ul><ul><ul><li>Voice control </li></ul></ul><ul><li>Adversive Techniques </li></ul><ul><ul><li>Physical restraint </li></ul></ul><ul><ul><li>Hand over mouth </li></ul></ul><ul><li>Pharmacologic Techniques </li></ul><ul><ul><li>Sedation </li></ul></ul><ul><ul><li>General Anesthesia </li></ul></ul>
  41. 41. <ul><li>Pharmacological agents </li></ul><ul><li>Pharmacological-alternatives </li></ul>Behavior Management
  42. 42. Behavior Management <ul><li>Traditional Techniques </li></ul><ul><ul><li>Tell-show-do </li></ul></ul><ul><ul><li>Distraction </li></ul></ul><ul><ul><li>Modeling </li></ul></ul><ul><ul><li>Positive Reinforcement </li></ul></ul><ul><ul><li>Voice control </li></ul></ul><ul><li>Adversive Techniques </li></ul><ul><ul><li>Physical restraint </li></ul></ul><ul><ul><li>Hand over mouth </li></ul></ul><ul><li>Pharmacologic Techniques </li></ul><ul><ul><li>Sedation </li></ul></ul><ul><ul><li>General Anesthesia </li></ul></ul>
  43. 43. <ul><li>T: Tell </li></ul><ul><li>S: Show </li></ul><ul><li>D: Do </li></ul>TSD Technique
  44. 44. <ul><li>A: Tell: Explanation of procedures at the right age/educational level </li></ul>
  45. 45. CHOOSE WORDS CAREFULLY <ul><li>AVOID </li></ul><ul><ul><li>Shot </li></ul></ul><ul><ul><li>Needle </li></ul></ul><ul><ul><li>Hurt </li></ul></ul><ul><ul><li>Pull </li></ul></ul><ul><ul><li>Etc. </li></ul></ul>For Most Children:
  46. 46. <ul><li>B: Show: demonstrate the procedure </li></ul><ul><li>C: Do: following on to undertake the task. </li></ul>
  47. 47. Positive reinforcement <ul><li>Find something to praise </li></ul><ul><ul><li>Anything </li></ul></ul><ul><li>Stress accomplishments </li></ul><ul><li>Prizes at end of visit </li></ul>
  48. 48. Adaptive method
  49. 49. Modeling <ul><li>Modeling could be used </li></ul><ul><li>to alleviate anxiety due </li></ul><ul><li>to ‘fear of the unknown’ </li></ul>
  50. 50. Live modeling Next patient watches
  51. 51. <ul><li>It’s not necessary to use </li></ul><ul><li>a live model, videos of </li></ul><ul><li>co-operative patients </li></ul><ul><li>are of value. </li></ul>
  52. 52. <ul><li>Asking patients to </li></ul><ul><li>identify their negative </li></ul><ul><li>thoughts </li></ul>Cognitive approaches
  53. 53. <ul><li>helping patients to recognize their negative thoughts and suggesting more positive alternatives ‘reality based’; </li></ul>
  54. 54. <ul><li>Shift attention from the dental setting towards some other kind of situation . </li></ul>Distraction :
  55. 55. Distraction <ul><li>Conversation </li></ul><ul><li>Mirror </li></ul><ul><li>Book </li></ul><ul><li>Electronics </li></ul><ul><li>Whatever… </li></ul>
  56. 56. Voice control <ul><li>Tone or inflection </li></ul><ul><li>Volume </li></ul><ul><ul><li>Soft and even </li></ul></ul><ul><ul><li>Loud and abrupt </li></ul></ul><ul><li>Use to hold child’s attention </li></ul><ul><ul><li>Do not telegraph frustration </li></ul></ul>
  57. 57. Parental presence? <ul><li>Supportive for very young patients </li></ul><ul><li>Instructive for parents </li></ul><ul><li>Parent is silent partner </li></ul><ul><ul><li>Never interpreter of same language </li></ul></ul><ul><li>Don’t threaten departure </li></ul>
  58. 58. Parental interactions Parents should be told where they should stand (sit), what they can say, and how they should react; without threats or condescension.
  59. 59. Uncooperative Patient <ul><li>Explanation </li></ul><ul><ul><li>maintain confidence </li></ul></ul><ul><li>Direct attention to child </li></ul><ul><ul><li>Speak directly </li></ul></ul><ul><ul><li>Parental presence </li></ul></ul><ul><ul><ul><li>Silent assurance </li></ul></ul></ul><ul><ul><li>Positive reinforcement </li></ul></ul><ul><ul><li>Persist </li></ul></ul>
  60. 60. Time Out <ul><li>Pause for reflection </li></ul><ul><li>May assist the dentist </li></ul><ul><li>Test of stamina </li></ul><ul><li>Economically difficult </li></ul>
  61. 61. Restraints <ul><li>Mouth Prop </li></ul><ul><li>Parental security </li></ul><ul><li>Wraps or Papoose Board </li></ul><ul><li>Hand over mouth </li></ul>
  62. 62. Mouth prop <ul><li>Support oral access </li></ul><ul><ul><li>Treatment aid </li></ul></ul><ul><li>Apply with care </li></ul><ul><ul><li>Not to impinge on lips </li></ul></ul><ul><ul><li>Not to subluxate mandible </li></ul></ul><ul><li>May be interpreted as restraint </li></ul><ul><li>Assure ratchet works </li></ul><ul><li>Open slowly </li></ul><ul><li>Don’t impinge on lips </li></ul><ul><li>Do not use as a crow-bar </li></ul>
  63. 63. Physical restraint <ul><li>Parent may be more supportive than wrap </li></ul><ul><li>Wraps/Boards </li></ul><ul><ul><li>Pediwrap®, Papoose Board® </li></ul></ul><ul><ul><ul><li>Supports physically challenged patients </li></ul></ul></ul><ul><ul><ul><ul><li>Necessity during sedation </li></ul></ul></ul></ul><ul><ul><ul><li>Downside </li></ul></ul></ul><ul><ul><ul><ul><li>Sense of helplessness, loss of control </li></ul></ul></ul></ul><ul><li>Avoid injury </li></ul><ul><li>Assure parental informed consent </li></ul><ul><li>Meet community standards </li></ul>
  64. 64. When to consider pharmacologic management...
  65. 65. Nitrous Oxide Analgesia <ul><li>Adjunct to non-pharmacological management </li></ul><ul><li>Assumes a minimal level of cooperation </li></ul><ul><ul><li>Child must be capable of following instruction </li></ul></ul><ul><ul><li>Capable of sitting alone in chair </li></ul></ul><ul><ul><li>Capable of breathing through the nose </li></ul></ul><ul><ul><li>Nasal inhaler hood must fit properly </li></ul></ul>
  66. 66. Sedation <ul><li>Definition of Conscious Sedation </li></ul><ul><ul><li>Minimally depressed level of consciousness that retains the patient’s ability to maintain a patent airway independently and continuously and to respond appropriately to physical stimulation and/or verbal command </li></ul></ul>
  67. 67. Sedation <ul><li>Strict guidelines requiring </li></ul><ul><ul><li>Monitoring & recording </li></ul></ul><ul><ul><li>Recovery area </li></ul></ul><ul><ul><li>Additional personnel </li></ul></ul>
  68. 68. Functional Levels of Sedation <ul><ul><li>I Anxiolysis </li></ul></ul><ul><ul><li>II Interactive </li></ul></ul><ul><ul><li>III Non-interactive, arousable with mild/moderate stimuli </li></ul></ul><ul><ul><li>IV Non-interative, non-arousable except with intensive stimulus </li></ul></ul><ul><ul><li>V General Anesthesia </li></ul></ul>Conscious Sedation Deep Sedation General Anesthesia
  69. 69. Conscious sedation (I,II,III)
  70. 70. General Anesthesia <ul><li>Last resort </li></ul><ul><li>Indications </li></ul><ul><ul><li>Immaturity </li></ul></ul><ul><ul><li>Extensive caries </li></ul></ul><ul><ul><li>Physical or mental challenge </li></ul></ul><ul><li>Definition </li></ul><ul><ul><li>Induced state of unconsciousness accompanied by loss of protective reflexes, including the ability to maintain an airway independently and respond appropriately to physical stimulation and/or verbal command </li></ul></ul>
  71. 71. Management entree´ selection <ul><li>Most patients require simple management techniques </li></ul><ul><li>A small cohort require the more aggressive management techniques </li></ul><ul><li>Advance preparation further minimizes necessity for aversive techniques </li></ul>
  72. 72. Number of children who actually present as management problem??? <ul><li>Estimated that 22% actually present moderate - severe management challenges </li></ul>
  73. 73. <ul><li>Curve moves left with increasing age </li></ul><ul><li>General anesthesia more likely to be utilized below the age of 2.5 yrs </li></ul>Management Technique Utilization
  74. 74. Successful Patient Management <ul><li>Goal: Safe, effective and quality dental care </li></ul><ul><ul><li>Significant resources are required </li></ul></ul>
  75. 75. Successful Patient Management <ul><li>Good communication with patients and parents to establish expectations and mitigate misunderstanding </li></ul><ul><ul><li>Patient’s recognition of their own accomplishment, without dreading the next visit </li></ul></ul><ul><ul><li>Parent’s recognition of the dentist’s accomplishment and an understanding of what will be necessary to complete future visits </li></ul></ul>
  76. 76. 6 First dental visit <ul><li>There seems to be a lot of confusion about the correct timing for the first dental visit. </li></ul>
  77. 77. 6.1 The correct time <ul><li>The AAPD recommends : within 6 months of the eruption of the first primary tooth and no later than 12 months of age </li></ul>
  78. 78. <ul><li>A child should have his or her first dental visit at the first birthday! </li></ul>
  79. 79. 6.2 Medical and dental record <ul><li>The dentist should record a thorough medical and dental history . </li></ul>
  80. 80. 6.3 oral examination <ul><li>Usually be accomplished with the parent present in the office. </li></ul><ul><li>The child patient may be sitting in knee-to-knee position </li></ul>
  81. 81. 6.4 Assess <ul><li>6.4.1 Assess the risk of oral and dental disease </li></ul><ul><li>6.4.2 Evaluate the child's oral and dental development </li></ul>
  82. 82. <ul><li>6.4.3 Evaluate the need for fluoride supplemen-tation. </li></ul>
  83. 83. <ul><li>6.4.4 It may be important to discuss non -nutritive habits, injury prevention, oral hygiene, and effects of diet on the dentition. </li></ul>
  84. 84. 6.5 Treatment <ul><li>If treatment is indicated the dentist should be prepared to provide therapy or he needs to refer the patient. </li></ul>
  85. 85. 第二章 生长发育
  86. 86. <ul><li>生长发育的概念 : 指机体组织形态机能中所显示的生物肉体、 心理、 生理、 情绪等变化过程的综合,可受遗传、 性别、 营养、 疾病、 锻炼等内外因素影响而存在个体差异。它是一个连续不断的发展过程,时间即年龄在儿童生长发育中是一个十分重要的因素。它包括两方面: </li></ul><ul><li>生长 : 指机体增殖的过程,是量的增加 </li></ul><ul><li>发育 : 指机能和成熟的程度,是质的变化 </li></ul>
  87. 87. 生长发育分期及各期特点 第一节
  88. 88. 一 按年龄阶段分期 二 按牙列分期 三 咬合发育阶段分期
  89. 89. 一 按年龄阶段分期 基因突变 环境有害因素 危险因素 1 胚胎第 4 周,牙板出现 2 胚胎第 8 周, 1) 初步形成人的面型, 2) 腭的发育才开始; 3) 乳牙胚已经发生 特 点 0~8 周 年龄阶段 胚芽期 生长期
  90. 90. 危险因素 特 点 阶段 生长期 母体营养不良 母体疾病 1 组织器官迅速生长 和功能渐趋出现 2 胎龄 14 周 1 )通过胎盘与母体 进行物质交换 2 )腭盖形成 3 )乳牙开始钙化 8 周 ~ 出生( 40 周) 胎儿期
  91. 91. 唾液腺不发达,唾液分泌少 危险因素 1 胎儿在母体内寄生的结束 2 乳牙冠部出现新生线 3 唾液腺不发达,唾液分泌量少 特 点 出生 ~4 周 阶段 新生儿期 生长期
  92. 92. 危险因素 特 点 阶段 生长期 营养紊乱和疾病 1 生长快,代谢率高 2 消化功能未发育完善 3 被动免疫消失,获得 性免疫尚未完全建立 4 乳牙开始萌出,恒牙 的钙化期 4 周 ~ 出生后 1 年 婴儿期
  93. 93. 进食次数多,糖类食品多 乳牙外伤多 感染后的变态反应性疾病开始出现 危险因素 1 神经系统发育 仍然很快, 2 3 岁时乳牙全部 出齐,钙化低 3 活动多 特 点 1~6 岁 阶段 幼儿期 生长期
  94. 94. 危险因素 特 点 阶段 生长期 扁桃腺肥大或咽部腺样体增生常常影响儿童呼吸道的通畅,患儿张口呼吸,久之容易形成开唇露齿的颌面畸形。 恒磨牙萌出,窝沟复杂 淋巴系统的发育处于高峰期,颈部和腹股沟处的淋巴结可以触及。 6 岁到 12~13 岁 学龄期
  95. 95. 恒磨牙龋病发病率高,病损严重 危险因素 身体骨骼出现第 2 次快速生长 特点 女孩 11~12 岁到 17~18 岁 男孩 13~14 岁到 18~20 岁 年龄阶段 青春发育期 生长期
  96. 96. 二 牙列的临床分期 <ul><li>(一)牙列分期 </li></ul><ul><li>1 无牙期: </li></ul><ul><li>2 乳牙列形成期: </li></ul><ul><li>3 乳牙列期: </li></ul><ul><li>4 混合牙列期: </li></ul><ul><li>5 恒牙列期: </li></ul>
  97. 97. <ul><li>二 儿童时期的 3 个牙列阶段 </li></ul><ul><li>1 乳牙列阶段 </li></ul><ul><li>2 混合牙列阶段 </li></ul><ul><li>3 年轻恒牙列阶段 </li></ul>
  98. 98. 3 个牙列阶段的特点 第一,二恒磨牙的保存 口腔内全部都是恒牙 恒牙龋病患病率高,病损严重 3 年轻恒牙列 1 预防错合畸形 2 防治恒牙龋病 1 儿童颌骨和牙弓主要生长发育期,也是恒牙合建立的关键时期 2 恒牙龋患开始 2 混合牙列 维护乳牙的健康完好 1 加强口腔卫生宣教 2 早发现,早治疗 主要任务 1 口腔内全部为乳牙 2 乳牙龋患开始和逐年增多 特点 1 乳牙列阶段 牙列阶段
  99. 99. 三咬合发育阶段的分期 恒牙列期 第三恒磨牙萌出完成期 Ⅴ A 第二恒磨牙萌出完成期 第三恒磨牙萌出开始期 A Ⅳ C 第一恒磨牙萌出完成期 (恒前牙部分或全部萌出完成) 侧方牙群替换期 第二恒磨牙萌出开始期 A Ⅲ B C 混合牙列期 乳牙列期 无牙期 乳牙萌出期 乳牙咬合完成期 第一恒磨牙及恒前牙萌出开始期 (前牙替换期) 乳牙萌出前 乳牙咬合完成前 A Ⅱ C A Ⅰ C
  100. 100. 第二节 颅面骨骼和牙列的生长
  101. 101. 一 颅面骨骼的生长 <ul><li>( 一)概论 </li></ul><ul><li>1 出生前 </li></ul><ul><li>1 )起源:原始胚胎的支持性结缔组织 </li></ul><ul><li>2 ) 化骨方式:膜内化骨 </li></ul><ul><li>软骨内化骨 </li></ul>
  102. 102. <ul><li>2 出生时 </li></ul><ul><li>颅面骨骼:面骨 =8 : 1 </li></ul><ul><li>原因:咀嚼器官的发育落后 </li></ul><ul><li>于脑和感觉器官发育 </li></ul>
  103. 103. <ul><li>3 出生后 </li></ul><ul><li>颅部生长: </li></ul><ul><li>1~2 岁,增长最快 </li></ul>5 岁后,增长减少 6 岁,已达成人 90% 10 岁后,变化甚少
  104. 104. <ul><li>面部生长 </li></ul><ul><li>高度 </li></ul><ul><li>宽度 </li></ul><ul><li>深度 </li></ul><ul><li>高度 > 深度 > 宽度 </li></ul>
  105. 105. 3 生长曲线: 1 ) 颅骨:与神经系统的生长曲线相一致 2 )面骨:一般躯体骨骼系统的生长曲线
  106. 106. (二)颅骨的生长 <ul><li>颅骨体积的增长: </li></ul><ul><li>1 )骨的表面增生 </li></ul><ul><li>2 )骨缝间质增生 </li></ul><ul><li>3 )软骨的间质及表面增生 </li></ul>
  107. 107. ( 三)面骨的生长 <ul><li>1 上颌骨 </li></ul><ul><li>1 )体积增长依赖于: </li></ul><ul><li>骨的表面增生 </li></ul><ul><li>骨缝间质增生 </li></ul><ul><li>上颌窦的发育 </li></ul>
  108. 108. <ul><li>2 )途径:长度: </li></ul><ul><li>A :骨缝间质增生 ( 额颌 颧颌 颧颞 翼腭 ) </li></ul><ul><li>B :上颌骨唇侧骨增生,舌侧骨吸收 </li></ul><ul><li>C :上颌结节区增长 </li></ul><ul><li>D :腭骨后缘的增长 </li></ul><ul><li>长度增加最明显的为上颌磨牙区 </li></ul>
  109. 109. <ul><li>宽度: </li></ul><ul><li>A :腭突及腭中缝的生长 </li></ul><ul><li>B :颧骨的宽度增加 </li></ul><ul><li>C :上颌骨前部 </li></ul><ul><li>上颌骨宽度增长较慢 </li></ul>
  110. 110. <ul><li>高度 </li></ul><ul><li>A :牙齿的萌出和牙槽骨的表面增生 </li></ul><ul><li>B :骨缝间质增生 </li></ul><ul><li>C :上颌窦的发育 </li></ul>
  111. 111. <ul><li>2 下颌骨 </li></ul><ul><li>1 )下颌骨的发育:由下颌突深部组织发 </li></ul><ul><li>育而来。 </li></ul><ul><li>2) 发育方式: </li></ul><ul><li>骨的表面增生 下颌 髁突软骨 生长 </li></ul><ul><li>无骨缝间质增生 </li></ul>
  112. 112. <ul><li>长度: </li></ul><ul><li>A : 骨板外新骨沉积,内侧陈骨吸收 </li></ul><ul><li>B : 下颌支前缘陈骨吸收,后缘新骨 </li></ul><ul><li>增生 </li></ul>
  113. 113. <ul><li>高度: </li></ul><ul><li>A :下颌髁突新骨增生 </li></ul><ul><li>B :牙槽突的增高及下颌骨下缘少量新骨增生 </li></ul>
  114. 114. <ul><li>宽度 </li></ul><ul><li>A :外侧骨增生,内侧骨吸收 </li></ul><ul><li>B :髁突向侧方生长 </li></ul>
  115. 115. 二 牙齿的发育 <ul><li>(一)牙齿发育的时间 </li></ul><ul><li>1 牙齿发育的三个阶段:生长期,钙化期和萌出期 </li></ul><ul><li>2 观察牙齿发育的方法: X- 线片观察牙齿钙化的不同阶段 </li></ul><ul><li>3 恒牙发育时间表 </li></ul><ul><li>4 恒牙钙化的 10 个阶段 </li></ul>
  116. 116. <ul><li>(二) 牙齿萌出 </li></ul><ul><li>1 牙齿萌出的概念:一般指牙齿突破口腔粘膜的现象 </li></ul><ul><li>2 组织学:包括一系列的变化 </li></ul><ul><li>3 牙齿萌出规律 : 1 )一定的时间 </li></ul><ul><li>2 )一定的顺序 </li></ul><ul><li>3 )左右对称 </li></ul><ul><li>4 牙齿萌出的变异 </li></ul>
  117. 117. <ul><li>生理性流涎:乳牙萌出时,对三叉神经产生刺激,引起唾液分泌量的增加,但由于小儿还没有吞咽大量唾液的习惯,口腔又浅,唾液往往流到口外来,形成“生理性流涎” </li></ul>
  118. 118. 三 咬合发育阶段的分期
  119. 119. 乳牙列的生理间隙 <ul><li>1 灵长间隙:存在于上颌乳侧切牙和乳尖牙之间,下颌乳尖牙与第一乳磨牙之间的间隙 </li></ul><ul><li>2 发育间隙:灵长间隙以外的生理间隙 </li></ul>
  120. 120. 恒前牙萌出期 <ul><li>正中分开 </li></ul><ul><li>丑小鸭阶段 </li></ul><ul><li>下切牙拥挤现象 </li></ul>
  121. 121. 侧方牙群替换期 <ul><li>1 侧方牙群 </li></ul><ul><li>2 剩余间隙 </li></ul>
  122. 122. 第三节 生长发育的评价
  123. 123. 常用评价方法 <ul><li>1 实际年龄 </li></ul><ul><li>2 生理年龄 </li></ul><ul><li>3 骨龄 </li></ul><ul><li>4 牙龄 </li></ul>

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