Presentation on theme: "Main textbooks Paul Coulthard, Keith Horner, Philip Sloan, et al. Master Dentistry. Volume 1,2, Oral and Maxillofacial Surgery, Radiology, Pathology, and."— Presentation transcript:
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.
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 Caries Micro- organisms host & tooth sugar time no caries no caries no caries no caries 1889, Miller: chemocoparasitic theory
Treatment Non-surgical - remineralization Surgical - restoration The 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 review What 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.
2-physical cause: sever thermal change (cavity preparation), large metallic restoration
5. Other cause: internal resorption internal resorption
Possible Pulpal Diagnoses Normal Reversible pulpitis Irreversible pulpitis — acute, chronic, polyp Necrosis Previous endodontic treatment
Reversible pulpitis Clinically 1.sharp pain & respond to sudden changes in temperature 2.pain disappear as the stimuli removed last less than 20 sec 3. easily localized & unaffected by body position
Clinical Examination in reversible pulpitis Thermal: Hypersensitive with mild pain
"name": "Clinical Examination in reversible pulpitis Thermal: Hypersensitive with mild pain
Treatment of Reversible Pulpitis Remove irritant if present If no pulp exposure: direct restore If pulp exposure: Carious: initiate RCT Mechanical: >1 mm: initiate RCT <1 mm crown planned: initiate RCT <1 mm: direct cap or RCT If recent operative or trauma – postpone additional treatment and monitor.
Irreversible Pulpitis Reversible pulpitis are left untreated.
Symptoms of Irreversible Pulpitis Thermal: Hypersensitive-moderate to severe Sweets: Moderately to severely sensitive Biting Pressure: Usually sensitive in later stages (periapical symptom) spontaneous pain: Moderate to severe
Diagnosis Irreversible 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. Clinically 1-spontaneous dull, itching pain 2-increased pain threshold (need strong stimuli) due to degeneration of the nerve fibers 3- the pain lasts for about 2 h. Chronic pulpitis
Chronic hyperplastic pulpitis(polyp) Clinically: 1- polyp 2- 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 Pulp Pulp 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 Pulp Thermal: 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 Pulp Distinguishing features: No response to cold. No response to EPT. Caveats Decreased sensitivity Periapical radiolucency is strong but not conclusive evidence that pulp is necrotic.
Root Canal Treatment The procedure involves removing inflamed or damaged tissue from inside a tooth and cleaning, filling and sealing the remaining space, to prevent re- infection.
Access and Working length
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, worldwide ： 1981, AIDS China ： 1985, AIDS, Beijing,Argentina Shanghai ： 1987, AIDS Hangzhou: 1985, AIDS--hemophila 2009, 1272/236 (HIV/AIDS) Epidemiology
Oral Manifestations observed in HIV Fungal Neoplastic Viral Bacterial Other
Fungal Manifestations ----candidiasis Can manifest in 4 different ways Pseudomembraneous candidiasis Erythematous candidiasis Hyperplastic candidiasis Angular chilitis
Neoplastic Oral Manifestations There are two types of neoplasms associated with oral manifestations in HIV individuals Kaposi ’ s Sarcoma (KS) Non-Hodgkin ’ s Lymphoma
Cytomegalovirus (CMV) ulcers Combination of HSV and CMV
Bacterial Manifestations Linear Gingival Erythema Necrotizing Ulcerative Periodontitis Tuberculosis
Linear Gingival Erythema (red-band gingivitis)
Necrotizing Ulcerative Periodontitis
Tuberculosis Oral 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) Minor Major Salivary Gland Disease Xerostomia
Aphthous Ulcerations minor major
Salivary Gland Disease
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 HIV Be familiar with fungal oral manifestation that may present in HIV infected individuals