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Main textbooks

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.

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Main textbooks

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  1. 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.

  2. DentalCaries

  3. Tooth loss is common health problem. What can cause tooth loss?

  4. Reasons of tooth loss • Microbial tooth loss (dental caries, periodontitis) • Non microbial tooth loss (trauma, congenital loss)

  5. Dental caries An chronic infectious disease with progressive destruction of tooth.

  6. Prevalence and incidence Almost everyone is affected by dental caries. http://www.wrongdiagnosis.com/d/dental_caries/stats-country.htm(2004)

  7. Etiology of Dental Caries Micro- organisms no caries no caries host & tooth sugar caries no caries no caries time 1889, Miller: chemocoparasitic theory

  8. MAJOR FACTORS

  9. Microorganisms: Role of bacteria • There are many kinds of bacteria in normal oral cavity. • Mainly the bacteria causing caries are Streptococcus Mutans (MS).

  10. Enamel Pulp Dentin Root canal Cememtum Apical tissue Microorganisms Role of plaque Crown gum Enamel Root Plaque is a biofilm on the surface of the tooth (enamel).

  11. host & tooth Role of Tooth • Quality • Position • Structure • arrangement

  12. host & tooth Role of saliva: • It plays role in remineralization on the teeth. • Saliva has the buffering action and cleansing effect.

  13. Sugar: Role of carbohydrates: • the most important cause; • refined carbohydrates are directly proportional with dental caries.

  14. MINOR FACTORS: • Enamel composition • Morphology of the tooth • Habit of brushing teeth • Immunity

  15. Clinical classification of caries • According to three basic factors : severity and rate of progression anatomical site(involving site) age patterns at which lesions predominate

  16. Tooth anatomy gum Enamel Crown Pulp Dentin Root canal Cememtum Apical tissue Root

  17. Classification according to the developing speed Acutecaries Rampant caries Chronic caries Arrested caries

  18. Classification according to the involving site Occlusal caries Root caries Smooth surface caries Linear enamel caries

  19. Clinical Manifestation and Symptoms changes in tissue color, texture, and structure • Visible pits or holes in the tooth • Colour changing • Soften • Pain

  20. A Early caries may have no symptoms B be sensitive to sweet foods or to hot and cold temperatures C very sensitive to stimulator D the acute pain A B C D

  21. Examination • Clinical observations (Visual change) • Probing The explorer tip can easily damage white spot lesions

  22. Examination Temperature test X-ray Transillumination

  23. Diagnosis • Clinical signs visual – color, texture, shape, location, cavitation, • Clinical symptoms • Diagnostic test--examination

  24. 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. filling material lining material pulp-capping material Calcium hydroxide

  25. Prevention is the most important for dental caries.

  26. 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.

  27. Endodontics

  28. Etiology of Pulpitis 1-bacterial cause: caries, fracture, bacteremia, periodontal pocket caries irreversible pulpitis

  29. pulp

  30. 2-physical cause: sever thermal change (cavity preparation), large metallic restoration

  31. 5. Other cause: internal resorption

  32. Possible Pulpal Diagnoses • Normal • Reversible pulpitis • Irreversible pulpitis—acute, chronic, polyp • Necrosis • Previous endodontic treatment

  33. Reversible pulpitis Clinically • sharp pain & respond to sudden changes in temperature • pain disappear as the stimuli removed • last less than 20 sec • 3. easily localized & unaffected by body position

  34. Clinical Examination in reversible pulpitis • Thermal: • Hypersensitive with mild pain • <mild • Sweets: • Sensitive • < mild • Biting Pressure: • None (unless tooth is cracked)

  35. 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.

  36. Irreversible Pulpitis Reversible pulpitis are left untreated.

  37. Symptoms of Irreversible Pulpitis • Thermal: • Hypersensitive-moderate to severe • Sweets: • Moderately to severely sensitive • Biting Pressure: • Usually sensitive in later stages (periapical symptom) • spontaneouspain: Moderate to severe

  38. DiagnosisIrreversible Pulpitis • Hypersensitive to hot or cold that is prolonged. • A history of spontaneous pain. • Vital or partially vital pulp.

  39. Acute pulpitis: may occur as a sequel of focal reversible pulpitis or occur due to acute exacerbation of chronic pulpitis. clinically1- big cavity or margin of a restoration 2- sleep pain 3- spontaneous pain 4- pain lasts 5- difficult to localized

  40. Chronic 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.

  41. Chronic hyperplastic pulpitis(polyp) Clinically:1- polyp 2- occurs in a tooth with large carious lesion3- not sensitivity4- bleed easily5- may confused with hypertrophic gingival polyp

  42. Treatment of Irreversible Pulpitis • Root canal treatment or extraction

  43. Necrotic Pulp • Pulp continued degeneration. • no reparative potential. • Commonly have apical radiolucent lesion.

  44. Maxillary first molar with large amalgam restoration and periapical radiolucencies around all three roots. The tooth was unresponsive to electrical and thermal testing.

  45. 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 spontaneouspain

  46. 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.

  47. Necrotic Pulp(additional considerations) • Antibiotic coverage • Pain Management • Occlusal Reduction

  48. 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.

  49. Pre-operative film

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