口腔学英文课件：Dental fluorosis

1、Dental fluorosis,Overview The proper amount of fluoride helps prevent and control tooth decay in children and adults. Fluoride works both while the teeth are developing and every day after the teeth have emerged through the gums. Fluoride consumed during tooth development can also result in a range

2、of visible changes to the enamel surface of the tooth. These changes have been broadly termed dental fluorosis.,Symmetric + stained+ defect,What is dental fluorosis? Dental fluorosis is a change in the appearance of the tooths enamel. These changes can vary from barely noticeable white spots in mild

3、 forms to staining and pitting in the more severe forms. Dental fluorosis only occurs when younger children consume too much fluoride from any source when teeth are developing under the gums.,Who develops dental fluorosis? Only children aged 8 years and younger can develop dental fluorosis because t

4、his is when permanent teeth are developing under the gums. Once the teeth erupt through the gums they can no longer develop fluorosis. The teeth of children older than 8 years, adolescents, and adults cannot develop dental fluorosis. permanent teeth are frequently severe than primary teeth,病因Etiolog

5、y,摄入过量的氟离子（ingestion of excess fluoride ions） 饮水含氟量，正常为1ppm（fluoride in water more than 1 ppm) 食物中的氟化物(fluoride in diet) 损害釉质发育期牙胚的造釉细胞（damage ameloblasts during the tooth formation) 造成釉质矿化不良，色素沉着（result in hypomineralized enamel & pigmentation),机理 Mechanism,在牙齿发育期间，过量摄入的氟才会导致氟牙症（dental fluorosis re

6、sult from a high intake during the period of tooth formation) 氟不易通过胎盘屏障，乳牙一般不受累（Placenta barrier can resist fluoride, so dental fluorosis seldom appear in deciduous dentition) 提示：67岁以前，高氟摄入易患氟牙症 ！ （Ingestion excess fluoride no more than 6-7 age is prone to high prevalence),临床表现 clinical features,多见于

7、恒牙，发生在乳牙者甚少，程度亦较轻。这是由于乳牙的发育分别在胚胎期和乳婴期，而胎盘对氟有一定的屏障作用。因此，氟牙症一般见于恒牙，但如氟摄人量过多，超过胎盘筛除功能的限度时，也能不规则地表现在乳牙上。(mainly found in the permanent dentition, but the deciduous teeth may be involved in severe cases and in areas of endemic fluorosis) 对摩擦的耐受性差，但对酸蚀的抵抗力强。(high acid-resist, rapid loss by abrasion and at

8、trition),Features Very mild and mild forms of dental fluorosisteeth have scattered white flecks, occasional white spots, frosty edges, or fine, lacy chalk-like lines. These changes are barely noticeable and difficult to see except by a dental health care professional. Moderate and severe forms of de

9、ntal fluorosisteeth have larger white spots and, in the rare, severe form, rough, pitted surfaces.,Dean classification Normal Questionable Very mild Mild Moderate Severe,White spot Frosty edge Lacy chalk like line Rough pitted surface -Normal Questionable: 1/2 Moderate: color Severe: enamel defect,W

10、hat are the common sources of fluoride? Toothpaste (if swallowed by young children). Drinking water in fluoridated communities. Beverages and food processed with fluoridated water. Dietary prescription supplements that include fluoride Other professional dental products (e.g., mouth rinses, gels, an

11、d foams).,Treatment 1 Restoration by resin,2 Dental crown,3 Bleach by strong oxidant 30%H2O2(oxyful ),Precautions For very young children, less than 2 years old: Do not use fluoride toothpaste For children aged 2 to 6 years, apply no more than a pea-sized amount of fluoride toothpaste to the brush a

12、nd supervise their toothbrushing, encouraging the child to spit out the toothpaste rather than swallow it. Until about age 6, children have poor control of their swallowing reflex and frequently swallow most of the toothpaste placed on their brush. Use an alternative source of water for children age

13、d 8 years and younger if fluoride of drinking water contains more than 1ppm.,Enamel hypoplasia,Enamel hypoplasiais an abnormality found in the same formation period the of the enamel.,Etiology 营养障碍 nutrition deficiency 内分泌失调 incretion disorder 婴儿、母体疾病 infant & maternal disease 局部因素 localized causes,

14、出生前 Prenatal,感染（infection)风疹(rubella)、梅毒(syphilis) 母亲的代谢性疾病（maternal systemic disease),婴儿 Postnatal,感染尤其是重症病毒感染（severe childhood infections especially the viral infections) 慢性疾病先天性心脏病、胃肠道疾病、内分泌疾病（chronic diseases in childhood,e.g. congenital heart disease, gastrointestinal and endocrine diseases) 营养

15、不良维生素D缺乏（nutritional deficiency, e.g. vitamin D) 肿瘤化疗（cancer chemotherapy) 氟中毒（dental fluorosis),局部因素 localized causes,感染（Infection) 创伤 （Trauma) 放疗 (Radiotherapy),提示 Note,Damage occurred during period of enamel development Damage in different cusp and incisal margin can indicate suffering time. 累及 6

16、31136 提示致病因素1岁以内 6321 1236（damage occur at age 1) 累及2 2 提示致病因素在出生后第2年（damage occur at age 2) 累及754457 提示致病因素在23岁以后 754457 (damage occur at age 2-3),Features 1 Symmetry 2 Damage in enamel 3 Color change or texture defect,重症 severe type,带状(横沟状)缺陷 (horizontal grooves in the enamel surface) 窝状缺陷 （pits i

17、n the enamel surface) 釉质变薄 （general reduction in the thickness of the whole enamel),特点：对称发生 (symmetry),例外？（exception),对称发生 (symmetry),特纳牙 Turner teeth,乳牙的感染、创伤导致恒牙的造釉细胞的损伤（infection or trauma related to the deciduous predecessor resulting in damage to the ameloblasts of the permanent successor) 釉质呈黄

18、色或棕色（yellowish or brownish pigmentation of the enamel) 表面凹陷、不规则(pits and irregularity of the surface) 牙冠小(the smaller crown than normal) no symmetry,Treatment 1 Restoration by resin 2 Dental crown 3 other measures to prevent caries (fluoride ),Turners hypoplasia,Turners hypoplasiais an abnormality f

19、ound inteeth. Its appearance is variable. usually is manifested as a portion of missing or diminishedenamelon permanent teeth. Unlike other enamel hypoplasia which affect a vast number of teeth, Turners hypoplasia usually affects only one tooth in themouthand, it is referred to as aTurners tooth.,If

20、 Turners hypoplasia is found on acanineor apremolar, the most likely cause is aninfectionthat was present when the primary (baby) tooth was still in the mouth. Most likely, the primary tooth was heavilydecayedand an area ofinflamedtissuesaround therootof the tooth (called aperiapicalinflammation), a

21、ffecting thedevelopment of the permanent tooth. If Turners hypoplasia is found in the front (anterior) area of the mouth, the most likely cause is a traumatic injury to a primary tooth. The traumatized tooth, which is usually amaxillary central incisor, is pushed into the developing tooth underneath

22、 it and consequently affects theformation of enamel.,Tetracycline stained teeth,Etiology :Taking tetracyclines during tooth development,病因 Aetiology,在牙的发育矿化期（妊娠期和婴幼儿8岁以下），服用的四环素族药物，可被结合到牙组织内，使牙着色。(Tetracycline is administrated to pregnant females or to children under age of 8, it may be incorporated

23、 into the dentin of the developing teeth) 呈黄色，在阳光照射下则呈现明亮的黄色荧光，以后逐渐由黄色变成棕褐色或深灰色。(It produces a yellow discoloration, the teeth will fluoresce from a bright yellow to brown or gray with exposure to sun light) 四环素可通过胎盘引起乳牙着色。(Permeate placenta to affect deciduous dentition),病因 Aetiology,四环素（tetracycli

24、ne),四环素牙（tetracycline stained teeth ),恒牙（permanent dentition),乳牙（deciduous dentition),Features 1 Symmetry 2 Damage in dentin 着色（stain) 可伴有釉质发育不全 (enamel hypoplasia),1 Symmetry 2 Damage in dentin Tetracycline has slide and shining surface which means enamel is not affected ,but severe tetracycline al

25、so concatenate enamel hypoplasia,Treatment 复合树脂修复法 (composite resin) 外脱色法 (bleaching) 内脱色法 (intracoronal bleaching: teeth after RCT ),2 Dental crown,Homework difference among dental fluorosis enamel hypoplasia tetracycline stained teeth,Etiology feature treatment,Dentine hypersensitivity牙本质过敏,Overvi

26、ew Dentine hypersensitivityis sensation felt when the nerves inside the dentinof theteeth are exposed to the environment. The sensation can range from irritation all the way to intense, shooting pain. This sensitivity can be caused by several factors, including wear,decaying or exposed tooth roots.,

27、Etiology Dentine contains many thousands of microscopic tubular structures that radiate outwards from the pulp. Changes in the flow of the plasma-like biological fluid present in the dentinal tubules can trigger mechanoreceptors present on nerves located at the pulpal aspect thereby eliciting a pain

28、 response.,This hydrodynamic flow can be increased by cold, air pressure, drying, sugar, sour, or forces acting onto the tooth. Hot or cold food or drinks, and physical pressure are typical triggers in those individuals with teeth sensitivity. definite method to confirm dentine hypersensitivity : sh

29、arp point probe glide on the suspicious surface,For a patient is defined, it is important to first prevent, modify, eliminate or controletiologicfactors such asplaque, improper toothbrushing, sodasand acidic foods Before the proper treatment fruits,fruit juicesandwinewhose acids can remove smear lay

30、ers and open dentinal tubules. Toothbrushing with abrasive toothpaste may abrade the dentin surface which may open up dentinal tubules if combined with erosive agents.,Treatment strontium chloride , fluoride therapy, (sodium monofluorophosphate, sodium fluoride ) calcium sodium phosphosilicate. silv

31、er iodide potassium nitrate (KNO3),wedge shaped defect,Overview wedge shaped defect is chronic consuming of hard tissus in the neck of buccal and facial surface.,Etiology method of transverse brushing structure of the neck acidic gingival groove fluid fatigue of hard tissue oversized occlusion force

32、,Features intersection by 2 or 3 surfaces. Sharp edges hard and smooth surface some surfaces may coloring premolar especially the first premolar is often observed enamel, dentin or pulp Exposure,Treatment Correct method of brushing No treatment: Shallow and asymptomatic Treatment of hypersensitivity

33、 Restoration by resin RCT: pulpitis and periapicalinflammation Core and crown: crown fracture,Bruxism磨牙症,Bruxism is the term that refers to an incessant grinding and clenching of the teeth, unintentionally, and at inappropriate times. Bruxers are often unaware that they have developed this habit, an

34、d often do not know that treatment is available until damage to the mouth and teeth has been done. Unconsciously bite in the daytime Bruxism in the night,symptoms Abraded teeth Chipped or cracked teeth sensitive teeth Wearing away of the tooth enamel, exposing the underlying dentin (inside of the tooth) temporomandibular joint