牙周组织疾病(口腔科)

1、牙周组织疾病Periodontal Disease 医院口腔科11、To be familiar with the causes and classification of periodontal diseases.2、To grasp the common clinical manifestations and control methods of periodontal diseases.3、To understand the clinical manifestations and treatment principles of various types of periodontal d

2、isease.2Introduction and EpidemiologyPeriodontal disease is an infective disease of the supporting tissues of teeth, aggressing the deep periodontal tissues or not.Gingival diseases, Periodontal diseases。牙周疾病是指发生在牙齿支持组织的，侵犯或不侵犯深部牙周组织的一种感染性疾病。包括牙龈病和牙周病。一、概念与流行病学3牙周组织4Abroad：prevalence 550，severe10。（J

3、 Periodontol., J-Clin-Periodontol., Ann-Periodontol. )China：prevalence 78.8， severe 3040。（The Second National Survey on Oral Health）5Gum Disease or Periodontal Disease not only affects the mouth but has been shown to increase the incidence of heart attacks, strokes, low birth-weight babies, and prem

4、ature baby deliveries. Periodontal Disease is a very serious disease and should not be ignored. Periodontitis is not only the leading cause of tooth loss in adults, but it is also considered to be contagious. 6Classification新建国际牙周疾病分类系统（美国牙周疾病分类国际研讨会）Annuals of Periodontology Volume 1999.二、牙周疾病分类7牙

5、龈 病（Gingival Diseases）牙菌斑性牙龈病（Dental Plaque-Induced Gingival Disease）非菌斑性牙龈病变（Non-Plaque-Induced Gingival Lesions）仅与牙菌斑有关受全身因素影响边缘性龈炎（Marginal Gingivitis）青春期龈炎（Puberty-associated Gingivitis）受药物影响药物性牙龈炎（Drug-influenced Gingivitis）妊娠期龈炎（Pregnancy-associated Gingivitis）8正常牙龈（ Gingiva）9边缘性龈炎（Marginal Gi

6、ngivitis）10青春期龈炎（Puberty-associated Gingivitis）11妊娠期龈炎（Pregnancy-associated Gingivitis）12药物性牙龈炎（Drug-influenced Gingivitis）13牙周病（Periodontal Disease）慢性牙周炎（Chronic Periodontitis）侵袭性牙周炎（Aggressive Periodontitis）牙周脓肿（Abscesses of the Periodontium）局限性（Localized）广泛性（Generalized）成人牙周炎青少年牙周炎快速进展性牙周炎青春前期牙周炎

7、局限性（Localized）广泛性（Generalized）复发性牙周炎难治性牙周炎14慢性牙周炎（ Chronic Periodontitis ）15侵袭性牙周炎（ Aggressive Periodontitis ）16Etiology1、Dental plaque：Gum Disease is caused by bacteria that are found in plaque. Pg, Aa.2、Promoting factors：dental calculus, food set-in, occlusal trauma, false denture, etc.3、Host：Teet

8、h crowding, defective defense system, systemic diseases.三、病因17181920牙石（ Calculus ）21（Clinical Manifestations）四、临床表现牙龈色、形、质龈沟深度（Probe Depth）附着位置（Attachment）探诊出血（Bleeding on Probe，BOP）龈沟液的变化221、正常牙龈色：浅粉红色形：菲薄而紧贴牙面，附着龈上有点彩质：致密而坚韧，有弹性龈沟深度：不超过23mm附着位置：釉牙骨质界探诊出血：无龈沟液：少23色：暗红、深红、紫红形：肿胀、边缘厚钝、肥大增生，与牙面不再紧贴2、牙

9、龈炎质：松软脆弱，缺乏弹性龈沟深度：可超过3mm附着位置：釉牙骨质界探诊出血：多见，是牙龈炎症的重要客观指标龈沟液：渗出增多，并有成分改变red gums swollen gumsbleeding gums24Gingivitis is the most common form of Gum Disease. Gingivitis is defined as the inflammation or swelling of the gum tissues (Gum Inflammation). Most cases of Gingivitis are the result of poor Ora

10、l Hygiene. Gums that are swollen, tender and bleed easily when you brush your teeth are more than likely affected by Gingivitis. Gingivitis starts to develop when bacteria build up between the teeth and gums. Gingivitis leads to irritation, inflammation and bleeding. NOTICE253、牙周炎病史：牙龈炎病史临床症状：牙龈红肿、退

11、缩，溢脓，口臭，牙齿松动、移位，咬合无力，牙周脓肿探诊出血：有或无牙周袋形成(Periodontal Pocket)：探诊深度超过3mm附着位置：附着丧失（Clinical Attachment Loss,CAL）X片：牙槽骨吸收(Alveolar bone Loss)26Gums pulling away from the teeth, swollen gums, Loose teeth, sensitive teeth, bleeding gums, Bite changes, Red gums27牙周袋形成28牙周袋形成29牙槽骨吸收（水平吸收，垂直吸收）30Early Periodon

12、titis In this stage plaque has already built up and hardened around and under the gums allowing more harmful bacteria to attach the gum tissue and bone tissue. The gums pull away from the teeth forming pockets of bacterial infection. Moderate Periodontitis In this stage, the pockets that have alread

13、y formed start to deepen as they fill with more plaque, toxins, and bacteria. The Pockets are six to seven millimeters deep. At this stage the Periodontitis can still be treated non-surgically; however, one-third of the bone supporting the teeth has been irreversibly lost. Advanced Periodontitis In

14、this stage, the gums severely recede from the tooth and the pockets deepen and fill with pus. There may be swelling, sensitivity to hot or cold, and or pain when brushing or cleaning teeth. As Advanced Periodontitis progresses bone continues to be lost and eventually teeth may be lost. The three sta

15、ges of Periodontitis31Normal gumEarly PeriodontitisModerate PeriodontitisAdvanced Periodontitis32牙石（Calculus）33牙龈退缩Gingiva retrocession34牙齿松动、移位溢脓Loose teeth ，Teeth replacementPyorrhea 35五、牙周疾病各论36边缘性龈炎（Marginal Gingivitis）临床特征：1、局部刺激因素：牙菌斑、牙石、食物嵌塞等。2、病损局限于游离龈和龈乳头。3、色形质变化，轻触出血。4、上皮附着（龈沟底）位于正常的釉牙骨质界。

16、治疗原则：去除病因，牙周洁治。37青春期龈炎，妊娠期龈炎临床特征：1、局部刺激因素是始动因素。2、全身背景（青春期、妊娠期）加重牙龈对原有刺激物的反应。3、增生性龈炎的临床表现。4、牙龈增生肥大的程度超过局部刺激的程度。治疗原则：去除刺激因素，控制菌斑。肥大增生者可手术切除。38Pregnancy tends to exaggerate the bodys normal response to dental plaque. This is because four basic hormones vital to the continuation of pregnancy are produce

17、d in large quantities during the gestation period. This hormonal increase, which occurs during pregnancy, exaggerates the way the gum tissues react to plaque bacteria increasing the risk of Pregnancy Gingivitis. For this reason, pregnancy can increase the likelihood that women will develop Gingiviti

18、s. 39药物性牙龈增生（Drug-influenced Gingivitis）临床特征：1、长期服药史。2、发生于全口牙龈，前牙区重。只发生于有牙区。3、起始于龈乳头与边缘龈，严重可波及附着龈。4、质地坚韧，探诊不易出血。治疗原则：1、与内科医生合作，药物交替使用。2、去除局部刺激因素，保持口腔卫生。3、手术切除增生牙龈，修整牙龈外形。40急性龈乳头炎临床特征：1、局限于个别牙间乳头的急性非特异性炎症。2、常因食物嵌塞、剔牙损伤、充填体悬突 刺激引起。3、自发性胀痛、探触痛，牙齿叩痛。4、牙间乳头发红肿胀、探易出血。治疗原则：去除刺激因素，局部冲洗上药。消除病因。41慢性牙周炎（Chroni

19、c Periodontitis）临床特征：1、3544岁为高发期，年龄越大，患病率越高，病情也越重。2、既往有牙龈炎史，进程缓慢，可长达十余年或数十年。3、患牙周围存在菌斑滞留的因素，菌斑、牙石量与牙周组织破坏的严重程度相一致。4、牙龈充血、肿胀，质软，探诊易出血，患者可主诉刷牙或咬硬物时易出血，出血可自动停止，无自发出血。5、牙周袋形成，甚至溢脓。426、附着丧失。7、牙槽骨吸收，水平吸收或垂直吸收。8、牙齿移位或松动，咀嚼无力。9、口臭、口腔异味感。10、重度牙周炎可伴逆行性牙髓炎症状。Chronic Periodontitis is usually not painful, and ma

20、ny time progresses slowly. The patient may not even be aware of Periodontitis until the advanced stages increasing the risk of Tooth Loss. 43治疗原则：1、口腔卫生指导（Oral Hygiene Instruction）。2、洁治、龈下刮治（根面平整）彻底清除龈上、下牙石，为新附着创造条件。3、炎症控制后咬合调整。4、药物辅助治疗。5、牙周手术治疗。6、松牙固定，修复缺失牙。7、维护治疗。44侵袭性牙周炎（Aggressive Periodontitis）

21、临床特征：1、发病年龄较低。2、牙周组织破坏程度与局部刺激物的量不成比例。3、切牙和第一恒磨牙最早受累，前牙扇形移位，出现牙间隙。4、X片显示第一恒磨牙的近远中垂直骨吸收（弧形），切牙水平吸收，左右对称。5、病程进展较快。6、部分患者有家族遗传倾向，免疫功能缺陷。45治疗原则：1、特别强调早期、彻底的基础治疗及口腔卫生指导。2、加强维护期的定期复查，复查间隔期应短，而且要长期追踪及治疗。3、配合全身用药。4、必要时手术治疗。5、炎症控制、牙周袋变浅后，部分病例可用正畸方法将移动牙复位。46龈下刮治Scaling47牙周脓肿（Abscesses of the Periodontium）临床特征：1、突然发作，牙龈上卵圆形突起，色红、水肿，表面可形成脓头。或无明显自觉症状，牙龈瘘道。2、局限性搏动性疼痛，牙齿伸长感、叩痛、咬合痛、松动。3、严重者全身不适，发热，末梢血白细胞增多，淋巴结肿大。48治疗原则：1、止痛，防止感染扩散，引流脓液。2、清除大块牙石，冲洗牙周袋，上药。3、成熟脓肿可切开引流或从牙周袋引流。4、必要时少量调合。5、慢性牙周脓肿在牙周基础治疗后行翻瓣术。49牙周牙髓联合病变逆行性牙髓炎临床特征：1、牙周炎、牙周脓肿病史，随后出现牙髓症状。2、牙周袋深及根尖。3、患牙有不同程度的松动。4、温度测疼痛或无