口腔专业英语2011电子版

Lesson1DentalAnatomyTheclassificationoftheteethHumaninhiswholelifehastwoseriesofteethincluding20deciduousteethasthefirstseriesand32permanentteethasthesecondseries.Deciduousteethcanbeclassifiedtothreekinds:deciduousincisor,deciduouscanineanddeciduousmolor.Permanentteethcanbeclassifiedtoincisor,canine,premolarandmolar.Theincisorsandcaninesarecalledanteriorteethbecausetheyareinthefrontofthecornerofthemouthandthepremolarsandmolarsarecalledposteriorteethbecausetheyarebehindthecornerofthemouth.ThefunctionoftheteethMastication.Afterthefoodiseateninthemouth,itundergoesaseriesofmechanicalprocessessuchascuttingbytheincisor,laniatingbythecanine,poundingtopiecesbypremolarandmillingbymolar.Meanwhilethefoodwillbemixedwithsalivaanddigestedpartiallybytheenzyme.Pronunciationandspeech:Teeth,lipsandtonguehavetightrelationshipwithpronunciationandspeech.Thecorrectnessofthepronunciationandtheclearanceofthespeechareseriouslyinfluencedbythepositionoftheteethandthepositionalrelationshipbetweentongue,lipsandteeth.Itisveryimportanttomaintainthefacialharmonyandbeauty.TherecordoftheclinicteethpositionRecentlytherearefouroftenusedmethodstorecordtheteethpositionsuchaspositionrecordingmethod,palmerrecordingsystem,universalnumberingsystemandFederationDentaireInternationalsystem.WithpositionrecordingmethodthedentalarchcanbedividedintoA,B,CandDquadrantsbytwoperpendicularlines.Theuprightlinerepresentsthecentrallineusedtoidentifytheleftandright.Thehorizontallinerepresentstheocclusalsurface.Themaxillaryteethareabovethelineandthemandibularteethareundertheline.ThedeciduousteethcanberepresentedbyRomannumberI-VandthepermanentteethArabiannumber1-8.VwmiiIVwmiiIIiimwVVwmiiIIiimwVThefollowingaretherecordingoftheclinicdeciduousteeth.ple,I|Forexamrepresentsthefirstdeciduousincisorintherightpartofthemaxillaryteeth.Thefollowingaretherecordingoftheclinicpermanentteeth.8 7 6 5 4 3 2 11 2 3 4 5 6 7 88 7 6 5 4 3 2 1 1 2 3 4 5 6 7 8Forexample,6representsthefirstmolarpermanentteethintheleftpartofthemandibularteeth.LandmarksoftheteethThecrownsoftheincisorsandcanineshavefoursurfacesandaridge.Thecrownsofthepremolarsandmolarshavefivesurfaces.Thosesurfacesoftheincisorsandcaninesfacingtowardthelipsarecalledlabialsurfaces,thosesurfacesofthepremolarsandmolarsfacingtowardthecheek,buccalsurfaces.Allsurfacesfacingtowardthetonguearecalledlingualsurfaces.Thesurfacesoftheteethwhichcomeincontactwiththoseintheoppositejawduringtheactofclosurearecalledocclusalsurfaces.61Thesurfacesoftheteethwhicharepresentedtowardorlieagainstadjoiningteethinthesamedentalarcharecalledproximalorproximatesurfaces.Thoseproximalsurfaceswhicharefacedtowardthemedianlinearecalledmesialsurfaces,andthosemostdistantfromthemedianlinearecalleddistalsurfaces.OtherlandmarksAcuspisanelevationormoundonthecrownportionofatoothmakingupadivisionalpartoftheocclusalsurface.Atubercleisasmallerelevationonsomeportionofthecrownproducedbyanovercalcificationofenamel.Acingulumisthelinguallobeofananteriortooth.Aridgeisanylinearelevationonthesurfaceofatoothandisnamedaccordingtoitslocationorform:buccalridge,incisalridge,marginalridge,etc.Marginalridgearethoseroundedelevationsoftheenamelwhichformthemarginsoftheocclusalsurfacesofpremolarsandmolars,mesiallyanddistally,andthemesialanddistalmarginsoftheincisorsandcanineslingually.Triangularridgesarethoseridgeswhichdescendfromthetipsofthecuspsofmolarsandpremolarstowardthecentralpartoftheocclusalsurfaces.Whenabuccalandalingualtriangularridgejoin,theyformatransverseridge,theunionoftwotriangularridgescrossingtransverselythesurfaceofaposteriortooth.Theobliqueridgeisavariableridgecrossingobliquelytheocclusalsurfacesofuppermolars;itresultsfromthejunctionoftwotriangularridges.Afossaisanirregular,roundeddepressionorconcavityfounduponthesurfaceofatooth.Lingularfossaearefounduponthelingualsurfaceofincisors.Centralfossaearefoundupontheoccluusalsurfaceofmolars,andareformedbytheconvergingofridgesterminatingatacentralpointinthebottomofthedepressionwherethereisajunctionofgrooves.Triangularfossaearefoundonmolarsandpremolarsontheocclusalsurfacesmesialordistaltomarginalridges.Asulcusisanotablylongdepressionorvalleyinthesurfaceofatoothbetweenridgesandcusps,theinclinesofwhichmeetatanangle.Adevelopmentalgrooveisashallowgrooveorlinedenotingevidenceofcoalescencebetweentheprimarypartsofthecrownorroot.Fissuresarelinearfaultsintheenamelcoveringofcrowns.61NewWordsandExpressionsdeciduous[2兴同♦兴2守"■"♦^♦]adj.每年落叶的，非永久性的incisor[为■同♦公兴并列n.门牙canine[同此我兴■公兴■]n.[解剖]犬齿adj.犬的，似犬的，犬科的，犬齿的molar[同。号*・号]adj.磨碎的，臼齿的n.臼齿，磨牙premolar[息口□为且息。号*,号]n.前臼齿mastication口.咀嚼laniate['•盟■陟虱陟8v.撕裂，撕开saliva[♦学息•公兴❖和n.口水，唾液quadrant[同此♦器2口号・6]n.象限，四分仪perpendicular隆口号以口号■息2为此时♦•利adj.垂直的，正交的n.垂线occlusal尸口法•曲以♦号•]adj.[医]（上下齿）咬合（面）的occlusalsurface牙合面maxillary[O盟法口♦陟•号门陟三口。盟此♦陟①]adj.上颌骨的n.上颌骨mandibular[。盟■息2兴皿"♦•q]adj.下颌〔骨〕ridgen.嵴，脊labial[息•虱兴皿兴号•]adj.唇的，嘴唇的，[语音]唇音的n.唇音，风琴管labialsurface唇面buccal[圾>此号•]adj.（面）颊的，口的，口腔的lingual[息•陟具丫♦麓学③叫adj.舌的，舌状的;语言的lingualsurfaces舌面proximal['pr器此♦为（□©•]（proximate['pr器ksimeit]）adj.最接近的median['m兴且dj®n]adj.中央的，中线的n.中部，当中，[数学]中线，中值mesial['mHHzj©l]adj.中央的，中间的distal['distl]adj.末梢的，远中的elevation[eli'veie©口]隆突mound[maund]耸起,小丘divisional[di'vie©n]adj.分割的，分区的tubercle「tj♦且b©（:）kl]结节overcalcification[ou♦:♦©此盟•♦兴彳兴'keie©n]过度钙化cingulum['s谖gjul©m]带，扣带;舌面隆突mesially['m兴且zj©li]近中地distally['dist©li]远中地oblique[©'bl为且k]斜的fossa[储s©]（复fossae['偿s兴且]）窝，凹converge[k©n'v©且d曹]v.聚合,会聚，集中于一点groove[gr由H>v]沟sulcus['s>lk©s]沟coalescence[kou©'lesns]n.合并，接合，联合linear['lini©]adj.线的，直线的，线性的61参考译文牙的分类人一生有两副牙齿，第一副为乳牙，第二副为恒牙。乳牙共20个，恒牙共32个。乳牙分为乳切牙、乳尖牙和乳磨牙三类；恒牙分为切牙、尖牙、前磨牙和磨牙四类。切牙和尖牙位于口角之前，称之为前牙；前磨牙和磨牙位于口角之后，故称为后牙。牙的功能咀嚼：食物进入口腔后，经过切牙的切割、尖牙的撕裂、前磨牙的捣碎和磨牙的磨细等一系列机械加工过程，同时与唾液混合，唾液中的酶对食物起部分消化作用。发音和言语：牙、唇和舌与发音和言语的关系密切。牙的位置以及舌与唇、牙之间的位置关系，对发音的准确性与言语的清晰程度有着重要的影响。保持面部的协调美观。临床牙位记录目前最常用的牙位记录方法有四：部位记录法，palmer记录系统，通用编号系统及国际牙科联合会系统。部位记录法以两条相互垂直的直线将牙弓分为A、B、C、D4个象限，竖线代表中线，区分左右；横线表示牙面，横线以上为上颌牙，以下为下颌牙。乳牙用罗马字I—V表示；恒牙用阿拉伯字1一8表示。乳牙临床牙位记录如下：VWmiiiiiimwVVWmiiiiiimwV例如I|表示右上第一乳切牙。恒牙临床牙位记录如下：876543211234567887654321 12345678例如|"6-表示左下第一恒磨牙。牙冠表面解剖标志切牙和尖牙的牙冠有四个面和一个切嵴，前磨牙和磨牙的牙冠有五个面。切牙和尖牙向着唇部的面叫唇面，前磨牙和磨牙向着颊部的面叫颊面。所有向着舌部的各个面都叫做舌面。上下颌牙齿的接触面叫牙面。在同一牙弓中，牙齿面向或紧靠邻牙的面叫邻面。靠近中线的邻接面叫近中面，远离中线的叫远中面。其他标志：牙尖：是牙冠高起的部分，它构成牙面的一部分。结节：是牙冠一些部分的较小突起，由于釉质的过度钙化所形成。舌面隆突：是前牙的舌叶。嵴：是牙面上任何一种长条形的突起部分，按照它的位置和形状来命名：颊嵴、切嵴、边缘嵴等等。边缘嵴：是釉质的圆形隆起，它形成前磨牙和磨牙牙合面的近远中边缘，切牙和尖牙舌面的近远中边缘。61三角嵴：起于磨牙和前磨牙牙尖顶部，向牙合面的中央部分延伸。当颊尖三角嵴和舌尖三角嵴相连，就形成一个横嵴；二个三角嵴的连接部分横贯于后牙的表面。斜嵴：是斜向横贯上颌磨牙牙面的变异性嵴；它由二个三角嵴连接而成。窝：牙面上呈不规则圆形的凹下部分叫窝。切牙在舌面有舌窝。磨牙在牙合面有中央窝，这是由嵴的末端在凹下部分底部中央聚集而成，并有沟连接。磨牙和前磨牙牙面边缘嵴的近中侧或远中侧可有三角窝。沟：是牙面上嵴与牙尖间的长条形凹陷或谷，斜面集合成角。发育沟：是一线性沟或线，显示牙冠和牙根发育期连接的痕迹。裂隙：是牙冠面上釉质呈细条状的断裂层。SupplementarymaterialUsefulQuestionstoPatientsIsitgettingworseatnightorbyday? Howlonghaveyouhadthepain?Haveyouhadanypaininthetempleortheear? Wheredoyoufeelthepainmost?Doyoufeelthepainwhenyoutouchyourtoothwithyourtongue?Doyougetmorepainwithcoldorwarmwater?Doyoubleedalotafterextraction?IsthepainmoreseverewhenIpresshereorhere?Howlongdoesthepainlast?Doyourgumsbleedwhenyoubrushyourteeth?Haveyouafeelingofweightinyourtooth?Haveyoubeeninhospitalforanything? Areyoutakinganymedicine?Haveyoueverhadrheumaticfever,kidneydisease,chestorlungdiseases?Haveyouanyallergies--particularlypenicillinallergy?TermsUsedinDentistryToapplyaclamp.Toarrestbleeding.Tobrushteeth.Tocapatooth.Tocauterize.Todrill.Toextractatooth(pullout,remove).Tofile.Tofill.Tokillanerve.Toplugatooth.Topolish.Toputagaginthemouth.Toremovethesalivabyapump.Torinsethecavity.Toscale.Animpactedtooth.Toscrape.Prematureteeth.Dentures/artificialteetharenotmyownteeth.Totakeanimpression.Totakethebite.Togrindofftheartificialtoothuntilthereisaperfectfit.Youmusthaveafull/top/bottomset.61Lesson2OralandMaxillofacialHistologyThemucousmembranesurroundingthenecksoftheteethisthegingivaorgum.Thegingivaisfirmlyattachedtothetoothinacuff-shapedmanner,butthearrangementofthetissuesissuchthatashallowsulcusformed.Thisgingivalsulcustendstocollectfoodanddebris,particularlyintheabsenceofadequateoralhygiene,andthisprovidesafavourablesituationforbacterialgrowth.Eveningingivaethatappearcompletelynormalclinically,atleastasparseinfiltrationofmacrophagesandlymphocytescanbenotedinthesubepithelialconnectivetissueinregionofthegingivalsulcus.Theepitheliumisnormallykeratinised,thoughofteninotherwisenormaltissueskeratinsationislacking,ortheremaybeparakeratosis.Themucousmembranecoveringthejawsfartherawayfromthegingivaconstitutesthealveolarmucosa.Heretheepitheliumlacksastratumcorncumandepithelialpegsarepoorlydevelopedorabsent.Themucousmembraneelsewhereinmouthshowssomevariationsinthedifferentareas.Theepitheliumofthehardpalateiswellkeratinisedandhasnumerouslongpegs.Mucousglandsarepresentinthesubepithelialconnectivetissueposteriorly.Thepalatinepapillacontainstheblindendingsofthenasopalatineducts,whicharelinedbycolumnarepitheliumwithnumerousgobletcells.Smallisletsofcartilagearesometimesfoundinthisarea,derivedfromtheparaseptalcartilages.Isletsofepitheliummaybepresent,usuallyclosetothepapillabutalsoelsewhereinthemidlineofthepalate.Thesemayshowcornification.Theyaretheremnantsoftheepitheliumthatcoveresthelineoffusionofthepalatalprocess.Theoralaspectofthesoftpalateiscoveredbynon-keratinisedsquamousepithelium.Thefreebordersofthenasalsurfacearealsocoveredbysqumousepitheliumbuttheremainderofthissurfaceiscoveredbyciliatedcolumnarepithelium.Numerousmucousglandsarepresentinthesubmucosa.Theepitheliumoftheskinofthelipisnormallywellkeratinised.Theepithelialpegsarefewandshort,andnumeroussebaceousglands,hairfolliclesandsweatglandsarepresentinthesubepithelialconnectivetissue.Theepitheliumoftheredzoneofthelipisalsokeratinised,butheretheepithelialpegsarelongandnumerous.Thecorrespondinglylongandnumerousdermalpapillaecarrytherichcapillarysupplythatgivesthiszoneitsredcolour.Hairfolliclesareabsentherethoughoccasionalsebaceousglandsareseen.Themucousmembraneproperofthelipisnotkeratinised.Theepithelialpegsareshortandblunt,andthelabialmucousglandsarepresentinthesubepithelialconnectivetissue.Theepitheliumofthecheeklackskeratinisation.Mucousarepresentinthesubmucosa,sebaceousglandsarealsonotinfrequentlyfound,Inthearealateraltothecornerofthemouth.Theseappeartothenakedeyesassmallyellowspots(Fordycespots).Themucosaofthefloorofthemouthisnotkeratinised.Theepithelialpegsareshort.Mucousglandsarepresentinthesubmucosa.Thegreaterpartofthetoothconsistsofdentine.Therootdentineiscoveredbyathinlayerofcementumanddentineofthecrowniscoveredbyenamel.Internally,thedentinecontainsthedentalpulpinthepulpchamber.Therootofthetoothoccupiesasocketinthealveolarbonetowhichitisattachedbytheconnectivetissuefibresoftheperiodontalmembrane.Thepulpconsisitsoflooseconnectivetissueandcarriestheblood,lymphaticandnervesupplytothetooth.Thedentineconsistsof30percentorganicmaterialandwater,and70percentinorganicmaterial.Theinorganicmaterialofenamelisanapatiteandsmallorganicfractionismainly61ofkeratinousnature.Enamelconsistsofrodsorprismsinaninterprismaticsubstancethatisslightlylessmineralizedthantherodsthemselves.Therodshavea“fish-scale”appearanceincross-section.Thecemetumcoversthedentineofthetoothrootinathinlayer.Theprincipalfunctionofcementumistogiveattachmenttofibresoftheperiodontalmembrane.NewWordsandExpressionshistology[his't器•©◎曹兴]n.组织学remark[ri'm赳且k]n.陈述cuff-shaped「k+f首eipt]a.呈袖套状的sulcus['s+lk+s]n.沟debris['debri:]n.碎片,残骸sparse[sp赳且s]a.稀少的，稀疏的macrophage「m盟kr+feid曹]n.巨噬细胞subepithelial[s+bepi冷兴且li+l]a.上皮下的keratinise['ker+tinaiz]丫匕角化keratinisation[ker+tinai'zei^+n]比角化parakeratosis[p盟r+ker+'tousis]n.角化不全pegn.钉dermala.皮肤的,真皮的papilla[p+'pil+]n.乳头stratum['streit+m]n.层corneum['k群且ni+m]n.角质层palatine['p掰l+tain]n.腭blindendingsn.盲端columnar[k+'l+mn+]a.柱形的，筒形的goblet['g器blit]n.高脚玻璃杯，酒杯islet['ailit]n.小岛paraseptal[p盟r+'septl]a.中隔旁的cornification[k器H>nifi'kei首+n]n.角（质）化fusion[修♦且曹+n]n.熔化，熔解，熔合squamous['skweim+s]a.有鳞片的，鳞片状的sebaceous[si'bei首+s]a.皮脂腺的，分泌脂质的follicle['fMikl]n.小囊，滤泡，卵泡nakedeyesn.肉眼cementum[si'ment+m]n.牙骨质，水门汀dentine['dentin]牙本质socket['s器kit]n.窝,穴，孔，插座，牙糟v.给…配插座periodontalmembranen.牙周膜61apatite['盟p®tait]n.磷灰石keratinous[kQr盟tin®s]a.角质的，角（质）蛋白的interprismatic[int®priz'm掰tik]a.棱柱间的mineralize['min©t®laiz]vt.使矿物化，使含无机化合物vi.采集矿物fish-scale[fieskeil]a.鱼鳞状的cross-section（transversesection）n.横切面参考译文口腔颌面部组织学围绕牙颈部的粘膜是牙龈。牙龈呈袖套状紧紧的附着于牙齿，但是与牙齿之间有一浅沟。牙龈沟容易积聚食物及各种碎屑，特别是在口腔卫生差的情况下，便提供了易于细菌生长的环境。甚至临床上完全正常的牙龈，在牙龈沟的上皮下结缔组织中均能发现少量巨噬细胞和淋巴细胞。虽然在其他部位的正常组织，上皮常常没有角化，但是牙龈上皮在正常情况下有角化和不全角化。上皮钉和真皮乳头长而狭窄。覆盖在离牙龈远一点颌骨上的粘膜为牙槽粘膜。这里的上皮缺乏角质层，上皮钉较少或无。口腔其他部位的粘膜在不同的区域表现不同。硬腭的上皮有较好的角化及许多长的上皮钉。在后部上皮下结缔组织中许多粘液腺。腭乳头内包含有鼻腭管的盲端，此管内衬柱状上皮，其中有大量杯状细胞。在此区内有时可见起源于中隔旁软骨的软骨小岛。在靠近腭乳头处常常有上皮小岛。但此小岛也可见于腭中缝的任何部位。这些小岛可能出现角化。它们是覆盖在腭突融合线上的上皮残余。软腭的口腔面覆盖着无角化的鳞状上皮。鼻腔面的游离缘也覆盖着鳞状上皮，但鼻腔面的其他地方覆盖着纤毛柱状上皮。在内膜下层有许多粘液腺。唇的皮肤上皮正常时角化较好。上皮钉少而短。在皮下结缔组织中有大量皮脂腺、毛囊和汗腺。唇红的上皮也有角化，但这里的上皮钉长而多。真皮乳头也相应的长而多，并含有丰富的毛细血管，因此使该区呈红色。虽然偶尔可见到一些皮脂腺，但是没有毛囊。唇部的固有粘膜没有角化。上皮钉短而宽，在上皮下结缔组织中有唇粘液腺。颊上皮没有角化。在粘膜下层有粘液腺。口角旁区的皮脂腺并非罕见。肉眼观为小的黄色斑（福代斯氏斑）。口底粘膜没有角化。上皮钉较短。粘膜下层有粘液腺。牙齿的大部分由牙本质构成。根部牙本质外面覆盖着薄层的牙骨质。冠部牙本质外面覆盖着釉质。在内部，牙本质含有牙髓腔，内有牙髓。牙根位于牙槽窝内，借牙周膜的结缔组织附于牙槽骨。牙髓由疏松结缔组织构成，给牙齿带来血液、淋巴和神经。牙本质含有30%的有机物和水，70%的无机物。釉质的无机物是磷灰石，少量的有机物主要是角质性的。釉质由釉柱和釉间质组成，后者的钙化程度比釉柱本身稍低。釉柱横切面呈“鱼鳞状”。牙骨质薄薄的覆盖在牙本质表面，其主要功能是于牙周膜的原纤维附着。61SupplementarymaterialInstructionstoPatientsandExplanationsofProceduresLeanback.Spitout.Pleasedon'tswallow.Unclenchyourteeth.Takeoutyourplate/dentures.Leanback.Spitout.Pleasedon'tswallow.Unclenchyourteeth.Takeoutyourplate/dentures.Yourtoothisdecayed.Takecarenottotouchthewound.Thismaymakeyoufeelalittleunpleasant.Yourteetharecrowded.I'llhaveto...Openyourmouthwide.Rinseyourmouthwell.Pleasekeepstillforamoment.Clenchyourteeth.Pleasedon'tcloseyourmouth.Thiswon'thurtyou.Iwantyoutopaintthegumswith...Thistoothisdecayed.Itneedsfilling.Youmustgargleeveryhour.Thistoothwillhavetohaveatemporary/permanentfilling.Anabscesshasformed.I'llhavetoopenitup.I'mgoingtoremovethetartarfromyourteethnow.I'mgoingtoscrapeyourteethandthenpolishthem.Itmustcomeout/beextracted.(Itmustbeextracted.)“Yourgumsareinpoorcondition.Iwantyoutomassagethemandusedentalflossorsticks.”“Pleasedon'thaveanysolidfoodforthreeorfourdays.Youmustcomeeverysixmonthsforacheck-upandremovaloftartar.”LanguageneededforanaesthesiaLocalanaesthesiaGenerallycalled:needleinthegum/prickinthegum.You'lljustfeelalittleprickinthegum.GeneralanaesthesiaGenerallycalled:gas(inhalationanaesthesia).prickinthearm(intravenousanaesthesia).Sometimesreferredtoas"go-to-sleepanaesthesia."61Lesson3DIAGNOSISANDTREATMENTPLANNING(1)Diagnosisandtreatmentplanningareactivitiesthatseparateanddistinguishprofessionalfromauxiliarypersonnel.Expanded-dutypersonnelhavebeentrainedtoperformroutineendodontictechnicalprocedures.However,onlythethedentisthastraininginbasicandclinicalsciences;thisentitlesthedentistalonetofirst,performalldiagnostictests;second,interpretdifferentiallythetestresults;third,psychologicallymanagethepatientduringtestingprocedures;andfourth,formulateanappropriatediagnosisandtreatmentplan.Differentialdiagnosisoforofacialdisordersisdemandingandmayconfusebothpatientandclinicianbecausethereisatendencytoequateacomplaintofpainwithanendodonticproblem.Inadditiontoteeth,otherstructuresandorganssuchastheperiodontium,jaws,sinuses,ears,temporomandibularjoints,masticatorymusculaturenose,eyes,andbloodvesselscaninducepainthatmaymimicdentalpain.Otherpathologicconditionssuchasneuralgiarmultiplesclerosis,myocardialischemia,orpsychiatricdisordersmayproducethesamesymptoms.Toavoidmisdiagnosisandtoruleoutorofacialpainofnonpulpalorperiapicalorigin,astep-by-stepsystematicapproachtodiagnosisandtreatmentplanningmustbefollowed:Ascertainthechiefcomplaint.Takepertinentinformationrelatedtothepatient'smedicalanddentalhistory.Conductthorough(butnotunnecessary)subjective,objective,andradiographicexaminations.Analyzethedataobtained.Formulateanappropriatediagnosisandtreatmentplan.Thischaptersuggestsasystematicapproachtodiagnosisandtreatmentplanningprimarilyasrelatedtorootcanaltreatment..ChiefComplaintThechiefcomplaintisgenerallythefirstinformationobtained.Thesearesymptomsorproblemsexpressedbythepatientinhisorherownwordsrelatingtotheconditionthatpromptsthepatienttoseektreatment.Thechiefcomplaintshouldberecordedinnontechnicallanguage;forexample,"Ihaveaninfectedtoothandagumboil,"orIhaveatoothachethatmaybecausingmysinusinfection.".HealthHistoryTakingacomprehensivehealthhistoryfornewpatientsandreviewingandupdatingthedataofpriorpatientsaremandatoryandconstitutethefirststepindiagnosis.Acompletehealthhistoryforanewpatientconsistsofroutinedemographicdata,medicalhistory,dentalhistory,chiefcomplaintandpresentillness..SubjectiveExamination.PresentConditionSomeroutineinformationrelatedtopersonaldata,medicalhistory,anddentalhistoryaswellasthechiefcomplaintmaybeobtainedbystaff.However,thedentistshouldreviewandbefamiliarwiththedatabeforeproceedingfurther.Often,thefirstcontactbetweenpatientanddentisttakesplaceduringcollectionofdataaboutthepresentillness.Mostpatientswithendodonticpathosesareasymptomaticorhavemildsymptoms.Ifpulpor61periradicularpathosisissuspectedbecauseofotherfindings,thedentistnotestheabsenceofsignificantsymptomsandmovesontoobjectivetests.However,oftenpatientsdoexpressnotablelevelsofpainanddistress.Thesepatientsrequireacareful,systematicsubjectiveexaminationwithpointed,probingquestions.Aninterestingandoftenconfusingentityistooth-relatedpainexperiencedwithchangesinambientpressure.Thisphenomenonisknownasbarodontalgiaandaffectspatientswhoexperienceapressureincreaseordecrease.Ithasbeendescribedinhigh-altitudeflyingaswellasscubadiving.Painanddiscomfortassociatedwithpulpalandperiradiculardiseasesdonotusuallyaffectapatient'sphysicalstateandhavelittleornoeffectonvitalsigns,skincolor,ormuscletone.However,severepulpalorperiradicularpainmayaffectapatient'sphysicalconditionandvitalsigns.Regardlessofdegree,dentalpainsignificantlyalterspsychologicalmake-upandemotionalstatus.Becauseofapprehensionandemotionalaswellasoccasionalphysicalinstability,endodonticpatientsarehandledwithextracare.Professionalappearance,attitude,andaproperatmospherearethemainfactorsneededinestablishinggooddentist-patientrapport.Inafriendlyandcompassionateenvironment,patientsexpressproblemsopenly.Withsuchathoroughapproachpatientsoftenvolunteermanydetailsaboutthelocation,onset,characterandseverityofthepain.Afterlisteningwithkeeninterest;thedentist,inasympatheticandunhurriedmanner,shouldaskfurtherquestionsaboutthespontaneityanddurationofthepainandthestimulithatinduceorrelieveit.Theseverityofthepainandthemedicationstakenforpainreliefandtheireffectivenessareveryimportant..SignificantAspectsofpainPainofhighintensityisusuallyintermittent,whereaslow-intensitypainisoftencontinuousandprotracted.Incontrasttoprotractedpain,whichissteadyanddull,paroxysmalpainconsistsofavolleyofbrightjabs.Painmayalsobedescribedaspricking,stinging,burning,aching,orthrobbing.Often,severepulpalorperiapicalpainhasathrobbingqualityandissynchronizedwithcardiacsystole.Myofascialpainisusuallydull,whereasthepainofneuralgiaisbrightandparoxysmal.Identificationofthenatureofthepainhelpstodifferentiatedentalpainfrompaininothertissues.Painisaverycomplexentity.Manyaspectsofpainarenotparticularlydiagnosticanddonotdifferentiateendodonticfromnonendodonticproblemsorindicatetheseverityoftheproblem.However,someaspectsofpainarestronglyindicativeofirreversibleendodonticpathosisandthusofthetreatmentrequired.Thesearethe(1)intensity,(2)spontaneity,and(3)continuityofthepain.IntensityofPain.Themoreintensethepain(i.e.,themoredisruptivethepainistothepatient'slifestyle),themorelikelyitisthatirreversiblepathosisispresent.Intensepainislikelytobeofrecentduration,isunrelievedbyanalgesics,andhasinducedthepatienttoseektreatment.Long-standingpainisusuallynotintense.Painofamildormoderatenatureoflongdurationisnotbyitselfparticularlydiagnostic.Intensepainmayarisefromirreversiblepulpitisorfromacuteapicalperiodontitisorabscess.SpontaneousPain.Spontaneouspainoccurswithoutanelicitingstimulus.Ifpainawakensthepatientorbeginswithoutanyreason,itisspontaneous.Asdescribedpreviously,spontaneouspaincombinedwithintensepainusuallyindicatesseverepulpalorperiradicularpathosis.Aninterestingandverydiagnosticoccurrenceisintense,continuouspainisrelievedonlybycold.These61

patientsoftenappearfortreatmentclutchingaglassoficewaterthattheysiptoretaincoldontheachingtooth.Thisispathognomicofirreversiblepulpitis.ContinuousPain.Thislingeringtypeofpaincontinuesandmayevenincreaseinintensityafterthestimulusisremoved.Forexample,thepatientreportsprolongedpainafterdrinkingcoldliquids.Anotherdescribesintensecontinuouspainafterchewing.Ifthepulpisvital,continuouspainwiththermalstimulususuallyindicatesirreversiblepulpitis.Ifthepulpisnecrotic,continuouspainafterapplicationofpressuretoatoothindicatesperiradicularpathosis.Aftertakingthemedicalanddentalhistoriesandidentifyingthemainsubjectivesignsandsymptomsofthepatient’sprdnent(aisldescribedpreviously),thedentistfrequentlyarrivesatatentativediagnosis..TentativeDiagnosisByexpandingonthepresentillnessandaskingcarefulsubjectivequestionsaboutthepatient'sproblem,thedentistcanfrequentlydeterminethepresenceofpathologicchangesinpulporperiapicaltissues.Thequalityandquantityofpresentandpastpainaswellasotherimportantsubjectivefindingsoftenruleoutconfusingnonendodonticentities.Theurgencyoftreatmentisalsodetermined.Carefulquestioningandinterpretationofthepatient'sresponsesoftenofferstrongcluestoatentativepulpalorperiradiculardiagnosis.Thetentativediagnosisisthenconfirmedordeniedbyhands-onoralexaminationandclinicaltests.Newwordsandexpressionsabscess脓肿 acuteapicalperiodontitis 急性根尖周炎ambientpressure环境压力 analgesics镇痛药apprehension理解，领会，焦虑不安，惧怕 ascertain查明，确定asymptomatic无症状的 chewing咀嚼，嚼服（法）,嚼auxiliary辅助,辅助的，补助，辅助品,附属的clinician临床医师barodontalgia航空牙痛，气压牙痛，气压性牙痛cardiacclutch心的；强心药，恢复药；心脏病患者；贲门的窝,离合器，夹紧装置,联轴器，扳手，套管cardiacclutchcompassionatea.慈悲的，富于同情心的，斟酌情况的;丫.怜悯，同情complaint 陈述，症状，疾病，complaint 陈述，症状，疾病，不适demographicdata人口数据diagnosis（鉴别）诊断disruptive破裂的，裂开，分裂distress不良应激,不舒适的应激，痛苦，苦恼，穷困，危难，使苦恼，损坏，事故dull愚钝的，不锋利的,呆滞的duration持续，持续时间，期间，耐久，持久，延续时间,延续期elicitingstimulus诱发刺激gumboil龈脓肿highintensity高强度induce elicitingstimulus诱发刺激gumboil龈脓肿highintensity高强度induce 感生，诱发，诱导，感应endodontichands-on牙髓的现成的indicativeof .指示的,预示的irreversible不可逆的61jabn.刺进;jabn.刺进;v捅；忽刺lingeringa.延迟的；逗留不去的low-intensity低强度的masticatory 咀嚼的，咀嚼剂mimic 拟态的，模仿的，模仿疾病的long-standing长期的mandatoryadj.强制性的，义务的,命令的medication药疗法，给药方法，附加药物multiplesclerosis多发性硬化症，轴周性硬化性脑炎，多发性硬化muscletone肌紧张，肌肉紧张度 moveon multiplesclerosis多发性硬化症，轴周性硬化性脑炎，多发性硬化muscletone肌紧张，肌肉紧张度 moveon 继续前进musculature肌肉（系统）,肌组织，肌肉系统myocardialischemia心肌缺血myofascialpain肌盘膜痛 necrotic 坏死的neuralgia神经痛 neuralgic 神经痛的objective接物镜，物镜,目的,目标,目标的,宾位的，客观的,客观的,（接）物镜paroxysmalpain阵痛paroxysmal发作的，阵发的pathognomonic特异病征性的pathosis病态Periapicaltissue 根尖周组织periradicular根周phenomenon现象pricking穿刺术，穿刺，放液穿刺protracted （拉protractus）伸展的，延长的psychological心理的,心理学的pulpitis牙髓炎rapport情感协调，感通ruleout排除，除外，拒绝sinuses窦,窦房结，窦道（复数）sip啜饮stinginga.刺人的，刺一般的，激烈的symptoms症状systematicapproach 系统化处理方法pathologic病理学的periapical根尖周的periodontium牙周组织,牙周膜pertinentinformation相关信息physicalstate 身体状态，体格状况prompt瞬发的，迅速的psychiatric精神病的，精神病学的psychologicallyad.心理上地；心理学地radiographic放射照相的rootcanaltreatment根管疗法significant显著的，有效的，有意义的,重要的sinusinfection 窦感染，鼻窦感染spontaneity n.自然发生，自生，自发subjective主观的,自觉的synchronized使同步的volley 排放,冲动排，一列冲动systole收缩（期），收缩（期）的,心缩期,收缩期temporomandibularjoint颞下颌关节，颞颌关节tentativediagnosis暂时的（假定的）诊断，试验性诊断thermalstimulus温热刺激物,热刺激throbbing搏动的 TreatmentPlanning治疗计划vital生病的，生机的,致命的，极其重要的 vitalsigns生命征象61Lesson4DIAGNOSISANDTREATMENTPLANNING(2)4.ObjectiveExamination(1)Duringthisstage,extraoralandintraoraltissuesareexaminedandcomparedbilaterallyforthepresenceorabsenceofpathosis..ExtraoralExaminationGeneralappearance,skintone,facialasymmetry,swelling,discoloration,redness,extraoralscarsorsinustracts,andtenderorenlargedfacialorcervicallymphnodesareindicatorsofphysicalstatus.Acarefulextraoralexaminationhelpstoidentifythecauseofthepatient'sc