牙体牙髓复习题目龋病.docx
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牙体牙髓复习题目龋病
第一章
名解:
Dentalcaries
Achronic,destructiveprocesscausingdecalcificationofthetoothhardtissueandleadingtocontinueddestructionofenamel,dentinorcementum,andcavitationofthetooth.
Abacteriainfecteddiseasecausedbyspecificbacteria.
Amultifactorialprocessoftoothwithdemineralization.
名解:
DMFindex
Atechniqueformanagingstatisticallythenumberofdecayed,missing,orfilledteethintheoralcavity.AnalysismaybebasedontheaveragenumberofDMFteeth(sometimescalledDMFT)perpersonortheaveragenumberofDMFtoothsurfaces(DMFS).
TrendsinEpidemiology:
Reality?
1.Theprevalenceratehasdecreasedindevelopedcountries,andthisdeclineisusuallyattributedtoincreasinglybetteroralhygienepracticesandpreventivemeasuressuchasfluoridetreatment.
2.InChinaandotherdevelopingcountries,theprevalencerateofdentalcarieshasincreasedduetotherisingsugarconsumptionandimperfectioninoralhygieneprophylaxis.
名解:
Prevalencerate
Thenumberofcasesofaspecificdiseasepresentinagivenpopulationatacertaintimepiont.
名解:
Incidencerate
Thefrequencyofdevelopingaparticulardiseaseduringagivenperiodoftime;thenumeratoristhenumberofnewcasesduringthespecifiedtimeperiodandthedenominatoristhepopulationatriskduringtheperiod.
恒牙列中,下颌第一磨牙患龋的频率最高,患龋率最低的是下颌前牙。
在乳牙列中,患龋率最高的是下颌第二乳磨牙。
龋病好发牙面:
occlusal>interproximal>buccal
第二章
✧名解:
Dentalplaque
Dentalplaqueisunmineralizedbacterialdepositethatbuildsupontheteeth.Itconsistsofadhesivematrixandbacteria.Ifnotremoved,itcanleadtodentalcariesorperiodontaldiseases.
Structureofdentalplaqueonsmoothsurface?
1.Plaque-dentalsurface
2.Middlelayer
3.Surfacelayerofplaque
Classificationofdentalplaque?
1.supragingivalplaque
2.subgingivalplaque
Compositionofdentalplaque?
1.carbohydrate
2.proteins
3.Inorganiccomponents
Cariogenicmicroorganisms?
1.Streptococcusmutans(变形链球菌)
2.Streptococcussanguinis(血链球菌)
3.Streptococcusmitis(轻链球菌)
4.Lactobacillus(乳杆菌属)
5.Actinomyces(放线菌属)
TherelationshipsofStreptococcusmutans,LactobacillusandActinomyceswithdentalcaries?
变形链球菌属——主要致龋菌;
乳杆菌属——与牙本质龋及龋病进展相关;
放线菌属——根面龋重要致龋菌。
变形链球菌的致龋特点?
1.对牙面具有强的黏附能力
2.形成菌斑基质
3.有过量糖时,细胞内糖原合成,营养受限时提供能量
4.产酸、耐酸
5.可利用多糖进行无氧代谢产酸,使菌斑pH减低,并在酸性环境中生长、繁殖,产酸
变形链球菌的致龋机制?
表面蛋白(粘附素):
AntigenI/II
葡糖基转移酶(GTF)
乳杆菌属的致龋特点?
1. 兼性或专性厌氧菌
2. 对牙面亲合力低
3. 产酸
4. 其数量与龋病活跃度成正比
✧致龋菌的主要特点?
1.产酸能力
2.耐酸能力
3.牙面附着能力
Theoriesorhypothesesabouttheetiologyofdentalcaries?
1.Chemicaltheory(化学学说)
2.Proteolytictheory(蛋白溶解学说)
3.Proteolysis-ChelationTheory(蛋白溶解-螯合学说)
4.Chemical-parasitictheory(化学细菌学说)
5.Four-factortheory
Thefourfactorsinclude?
1.Microorganisms
2.Substrate/food
3.Host
4.Time
第三章
Zonesofenamelcaries?
1.translucentzone
2.darkzone
3.bodyofthelesion
4.surfacezone
Theeventsofthedentinalcaries?
1.Defensereactionofthepulpodentinalcomplex(牙髓牙本质复合体)
①Sclerosis(硬化)
②Reactionarydentineformation(反应性牙本质形成)
③Sealingofthedeadtracts
2.Cariousdestruction
①Demineralization
②proteolysis
名解:
secondarycaries
Dentalcariesdevelopinginatoothalreadyrepaired;oftenanewlesionformedadjacenttoorbeneatharestoration.
龋病的诊断方法?
1.视诊(visual)
2.探诊(tactile)
3.温度刺激试验
4.X线检查
5.透照(transillumination)
第四章
名解:
pulpodentinalcomplex
牙髓和牙本质在胚胎发生上联系很密切,对外界刺激的应答有互联效应,是一个生物整体,被称为牙髓牙本质复合体。
Clinicalsignificanceofpulpodentinalcomplex?
1.当釉质丧失后,暴露的牙本质小管就成为牙髓与口腔环境间的通道。
牙本质受到外界的任何刺激,无论是生理的或病理的,都能产生感觉,并引起牙髓的相应反应。
2.越接近髓腔,单位面积的小管数越多,对外界刺激的反应也越强,更容易造成对牙髓的损伤。
3.0.5mm厚的牙本质可减少有毒物质对牙髓的影响达75%,1mm厚牙本质减少90%,2mm厚牙本质则使牙髓的反应很小。
4.牙本质受到外界刺激时,可引起小管内的液体快速流动,导致成牙本质细胞突和细胞体移位,使缠绕的神经末梢被激惹,从而引起疼痛。
Purposeoftreatment?
1.Terminatethediseaseprogress
2.Protectdentalpulp
3.Restoretoothmorphologyandfunction
4.Establishnormalanatomyinrelationtoadjacenttissues
Indicationsofnon-surgicaltreatment?
1.Earlyenamelcarieswithoutdefect
2.Earlyenamelcarieswithoutchewingforce
3.Arrestedcaries
4.Deciduousteethnearreplacement
5.Nonfunctionaltooth
Methodsofnon-surgicaltreatment?
1.Chemicaltherapy
2.Remineralizativetherapy
3.Pitandfissuresealing
Chemicalsusedinchemicaltherapy?
Fluoride&silvernitrate(氟化物&硝酸银)
名解:
Remineralizativetherapy(再矿化治疗)
Thereintroductionofcomplexmineralsaltsintoenamelorcementum,torecoverthehardnessandarrestorreversetheearlycarieslesions.
Componentsofmineralsolution?
Calcium&phosphorus&fluorides
TreatmentofPitandfissuresealing?
1.cleantoothsurface
2.wetinsulation
3.acidcorrosion
4.coatingofsealant
5.lightcuring
Purposesofdentalcariesrestoration?
1.Torestoretheintegrityofthetoothsurface
2.Torestorethefunctionofthetooth
3.Torestoretheappearanceofthetooth
4.Toremovethediseasedtissuefromthetooth
Principalofdentalrestoration?
1.Removethedecayedtissue
2.Keepthehealthytissue,preventpulpvitality
3.Designandpreparationofresistanceformandretentionform
CavityclassificationbyG.V.Black?
1.ClassI——Cariesaffectingpitandfissures.
2.ClassII——Cariesaffectingtheapproximalsurfacesofposteriorteeth.
3.ClassIII——Cariesaffectingtheapproximalsurfacesofanteriorteeth
4.ClassIV——cariesaffectingtheapproximalsurfacesofanteriorteethandinvolvingtheincisalangle.
5.ClassV——Cariesaffectingthecervicalsurfaces
名解:
resistanceform
Theshapegiventoapreparedcavitytoenabletherestorationandremainingtoothstructuretowithstandmasticatorystresswithoutfracture.
Mainresistanceforms?
1.Cavitydepth
2.Boxshapewithrelativelyflatfloor
3.Step-structure
4.Cavo-surfacelinesaresmoothlyroundedcurves,andarekeptawayfromareasofstresssuchasinclinationandtipsofcusps.
5.Removeanyunsupportedenamel.
6.Allweakenedenamelwallsandcuspsshouldberemoved.
名解:
Retentionform
Theshapeorformoftheconventionalpreparationthatresistdisplacementorremovaloftherestorationfromlateralorverticalforces.
Structuresofretentionform?
1.Lateralretention(侧壁固位)
2.Undercut(倒凹固位)
3.Dovetail(鸠尾固位)
4.Trapezoid(梯形固位)
Principlesofcavitypreparation?
1.Removealldecayeddentaltissue
2.Preventpulpvitality
3.Savehealthydentaltissues
Stepsofcavitypreparation?
1.Primarypreparationofcavityshape
2.Moisturecontrolandtoothisolation
3.Cavitysterilization
4.Cavitysealing,liningandbasing
洞深一般要求多深?
釉牙本质界下0.2~0.8mm深。
/Preparingacavitydepthof0.2to0.8mmpulpallyoftheDEJposition.
Isolationmethods?
常用:
cottonroll;salivapump;rubberdam
选择性:
refractioncord;mouthprop;Drug(e.g.atropine)
常用的消毒药?
1.25%thymol-ethanol(25%麝香草酚乙醇溶液)
2.camphoratedphenol(CP)(樟脑酚)
3.75%ethanol(75%乙醇)
Sealantsforcavitysealing?
1.cavityvarnish(洞漆)
2.resinbondingagent(树脂粘结剂)
Whatiscavitylining?
Cavitylinersareplacedinthedeepestportionofthecavitypreparationontheaxialwallsorpulpalwalls.nWhenthelinersarehardened,theyformasacementlayerwithminimumstrength.Linersprotectthepulpfromchemicalirritationsandalsoprovideatherapeuticeffecttothetooth.Linersalsocalledlow-strengthbase.
Thethicknessofcavitylining?
<0.5mm
常用的洞衬剂?
CalciumHydroxideCement(氢氧化钙)
Compositeresinglassionomercement(玻璃离子粘固剂)
ZincOxideandEugenolCement(氧化锌丁香油酚粘固剂)
名解:
basing
垫底:
是在洞底(髓壁和轴壁)垫一层足够厚度(>0.5mm)的材料,隔绝外界和充填材料的温度、化学、电流及机械刺激,同时有垫平洞底,形成窝洞,承受充填压力和咀嚼力的作用。
Thicknessofbasing?
>0.5mm
常用的垫底材料?
1.ZincOxideandEugenolCement(氧化锌丁香油酚粘固剂)
2.ZincPhosphateCement(磷酸锌粘固剂)
3.Polycar-boxylatecement(聚羧酸锌粘固剂)
4.Compositeresinglassionomercement(玻璃粒子粘固剂)
Indicationsofamalgamrestoration?
1.ClassⅠ,ⅡandⅤoftheposteriorteeth
2.Abutmentteeth(基牙)
3.Disto-proximalcavityoncanine
4.Largerestoration:
restorativepin+amalgam
5.Fillingbeforecrownrestoration
名解:
粘结
两个同种或异种固体物质与介于两者表面间的第三种物质作用而产生牢固结合的现象。
✧牙体粘结技术原理?
(牙釉质?
)
1.化学性粘结力——粘结剂与粘结物体间的化学反应形成的化学键,包括共价键、离子键、配位键和分子间引力,为分子或原子水平的粘结。
2.物理性粘结力——是最基本的粘结力,粘结剂渗入粘结表面酸蚀后形成的微孔,固化后在界面形成机械作用力,包括嵌合、钩合和锚合,本质上是摩擦力。
Enameladhesion
Enamelsurface―acid-etching→demineralization―enamel-bondingagent→resintags
影响粘结的因素?
(可以用来回答“如何避免粘结失败”吗?
)
1.粘结剂对牙面的润湿程度
2.牙釉质和牙本质的结构
3.牙本质表面及内部的湿润程度
4.玷污层或称污染层(Smearlayer)
名解:
wettability
润湿:
粘结剂与粘结表面接触的能力。
名解:
smearlayer
污染层:
切削牙体组织后变性有机质与牙本质粉末、牙本质小管溢出液、唾液和细菌等混合贴附洞壁所形成,厚0.5~5um。
Cuttingorabradingthehardtissuewithrotaryandhandinstrumentsproducesalittlechipsorparticleswhichattachedtothetoothsurface,whichproducesthesmearlayer.
酸蚀的作用?
1.机械清洁釉质表面Cleaningtheenamelsurface
2.增大釉质表面可湿性increasewettability
3.增大表面自由能increasesurfaceenergy
4.活化釉质表层Exposingamorereactivesurfacelayer
5.增加釉质表面粗糙度Increasingtheenamelsurfaceareaavailableforbonding
6.利于粘结剂的润湿、铺展和渗入
釉质酸蚀的影响因素?
1.酸的种类和浓度(30%磷酸)Thekindandconcentrationofacid
2.酸蚀时间(一般30-60s)Theetchingtime
3.酸蚀剂的类型(凝胶或水溶液)Theformoftheetchant
4.釉质的组成和结构(乳牙酸蚀效果较恒牙差)Thekindoftooty
5.酸蚀面与釉柱方向的关系Theorientationofenamelprismstotheetchedsurface
6.酸蚀涂布的压力(轻轻涂布)
7.Therinsetime
釉质粘结的步骤?
1.酸蚀
2.应用树脂粘结剂
牙本质粘结的步骤?
1.酸蚀etching
2.涂底漆priming
3.涂粘结剂bonding
✧名解:
hybridlayer
混合层:
粘结剂渗入脱矿牙本质表面暴露的胶原纤维网聚合后在牙本质和树脂间形成的铰链层。
Aresinimpregnented(浸透)dentine——Thebondingagentpenetratesthedentinetubulesaswellastheetchedintertubularandpertubulardentine.Itscomponentsincludethepolymer,collagenandhydroxyapatitecrystals.Itprovidesastrongbondfortheresin——sealingoffthedentinetubulesfromtheingressofmicro-organisms.
牙本质粘结体系包括什么?
1.牙本质处理剂(etchant)
2.底漆(primer)
3.粘结剂(bonding)
Totaletchingsystem的操作步骤?
第一步:
酸蚀15秒-冲洗-吹干
第二步:
涂布底漆–轻吹
第三步:
涂布