Hua Yao DMD, Ph.D.

1
Hua Yao DMD, Ph.D.

• Dept. of Stomatology, the First Affiliated
  Hospital, College of Medicine, Zhejiang
  University

E-mail yaohuauk_at_hotmail.com TEL
87236338
2
Dental Caries
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/stat
s-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

3 necessary requirements 1) Microorganismsbacteria, plaque 2) sugar --- carbohydrates 3) host tooth---saliva, tooth ( and) 4) time.
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
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
Streptococcus mutans
demineralization
remineralization
16
Clinical classification of caries

• According to three basic factors
• severity and rate of progression
• anatomical site(involving site)
• age patterns at which lesions predominate

17
Tooth anatomy
Root
18
Classification according to the developing speed

Acute caries
Rampant caries
Chronic caries
Arrested caries
19
Classification according to the involving site

• Occlusal caries
• Root caries
• Smooth surface caries
• Linear enamel caries

20
Clinical Manifestation and Symptoms
changes in tissue color, texture, and structure

• Visible pits or holes in the tooth
• Colour changing
• Soften
• Pain

21
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
22
Examination

• Clinical observations
• (Visual change)
• Probing

The explorer tip can easily damage white spot
lesions
23
Examination
Temperature test X-ray Transillumination
24
Diagnosis

• Clinical signs
• visual color, texture, shape,
• location, cavitation,
• Clinical symptoms
• Diagnostic test--examination

25
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
26
Case
27
Case
28

• Prevention is the most important for dental
  caries.

29
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.

30
PULP DISEASES
31
Etiology fo pulp diseases 1-bacterial cause
caries, fracture, bacteremia,
periodontal pocket
caries irreversible pulpitis

32
pulp
33
periodontal pocket
34
2-physical cause sever thermal change
(cavity preparation), large metallic
restoration
35
3-trauma from occlusion, like attrition
or accident 4-chemical cause filling
(amalgam, composite resin), bases,
disinfectant, eugenol)
36
5. Other cause internal resorption
37
Possible Pulpal Diagnoses

• Normal
• Reversible pulpitis
• Irreversible pulpitisacute, chronic, polyp
• Necrosis
• Previous endodontic treatment

38

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

39
Clinical Examination in reversible pulpitis
Thermal Hypersensitive with mild
pain ltmild Sweets Sensitive lt mild Biting
Pressure None (unless tooth is cracked)
40
Treatment of Reversible Pulpitis

• Remove irritant if present
• If no pulp exposure direct restore
• If pulp exposure
• Carious initiate RCT
• Mechanical gt1 mm initiate RCT
• lt1 mm crown planned
  initiate RCT
• lt1 mm direct cap or RCT
• If recent operative or trauma postpone
  additional treatment and monitor.

41

• Irreversible Pulpitis

Reversible pulpitis are left untreated.
42
Symptoms of Irreversible Pulpitis

• Thermal
• Hypersensitive-moderate to severe
• Sweets
• Moderately to severely sensitive
• Biting Pressure
• Usually sensitive in later stages (periapical
  symptom)
• spontaneous pain Moderate to severe

43
DiagnosisIrreversible Pulpitis

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

44
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
45
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.
46
Chronic hyperplastic pulpitis(polyp)
Clinically1- polyp 2- occurs in a tooth with
large carious lesion3- not sensitivity4- bleed
easily5- may confused with hypertrophic gingival
polyp
47
Treatment of Irreversible Pulpitis

• Root canal treatment or extraction

48
Pulpal Disease

• Necrotic Pulp

49
Necrotic Pulp

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

50
Maxillary first molar with large amalgam
restoration and periapical radiolucencies around
all three roots. The tooth was unresponsive to
electrical and thermal testing.
51
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 spontaneous pain

52
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.

53
Necrotic Pulp(additional considerations)

• Antibiotic coverage
• Pain Management
• Occlusal Reduction

54
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.
55
Pre-operative film
56
(No Transcript)
57
Access and Working length
58
Completed RCT
59
case
60
Points you must know

• What is root canal treatment?
• Simply describe the clinical manifestation of
  pulpitis.

61
The oral manifestation of HIV Infection

62
human immuno-deficiency virus (HIV)
retroviruses
acquired immune deficiency syndrome,
(AIDS)
63
Oral manifestations are often the first clinical
feature of HIV infection.
Epidemiology
The first AIDS case,
worldwide1981, AIDS China 1985,
AIDS, Beijing,Argentina Shanghai 1987,
AIDS Hangzhou 1985, AIDS--hemophila
2009, 1272/236 (HIV/AIDS)
64
Oral Manifestations observed in HIV

• Fungal
• Neoplastic
• Viral
• Bacterial
• Other

65
Fungal Manifestations ----candidiasis

• Can manifest in 4 different ways
• Pseudomembraneous candidiasis
• Erythematous candidiasis
• Hyperplastic candidiasis
• Angular chilitis

66
Pseudomembraneous Candidiasis
67
(No Transcript)
68
Hyperplastic Candidiasis
69
Angular chilitis
70
Neoplastic Oral Manifestations

• There are two types of neoplasms associated with
  oral manifestations in HIV individuals
• Kaposis Sarcoma (KS)
• Non-Hodgkins Lymphoma

71
Kaposis Sarcoma
72
Non-Hodgkins Lymphoma
73
Viral Manifestations

• Herpes Simplex Virus (HSV) lesions
• Herpes Zoster
• Hairy leukoplakia
• Cytomegalovirus (CMV) ulcers
• Human Papillomavirus (HPV) lesions

74
Leukoplakia
75

• Herpes Simplex Virus (HSV) lesions

76
Cytomegalovirus (CMV) ulcers
Combination of HSV and CMV
77
HPV
78
Bacterial Manifestations
Linear Gingival Erythema Necrotizing Ulcerative
Periodontitis Tuberculosis
79
Linear Gingival Erythema(red-band gingivitis)
80
Necrotizing Ulcerative Periodontitis
81
Necrotizing Ulcerative
82
Tuberculosis

• Oral lesions in people with tuberculosis are seen
  rarely.
• They have been reported as ulcers on the tongue
  secondary to pulmonary tuberculosis.

83
Other Oral Manifestations

• Aphthous Ulcerations (canker sores)
• Minor
• Major
• Salivary Gland Disease
• Xerostomia

84
Aphthous Ulcerations
major
minor
85
Salivary Gland Disease
86
Xerostomia
87
Conclusions

• Lesions or other manifestations in the mouth
  may be the initial indicator of a persons HIV
  status or it may indicate a further decrease or
  worsening of an infected individuals immune
  system.

88
You must know

• What is the main oral manifestation of HIV
  infection?
• List the four categories of oral manifestations
  that may present in HIV
• Be familiar with fungal oral manifestation that
  may present in HIV infected individuals