牙体牙髓病学：牙体硬组织非龋性疾病-4.ppt

* 临床表现 硫酸： 不易引起酸蚀，对牙影响甚少 胃酸： 牙舌面或后牙牙合面的损害 * Erosion HNO3 Hcl * This 14-year-old female exhibits total loss of surface characteristics and polished appearance of enamel on her maxillary incisors. The enamel layer was also very thin. * Gastroesophageal reflux disease (GERD) was discovered in this 19 year old boy who exhibited early, generalized erosion (arrow A). Note the preservation of the enamel at the gingival crevice (arrow B). * This 33-year-old male with GERD had severe asymptomatic erosion. Note the amalgams rising above the adjacent eroded occlusal surfaces. * Citric acid from lemons absolutely destroys teeth at an early age.? I have seen cases of teen-agers that have ruined their front teeth from sucking on lemons all the time. * This illustrates erosion of the left side mandibular molars of a 20-year old female who habitually enjoyed holding a cola beverage in this area for several minutes before swallowing. * illustrates erosion in a 5-year-old child caused by frequent consumption of an acidic fruit juice at bedtime. * This illustrates attempts of the dentist to repair erosion in a patient with Sjogrens syndrome. The patient sipped an acidic sugarless drink all day to maintain oral moisture until he was made aware of the cause of his erosion. Arrow A points to a restored surface placed to protect the dentin.?? Arrow B points to exposed dentin. * 酸蚀症 局部脱敏 缺损严重可根据情况充填法或修复法处理 若有牙髓感染，先进行牙髓治疗，然后在充填或修复处理 2 3 4 1 改善工作条件，纠正不良习惯 治 疗 * * * 上颌磨牙好发，其次是 下颌磨牙和上颌前磨牙 上颌第一磨牙明显多于 上颌第二磨牙，尤其近 中腭尖更易发生。 牙冠表面的非生理性细小裂纹 牙 隐 裂 概 念 * 牙齿结构的薄弱环节，抗力强度低，应力集中部位－内在条件 牙尖斜度：越大，发生隐裂的机会越多－易感因素 创伤合力－致裂因素 温度作用：釉质牙本质膨胀系数不同，长期的冷热温度循环作用下，釉质可出现裂纹 病 因 * 好发于磨牙牙合面，上颌第一磨牙最常见 明显磨损和高陡牙尖，与对颌牙咬合紧密 位置常与合面某些窝沟重叠，上颌磨牙近中舌沟，下颌磨牙近远中发育沟, 前磨牙中央沟 较浅的隐裂常无明显症状，较深时则遇冷热刺激敏感或咬合不适 病史较长，咬在特殊部位可引起剧烈疼痛，或引起牙髓或根尖周病，甚至牙劈裂 临床表现 * 诊 断 患牙可有较长时间的咬合不适或咬在某一特殊部位时剧烈疼痛（定点性咀嚼剧痛） 叩诊，叩痛显著处为隐裂所在位置 患牙对温度刺激敏感，以隐裂处最敏感 当探针置于裂隙处加压或用力撬动，有时可出现疼痛感 2.5%的碘酊或其他染料类药物可使裂纹清晰可见 将棉签放在可疑牙隐裂处做咀嚼运动时，可引起撕裂样疼痛 * Normal