DentalCariesOuyangYong

AssociateprofessorDepartmentofEndodonticsandOperativeDentistrySunYat-senUniversity岳松齡

王滿恩

史俊南

劉正

樊明文

李玉晶王嘉德

周學東

高學軍凌均棨劉天佳學習齲病學需要了解的人史俊南劉正樊明文李玉晶周學東凌均棨吳補領高學軍IntroductionPhotosofdentalcariesPhotosofdentalcariesPhotosofdentalcaries'Caries'isLatinfor'rot'or'rotten'.Dentalcariesmeansrottenteeth.CariesisthenounwhichnamesthediseaseCariousistheadjective,not'acaries‘,'acariousarea'or'anareaofcaries'.DentalcariescanbedefinedasChronicprogressivedeconstructivediseaseofharddentaltissuesBacterialinfecteddiseasescausedbyspecificbacteriaareversiblemultifactorialprocessoftoothdemineralizationandremineralization.

DentalcariesDentalcaries,abacterialinfection,maybedefineasaposteruptivepathologicalprocessofexternalorigin,involvingthesofteningoftheharddentaltissueandproceedingtocavityformation.Thisisdistinctfromthedissolutionoftheharddentaltissuesofanuneruptedtoothwhichisnotdentalcariesbuttoothresorption.Thecariousprocess

a

pathologicalprocessoflocalizeddestructionofcalcifiedtoothtissuesbyacidsproducedbyorganisms.Etiologicallycariesisconsideredamulti-factorialdisease,whichinvolvesinterplaybetweenthehost(salivaandteeth)microorganisms(streptococcusmutans),andthesubstrate(dietarycarbohydratesucrose),withtheproductionofLacticacid.Dentalplaque(Bio-film)servesasthemediumforcariesdevelopment.Basicpathologicalchangesdemineralizationofinorganic

tissuesoftoothDisintegrationoftheorganictissuesoftoothinvolvesenamel,dentin,cementumEpidemiologyofdentalcaries

流行病學Prevalencerate〔患病率〕：istheproportionofapopulationaffectedbyadiseaseofaconditionatonepointtime.Incidence〔發(fā)病率〕：isamesurementoftherateatwhichadiseaseprogressestheincreaseordecreaseinthenumberofnewcasesoccurringinapopulationwithinthesametimeperiodMeasuringcariesactivityDMFindexD

themeannumberofdecayedteethwithuntreatedcariouslesionsM

themeannumberofteethwhichhavebeenextractedandarethereforemissingFthemeannumberoffilledteethDMF(T)

todenotedecayed,missing,andfilledteethDMF(S)

todenotedecayed,missing,andfilledsurfacesinpermanentteethdmf(t)

dmf(s)

similarindicesfortheprimarydentitionFrequencydistributionofdentalcariesaccordingtovarioustoothlocationpermanentdentitionDeciduousdentitiondistributionofdentalcariesaccordingtotoothsurfaceOcclusal>interproximal>buccalCariesisworldwideinitsdistribution

TheprevalenceofdentalcariesincreaseswiththedevelopmentofeconomyHighDMFbefore1970intheindustrializedcountryTodecreaseafter1970intheindustrializedcountryMoreprevalenceinindustrializedthaninthethirdwordcountryCariesexperiencetendstoincreaseinthedevelopingcountryanddeclineinmanywesterncountries.Cariesexperienceishigherinurbanthaninruralcommunitiesindevelopingcountries.Prevalenceofdentalcaries(1995)，specialfor12-18Yagegroupsisincreasedsignificantly〔20-40%〕Inrecent10years,prevalenceofdentalcariesinprimarydentitionisincreasedsignificantlythanthepermanentWhyhascariesprevalencedecreasedinmodernpopulation?TheispossiblyattributabletoThefluoridationofdrinkingwater,useoffluoridetoothpastesandimprovedoralhealthAchangingpatternofsugarconsumptionAdecreaseinvirulence(毒力)oftheorgansimsAetiologyofdentalcaries

齲病的病因學原發(fā)性釉護膜(primaryenamelcuticle)殘余釉上皮（reducedenamelepithelium)獲得性膜（acquiredpellicle）食物碎片（fooddebris,materialalba）牙菌斑（dentalplaque）牙結石（calculus,tartar）Theorganicdepositsontheenamelsurface

fourfactorsisessentialfortheinitiationofdentalcaries,namely:Micro-organismmutansstreptococciLactobacilliActinomycesSubstrateRefinedcarbohydrates(精制碳水化合物)suchassucrose蔗糖provideasuitablesubstrateonwhichthecariogenicmicro-organismsacttoproducetheacidsthatleadtodissolutionoftheharddentaltissuesCariesexperienceisinfluencedbythequantity,qualityandespeciallyfrequencyofconsumptionoftherefinedcarbohydrateSusceptibleteeth易感牙Theingestionoffluoridesduringtoothmineralizationleadstotheformationoffluor-apatiteinenamel.Itspresenceinenamelmakesthetoothlesssusceptibletodentalcariesbecauseitislesssolubleinacidthanthehydroxyapatite(羥磷灰石)whichisnormallypresentintheharddentaltissuesTimeAllthefactorsshouldbepresentforsufficientlylongtimeforthecariesprocesstobeinitiated.Definition:Dentalplaque〔牙菌斑〕ClassificationofDentalplaquesupragingivalplaque

-----dentalcariessubgingivalplaque-----periodontaldiseasesSTRUCTUREOFDENTALPLAQUEPlaqueonsmoothsurface

Plaque-dentalsurfaceMiddlelayer----condensedmicrobiallayerbodyofplaqueThesurfacelayerofplaquePlaqueinpitandfissureCompositionofDentalplaquebacteriawhichform50-70%ofdentalplaque

asmallnumberofepithelialcellsLeukocytesMacrophagesglycoproteinswhich,togetherwithextracellularpolysaccharides,formtheplaquematrixmucopolysaccharides(粘多糖)suchasglucansandfructans(右旋糖)

Inorganiccomponentscalciumphosphorusfluorides.MECHANISMSOFPLAQUEFORMATIONTheattachment,growth,removalandreattachmentofbacteriatothetoothsurfaceisacontinuousanddynamicprocess.SeveraldistinctprocessescanberecognizedAbsorptionofsalivaryproteinsandglycoproteins,togetherwithsomebacterialmolecules,tothetoothsurfacetoformaconditioningfilm(theacquiredpellicle).——獲得性膜的形成non-specificinteractionofmicrobialcellsurfaceswiththeacquiredpellicleviavanderWallsattractiveforces.Irreversibleadhesioncanoccurifspecificinter-molecularinteractionstakeplacebetweenadhesionsonthecellsurfaceandreceptorsintheacquiredpellicle.Secondaryorlate-colonizersattachtoprimarycolonizers(coaggregation共集),alsobyspecificinter-molecularinteractions.FORMATIONANDDEVELOPMENTOFDENTALPLAQUEFormationofacquiredpellicleandprimaryaggregationBacteriagrowthanddevelopmentThematureofdentalplaqueDevelopmentPellicleformationMicroorganismsdonotattachthermselvesdirectlytothemineralizedtoothsurfaceandtheteetharealwayscoveredbyanacellularproteinaceousfilm,thepellicleFormsonthe“naked〞toothsurfacewithinminutestohoursSalivaryglycoproternsCarbohydratesLipidalesserextentcomponentsfromthegingivalcrevicularfluid(齦溝液)MajorconstituentsofPellicleBecauseofitsselectivenaturerestricttransportationofironsinandoutofthedentalhardtissue.ItmayplayanimportantmodifyingroleincariesProvidefurtherprotectionagainstdemineralizationoftheenamelModifythenumberofpotentialadsorptionsitesfordifferentbacterialspeciesAsthesubstrateforthemicroorganisms

FunctionofPelliclemicrobialcolonizationInitialmicrobialcolonizationstreptococcusmutans(變形鏈球菌)

accountingfor56%ofthetotalinitialmicrofloraActinomycesspp(放線菌)

aminorproportion

gram-negativebacteria(G-)MicrobialsuccessionTheinitialestablishmentofastreptococcalfloraappearstobeanecessaryantecedentforthesubsequentproliferationofotherorganismsThemoststrikingchangedisshiftfromstreptococcus-dominatedplaquetoplaquedominatedbyActinomyces.MICROBIALAETIOLOGYOFCARIESanimalstudies

micro-organismsareinvolvedintheaetiologyofdentalcaries

cariogenicmicroorganisms

Streptococcusmutanslactobacillus

ActinomycesCariogenicproperties

(致齲菌的特性)theyareabletoproduceacidrapidlyfromfermentablecarbohydrates(acidogenic).Theythriveunderacidconditions(aciduric)

abletoadheretothetoothsurfacebecauseoftheirability

tosynthesizestickyextracelluarpolysaccharidesfromdietarysugarsAdvancedlesionsoftenhaveahighproportionoflactobacillidentinallesionshaveadiversemicroflorawithmanyGrampositiveGramnegativebacteria.RootsurfacecarieswasoriginallyassociatedwithActinomycesspp.butrecentstudiessuggestasimilaraetiologytoenamelcariesRampantcariescanoccurinxerostomicpatientsandininfantsfedwithhighlevelsofsugarinpacifiers(nursingbottlecaries).Theplaquecontainshighlevelsofmutansstreptococciandlactobacilli.Micro-organismandcariesHypothesesandtheoryrelatingtoAetiologyofdentalcariesChemico-parasitictheory

(化學細菌學說)Thispostulatesthatoralbacteriaactonsugartoproduceacidwhichdemineralizestheinorganiccomponentofenamel,resultinginthedevelopmentofacariouslesion.Proteolytictheory(蛋白溶解學說)Itisthoughtthattheorganiccomponentofenamelisfirstbrokendownbyproteolyticenzymes,openinguppath-waysforbacteriatoattacktheenamelbyotherprocessessuchasbyacidorbychelation.Chelationtheory(螯合學說)ThispostulatesthatenamelisdemineralizedbychelatingagentsatneutralpH.Proteinbreakdownproductsaswellaslacticacidaresomechelatingagentsknowntoexistinnature.Auto-immunitytheoryInthistheory,itissuggestedthat'forbiddenclones'oflymphocytesattacktargetcells(odontoblasts)renderingthetoothvulnerabletocariesattack.

FourfoctorstheoriesmicroorganismsHost&toothsubstratetimecariesThefourcirclediagrammaticallyrepresenttheparametersinvolvedinthecariousprocess.Allfourfactorsmustbeactingconcurrently(overlappingofthecircles)forcariestooccur.TheroleofdietarycarbohydrateNutrition------systemicdietaryeffectsDiet------localdietaryeffectsCariesprevalenceislowinpopulationsadheringtoaprimitivewayoflivingandadietoflocalproductswithlittlesugarAdrasticincreaseincariesisinvariablyseenwhenthesepopulation“improve〞theirstandardoflivingandadoptamodern“civilized〞dietwithhighsugarcontentAstrongcorrelationbetweencariesdevelopmentandsugarconsumption

epidemiologicalstudiesSucrose(蔗糖)------calledthearch-criminalindentalcariesMonosaccharides,disaccharidesandofthepolysaccharidestarchcanbefermentedtoacidbytheplaquebacteriaSorbitol〔山梨糖〕xylitol(木糖醇)-----sugarsubstitutesusedinsugar-freechewing-gumsDietaryhabitsandcariesprevalenceHost&tooth(susceptibleteeth)ItwasaclinicalexperiencethatnotallindividualswithpoororalhygieneandfrequentsugarconsumptiondevelopcariesInthelaboratory,extractedteethexposedtothesameacidicbufferchallengecertainlydonotdevelopartificatialcaries-likelesionstothesamedegreewithinashortperiodoftimeToothmorphology:susceptiblesitesEnvironmentofthetooth:SalivafluorideHost&toothToothmorphologybacterialplaqueisanessentialprecursorofcaries,sitesonthetoothsurfacewhichfavourpalqueretentionandstagnationareparticularlypronetodecaySalivaundernormalconditions,thetoothiscontinuallybathedinsaliva.ItiscapableofremineralizingtheearlycariouslesionbecauseitissupersaturatedwithCaandP.whensalivarybufferingcapacityhasbeenlost,alowPhenvironmentisencouragedandpersistslongerFluorideparticularinterestwasthediscoveryoftheassociationbetweenfluorideconcentrationinwatersuppliesandprevalenceofdentalcariesinchildren

Itisevidentthatthemereexistenceofthethreefactorsoperatingtogetherdoesnotresultininstantaneousminerallossthereforeafourthcircleisoftenaddedtostressthetimedimensiontakenfordentalcariestodevelop

Time

OtherfactorsAgeSexGeographyRaceEconomicsstatusNutritionHealthstatusThankyouforyourattention!jhfdb986420-(&$#YWUTRPNLJHFDBzxvusqomkigeca86431+)*%!ZXVTRPOMKIGECAywusqpnljhfdb975310-(&$#YWUSQOMKJHFDBzxvtrpnlkigeca86420QOMKIHFDBzxvtrpnljigeca86420-(&$!ZXVTRPNLJHFDCAywusqomkigedb97531+)*%!ZYWUSQOMKIGECAyxvtrpnljhfdb986420-(&$#YWUTRPNLJHFDBzxvusqomkigeca86531+)*%!ZXVTRPOMKIGECAywusqpnljhfdb975310-(&$#YWUSQOMLJHFTRPNLJHFECAywusqomkigfdb97531+)*%!#YWUSQOMKIGECBzxvtrpnljhfdba86420-(&$#YWVTRPNLJHFDBzxwusqomkigeca87531+)*%!ZXVTRQOMKIGECAywusrpnljhfdb975320-(&$#YWUSQONLJHFDBzxvtrpomkigeca86420-)*%!ZXVTRPNLJpnlkigeca86420-(*%!ZXVTRPNLJHGECAywusqomkigfdb97531+)*%!#YWUSQOMKIGECBzxvtrpnljhfdca86420-(&$#YWVTRPNLJHFDBzxwusqomkigeca87531+)*%!ZXVTSQOMKIGECAywusrpnljhfdb975320-(&$#YWUSQONLJHFDBzxvtrpomkigusqomkjhfdb97531+)*%$#YWUSQOMKIGEDBzxvtrpnljhfeca86420-(&$#ZXVTRPNLJHFDBzywusqomkigeca97531+)*%!ZXVUSQOMKIGECAywvtrpnljhfdb975420-(&$#YWUSQPNLJHFDBzxvtrqomkigeca86421+)*%!ZXVTRPNLKYWUSQOMKIGFDBzxvtrpnljhgeca86420-(&$!ZXVTRPNLJHFDBAywusqomkigecb97531+)*%!ZXWUSQOMKIGECAyxvtrpnljhfdb986420-(&$#YWUSRPNLJHFDBzxvtsqomkigeca86431+)*%!ZXVTzxvtrqomkigeca86420+)*%!ZXVTRPNLKIGECAywusqomljhfdb97531+)(&$#YWUSQOMKIGFDBzxvtrljhfdb986420-(&$#YWUTRPNLJHFDBzxvusqomkigeca86531+)*%!ZXVTRPOMKIGECAywusqpnljhfdb975310-(&$#YWUSQOMLJHFDBzxvtrpnlkigeca86420-(*%!ZXVTRP%!#YWUSQOMKIGECBzxvtrpnljhfdca86420-(&$#YWVTRPNLJHFDBzxwusqomkigeca87531+)*%!ZXVTSQOMKIGECAywusrpnljhfdb975320-(&$#YWUSQONLJHFDBzxvtrpomkigeca86420-)*%!ZXVTRPNLJIGECAywusqomkjhfdrpnljhfeca86420-(&$#ZXVTRPNLJHFDBzywusqomkigeca97531+)*%!ZXVUSQOMKIGECAywvtrpnljhfdb975420-(&$#YWUSQPNLJHFDBzxvtrqomkigeca86421+)*%!ZXVTRPNLKIGECAywusqomljhfdb97531+)(&JIGECAywusqomkjhfdb97531+)*%$#YWUSQOMKIGEDBzxvtrpnljhfeca86420-(&$#ZXVTRPNLJHFDBzywusqomkigeca97531+)*%!ZXVUSQOMKIGECAywvtrpnljhfdb975420-(&$#YWUSQPNLJHFDBzxvtrqoCAywusqomljhdb97531+)*%$#YWUSQOMKIGECBzxvtrpnljhfdca86kigeca87531+)*%!ZXVTSQOMKIGECAywutrpnljhfdb975320-(&$#YWUSQONLJHFDBzxvtrpomkigeca86420+)*%!ZXVTRPNLJIGECAywusqomkjhfdb97531+)*&$#YWUSQOMKIGFDBzxvtrpnljhfeca86420-(MKIGECBzxvtrpnljhfdca86420-(&$#YXVTRPNLJHFDBzxwusqomkigeca87531+)*%!ZXVTSQOMKIGECAywutrpnljhfdb975320-(&$#YWUSQONLJHFDBzxvtrpomkigeca86420+)*%!ZXVTRPNLKIGECQOMKIGEDBzxvtrpnljhfeca86420-(&$#ZXVTRPNLJHFDBAywusqomkigeca97531+)*%!ZXVUSQOMKIGECAywvtrpnljhfdb976420-(&$#YWUSQPNLJHFDhfdb97531+-(&$#YWUSQOMKJHFDBzxvtrpnlkigeca86420-(*%!ZXVTRPNLJHFECAywusqomkigfdrpnljhfdba86420-(&$#YWVTRPNLJHFDBzxvusqomkigeca86531+)*%!ZXVTRQOMKIGECAywusrpnljhfdb975320-(&$#YWUSQOMLJHFDBzxvtrpnmkigeca86420-)*%!ZXVTRPNLJIGECAywusqoCBzxvtrpnljhfdca86420-(&$#YXVTRPNLJHFDBzywusqomkigeca87531+)*%!ZXVTSQOMKIGECAywutrpnljhfdb975420-(&$#YWUSQONLJHFDBzxvtrpomkigeca86420+)*%!ZXVTRPvtrpnmkigeca86420-)*%!ZXV)*%!ZXWUSQOMKIGECAyxvtrpnljhfdb986420-(&$#YWUTRPNLJHFDBzxvusqomkigeca86431+)*%!ZXVTRPOMKIGECAywusqpnljhfdb975310-(&$IGECAywusqomljhfdb97531+)(&$#YWUSQOMKIHFDBzxvtrpnljigeca86420-(&$!ZXVTRPNLJHFDCAywusqomkigedb97531+)*%!ZYWUSQOMKIGECAyxvtrpnljhfdb9omkigeca86431+)*%!ZXVTRPOMKIGECAywusqpnljhfdb97531+-(&$#YWUSQOMKJHFDBzxvtrpnlkigeca86420-(*%!ZXVTRPNZXWUSQOMKIGECAywvtrpnljhfdb976420-(&$#YWUSRPNLJHFDBzxvt975420-(&$#YWUSQONLJHFDBzxvtrpomkigeca86420+)*%!ZXVTRPNLKIGECAywusqomkjhfdb97531+)*&$#YWUSQOMKIGFDBzxvtrpnljhgeca8mkigecb97531+)*%!ZXVUSQOMKIGECAywvtrp531+)*%!ZXVTSQOMKIGECAywu