PAGEPAGE5上海交通大學(xué)口腔醫(yī)學(xué)院教案課程名稱牙體牙髓病學(xué)第6、7次課2007年教師姓名孫喆職稱副教授教研室口腔內(nèi)科教學(xué)時(shí)數(shù)3授課題目牙發(fā)育異常和牙震蕩、牙脫位教學(xué)對(duì)象口腔04級(jí)七年制授課地點(diǎn)教室教學(xué)方式大課本課的重點(diǎn)、難點(diǎn)：本課的重點(diǎn)難點(diǎn)及對(duì)策重點(diǎn)：氟牙癥、四環(huán)素牙、畸形中央尖的病因、癥狀、診斷和防治難點(diǎn)：釉質(zhì)發(fā)育不全的發(fā)病機(jī)理，氟牙癥的治療，畸形中央尖的臨床表現(xiàn)及治療，牙震蕩和牙脫位的臨床表現(xiàn)及治療對(duì)策：用多媒體圖片顯示釉質(zhì)發(fā)育不全的發(fā)病機(jī)理簡(jiǎn)圖，配合各疾病的典型病例的臨床表現(xiàn)和治療方法，加以詳細(xì)講解。本次課應(yīng)用的教具：本次課應(yīng)用的教材教具參考書教材:《牙體牙髓病學(xué)》（第二版）樊明文主編人民衛(wèi)生出版社2000年教具：電腦、多媒體投影儀、電子教棒。參考書：《口腔科手冊(cè)》(第二版)劉正主編上?？茖W(xué)技術(shù)出版社1997年《BLEACHINGTECHNIQUESINRESTORATIVEDENTISTRY》EditedbyLindaGreenwallMartinDunitzLtd,amemberoftheTaylor＆Francisgroup

主要教學(xué)內(nèi)容：（可另附頁(yè)）主要教學(xué)內(nèi)容及時(shí)間安排介紹牙齒發(fā)育異常及部分牙外傷的內(nèi)容：釉質(zhì)發(fā)育不全、氟牙癥、畸形中央尖、牙震蕩、牙脫位（introducethesummaryofdisordersofdevelopmentandinjuryofteeth,includingenamelhypoplasia,dentalfluorosis,abnormalcentralcusp,concussionanddislocationoftheteeth）（2分鐘）介紹牙齒發(fā)育異常的內(nèi)容：結(jié)構(gòu)、形態(tài)、數(shù)目和萌出異常，結(jié)合鐘狀期造釉器圖，復(fù)習(xí)牙釉質(zhì)、牙本質(zhì)的發(fā)育過程(introducethesummaryofdisordersofdevelopmentofteeth,includinghistodifferentiation,morphodifferentiation,disturbanceinnumberandgermination,andreviewtheformationofenamelanddentinewiththefigureofenamelorganinbellstage)（3分鐘）釉質(zhì)發(fā)育不全(enamelhypoplasia)病因(aetiology)：營(yíng)養(yǎng)障礙，內(nèi)分泌失調(diào)，嬰兒、母體疾病，局部因素。(nutritiondeficiency,incretiondisorder,infant&maternaldiseaseandlocalagent)臨床表現(xiàn)(clinicalfeature)：輕癥、重癥，發(fā)病時(shí)間和臨床表現(xiàn)的關(guān)系。(Mildandseveretype,indicatingtherelationshipbetweentheaffecttimeandclinicalfeature)防治(preventionandcure)：無法預(yù)防(impossibletoprevent)；復(fù)合樹脂修復(fù)(compositeresin)（10分鐘）氟牙癥(dentalfluorosis)病因(aetiology)：飲水含氟量過高，正常飲水含氟量為1ppm(ingestionexcessivefluorineindrinkingwater,and1partpermillionoffluorideinnormaldrinkingwater)。發(fā)病機(jī)理(mechanism):氟濃度增高，抑制堿性磷酸酶活力，造成釉質(zhì)礦化不良，色素沉積。多媒體顯示發(fā)病機(jī)理圖。(Owingtoexcessivefluoride,inhibitionofalkalinephosphataseresultsinenamelhypormineralizationandpigmendeposition)臨床表現(xiàn)(clinicalfeature)：輕、中、重(mild,middleandseveretype)。預(yù)防(prevention)：重選水源，去除水中過量氟(reselectwatersource,orgetridofexcessivefluoride)。治療(therapy)：脫色法，復(fù)合樹脂修復(fù)(discolorationorcompositeresin)(10分鐘)四環(huán)素牙(tetracyclinestainedteeth)發(fā)病機(jī)理(mechanism)：牙齒發(fā)育礦化期服用大量四環(huán)素牙著色四環(huán)素牙，(多媒體顯示發(fā)病機(jī)理圖)。(duringtheformationoftheteeth,sufficienttetracyclineadministrateleadstoteethstainedandtetracyclinestainedteeth)臨床表現(xiàn)(clinicalfeature)：顏色改變，病理磨片熒光染色。(colouralteration,andfluorescencestainingroundsection)預(yù)防(prevention)：孕婦和8歲以下兒童少用四環(huán)素(pregnantfemalesandchildrenunderageof8avoidtheusageoftetracycline)。處理(treatment)：內(nèi)脫色，外脫色，樹脂修復(fù)(intracoronalbleaching,bleachingandcompositeresin)(10分鐘)乳光牙(hereditarydentinogenesisimperfecta)病因(aetiology)：常染色體顯性遺傳(autosomaldominantinheritance)。病理變化(pathology)：(1)雜亂牙本質(zhì)充滿牙髓腔，髓腔閉鎖(pulpchamberfullofirregulardentine,andatresiaofpulpchamber)；(2)髓腔內(nèi)為大量牙髓，髓腔增大(pulpchamberwithlargeamountofpulp,augmentationofpulpchamber)。臨床特點(diǎn)(clinicalfeatures)：乳光微黃半透明色(translucent,opalescentamber-likeappearance)。治療(therapy)：義齒修復(fù)(denturerestoration)(5分鐘)先天性梅毒牙(congenitalsyphiliticteeth)病因(c)：牙胚發(fā)育期，梅毒侵害，成釉細(xì)胞受害，牙本質(zhì)礦化障礙。(Duringteethformation,withspirochaeteinfection,ameloblastinjured,anddentinemineralizariondisturbanceoccurred)病理變化(pathology)：釉質(zhì)明顯減少和缺失，牙本質(zhì)生長(zhǎng)線明顯。(Significantlylackorlossofenamel,dentineincrementallinesareeasytodetect)臨床表現(xiàn)(clinicalfeatures)：半月形切牙，蕾狀磨牙(Hutchinsonteeth,moonteeth)預(yù)防(prevention)：妊娠早期治療梅毒(treatmentofsyphilisduringearlytrimesterofpregnancy)。（5分鐘）畸形中央尖(abnormalcentralcusp)病因(aetiology)：牙齒發(fā)育期，牙乳頭向造釉器突起。(duringteethformation,dentalpapillaprotrudeintoenamelorgan)臨床表現(xiàn)和診斷(clinicalfeaturesanddiagnosis)：合面中央窩半圓形突起，可有牙髓伸入。(hemicycleprotuberanceincentralfossaofocclusalsurface,withofwithoutdentalpulp)治療(therapy)：多次磨除脫敏，磨除后蓋髓治療，根尖成行術(shù)．(grind&desensitizationtimeaftertime,pulpcappingaftergrind,apexification)(20分鐘)牙內(nèi)陷(densinvaginatus)病因(aetiology)：牙發(fā)育期，造釉器過度增殖深入牙乳頭中。(duringteethformation,over-proliferatedenamelorganprotrudeintodentalpapilla)臨床表現(xiàn)和診斷(clinicalfeaturesanddiagnosis)：畸形舌側(cè)窩，畸形根面溝、畸形舌側(cè)尖，牙中牙。(lingualfossadeformity,lingualfurrowdeformity,lingualcuspdeformity,densindents)治療(therapy)：充填，手術(shù)(filling,operation)(15分鐘)牙震蕩(concussionofteeth病因(aetiology)：較輕外力(minorimpact)臨床表現(xiàn)(clinicalfeatures)：伸長(zhǎng)不適感、輕微松動(dòng)和叩痛，齦緣可有滲血。(senseofstretchanddiscomfort,slightmobility,tendertopercussionandmastication)治療(therapy)：患牙休息、調(diào)合、固定。(occlusalrelief,fixation)（5分鐘）牙脫位(dislocationofteeth)病因(aetiology)：撞擊(violentimpact)。臨床表現(xiàn)及診斷(clinicalfeaturesanddiagnosis)：(1)部分脫位(luxation&intrusion)：嵌入、伸長(zhǎng)、唇舌向移位(intrusion,elongationandlabialorlingualdisplacement)。(2)完全脫位(dislocationofteeth)：牙槽窩空虛，牙齒脫落或少許軟組織相連(emptyalveolarsocketwithoutteeth,orwithteethlinkedtoabitsofttissue)。各種并發(fā)癥(complication)：牙髓壞死、髓腔變窄或消失、牙根外吸收、邊緣性牙槽骨吸收。(pulpnecrosis,lossofpulpchamber,rootexternalabsorptionandalveolarprocessabsorption)治療原則(therapeuticprinciple)——保存患牙(conservation)。(1)部分脫位(luxation&intrusion)：復(fù)位，結(jié)扎固定(relocation,deligationandfixation)。(2)完全脫位(dislocationofteeth)：牙齒重植——方法(replantation)。牙再植后愈合方式(healingmod)：牙周膜愈合，骨性粘連，炎性吸收(periodontalligamentrecover,dentalankylosisandinflamma