Main textbooks
Paul Coulthard, Keith Horner, Philip Sloan, et al.
Master Dentistry. Volume 1,2, Oral and
Maxillofacial Surgery, Radiology, Pathology,
and Oral Medicine.
Churchill Livingstone 2003
Updated knowledge from library and Website.
Dental Caries
Tooth loss is common health problem.
What can cause tooth loss?



Reasons of tooth loss
Microbial tooth loss
(dental caries, periodontitis)
Non microbial tooth loss
(trauma, congenital loss)
Dental caries
An chronic infectious disease with
progressive destruction of tooth.
Prevalence and incidence
Almost everyone is affected by dental caries.
http://www.wrongdiagnosis.com/d/dental_caries/stats-country.htm(2004)
Etiology of Dental Caries
Microorganisms
no
no
caries caries
host
caries
sugar
& tooth
no
caries
time
1889, Miller:
no
caries
chemocoparasitic theory
MAJOR FACTORS
3 necessary requirements:
1) Microorganisms—bacteria, plaque
2) sugar --- carbohydrates
3) host & tooth---saliva, tooth
( and) 4) time.
Microorganisms:
Role of bacteria
 There are many kinds of bacteria in normal oral
cavity.

Mainly the bacteria causing caries are
Streptococcus Mutans (MS).
Microorganisms
Role of plaque
Enamel
gum
Crown
Pulp
Dentin
Root
Root canal
Cememtum
Apical tissue
Plaque is a biofilm on the surface of the tooth (enamel).
host & tooth
Role of Tooth
• Quality
• Position
• Structure
• arrangement
host & tooth
Role of saliva:


It plays role in remineralization on the
teeth.
Saliva has the buffering action and
cleansing effect.
Sugar:
Role of carbohydrates:


the most important cause;
refined carbohydrates are directly proportional
with dental caries.
MINOR FACTORS:




Enamel composition
Morphology of the tooth
Habit of brushing teeth
Immunity
Clinical classification of caries

According to three basic factors :
severity and rate of progression
anatomical site(involving site)
age patterns at which lesions predominate
Tooth anatomy
gum
Enamel
Crown
Pulp
Dentin
Root canal
Cememtum
Apical tissue
Root
Classification according to
the developing speed
Acute caries
Rampant caries
Chronic caries
Arrested caries
Classification according to the
involving site
Occlusal caries
Root caries
Smooth surface caries
Linear enamel caries
Clinical Manifestation and Symptoms
changes in tissue color, texture, and structure
• Visible pits or
holes in the tooth
• Colour changing
• Soften
• Pain
A Early caries may have
no symptoms
B be sensitive to sweet
A
B
C
D
foods or to hot and cold
temperatures
C very sensitive to
stimulator
D the acute pain
Examination
•

Clinical observations
(Visual change)
Probing
The explorer tip
can easily
damage white
spot lesions
Examination
Temperature test
X-ray
Transillumination
Diagnosis

Clinical signs
visual – color, texture, shape,
location, cavitation,
Clinical symptoms

Diagnostic test--examination

Treatment
Non-surgical
Surgical
-
remineralization
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
Prevention is the most
important for dental caries.
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.
Endodontics
Etiology of Pulpitis
1-bacterial cause:
caries, fracture, bacteremia,
periodontal pocket
caries
irreversible pulpitis
pulp
2-physical cause:
sever thermal change
(cavity preparation),
large metallic restoration
5. Other cause:
internal resorption
Possible Pulpal Diagnoses





Normal
Reversible pulpitis
Irreversible pulpitis—acute, chronic, polyp
Necrosis
Previous endodontic treatment
Reversible pulpitis
Clinically
1. sharp pain & respond to sudden changes
in temperature
2. pain disappear as the stimuli removed
last less than 20 sec
3. easily localized & unaffected by body
position
Clinical Examination in
reversible pulpitis
Thermal:
Hypersensitive with mild pain
<mild
Sweets:
Sensitive
< mild
Biting Pressure:
None (unless tooth is cracked)
Treatment of Reversible Pulpitis



Remove irritant if present
If no pulp exposure: direct restore
If pulp exposure:



Carious: initiate RCT
Mechanical: >1 mm: initiate RCT
<1 mm crown planned: initiate RCT
<1 mm: direct cap or RCT
If recent operative or trauma – postpone
additional treatment and monitor.
Irreversible Pulpitis
Reversible pulpitis are left
untreated.
Symptoms of Irreversible Pulpitis

Thermal:


Sweets:


Hypersensitive-moderate to severe
Moderately to severely sensitive
Biting Pressure:

Usually sensitive in later stages (periapical
symptom)

spontaneous pain: Moderate to severe
Diagnosis
Irreversible Pulpitis

Hypersensitive to hot or cold that is
prolonged.

A history of spontaneous pain.

Vital or partially vital pulp.
Acute pulpitis:
may occur as a sequel of focal reversible pulpitis or
occur due to acute exacerbation of chronic pulpitis.
clinically
1- big cavity or margin of a restoration
2- sleep pain
3- spontaneous pain
4- pain lasts
5- difficult to localized
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.
Chronic hyperplastic
pulpitis(polyp)
Clinically:
1- polyp
2- occurs in a tooth with large carious lesion
3- not sensitivity
4- bleed easily
5- may confused with hypertrophic gingival polyp
Treatment of Irreversible Pulpitis

Root canal treatment or extraction
Necrotic Pulp

Pulp continued degeneration.
no reparative potential.

Commonly have apical radiolucent lesion.

Maxillary first molar with large amalgam restoration and
periapical radiolucencies around all three roots. The tooth
was unresponsive to electrical and thermal testing.
Symptoms of Necrotic Pulp

Thermal:


Sweets:


No response
Biting Pressure:


No response
Usually moderate to severe pain (not symptom of
necrotic pulp, but rather periapical inflammation)
Moderate to severe spontaneous pain
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.
Necrotic Pulp
(additional considerations)

Antibiotic coverage
Pain Management

Occlusal Reduction

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 reinfection.
Pre-operative film
Access and Working length
Completed RCT
case
Points you must know:


What is root canal treatment?
Simply describe the clinical
manifestation of pulpitis.
The oral manifestation
of HIV Infection
human immuno-deficiency virus (HIV)
retroviruses
acquired immune deficiency syndrome,
（AIDS）
Epidemiology
The first AIDS case,
worldwide：1981, AIDS
China：
1985, AIDS, Beijing,Argentina
Shanghai： 1987, AIDS
Hangzhou: 1985, AIDS--hemophila
2009, 1272/236 (HIV/AIDS)
Oral manifestations are often the first
clinical feature of HIV infection.
Oral Manifestations observed in
HIV





Fungal
Neoplastic
Viral
Bacterial
Other
Fungal Manifestations
----candidiasis

Can manifest in 4 different ways




Pseudomembraneous candidiasis
Erythematous candidiasis
Hyperplastic candidiasis
Angular chilitis
Pseudomembraneous Candidiasis
Erythematous Candidiasis
Hyperplastic Candidiasis
Angular chilitis
Neoplastic Oral Manifestations

There are two types of neoplasms
associated with oral manifestations in
HIV individuals


Kaposi’s Sarcoma (KS)
Non-Hodgkin’s Lymphoma
Kaposi’s Sarcoma
Non-Hodgkin’s Lymphoma
Viral Manifestations





Herpes Simplex Virus (HSV) lesions
Herpes Zoster
Hairy leukoplakia
Cytomegalovirus (CMV) ulcers
Human Papillomavirus (HPV) lesions
Leukoplakia
Herpes Simplex Virus (HSV) lesions

Cytomegalovirus (CMV) ulcers
Combination of HSV and CMV
HPV
Bacterial Manifestations
Linear Gingival Erythema
Necrotizing Ulcerative Periodontitis
Tuberculosis
Linear Gingival Erythema
(red-band gingivitis)
Necrotizing Ulcerative
Periodontitis
Necrotizing Ulcerative
Tuberculosis


Oral lesions in people with tuberculosis
are seen rarely.
They have been reported as ulcers on
the tongue secondary to pulmonary
tuberculosis.
Other Oral Manifestations

Aphthous Ulcerations (canker sores)




Minor
Major
Salivary Gland Disease
Xerostomia
Aphthous Ulcerations
minor
major
Salivary Gland Disease
Xerostomia
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.
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