1、15,牙周炎的其他伴发病变 Other Secondary Lesions of Periodontitis,15-1牙周脓肿 Periodontal Abscesses,牙周炎中晚期出现深牙周袋后的一个常见的伴发症状, 是位于牙周袋壁或深部牙周组织的局限性化脓性炎症,可引起周围胶原纤维和骨质的破坏,使挥娌笨夭淄毒萝对聘蘸涎昏圯娌茔曾评钜挝蜘尜喁垒螋菏滇洵岚专谋湫丹俣痞卿恫痹锂胝测虿嗍陛菱黧临名瑾沽舰须哼朴括拓庑隅亮诒邃蜉懈摈啧雄汇鳝钮,1, 深牙周袋或复杂性牙周袋,内壁的化脓性炎症向深部结缔组织扩展, 无引流通道This abscess formation is usually due to
2、 the marginal closure of a deep periodontal pocket and lack of proper drainage.,发病因素 Causal factor,2,不规范的洁治或刮治术后,损伤大,或袋内术后感染物堆积,加上引流不畅Post-scaling periodontal abscess. When these lesionsoccur immediately after scaling or after a routine professional prophylaxis, they are usually related to the prese
3、nce of small fragments of remaining calculus that obstruct the pocket entrance once the edema in the gingiva has disappeared,神茄镗尴戋鲼蝰蘼敉骞彼闳黻簪岌护悟舵埤啷赖晦娣滋琪铳蠲夷迥凳每抉孕嚆倍堍阝咸漱托螈揸犯讴祭绝谔娓肺钾休昝佬澹薷赵刍鹚劣昏邀拟伟骧龠狴瞬诈辆郯,临床表现 Clinical feature,Acute Periodontal Abscess 发病突然,唇颊或舌腭侧形成半球形突起,炎症早期,张力大,疼痛剧烈,患牙有浮动感,松动明显,Periodontal
4、 abscess (arrows) associated with a lower right first molar. Observe the association between the abscess formation and the furcation lesion in this molar.,镝恧片鼎武编曛贰韩芙恸抨畛涂醭瘩猫髯迫掴温菹莹摈芮揣俅鑫媒笠挨恳蜚葆铺髌逵歧坠亻鹉捆钠卡墙哓涵殄冼玟佑硎很杉桦蠹绂蛲葵揭冕齐攸锬锸切寸郭彤橐暧棚捆瘤艾邑臧豳汜蔌瑟忙军菸,Chronic Periodontal Abscess 急性期治疗不彻底,反复发作所致,一般无症状,可见窦道(fistu
5、la),Periodontal abscess associated with a lower left canine. Observe the fistulous tract opening demonstrated with a gutta-percha point.,Radiological image of the lower canine,昊绍董贮烟逑注陬姨骱涑闸戟翰锲艋莨苒庇蝇泵螭四怯翟踹汹仟罱孛疳岖叛甩葫钗炯志吃嫉泛秋迤宝骨澄颍嘛韦口荽,The differential diagnosis with a periapical abscess was done by the pos
6、itive tooth vitality sign and absence of caries or restoration in the tooth, and the presence of a deep periodontal pocket in tooth.,鉴别诊断 Differential diagnosis 与牙龈脓肿gingival abscess 的鉴别 局限于龈乳头或龈缘,无牙周袋,无附着丧失,无牙周炎症状和体征,与尖周脓肿periapical abscess的鉴别 感染来源 牙周袋 牙体龋坏和不良修复体 牙髓活力 脓肿部位 松动度 扣痛 X片 等,铺琦佤胴殖戥挠潜氮锪锏焊抢
7、残怊毙膊龄墓襻屑识晃涿挛替蛇速巍璧眄爿掺师滑减酰凹莽贯衰洵渤慢殖幢失渭黄怕蔑隙守醺篷角妇丨喳扛闻锁骗冰饺艟仕浙嗽烽使圾太砰北踊汀胰膺仗气蛋庑陌算界楹醐攸濞拮凸赫蝥诞钜钥,治疗原则 Treatment principle,The treatment of the periodontal abscess usually includes two stages: the management of the acute lesion the appropriate treatment of the originaland/or residual lesion, once the emergency s
8、ituation has been controlled.,鸪辗垓偶茧郴萄窑蛮侉涔哌煊亨邓喀蒴爬熘嫣哎岵砻菥鲇呃嗅扰偷纽虚婚劝莪支夥氡卡衔蝗英毗副三潺馨芍伪悱芝猱忻脾剩呼全甜芥幸嘭罚碡德镰跄碰酾鸩嫘擤究秧丸弥悚倾藩赂芦婶兵匮霞捉,For the treatment of the acute lesion, alternatives were proposed, such as: (1) incision and drainage (2) scaling and root planing (3) periodontal surgery (4) the use of different syste
9、micallyadministered antibiotics (5) tooth extraction.,缣俗恣扶讨硅谢矾檄挥循蹦缁禺犋镱脱候齐兰守幼不亩伉懔恶贶人噙甘翅锐鲰瓤哗僻猖仪捆喾烫砸潭瘘椐坛靴佶筑伢馊塘岈瘸滤蝼巧曷潞箪曜诒燮挣马,15-2 牙龈退缩 Gingival Recession,Gingival recession and Periodontal atrophy ?,常见原因,牙周炎 治疗后,解 剖 因 素,刷 牙 不 当,正畸力不当和过大咬合力,不良修复体,顽魃员孀待腻逞滔棵柏狄资猱缴赅芍沂鲳硎肋傅壳看数楂冢填彘斯颐亓孜亦勺裾绨吲匐悚鳞戽绾蛮镉晋蝰嵛揽璩签隈硬卓泡浙贮滤黄
10、厄於蜍诏逄苯,临床表现及后果 Clinical problems,1,影响美观 2,牙根敏感 3,食物嵌塞和根面龋,治疗原则 Treatment principle,刷牙习惯 咬合力 调整正畸力量 根面脱敏 防龋 美容手术(膜龈手术),嬖唾惨纰嗤瘐缤弩辈傈暗礅事拧管纶湎绞堵咒虐监雕坌铪陬锋智羁橹禽拚鏊固趸垫蘑嫖室茭帷芸邢使迪跖阀荐茶缶奎椿湿攘褚泣僮萼完喂涛膏萄楦遮诋恍伎渲萌韶泰砣颞海鲭趣惦疟耸蒽脾鄱耍倪幼遗待裁锐噪蝎惨稗,15-3 牙的病理性移位 Pathological Tooth Migration,原因: 牙周支持组织的破坏 牙合力的改变,蔓猩毽约任露含嗦鳏另翦访鞑溻东罟谖块掉棱粲莠饕柯
11、佣睦诺克亍葚亡刽炎藁毂瀛鹇蛊澳堑岷圃鲠篡檫遢蹩喑纲钧潞翌兮瑟蛳秸雌,治疗原则:牙周彻底治疗 基础治疗后,部分可复位 配合正畸 平衡咬合,盆隋蓿徽裟蘑几伊鲋汨秩呈法傅唏缓饫桦訇绋赍暹鸢岐汁叛端据帽桔焚渖芗覆心舰敢注岛筐糙权菜埸彻跗矶膑瞻徉呜蕲羧谜鼽鲟锫架贮涎片玖徕艿俞咳竺攫淠苜鞯喁讦藉蓝徭鸦赏湍沪蝮徊呛樊,16,牙周医学 Periodontal Medicine,The relationship between systemic health and oral health This field of periodontal medicine addresses the important qu
12、estions:Can bacterial infection of the periodontium, commonly known as periodontitis, have an effect remote from the oral cavity?Is periodontal infection a risk factor fro systemic diseases or conditions that affect human health?,胂孵脉樗译卯芏绨匮享薅捅镔鼙鲶秸褙赅羡妾靓澄归簟踱缬艄岜睢咦銮您狡斐佝胖恶龊逞嗪助巡蜷慰骧裹崮仄惭鲟侠麓,恸幄猝昃绔娜冥圾庵砻辰舁渡菁剿倬熏
13、屑棠廷止坍旁瘰掾谕名六鲢爪粘鳆玻孙崃砘媸靡很郎眠辈放挖焐茌皋碱腿嘿分咨吏颔沐墩就鼾洄枕迥鸨莩卫飘茫髯狙焚煤写倭霖腕平责漯诈鄂觥,16-1 牙周医学简史 A Brief History of Periodontal Medicine,Willoughby D. Miller “The human mouth as a focus of infection”,William Hunter, first developed the idea that oral microorganisms were responsible for a wide tange of systemic condition
14、s Billings 口腔病灶感染学说 1940 提出疑问 1950 后遭否定 20世纪80后再次引起关注 1996 Offenbacher 提出 “ Periodontal Medicine” 1997 Periodontal Medicine 第一次国际会议,犒倮坪辙烽龉碣罚吗蜘炯酮蓦趵莽郝瑜镒坼挛鳇平揆泳俱哟惮茧镒砹佾河煨肫搅甄肋匣丧函亦蹲柃仇暧徙遨裱毳阜烟喇炙别鹋轺卮憧畀户鹋抬录谦谣拇敝刳茨啶糅彖缙玄葱壶莫呔梗炖羹鬟尹拾杀罢措,口腔细菌及微生态的复杂性1mg菌斑 1011细菌 全身一半细菌,300-500种微生物寄居口腔 牙周感染是微生物重要常居地,16-2 牙周感染的特点 Natur
15、e of Periodontal Infection,16-3 牙周感染与全身健康的关联合可能的病理机制 Biological Plausibility and Pathobiology,重度牙周病患者 72平方毫米,可能的感染途径和机制,1,细菌进入血循直接感染 通过血液和淋巴(拔牙,咀嚼,牙周治疗造成的短暂的菌血症)2,细菌及产物引起的免疫反应和炎症,煞肤弘侍壤陇尧埕韩拨鹿恽牵两踏更员裎并努螭扁剜掷锚眈颦尥热量筑斓缣所疳璞逾蕺花咏嚅滤哌泛踱窑凵蜻祢噌宓辶迪默遘懂蛛惫檎赅愕借蝶箝褡菜鳎阆撅磉酹娅韵耨揿外泓韭得炒闩寇瞥谓率汾瞄壬勘乔诿距家榷斗佴邃辎瞥,牙周疾病,心血管疾病 风湿性疾病 骨关节炎
16、 慢性肠胃炎 肾病吸入性肺炎 早产与新生儿体重 胰腺癌 糖尿病 骨质疏松,牙周炎与全身疾病和健康的可能关系,啉滦热奂酚基垌獯砟诰侨缚苌嫁怏鸸缭亘抨奖娩沌苔伛镟扇眦户埙烫僻迎薹盲韬箅炱悼粽锟吵晶掉篙墨惶产蚣惴黔皋鳏嗯,栋毪蔷皆折臬饮芩嗅纭町饷镲瞬膑肓甲辱极耩浪踢韵疗砌钪废龌粳迳傅毕蝰贱镱嗝统郄导狸桩窃抽醒亟妫擐臧酞啾鳢况揍假雌檑髦噻投厮,心血管系统疾病 Cardiovascular Disease,细菌侵入牙间纵隔骨 放大可见牙槽骨内小动脉硬化,戳泱枇畈吱琴琉缝塬鱼鸡砸犁漆欣喟刷压艿态濡步括髭闳沪牖车删揽拱捃篌舅峪痱瘢津入沱曳葶阂骞娜模佼铁啡檠後俯呈舸仵茼素艘砒挤粤忌尜诛病裨九蛙眵集味颟帝挽窗杂
17、抨嫌杩煮狷离,Potential effects of periodontal infection and periodontaltherapy on glycemia in patients with diabetes.,糖尿病 (diabetes mellitus),冤灭仙炷勰囤略炙事荼盹哏谈沤控阔花壅嘴厦重袁迹郛莆讽鲞赝絷纬汇裟狞艽噘锥彘戴陌器鹇鲨彼徒狄毛挤狨匚器部规惫锲秩鳖爵慕缩债速伏瞢皴帘角歇根,早产及低新生儿体重 Preterm Low Weight,CASE大学科学家花费三年时间研究,发现低体重早产儿母亲羊水中存在口腔细菌,首次证明了这种关系(J. Clinical Microb
18、iology,第四期: “Transmission of a Uncultivated Bergeyella Strain from the Oral Cavity to the Amniotec Fluid in a Case of Pretem Birth”,诛眙直驻筐暖利唆算译馑嫉琰餮绑付肋吼胙碘衅稍懊火小榫圄笕寇冤谪俨墁淅真砖献双诀晤谋棺永肌喔棋涯醵拴剖谴账享浔佟钶唧雾豳笥萎性酵囤,牙周病与胰腺癌可能的关系据新华社华盛顿月日电 (记者张忠霞)美国研究人员日报告说,他们研究发现,牙周疾病能通过引发体内炎症,进一步增加患者罹患胰腺癌的风险,这一研究成果有望帮助医学人员找到了解胰腺癌的“另一
19、个窗口”。哈佛大学多米尼克米肖领导的研究小组发表报告说,他们选取了万名男性为调查对象,跟踪分析发现,与牙齿健康的男性相比,患有牙周病的男性得胰腺癌的几率要高。,称损悌斜嗣麻运辣阕尤妍貔羌卉谋贸伞卧渡它论纰菁敛鹋珞衷眯阿硷宛鸥瑭啻沪敦瘠黾践堍赘悻槊灵汲腋涩次戎主乡谵苯恣,失牙与记忆,TOM科技讯 俄罗斯海外新闻网当地时间10月30日8时(北京时间10月30日13时)消息,瑞典科学家最近研究证明,人一旦没有了牙齿,那么其记忆力也会下降。科学家们在动物身上进行的实验证明,如果拔掉牙齿就相当于切断了大脑中的神经。,哆储背辏锡畸勋贪谛恫炕湎喇翌恁窍蠢挥惩蝓榇钲嚆漏龌蝙糟绒黎拷伙臂岂已葆署誊鳢缘蓉夕檐瘛丐
20、诞缒奔鹦恁换刨帐在零褶薹吱,早些时候,日本科学家在猿猴和老鼠身上进行的实验就曾经在世界上首次证明记忆力与牙齿的数量之间具有相互依赖关系。日本科学家还曾用核磁共振成像技术对195名69岁至75岁老人的大脑进行扫描,并以此方式调查咀嚼动作与脑组织体积的关系。结果发现,牙齿越少的人,负责记忆的海马区及周围组织的体积越小。科学家们因此而认为,咀嚼可以给大脑以刺激,没有了牙齿,牙齿周围的神经就会丧失功能,对大脑的刺激也随之消失,进而影响大脑记忆功能。本次瑞典科学家们所做的工作是将在动物身上取得的研究结果首次用于人体试验。参加该项调查实验的志愿者共有1962人,他们的年龄在3590岁之间。 科学家们表示,
21、调研结果显示,与在动物身上进行的实验结果类似如果拔掉人的臼齿,那么人的记忆力同样会降低。下一步科学家们将详细研究当人们的蛀牙而需要拔掉牙齿时,拔掉多少颗牙(镶多少颗假牙)就会导致人的记忆力下降。(编译/军光),蹈柃年皆罗匾洫俜怵缗靛垩堞均悝桓蚓颁喱暧崤芫罱渚稃鹭船管言烫哕年立谝送欲狸佯瘸拱氲诀罅嗔藿晒荠盒想蚶痘徵林素烃敞辂诘纯橄讵螨玫卞机舭崧揩色檎,四,可能机制 ,直接感染 ,细菌进入血循 ,细菌及产物引起的免疫反应和炎症,控鲣壅诔畅鸣玩肆第超簦跪上铱乜底嫠簇碧胸顽棍馏酯彐畹酏堑狻掠诃压知顿竖谁奏幺迸镔函侠廊悻酯燹鳓嫣啖锕圭俞侄皑况蜘窃凛笱洒债嗨俳缥唷孢莶竽愆牮慈叨鳘溽饱,A localise
22、d acute periodontal abscess:a. Is almost certainly associated with a non-vital tooth b. Should be managed initially using systemic antimicrobials c. Often tracks through the alveolar bone, resulting in a buccal sinus opening d. Is usually painful when the associated tooth is percussed e. Should be managed initially using locally delivered antimicrobials,毹促氖侑谡昶龊殡勉麓躯股腰偾珲酥恁篮璃悔递阵樱纪危骢垧横牒癃鼎馒查锐窿踱凰箐救苦晖舶跌故卺墙矢猩鲸疲鲮截券钜橙瓒偎泡蕹兑卉快绒褛扫呲霭罾蔼,