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1、非龋性疾病,non carious disease,牙外伤 (injury of teeth),牙发育异常 (developmental abnormality of teeth),牙体慢性损伤 （chronic injury of teeth),牙本质过敏症 （dentine hypersensitivity),牙发育异常,developmental abnormality of teeth,主要内容 Summary,牙结构异常 Abnormalities of histodifferentiation 牙形态异常 Abnormalities of morphodifferentiation
2、 牙数目异常 Disturbances in number of teeth 牙萌出异常 Disturbances in germination of teeth,钟状期造釉器(enamel organ in bell stage),dental papilla,stellate reticulum,enamel,dentine,external enamel epithelium,牙结构异常 Abnormalities of histodifferentiation,釉质发育不全 enamel hypoplasia 氟牙症 dental fluorosis 四环素牙 tetracycline
3、 stained teeth 遗传性牙本质发育不全 hereditary dentinogenesis imperfecta 先天性梅毒牙 congenital syphilitic teeth,釉质发育不全 enamel hypoplasia,定义 definition,牙齿发育期间，由于全身疾患、营养障碍或乳牙的严重的根尖周感染所导致的釉质的结构异常。(enamel abnormalities of histodifferentiation result from systematic disease, nutrition deficiency or severe apical affec
4、tion of deciduous dentition during teeth formation),釉质发育不良：釉质基质形成障碍(dyspoiesis of enamel matrix),釉质矿化不良：基质形成正常，但矿化不良 (hypomineralization),釉质实质缺损(with enamel loss),釉质无实质缺损(without enamel loss),enamel agenesis,enamel hypocalcification,病因 Aetiology,营养障碍 nutrition deficiency 内分泌失调 incretion disorder 婴儿、
5、母体疾病 infant & maternal disease 局部因素 localized causes,釉质发育不全 （enamel hypoplasia),病因（Aetiology),婴儿、母体疾病 infant & maternal disease,出生前 Prenatal 新生儿 Neonatal 婴儿 Postnatal,出生前 Prenatal,感染（infection)风疹(rubella)、梅毒(syphilis) 母亲的代谢性疾病（maternal systemic disease),新生儿 Neonatal,新生儿溶血性疾病（haemolytic disease of th
6、e newborn) 低钙血症 （hypocalcaemia) 早产儿/晚产儿（premature birth/prolonged labour),婴儿 Postnatal,感染尤其是重症病毒感染（severe childhood infections especially the viral exanthemata) 慢性疾病先天性心脏病、胃肠道疾病、内分泌疾病（chronic diseases in childhood,e.g. congenital heart disease, gastrointestinal and endocrine diseases) 营养不良维生素D缺乏（nut
7、ritional deficiency, e.g. vitamin D) 肿瘤化疗（cancer chemotherapy) 氟中毒（excess fluoride ions),局部因素 localized causes,感染（Infection) 创伤 （Trauma) 放疗 (Radiotherapy),临床表现 clinical features,轻症 mild type 重症 severe type,轻症 mild type,釉质形态基本完整（smooth-surface enamel) 仅有色泽和透明度的改变 （white, opaque spots, brown-stained a
8、fter eruption),重症 severe type,带状(横沟状)缺陷 (horizontal grooves in the enamel surface) 窝状缺陷 （pits in the enamel surface) 釉质变薄 （general reduction in the thickness of the whole enamel),特点：对称发生 (symmetrical),例外？（exception),对称发生 (symmetrical),提示 Note,累及 631136 提示致病因素1岁以内 6321 1236（damage occur at age 1) 累及2
9、 2 提示致病因素在出生后第2年（damage occur at age 2) 累及754457 提示致病因素在23岁以后 754457 (damage occur at age 2-3),特纳牙 Turner teeth,乳牙的感染、创伤导致恒牙的造釉细胞的损伤（infection or trauma related to the deciduous predecessor resulting in damage to the ameloblasts of the permanent successor) 釉质呈黄色或棕色（yellowish or brownish pigmentation
10、 of the enamel) 表面凹陷、不规则(pits and irregularity of the surface) 牙冠小(the smaller crown than normal),治疗 Therapy,（略）,氟牙症,Dental Fluorosis,定义definition,又称氟斑牙或斑釉牙，主要是在牙齿发育矿化期，摄入过量的氟所引起的釉质发育不全、矿化不全。(ingestion of excessive fluoride during teeth formation result in enamel hypoplasia or hypocalcification),病因A
11、etiology,摄入过量的氟离子（ingestion of excess fluoride ions） 饮水含氟量，正常为1ppm（1 part per million of fluoride in the drinking water) 食物中的氟化物(fluoride in diet) 损害釉质发育期牙胚的造釉细胞（damage ameloblasts during the tooth formation) 造成釉质矿化不良，色素沉着（result in hypomineralized enamel & pigmentation),机理 Mechanism,磷酸酯（phospholipi
12、d)无机磷酸盐（inorganic phosphate),碱性磷酸酶（Alkali phosphatase）,抑制(inhibition),骨、牙齿的重要组成部分,焦磷酸和ATP骨基质矿化(mineralization),氟浓度增高（fluoride increasing),结果（result)：釉质矿化不良（hypomineralized enamel),造釉细胞（ameloblast),高氟导致氟牙症（excess fluoride result in dental fluorosis),？,(pyrophosphoric acid and Adenosine Triphosphate),
13、机理 Mechanism,在牙齿发育期间，过量摄入的氟才会导致氟牙症（dental fluorosis result from a high intake during the period of tooth formation) 氟不易通过胎盘屏障，乳牙一般不受累（Placenta barrier can resist fluoride, dental fluorosis seldom appear in deciduous dentition) 提示：67岁以前，高氟摄入易患氟牙症 ！ （Ingestion excess fluoride no more than 6-7 age is p
14、rone to high prevalence),机理 Mechanism,氟牙症（dental fluorosis),临床表现 clinical features,在同一时期萌出的釉质上有白垩色到褐色的斑块(fluoride opacities occur symmetrically around the arch characterized by faint white flecking of the enamel, white patches or striations) 严重者还并发釉质的实质缺损。(in severe cases may associate with loss of
15、the normal tooth form) 临床上常按其轻、中、重度而分为白垩型（轻度)、着色型（中度）和缺损型（重度）3种类型。,临床表现 clinical features,多见于恒牙，发生在乳牙者甚少，程度亦较轻。这是由于乳牙的发育分别在胚胎期和乳婴期，而胎盘对氟有一定的屏障作用。因此，氟牙症一般见于恒牙，但如氟摄人量过多，超过胎盘筛除功能的限度时，也能不规则地表现在乳牙上。(mainly found in the permanent dentition, but the deciduous teeth may be involved in severe cases and in ar
16、eas of endemic fluorosis) 对摩擦的耐受性差，但对酸蚀的抵抗力强。(high acid-resist, rapid loss by abrasion and attrition) 严重的慢性氟中毒(severe cases),临床表现 clinical features,分类 Classification,治疗Therapy,脱色（bleaching) 复合树脂（composite resin) （略）,脱色（bleaching),四环素牙,tetracycline stained teeth,定义definition,在牙齿的发育矿化期，服用的四环素族药物，结合到牙组
17、织内，造成的牙齿的染色(discoloration of teeth resulting from deposits of tetracycline ingestion during tooth development)。,病因 Aetiology,在牙的发育矿化期（妊娠期和婴幼儿8岁以下），服用的四环素族药物，可被结合到牙组织内，使牙着色。(Tetracycline is administrated to pregnant females or to children under age of 8, it may be incorporated into the dentin of the developing teeth) 呈黄色，在阳光照射下则呈现明亮的黄色荧光，以后逐渐由黄色变成棕褐色或深灰色。(It produces a yellow discoloration, the teeth will fluoresce from a bright yellow to brown to gray with exposure to light) 四环素可通过胎盘引起乳牙着色。(Permeate placenta to affect deciduous dentition),
