牙周专业英语

牙周专业英语常用词汇

Gingival inflammation

Etiological factors

interdental embrasure

interdental papilla

inflammatory exudate

attached gingiva

alveolar mucosa

mucogingival junction.

false pocketing

periodontal pocketing

crevicular epithelium

periodontal ligament

gingival swelling,

papillary swelling,

Gingival bleeding

toothbrushing.

interdental space.

oral hygiene

residual food deposits

odour

chronic periodontitis

Gingival recession

Tooth mobility

Tooth migration

Alveolar bone loss

offensive taste.

control plaque

subgingival deposits

scaling,

Probing

Pocket depth

single-rooted teeth

calculus

Risk factor

Biofilm

Dental plaque

Dental plaque biofilm

Supragingival plaque

Subgingival plaque

Resorption of alveolar bone

periodontal ligament

bone loss,

alveolar margin.

interdental crater

furcation

furcation involvement

furcation lesion

clenching

mesiobuccal and mesiolingual

infrabony pockets.

gingival margins

periapical films

orthopantomograph

Overbite and overjet

treatment plan

Plaque control and scaling

bruxism.

Periodontal disease

Gingival disease

Periodontitis

destructive periodontal disease

Periodontology

Periodontics

Gingiva

Free gingiva

Attached gingiva

Mucogingival junction

Gingival papilla

Oral epithelium

Sulcular epithelium

Junctional epithelium

Biological width

Dento- gingival junction

Re-attachment

Free gingival groove

Periodontal ligament

Alveolar crest fibers

Root planing

New attachment

Root cones

Enamel projection

Initial therapy

Plaque control

Supragingival scaling

Subgingival scaling

Prophylaxis

Attachment gain

Coronoplasty

Chemotherapy

Metronidazole

Periodontal irrigation

Chlorhexidine

Vertical incision

Interrupted interdental suture

Sling suture

Periodontal pack

Periodontal dressing

Gingivectomy

Gingivoplasty

Flap surgery

Internal bevel incision

Bone grafts

Bone fill

New attachment

Guided tissue regeneration, GTR

Root amputation

Root resection

Tooth hemisection

Frenotomy

Maintenance

Supportive periodontal therapy

Attachment loss, AL

Wearing facet

Marginal gingivitis

Gingival diseases

Dental plaque-induced

temporomandibular

joint

discomfort

Mouth rinse

Attachment apparatus of the tooth

Periodontal osseous surgery

Gingiva sulcus (gingival crevice)

Long junctional epithelium

periodontal destruction.

Gingival col

Food debris

Endotoxin

Vesicles

Necrotizing ulcerative

periodontitis

Osteoporosis

Stress

Attachment loss

Bone loss

Horizontal resorption

Vertical resorption

Osseous crater

Plaque index, PLI

Calculus index, CI

Gingival index

Bleeding index. BI

Bleeding on probing, BOP

Probing depth, PD

Attachment level, AL

pocket wall.

Diabetes mellitus

probe

Cemento-enamel junction

Alveolar bone

Fenestration

Dehiscence

Polymorphonuclear leukocytes

Dental calculus

Food impaction

Trauma from occlusion

Linear gingival erythema, LGE

Periodontic-endodontic lesions

Combined periodontal-Endodontic

lesions

Chronic periodontitis

Loss of supporting tissue

Occlusal trauma.

occlusal adjustment

labiolingual displacement

root exposure

gingivitis

Non-plaque- induced gingival

lesions

Localized aggressive

periodontitis

periodontitis

Abscesses of the periodontium

Gingival abscess

Periodontal abscess

Pericoronal abscess

Periodontal trauma

Traumatic occlusion

Undermining resorption

Buttressing bone formation

Bruxism

Clenching

Interproximal pocketing

gingival recession

subgingival calculus

Putative

periodontopathic

bacteria

Generalized aggressive

牙周专业英语课文

CLINICAL FEATURE OF CHRONIC PERIODONTAL DISEASE

??

Chronic gingivitis

??

The manifestations of gingival inflammation vary considerably between individuals and from

one part of the mouth to another. This variation reflects the aetiological factors at work and

the

tissue

response

to

these

factors.

This

response

is

essentially

a

mixture

of

inflammation

and

fibrous tissue repair. When the former predominates, signs and symptoms are more obvious; when

the fibrous tissue component predominates, clinical manifestations can be much more subtle and

recognized only by careful examination.

??

In making a diagnosis it is important to keep in mind the appearance of health, departures

from which may indicate disease.

??

Clinical features are:

??

l . Altered gingival appearance.

??

2. Gingival bleeding.

??

3. Discomfort and pain

??

4. Unpleasant taste

??

5. Halitosis.

??

Altered gingival appearance

??

Changes in appearance are usually described according to color, shape, size, and surface

characteristics.

??

Healthy gingivae are pale pink and the margin is knife edged and scalloped; a streamlined

papilla is often grooved by a sluice-way and the attached gingiva is stippled.

??

Because the interdental embrasure is the site of greatest plaque stagnation gingival

inflammation

usually

starts

in

the

interdental

papilla

and

spreads

around

the

margin.

As

the

blood

vessels dilate the tissue becomes red and swollen with inflammatory exudate. The knife-edged

margin

becomes

rounded,

the

interdental

sluice-way

is

lost

and

the

surface

of

the

gingiva

becomes

smooth and glossy. As the gingival fiber the inflammatory process the gingival cuff loses tone

and comes away from the tooth surface so that a shallow pocket is formed breaks up bundles. If

the inflammation becomes more diffuse and spreads into the attached gingiva the stippling

disappears. If inflammation is severe it can spread across the attached gingiva to the alveolar

mucosa and so obliterate the normally well-defined mucogingival junction.

??

Usually the most pronounced inflammatory swelling is seen in adolescents and young adults

so

that

false

pocketing

is

formed.

It

is

called

false

as

opposed

to

real

or

periodontal

pocketing

which is formed by apical migration of the crevicular epithelium as the periodontal ligament is

destroyed by inflammation. Where several aetiological factors combine, e. g. plaque deposition

plus lack of lip-seal plus the endocrinal changes of puberty, gingival swelling, especially

papillary swelling, can be pronounced.

??

If

plaque

irritation

is

longstanding

and

low

grade,

the

main

tissue

reaction

will

be

fibrous

tissue

production

so that the gingiva

may

remain

firm

and pink but become thickened

and lose its

streamlined shape.

??

Gingival bleeding

??

Gingival bleeding is probably the most frequent patient complaint. Unfortunately gingival

bleeding is so common that people may not take it seriously and even believe it to be normal;

however,

unless

bleeding

obviously

follows

an

episode

of

acute

trauma,

bleeding

is

always

a

sign

of

pathology.

It

occurs

most

frequently

on

toothbrushing.

Bleeding

may

be

provoked

by

eating

hard

food, apples, toast, etc. When gingivae are extremely soft and spongy, bleeding can occur

spontaneously.

??

Blood may be tasted by the patient and may be smelt on the patient's breath.

If the tissue response is fibrous overgrowth, there is no bleeding even with vigorous

toothbrushing.

??

Discomfort and pain

??

These are uncommon features of chronic gingivitis and this is probably the main reason for

the

diseases

being

overlooked. The

gingivae may

feel sore

when

the

patient brushes his teeth

and

because of this he brushes more lightly and less frequently so that plaque accumulates and the

condition is perpetuated.

??

This

relative

absence

of

pain

is

one

of

the

symptoms,

which

differentiates

a

chronic

gingivitis

from an acute ulcerative gingivitis.

??

Unpleasant taste

??

Patients may notice the taste of blood, particularly if they suck at an interdental space.

Unfortunately

the

senses

are

quickly

blunted

and

a

disagreeable

taste

is

a

relatively

infrequent

complaint.

??

Halitosis

??

'Bad breath'

frequently

accompanies

gingival disease

and is

a common

cause of

a

visit

to

the

dentist.

The

smell

derives

from

blood

and

poor

oral

hygiene

and

must

be

distinguished

from

smells

from different sources.

??

Halitosis

has a number

of causes, both intra-oral

and extra-oral. Oral disease

and

residual

food deposits, especially those of a volatile nature such as peppermint, garlic, curry, etc.,

represent

the

most

common

cause

of

halitosis.

Pathology

of

the

respiratory

tract,

nose,

sinuses,

tonsils and lungs can cause an embarrassing smell, as can disease of the digestive tract. Some

items

of

diet,

e.g.

garlic,

are

absorbed

by

the

intestines,

taken

into

the

intestinal

bloodstream

and

finally

exhaled

by

the

lungs

so

that

they

can

be

smelt

a

long

time

after

they

have

been

eaten.

Mouth odour is common on waking and between meals, when it is associated with food stagnation

and reduced salivary flow. Metabolic diseases, diabetes and uraemia give characteristic smells

to the breath. Halitosis can increase with age.

??

Chronic periodontitis

??

The clinical features of chronic periodontitis are:

??

1. Gingival inflammation and bleeding

??

2. Pocketing

??

3. Gingival recession

??

4. Tooth mobility

??

5. Tooth migration

??

6. Discomfort

??

7. Alveolar bone loss

??

8. Halitosis and offensive taste.

??

Of

this

only

pocketing

and

alveolar

bone

loss

are

essential

features

of

chronic

periodontitis.

??

Gingival inflammation and bleeding

??

Although gingival inflammation is a necessary precursor to periodontitis, obvious

manifestations of inflammation become less apparent with the progress of periodontitis.

Frequently

the

gingivae

are

pink

and

firm,

the

contours

may

be

almost

normal,

there

is

no

bleeding

on careful probing and the patient does not complain of bleeding on brushing. It is as though

with the development of the pocket the disease has gone underground.

??

The presence and severity of gingival inflammation depends upon oral hygiene status; where

this is poor, gingival inflammation is evident and bleeding of brushing, or even spontaneous

bleeding,

is

noticed

by

the

patient. When the patient' s toothbrushing

is good enough

to

control

plaque but where subgingival deposits, because of inadequate scaling, persist, the presence of

periodontal

disease

may

not

be

apparent

on

superficial

examination.

If

a

careful

history

is

taken

many such patients report a history of past bleeding which stopped when their toothbrushing

technique

improved.

Periodontal

destruction

in

the

average

adult

is

the

product

of

past

neglect,

not

the result of present oral hygiene habits.

??

Pocketing

??

Pocket measurement is an essential part of periodontal diagnosis but must be interpreted

together

with

gingival

inflammation

and

swelling

and

radiographic

evidence

of

alveolar

bone

loss.

Theoretically, if there is no gingival swelling a pocket over 2 mm deep indicates some apical

migration of crevicular epithelium but inflammatory swelling is so common especially in the

younger individual that pocketing of 3-4mm may be entirely gingival or 'false'.

?????

Pocketing of 4mm is likely to indicate an early chronic periodontitis.

??

The precise measurement of pockets is difficult because:

??

1.

Probing the pocket can

be

uncomfortable and

even painful if there

is

frank

inflammation.

??

2. Pocket depth is extremely variable around a tooth. Interproximal pocketing is usually

deepest because that is the site of greatest plaque accumulation, while pocketing on the facial

aspect of the tooth is usually most shallow as this is where the toothbrush makes the greatest

impact and may even produce gingival recession. This means that four or more measurements may

be required on each tooth to give an accurate picture.

??

3. Where present oral hygiene is good the gingival cuff may be so tight around the neck of

the tooth as to resist the insertion of an ordinary periodontal probe without causing pain. The

measurement of pockets in anaesthetized tissue often produces quite different results from

previous measurement made in sentient tissue.

??

4. Tooth contour and angulation, subgingival calculus or restorations, as well as carious

cavities, may impede the insertion of the probe.

??

There are many designs of pocket-measuring probe, some of, which are too thick to provide

accurate measurement and some of which are sharp so that the tissue is penetrated unless great

care

is

taken.

It

has

been

shown

that

pockets

of

over

3mm

are

measured

with

diminishing

reliability,

and

it

is

unfortunate

that

much

periodontal

research

is

based

upon

such

an

unreliable

criterion.

Sometimes a purulent discharge can be expressed from the pocket by pressure on the pocket wall.

??

Gingival recession

??

Gingival recession and root exposure may accompany chronic periodontitis but are not

necessarily a feature of the disease. Where recession occurs pocket depth measurement is only

a partial representation of the total amount of periodontal destruction.

??

Tooth mobility

??

Some

tooth

mobility

in

a

labiolingual

plane

can

be

elicited

in

healthy,

single-rooted

teeth,

especially lower incisors, being more mobile than multirooted teeth. Increasing tooth mobility

is produced by,

??

l. Spread of inflammation from the gingiva into the deeper tissues

??

2. Loss of supporting tissue

??

3. Occlusal trauma.

??

Mobility

also

increases

after

periodontal

surgery

and

in

pregnancy.

In

periodontal

pathology

tissue destruction is always accompanied by inflammation and frequently by occlusal trauma.

Mobility, which is produced by inflammation and occlusal trauma, is reversible, as demonstrated

by

the

reduction

in

mobility

following

scaling

and

occlusal

adjustment;

mobility

associated

with

destruction of supporting tissue is not reversible.

??

Assessment

of

mobility

for

research

purposes

can

be

made

using

special

apparatus

but

clinical

assessment is usually subjective. It is elicited by exerting pressure on one side of the tooth

under examination with an instrument or finger tip while placing a finger of the other hand on

the other side of the tooth and its neighbour which is used as a fixed point so that relative

movement can be discerned. Another way of eliciting mobility (although not assessing it) is to

place fingers over the facial surfaces of the teeth while the patient grinds the teeth.

??

The degree of mobility may be graded as follows:

??

Grade l. Just discernible

??

Grade 2. Easily discernible and up to l mm labiolingual displacement

??

Grade 3. Over l mm labiolingual displacement, mobility of the tooth up and down in an axial

direction.

??

Tooth migration

??

Movement of a tooth (or teeth) out of its original position in the arch is a common feature

of

periodontal disease and

one

which alerts

the patient

to

the problem.

A balance

of tongue, lip

and

occlusal

forces

maintains

tooth

position

in

health.

Once

supporting

tissue

is

lost

these

forces

determine

the

pattern

of

tooth

migration.

The

incisors

move

most

frequently

in

a

labial

direction

but teeth may move in any direction or become extruded. Once a tooth migrates the force on that

tooth changes and this may promote further stress and further migration. If an upper incisor

migrates

labially

the

lower

lip

may

come

to

lie

lingual

to

the

incisal

edge

of

the

tooth

and

produce

further migration.

??

Discomfort

??

One of the most important features of chronic periodontitis is the almost total absence of

discomfort or pain unless acute inflammation supervenes. This is one of the main distinctions

between periodontal and pulp disease. Discomfort or pain on percussion of the tooth indicates

some

active

inflammation

of

the

supporting

tissues,

which

is

at

its

most

acute

in

abscess

formation

when the tooth becomes exquisitely sensitive to touch. Sensitivity to hot and cold is sometimes

present

when

there

is

gingival

recession

and

root

exposure.

Indeed

one

common

clinical

experience

is the appearance of sensitivity, especially to cold, when roots once covered in calculus are

cleaned. On occasion pulp pathology may be a complication of advanced periodontal disease and

severe pain may then develop.

??

Alveolar bone loss

??

Resorption of alveolar bone and the associated destruction of periodontal ligament are the

most important feature of chronic periodontitis, and the one, which leads to tooth loss. There

is

considerable

variation

in

both

the

form

and

rate

of

alveolar

bone

resorption

and

in

constructing

a treatment plan the amount of bone loss, the rate at which resorption is progressing and the

pattern

of

bone

loss

need

to

be

accurately

established.

Radiographic

examination

is

an

essential

part

of

periodontal

diagnosis

and

with

certain

limitations

provides

evidence

of

the

alveolar

bone

height,

the

form

of

bone

destruction,

the

width

of

the

periodontal

ligament

space

and

the

density

of cancellous trabeculation. Serial radiographs taken over a period of time can provide

information about the rate of bone loss. However, radiographic examination without careful

clinical examination can be very misleading. A periodontal diagnosis cannot be made from

radiographs alone as there is no way of distinguishing on the radiograph past bone destruction

from current bone resorption.

??

Because

the

images

of

the

facial

and

lingual

plates

of

bone

are

largely

obscured

by

the

dense

image

of

the

tooth,

diagnosis

depends

upon

obtaining

a

clear

image

of

the

interdental

bone.

Careful

angulation

of

the

X-ray

beam

and

a

standardized

routine

of

exposure

and

processing

the

radiographic

film is essential.

??

The first radiographic sign of periodontal destruction is loss of density of the alveolar

margin. This is most clearly seen between posterior teeth where in health the broad interdental

septum projects a dense and well- defined image of the alveolar margin. The image of the narrow

interdental septa between anterior teeth is less well defined in health and early pathological

changes are less easy to see. With continuing bone resorption the height of the alveolar bone

is further reduced.

??

Even correctly angulated the radiographs may not disclose the true state of interdental

resorption, e. G.

An

interdental

crater

between

molars

can

be

masked by the

images of the

facial

and lingual walls of the defect. Bone defects, which lie over the facial or lingual aspects of

the teeth, e. G. Marginal gutters, may be completely obscured and revealed only when flaps are

raised at surgery.

??

Moreover, distinguishing between facial and lingual defects may not be possible from

radiographic evidence alone. Two radiographs taken at slightly different angles often reveal

defects undetected by one. This is especially true in the diagnosis of furcation defects. These

are usually revealed by radiographic examination but the exact form of the defect may not be

discernible. The thick palatal root of an upper molar may mask a trifurcation defect. Widening

of the periodontal space in the furcation provides evidence of an early lesion. Widening of the

periodontal

space

on

one

side

or

all

around

a

tooth

frequently

indicates

excessive

occlusal

stress.

This is sometimes accompanied by widening or funnelling of the coronal aspect of the socket.

??

All

departures

from

the

normal

radiographic

appearance

must

be

checked

against

other

clinical

features, in particular pocket depth and mobility patterns, and if these do not correspond

reexamination should be carried out. Clinical features taken together should make a reasonable

fit, which sheds light on both the pathological condition and its aetiology. Thus, where

radiographic

examination

of

a

mobile

tooth

reveals

that

the

supporting

bone

is

virtually

intact,

careful examination of the occlusion is essential. There must always be an identifiable reason

for any pathological change.

??

Halitosis and offensive taste

??

An offensive taste and smell frequently accompany periodontal disease especially when oral

hygiene is poor. Acute inflammation, with the production of pus, which exudes from pockets on

pressure,

also

causes

halitosis.

A

source

of

constant

surprise

is

the

lack

of

awareness

of

affected

individuals and their spouses to the powerful fetor, which like a malignant wind escapes from

their mouths when they speak. Lack of sensibility and unconcern about dental health seem to go

hand in hand, and as patient cooperation is essential to the success of periodontal treatment

this sensibility, or lack of it, can provide a clue to prognosis.

Diagnosis, prognosis and treatment plan

??

Making a diagnosis

??

The

diagnosis

should

not

be

limited

to

giving

a

name

to

the

condition.

If

periodontal

disease

is to be treated and its recurrence prevented, a diagnosis should include the identification of

all aetiological factors, i.e. (i) those factors which predispose to plaque deposition and

retention, and (ii) those factors, local or systemic, which influence adversely the behavior of

the tissue. It should go without saying that you cannot remove or control factors, which have

not been identified, yet all too frequently treatment is reduced to the control of signs and

symptoms, and inevitably disease recurs.

??

??

At the time of the initial examination some attempt should be made to assess the

patient's attitude to dental health. Patient cooperation is essential to the success of

periodontal treatment and it is this fact which makes the treatment of periodontal disease

different from that

of

caries and

other

dental

diseases

when

the patient can

take

a

more

passive

attitude.

??

??

??

??

Patient examination

??

??

The

examination

should

be methodical and comprehensive

and

should

follow

the

standard

pattern of the classic case history.

??

??

Present complaint and its history

??

??

A

patient with

periodontal disease

may

have

no complaint

at all

and

the obvious

to

the

presence of any disease in the mouth; indeed, the patient may be suspicious of any suggestion

that disease is present! The most common complaints are bleeding gums, loose teeth, drifting of

the

teeth

(usually

the

upper

incisors),

nasty

taste,

halitosis,

swelling

of

the

gums,

discomfort

and occasionally acute pain.

??

??

Few patients at the initial consulation provide concise and completely relevant

information. All too often, the necessary information has to be elicited by abstraction from a

long,

sometimes

rambling,

and

account

which

must

be

listened

to

with

patience

and

close

attention.

In addition, Pertinent questions should be asked:

??

??

Are you in pain?

??

??

Where is the pain?

??

??

Is it a throbbing or dull pain?

??

??

Does the pain keep you awake?

??

??

What brings on the pain - - hot, cold, sweet, biting?

??

??

Have you had pain in the past or is this the first time?

??

??

What treatment have you received for pain?

??

??

Do your gums ever bleed?

??

When you brush your teeth?

??

When you eat hard food?

??

Did your gums bleed in the past?

??

What treatment did you receive?

??

Do any of your teeth feel loose?

??

Have you always had that space between your front teeth?

??

Have you had any swelling in your mouth? Where, when, etc.?