Oral and Dental Disease for Medical Students

8/3/2019 Oral and Dental Disease for Medical Students

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Oral and Dental Disease

Victor Lopes PhD FRCS FDSRCS

Clinical Director, Head & Neck.

TOOTH CHARTING

Each arch is divided in half at the midline,forming FOUR QUADRANTS

maxillary right

maxillary left

mandibular right

mandibular left

PERMANENT DENTITIONFour quadrants and withineach quadrant there is

8 teeth

1= Central Incisor

2= Lateral Incisor

3= Canine

4= First Premolar

5= Second Premolar

6= First Molar

7= Second Molar

8= Third Molar / Wisdom

Tooth

PRIMARY DENTITIONOnly 5 teeth per quadrant

a / 1 = Central Incisior

b / 2 = Lateral Incisor

c / 3 = Canine

d / 4 = First Primary Molar

e / 5 = Second Primary Molar


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Examples of complete tooth names are:

- mandibular left permanent first molar

- maxillary right primary canine

Because their names are cumbersome,teeth are frequently referred to by number

The tooth numbering systems primarilyused today are the:

- Palmar Notation

- Fdration Dentaire Internationale (FDI)

PALMAR NOTATIONPermanent Teeth

R L

PALMAR NOTATIONPrimary Teeth

R L

e d c b a a b c d e

e d c b a a b c d e

FDI SYSTEMR L

RADIOGRAHICINTERPRETATION


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OPG OPGamalgam restoration

unerupted canine

composite restoration

3. THE APICAL TISSUES

a) integrity of lamina dura

b) radiolucencies assoc. with theapices

4. THE PERIODONTAL TISSUES

a) width of the periodontal ligamentb) level and quality of crestal bone

c) vertical and horizontal bone loss

d) furcation involvement

MIXED DENTITION DENTAL CARIES


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BASIC DENTAL ANATOMY

ENAMEL: hardest and most impermeable ofthe tissues

DENTINE: tubular structure, highly permeable

PULP: connective tissue within a pulp cavitysurrounded by dentine, communicateswith periradicular tissue through apicaland lateral canals

SUGAR

AETIOLOGY OF DENTAL CARIES

TOOTH

BACTERIA

TIME

CARIES

Dental caries is a sugar-dependantinfectous disease

Acid is produced as a by-product ofcarbohydrate metabolism by plaquebacteria

Results in a drop in pH at the tooth surface

In response, Ca and P ions diffuse out ofthe enamel => DEMINERALIZATION

Process is reversed when the pH rises

again

Caries is a dynamic process with episodicdemineralization and remineralization

If demineralization predominates

Disintegration of the mineral component

Cavitation


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TOOTHACHE

Pain may be arising from a variety ofdifferent structures:

- Pulpal pain

- Periapical / periradicular pain

- Non-dental pain

CLASSIFIACTION OF DENTAL PAIN

The sensory response of teeth iscontrolled by myelinated (A) nerve fibresand unmyelinated (C) fibres

Differences between the two fibres assistin the classification of dental pain

Disturbances in the pulp dentine complexinitially have their effects on the lowthreshold A fibres, which produce

- quick pain

- sharp pain

Inflammatory tissue damage in the pulpinvolves the high threshold C fibres, which

produce- spontaneous pain

- lingering pain

NORMAL PULP

Never spontaneously symptomatic

Reacts to thermal and electrical testing

Percussion does not cause pain

Radiographic picture is normal

REVERSIBLE PULPITIS Suggests the presence of mild inflammation

Thermal / electrical stimuli produce short,sharp pain for the period of stimulation

(This is a typical A nerve response)

Radiographically no evidence of pathology

Removal of the cause of inflammation (egdental caries) leads to resolution of thecondition

Rx OF REVERSIBLE PULPITIS

Remove any caries present and restorewith a suitable lining

Vitrabond (RMGI)

GI

ZnO

Ca(OH)

Then place permanent restoration Amalgam

Composite Resin


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IRREVERSIBLE PULPITIS

Inflammation that results in the dull throbbingpain of toothache

Spontaneous pain

May last several hours, often worse at nightand may keep the patient awake

Difficult to localize source of pain

Pain is elicited by hot and cold at first, butin later stages heat is more significant andcold may actually ease the symptoms

A characteristic feature is that the painremains after the removal of the stimulus

Radiographic changes may be evident ifthe inflammation extends to theperiodontal ligament e.g. widening of thelamina dura

Rx OF IRREVERSIBLE PULPITIS

Extirpation of the pulp and RCT

OR

Extraction

PULP NECROSIS

Progression of irreversible pulpitisultimately leads to death of the pulp

At this stage pt may experience RELIEFfrom pain and thus may not seek attention,HOWEVER INFECTION STILL REMAINS

If neglected, the bacterial and pulpalbreakdown products leave the root canalsystem via the apical foramen or lateralcanals and lead to inflammatory changesand possibly pain.

PULPAL NECROSIS WITH

PERIAPICAL PERIODONTITIS Dull ache, exacerbated by biting on the tooth

No response to hot / cold

Tender to percussion

Radiographically apical PDL may be widenedor may be a periapical radiolucency (granulomaor cyst)


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Rx OF PULPAL NECROSIS WITHPERIAPICAL PERIODONTITIS

Extirpation of the pulp and RCT

OR

Extraction

ACUTE PERIAPICAL ABSCESS

Severe pain

Will disturb sleep

Extremely tender to touch

ACUTE PERIAPICAL ABSCESS

May be associated localised / diffuseswelling

Radiographically varies from widening ofPDL / Lamina Dura to an obvious

radiolucency

Rx OF ACUTE PERIAPICALABSCESS

Drain pus

a) Enter pulp chamber with high speeddiamond bur. After drainage, prepare thecanal and place temporary dressing

NOTE:

Open Drainage should be avoided ifpossible, but if absolutely necessary for


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RECURRENT ORAL ULCERATIONS

MINOR APHTHAEMAJOR APHTHAE

HERPETIFORMBEHCETS SYNDROME


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FACTORS ASSOCIATED WITH APHTHAE

Hereditary Hypersensitivity

Psychological Chemicals in foodSocio-economic Trauma

Endocrine Strep. SanguisAIDS

BEHCETS SYNDROMECLINICAL FEATURES AND POSSIBLE

COMPLICATIONS

1. ORALAphthous Stomatitis

2. OCULARUveitis

Retinal VasculitisOptic atrophyBlindness

3. GENITALUlcers


COMPLICATIONS (cont.)

4. NEUROLOGICALSyndromes resembling multiple sclerosisSyndromes resembling psudobulbar palsy

Benign intracranial hypertensionBrain-stem lesions

5. CUTANEOUSPustulesErythema nodosum

6. PSYCHIATRICDepression


COMPLICATIONS (cont.)

7. JOINTSArthralgia (large joints)

8. VASCULAR

AneurysmsThromboses of vena cavae

9. RENALProteinuriaHaematuria


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APHTHAE WITH GI DISORDERS

COELIAC DISEASECROHNS DISEASE

ULCERATIVE COLITISMALABSORPTION SYNDROME

NUTRITIONAL DEFICIENCIESASSOCIATED WITH APHTHAE

IRONB12

FOLATEB1 B2 B6

LOCAL THERAPY: chlorhexidine mw &orabase, NOT BONJELA

SYSTEMIC THERAPY FOR APHTAE

COLCHICINELEVAMISOLETHALIDOMIDE


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LICHEN PLANUS

LICHENOID REACTIONLICHENOID DYSPLASIA


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DRUGS CAUSING LICHENOID REACTIONS

Allopurinol Gold Practolol

Amiphenazole Hydroxychloroquine PropanololAtorvastatin (Lipitor) Ketoconazole PyrimethamineCaptopril Labetanol QuinidineCarbamazetine Mercury QuinacrineChloroquine Methyldopa SpironolactoneChlorpropamide Metopromazine Streptomycin

Cyanamide NSAID TetracyclineDapsone Oxyprenolol ThiazidesEnalapril Palladium TolbutamideErythromycin Para-amino salicylic acid TriprolidineFenclofenac Penicillamine ZoloftFurosemide Phenothiazines


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PEMPHIGUSVULGARISVEGETANS

FOLIACEOUSERYTHEMATOSUSPARANEOPLASTIC


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PEMPHIGOID

MUCOUS MEMBRANE OR CICATRICIALBULLOUS

LINEAR IgA DISEASE


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ERYTHEMA MULTIFORME

STEVENS JOHNSON SYNDROME


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LUPUS ERYTHEMATOSUS

DISCOIDSUBACUTE CUTANEOUS

SYSTEMIC


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SCLERODERMA

CIRCUMSCRIBED (MORPHEA)SYSTEMIC SCLEROSIS


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BENIGN MIGRATORY GLOSSITIS

(ERYTHEMA MIGRANS, GEOGRAPHIC TONGUE)STOMATITIS AREATA MIGRANS

PSORIASIS


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GEOGRAPHIC TONGUEERYTHEMA MIGRANS

BENIGN MIGRATORY GLOSSITIS

STOMATITIS AREATA MIGRANSPSORIASIS

Morris, LF, et al. Oral Lesions in patients with psoriasis: acontrolled study. Cutis 49:339-44, 1992


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SUMMARY OF FINDINGS

- GT was 4 times more frequent in psoriatics.- Male psoriatics had 2.5 times the incidence of

GT than female psoriatics.- Males with GT had 10 times the incidence of

psoriasis than females with GT.- Ectopic lesion were 5 times more frequent in

psoriatics.

- Incidence of FT was the same in both groups.- Incidence of FT increased with age in both

groups.

Oral and Dental Disease for Medical Students

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