最新牙周组织疾病 教学课件课件PPT.ppt 49页

'牙周组织疾病教学课件 第二节牙周组织的应用解剖和生理一、牙周组织包括:1、牙龈2、牙周膜3、牙槽骨4、牙骨质 第三节牙周组织病的病因学一、牙周病的局部促进因素：1.牙石(dentalcalculus)2.牙面着色3.食物嵌塞(foodimpaction)4.咬合创伤(traumafromocclusion,occlusaltrauma)5.解剖因素和不良习惯、医源性因素 第四节牙龈病二、受全身因素影响的牙龈病(一)青春期龈炎青春期龈炎(pubertygingivitis)是指发生于青春期的慢性非特异性牙龈炎，男女均可患病，但女性较多。【病因】青春期少年未养成良好的刷牙习惯，在错眊拥挤、口呼吸以及戴各种正畸矫治器的情况下，前牙、替牙部位易发生牙龈的炎症。 第四节牙龈病【临床表现】好发于前牙唇侧的牙间乳头和龈缘，唇侧龈缘明显肿胀，乳头呈球状突起，龈色暗红或鲜红，光亮，质地软，龈袋形成，探诊易出血。【治疗原则】通过洁治术去除菌斑和牙石，或可配合局部药物治疗，如龈袋冲洗及袋内上药，给予含漱剂清洁口腔。病程长且过度肥大增生者常需手术切除。 第四节牙龈病（二）妊娠性龈炎（pregnancygingivitis）1、由于妊娠时性激素水平的改变，使原有的龈炎加重;2、龈发红、肿大、发亮、易出血;3、个别不增大呈球状,称妊娠病;4、洁牙或手术。 第四节牙龈病（三）药物性牙龈病(druginfluencedgingivaldiseases)是指服用某些药物而引起的牙龈病。分为以下两种：(1)药物性牙龈肥大：牙龈纤维增生和体积增大；(2)药物性牙龈炎：牙龈慢性炎症； （三）药物性牙龈病(druginfluencedgingivaldiseases)（1）长期服用苯妥英钠、环孢素A以及心痛定所致;（2）开始呈小球状突起，以后逐渐增大;（3）坚实、浅红色、有弹性、不出血;（4）治疗：停药或更换其他药物是最根本的治疗、洁牙、切除、药物。 第五节慢性牙周病炎慢性牙周炎又称成人牙周炎(adultperiodontitis,AP)，曾称为边缘性牙周炎或单纯性牙周炎(periodontitissimplex，PS)。慢性牙周炎是一种感染性疾病，导致牙齿支持组织的炎症、进行性附着丧失和牙槽骨吸收的疾病。【病因】1、菌斑2、多种类型细菌3、牙石4、食物嵌塞5、不良修复体 第五节慢性牙周病炎【临床表现】临床体征为牙龈呈现不同程度的慢性炎症，如牙龈色泽变为深红色或暗红色，炎性充血，组织发红、水肿，刺激后出血，牙龈外形和质地的改变，存在牙石和菌斑，可波及附着龈。 第五节慢性牙周病炎【治疗原则】(1)控制菌斑；(2)彻底清除牙石，平整根面；(3)牙周袋及根面的药物处理，可用复方碘液等；(4)牙周病的基础治疗后一个月复查疗效；(5)建立平衡的牙合关系；(6)尽早拔除有深牙周袋、过于松动、确已无保留价值的患牙；(7)积极治疗并控制全身病；(8)牙周支持疗法，预防牙龈炎症及牙周炎的复发。 第六节侵袭性牙周炎侵袭性牙周炎(aggressiveperiodontitis)可分为局限型侵袭性牙周炎和广泛型侵袭性牙周炎。侵袭性牙周炎是一类临床和实验室检查均明显不同于慢性牙周炎的牙周炎症性破坏性疾病。【病因】伴放线放线杆菌、牙龈卟啉单胞菌、中间普氏菌、福赛类杆菌、侵蚀艾肯菌、核梭形杆菌、直肠弯曲菌、牙密螺旋体等。 第六节侵袭性牙周炎【临床表现】侵袭性牙周炎的共同表现有：患者除患牙周炎外，通常在其他方面正常；快速的附着丧失和骨破坏；家族聚集性。【治疗原则】早期进行洁、刮治术和根面平整等基础治疗，彻底清除感染，然后进行牙周手术、调牙合等局部治疗。 第七节急性坏死性溃疡性龈炎急性坏死性溃疡性龈炎(acutenecrotizingulcerativegingivitis,ANUG)又称奋森龈炎，是指发生于龈缘和龈乳头的急性坏死性炎症。【病因】由于某些原因导致局部抵抗力下降，存在于龈炎和牙周炎菌斑中的梭性杆菌、中间普氏菌和螺旋体大量繁殖，直接或间接地造成牙龈的坏死性和炎症。 第七节急性坏死性溃疡性龈炎【临床表现】以牙龈坏死为特点，表现为龈乳头破坏，并伴有牙龈出血、疼痛、口臭和伪膜形成。起病急，主要表现为龈乳头和边缘龈的坏死，前牙尤其是下前牙最多见。 第七节急性坏死性溃疡性龈炎【治疗原则】急性期可先轻轻除去坏死组织并初步刮除大块牙石。局部用氧化剂溶液冲洗和反复含漱，全身给以维生素Ｃ等支持治疗，及时进行口腔卫生指导；有全身因素者同时予以治疗。 第八节伴有牙髓病变的牙周炎牙周-牙髓联合病损（combinedperiodontalendodonticlesion）为牙髓和牙周病损合并存在。【病因】通常来自菌斑有关的牙周炎（主要为慢性牙周炎或侵袭性牙周炎）；【治疗原则】当牙髓病损是临床感染的主要原因时，可通过牙髓治疗的方法解决；而来自慢性牙周炎、侵袭性牙周炎等牙周炎导致牙髓感染时，除进行牙髓治疗外，还应进行牙周综合治疗； 第九节咬合创伤咬合创伤为发育性或获得性(后天性)异常的状况类牙周病，分为原发性咬合创伤(primaryocclusaltrauma)和继发性咬合创伤(secondaryocclusaltrauma)。【病因】咬合创伤的发病是由于牙合力导致的损伤使附着装置发生组织学改变，如早接触、牙尖干扰等。 第九节咬合创伤【临床表现】牙合力如超过牙周组织支持潜能，便可造成牙周组织创伤、牙周纤维破坏、牙槽骨和牙骨质吸收、牙齿松动。【治疗原则】咬合创伤确诊后应进行调牙合等治疗。包括选磨法(用砂石轮等磨改牙齿外形以清除咬合创伤的方法，又称牙冠成形术)修复缺失牙，正畸矫治和松动固定。 欣赏下列两个语段，并指出它们的技巧1.Briefasthepassageis,itstillarousesmyendlessimaginationtothepasttime.WereIinthepast,IwouldlikethatIstayedinBritaininthe19thcentury,whereandwhentheRevolutionofIndustrywasflourishing.Withtheinspiringatmosphereofthecreativetimes,Iwouldtrymyutmosttodomyfavoritescientificexperiment,sinceIhavegreatinterestinscience.What’smore,thescientificloverswouldbeinvitedtojoinmylittleclubtoinventsomebrand-newinventionsandcreatenewdesignsofourdailylife’sproducts,cooperatingtoputthetheorywelearnedfrombookstoourpracticallife.InthiswayIcouldgetinspirationofwisdomandresourcefulnesstobringconvenienceandimprovementstoourlife. 2.ShouldIbegiventheopportunitiestotraveltothepast,IwouldliketogobacktoQingDynastyofearly20thcenturywhenChinawasinadisaster.WereIbackinthelateQingDynasty,IwouldmakeeveryendeavortorescueChinafromtheforeigninvadersandpreventitfrombeingbulliedwithoutresistance.Firstly,Iwouldteachmymoderntheoryandknowledgetothegovernors,instructingthemtofightagainsttheenemiesandconstructpowerfularmies.Secondly,allthecitizenswouldbecalledontounitetogetherandresistothercountries’invasionbravely.What’smore,joiningsomeanti-invaderspartieswouldalsobemychoice. 亮点句型写作指导除了虚拟语气外，有许多亮点句型可以应用到写作中，增分添彩。 比喻AistoBwhatCistoD.Likethesunshine,kindnesscanhelpthoseintrouble.Kindnessislikethelighthouse,whichcandirectthewayforthosewhoareindimsituation. 排比IfIcouldgobacktothepastanddotheabovementionedthings,thelastthingmygrandparememberedwouldnotbetheindifferenceandthebackofhisbelovedgrandson.IfIcouldtravelbackthroughtime,thelastmemorybetweenhimandmewouldnotbehisclosedeyesandthedeadlookofhalf-unconscioussuffering.Thennow,Iwouldnothavetolivewiththisunbearableregretandpainfortherestofmylife.IfonlyIcould! 倒装（赢在写作P37-38）Simpleasthestoryis,Heregoesthesayingthat___.Onlywhen_____canwe___.Onlyinthisway,canweOnlybydoing-,canwe____.Onlyafterdoingsth,canweOnthewestoftheschoolliesapond,wheremanyfishareswimming.Undernocircumstanceshouldwe-类似的用法：Never/Bynomeans/onnoaccount/innoway/atnotimeshouldI.Hardly/scarcelyhadIgotintotheroomwhenitbegantorain.(nosooner，than) Haditnotbeenforherstickingtobeingontime,shewouldn’thaveearnedherselfawell-paidjobandmoreimportantlybuiltupanimageofreliabilityandintegrity.倒装ShouldIbegiventheopportunitiestotraveltothepast,IwouldliketogobacktoQingDynastyofearly20thcenturywhenChinawasinadisaster.WereIbackinthelateQingDynasty,IwouldmakeeveryendeavortorescueChinafromtheforeigninvadersandpreventitfrombeingbulliedwithoutresistance. 亮点写作的注意事项1.过多的亮点，显得堆砌对策：亮点分布，尽量首句2.亮点单一，例如全段排比或比喻对策：最好总—排比---总的结构。照顾段落的完整性。3.华而不实，不重视内容，徒有框架没有内容对策：先想内容，再想修辞手法4.过多注重运用亮点，没有注意谋篇，顾此失彼对策：谋好篇，定好每点行数，才能下笔 亮点句型写作训练练习：1.说明挫折的意义2.你怎样看待老师对学生的影响。3.说说你对母爱的理解4.谈谈决心对人的影响 使用虚拟语气写作的注意事项：1.确定到底要不要“虚”？2.确定到底使用哪个时态的“虚”？3.所谓“一虚到底”，其实是指在该假设情境中的虚拟的时态的一致性。而非一定是通段都使用虚拟！一切要看情况进行选用。 说说挫折的意义1.Hardandpainfulasfrustrationis,itisofsignificanceinourlife.Astheoldsayinggoes,“stormmakestreestakedeeperroots”,withoutfrustration,nevercouldwegrowupasastrong-willedperson.Werewesurroundedbyover-praiseandimmersedintheprideandhappiness,frustrationwouldbeatimelyalarm,urgingusnottostopattheso-calledpeakandcontinueyourpaceofpursuit.Wereweconfrontedwithobstacles,frustrationcouldbeaphilosopher‘sstone（魔法石）,withwhichwecouldtransformthetemporarysetbackstogreatopportunitiestobecomestrongerInaword,lifeisnotonlyabouthowtolivethroughthestormbutalsohowtodanceintherain. 说说挫折的意义2.Nevercanweemphasizethesignificanceofsetbacktoomuch.Withoutsetback,ourlifewouldbearoselackingfragrance.Withoutsetback,ourlifewouldbeavoyagelackingdirection.Itisnoexaggerationtosaythatfrustrationhassowntheseedofmaturityandself-developmentinmyinnerheartandhasmadeitpossibleformetoachievegreatsuccess. 老师对学生的影响1.Supposethatteacherswereabsentinourlife,students’lifewouldbeapicturewithintensedarkness.Withoutteachers,thelaboriousengineersofoursoul,students’personalitiesandcharacterswouldnotbeshaped.Withoutteachers,theladderwithselflessdevotion,ourheartwouldnotbeliftedupbyencouragementandgrowmature.Withoutteachers,thesparklinglighthouseintheoceanofknowledge,nevercouldteenagersfindaccesstothesuccessfullifeinthefuture. 老师对学生的影响2.Withoutthepatientandcarefulteachers,nevercouldstudentsgrowfromachildishanddependentchildintoamatureandindependentadult.Withouttheselflessandaffectionatepreachingofteachers,nevercouldstudentsstepontoapathwithabrightandpromisingfuture.Withouttheknowledgeableteachers,neverwouldstudentsmasterthenecessaryknowledgeanddevotethemtotheconstructionofamoreharmonioussocietyandcountry. 母爱的理解1.Withoutmaternalaffection,wewouldchangefromfragrantflowersintoweedsabandonedbyotherswithoutashelterandcare.Withoutthisever-lastingemotion,neverwouldweliveasfullandrichalifeasotherchildrensurroundedbymerrimentandhappiness. 母爱的理解2.Maternalloveislikeacircle.Ithasnobeginningandnoending.Butformotherhood,wewouldbethelittlestrayedlambswhosteponthemistakentrack.Butformotherhood,nevercanwebeenvelopedinwarmthandmerrimentbyapatchofsunlight.Butformotherhood,wecouldbeoverwhelmedbyendlessdarknessandtheworldwouldfadefromcolorfulandwonderfultodimandcold. 决心的影响1.Determinationisthefuelofships,withoutwhich,nevercouldwearriveattheshoreofsuccess.Determinationisthewalkingstickoftheclimber’s,withoutwhich,nevercouldwereachthepeakoflife.Determinationistheverycondition,withoutwhich,nevercouldwegetridofthedarkdepthofdepression. 决心的影响2.Withoutthefirmdetermination,nevercouldindividualsgrowintostrongtreesstrugglinginthewindandrain.Withoutthesteadfastmind,nevercouldteamsunitetogethertocreatemiracle.Withouttheunswervingresolution,nevercouldcountriesuniteandfightfortheflourishingandbrightfutureaswellasaharmoniousworld. 说说挫折的意义1.Hardandpainfulasfrustrationis,（倒装）itisofsignificanceinourlife.Astheoldsayinggoes,“stormmakestreestakedeeperroots”,（名言）withoutfrustration,nevercouldwegrowupasastrong-willedperson.（虚拟）Werewesurroundedbyover-praiseandimmersedintheprideandhappiness,frustrationwouldbeatimelyalarm,urgingusnottostopattheso-calledpeakandcontinueyourpaceofpursuit.Wereweconfrontedwithobstacles,frustrationcouldbeaphilosopher‘sstone（魔法石）,withwhichwecouldtransformthetemporarysetbackstogreatopportunitiestobecomestronger.(虚拟+排比+非限制性定从)Inaword,lifeisnotonlyabouthowtolivethroughthestormbutalsohowtodanceintherain.(总结部分可以用现在时) 说说挫折的意义2.Nevercanweemphasizethesignificanceofsetbacktoomuch.(倒装)Withoutsetback,ourlifewouldbearoselackingfragrance.Withoutsetback,ourlifewouldbeavoyagelackingdirection.Itisnoexaggerationtosaythatfrustrationhassowntheseedofmaturityandself-developmentinmyinnerheartandhasmadeitpossibleformetoachievegreatsuccess.（虚拟反说+比喻+排比） 老师对学生的影响1.Supposethatteacherswereabsentinourlife,students’lifewouldbeapicturewithintensedarkness.Withoutteachers,thelaboriousengineersofoursoul,students’personalitiesandcharacterswouldnotbeshaped.Withoutteachers,theladderwithselflessdevotion,ourheartwouldnotbeliftedupbyencouragementandgrowmature.Withoutteachers,thesparklinglighthouseintheoceanofknowledge,nevercouldteenagersfindaccesstothesuccessfullifeinthefuture.（虚拟反说+排比） 老师对学生的影响2.Withoutthepatientandcarefulteachers,nevercouldstudentsgrowfromachildishanddependentchildintoamatureandindependentadult.Withouttheselflessandaffectionatepreachingofteachers,nevercouldstudentsstepontoapathwithabrightandpromisingfuture.Withouttheknowledgeableteachers,neverwouldstudentsmasterthenecessaryknowledgeanddevotethemtotheconstructionofamoreharmonioussocietyandcountry.（虚拟反说+排比） 母爱的理解1.Withoutmaternalaffection,wewouldchangefromfragrantflowersintoweedsabandonedbyotherswithoutashelterandcare.Withoutthisever-lastingemotion,neverwouldweliveasfullandrichalifeasotherchildrensurroundedbymerrimentandhappiness.（虚拟反说+排比） 母爱的理解2.Maternalloveislikeacircle.Ithasnobeginningandnoending.（比喻，多一句进行补充说明，使得比喻更具体形象）Butformotherhood,wewouldbethelittlestrayedlambswhosteponthemistakentrack.Butformotherhood,nevercanwebeenvelopedinwarmthandmerrimentbyapatchofsunlight.Butformotherhood,wecouldbeoverwhelmedbyendlessdarknessandtheworldwouldfadefromcolorfulandwonderfultodimandcold.（虚拟+比喻+排比） 决心的影响1.Determinationisthefuelofships,withoutwhich,nevercouldwearriveattheshoreofsuccess.Determinationisthewalkingstickoftheclimber’s,withoutwhich,nevercouldwereachthepeakoflife.Determinationistheverycondition,withoutwhich,nevercouldwegetridofthedarkdepthofdepression.（先总说比喻决心像…，再用非限制性定从+虚拟反说进行论证，还采用了排比的手法） 决心的影响2.Withoutthefirmdetermination,nevercouldindividualsgrowintostrongtreesstrugglinginthewindandrain.Withoutthesteadfastmind,nevercouldteamsunitetogethertocreatemiracle.Withouttheunswervingresolution,nevercouldcountriesuniteandfightfortheflourishingandbrightfutureaswellasaharmoniousworld.(虚拟排比递进：个人—团队---国家)'