牙齿发育异常

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1、授课章节牙齿发育异常授课对象口腔3系学时2时 间4014授课地点教 材葛立宏儿童口腔医学 人民卫生出版社 教学目的要求掌握：牙齿萌出与脱落异常熟悉：牙齿结构、形态、数目异常教学重点难点重点: 牙齿结构、形态、数目异常，牙齿萌出与脱落异常难点；牙齿萌出与脱落异常 教学方法讲授式启发式教具多媒体课件授课提纲1、 牙齿结构异常 （40分）釉质发育不全、牙本质发育不全、氟牙症、四环素牙先天性梅毒牙2、牙形态异常 （15分） 3、牙齿萌出过早、过迟、牙齿脱落异常 （20分） 4、牙齿数目不足、过多 （5分）教 学 主 要 内 容备 注 牙发育异常(developmental abnormality of

2、 teeth)主要内容 Summary牙结构异常 Abnormalities of histodifferentiation牙形态异常 Abnormalities of morphodifferentiation牙数目异常 Disturbances in number of teeth牙萌出异常 Disturbances in germination of teeth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 stained te

3、eth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 affection of deciduou

4、s dentition during teeth formation)病因 Aetiology营养障碍 nutrition deficiency内分泌失调 incretion disorder婴儿、母体疾病 infant & maternal disease局部因素 localized causes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 system

5、ic disease)新生儿 Neonatal新生儿溶血性疾病（haemolytic disease of the 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, gast

6、rointestinal and endocrine diseases)营养不良维生素D缺乏（nutritional 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

7、 （white, opaque spots, brown-stained after 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)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 2 提示致病

8、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 of the ena

9、mel)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Aetiology摄入过量的氟离子（in

10、gestion 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（phospholipid)无机磷酸盐（inorganic p

11、hosphate)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 ag