上海交通大学口腔医学院 01级七年制教学日历

Size: px

Start display at page:

Download "上海交通大学口腔医学院 01级七年制教学日历"

缎自明
5 years ago
Views:

1 上海交通大学医学院教案课程名称 : 口腔预防医学第 2 次课 2016 年 2 月 26 日教师姓名陈曦职称讲师教研室口腔预防教学时数 3 授课题目龋病和牙周病的流行病学教学对象 12 级七年制授课地点教室教学方式大课授课方式, 双语教学 Key points: 1) DMFT/DMFS 2) Gingival index 3) Plaque index 4) Community periodontal index 5) Fluorosis Index Difficult points: The application of Community periodontal index Strategies: Give more examples using ppt slides and pictures 本课的重点难点 : 重点 : 龋失补牙数 / 牙面数菌斑指数牙龈指数社区牙周指数氟牙症指数难点 : 社区牙周指数的应用对策 : 利用 ppt 幻灯片和疾病图片进行举例讲解本次课应用的教具 : Textbook: Preventive dentistry, 4 th edition ( 口腔预防医学, 第 4 版, 人民卫生出版社 ) Teaching aid: Multimedia and slide projector ( 教具 : 多媒体和幻灯投影仪 ) Reference book: Oral Health Epidemiology 上海交通大学医学院教案 1

2 主要教学内容及时间分配 : Road Map of Lecture Chapter 2 Oral Epidemiology Section 3 Epidemiology of Caries Total 40 min 一 Caries Indies 30min 1 decayed missing filled teeth DMFT/dmft DMFS/dmfs 2 mean DMFT/dmft/DMFS/dmfs 3 caries prevalence rate 4 caries incidence rate 5 caries-free rate 二 Epidemiological characters and associated factors 10 min 1. distribution of caries according to place 2. distribution of caries in term of time 3. distribution of caries in term of persons Section 4 Epidemiology of Periodontal Diseases Total 80min Introduction: 8min Periodontal diseases are very popular in Chinese population. Indices for periodontal health 1.OHI-S 1) DI-S A.Method B.Criteria 0 = No debris in the surface of the teeth. 1 = Debris covered less than one third area of the surface. 2 = Debris covered between one third to two third area of the surface. 3 = Debris covered more than two third area of the surface. 2) CI-S A.Criteria 0 = No calculus in the surface of the teeth. 上海交通大学医学院教案 2 8min

3 1 = Supragingival calculus covered less than one third area of the surface. 2 = Supragingival calculus covered between one third to two third area of the surface or sporatic subgingival calculus on the dental cervix. 3 = Calculus covered more than two third area of the surface or continuous subgingival calculus on the dental cervix. 2.Plaque index, PLI *(key point) 8min 1) Silness & Loe in 1964 A.Method B.Criteria 0 = no plaque in the gingival area. 1 = a film of plaque adhering to the free gingival margin and adjacent area of the tooth, the plaque may be recognized only by running a probe across the tooth surface. 2 = moderate accumulation of soft deposits within the gingival pocket, on the gingival margin and/or adjacent tooth surface, which can be seen by the naked eye. 3 = abundance of soft matter within the gingival pocket and/or on the gingival margin and adjacent tooth surface 2) Turesky modified index, 1970 A.Method Ramfjord teeth:16, 21, 24, 36, 41, 44 B.Criteria 3. Gingival index *(key point) 6min A.Method B.Criteria 0 = Normal gingiva 1 = Mild inflammation: slight change in color, slight edema.no bleeding on probing 2 = Moderate inflammation: redness, edema, and glazing.bleeding on probing. 3 = Severe inflammation: marked redness and edema.ulceration. Tendency to spontaneous bleeding. 4.SBI by Muhleman & Son in min A.Method B.Criteria 5. CPI (Community periodontal index) *(key point) 27min 1) Definition 上海交通大学医学院教案 3

4 2)Examination methods A.Instrument CPI probe B.Examination items Gingival bleeding, calculus, PPD C.Methods D.Criteria 0 Healthy 1 - Bleeding observed, directly or by using a mouth mirror, after probing. 2 - Calculus detected during probing, but all of the black band on the probe visible 3 - Pocket 4-5 mm (gingival margin within the black band on the probe 4 - Pocket 6 mm or more (black band on the probe not visible ). X - Excluded sextant (less than two teeth present). 9 - Not recorded E.Rules F.Examples Epidemiological characters and associated factors 1. Epidemiological characters 10min 1) Global distribution More than 70% of adults in all parts of the world have some degree of gingivitis and periodontitis. Gingivitis and calculus are more prevalent and severe in developing countries. There are fewer global differences in the prevalence and severe periodontitis. 2) Geographic distribution 3) Distribution of time 4) Distribution of Age The severity of the disease increased with advancing age The prevalence and severity of gingivitis from 5~6 years old begin, then progressed to periodontitis. Periodontitis progressed with age 5) Distribution Gender Epidemiologic evidence is that there are no inherent differences between men and women in susceptibility to periodontitis Usually Men have poorer periodontal health than women Smoking for men women usually exhibit better oral hygiene than do men 6) Distribution of Race 2. Associated factors 10min 1) Oral hygiene the relation between plaque deposits and gingivitis to be one of cause and effect. less calculus, both supragingival and subgingival, as a result of better oral hygiene and more professional dental care. Plaque and calculus deposits correlate poorly with severe periodontitis Plaque control is vital to the maintenance of periodontal health The etiologic role of oral hygiene in periodontitis might be similar to that of sugar in dental 上海交通大学医学院教案 4

5 caries 2) Smoking Smoking is a major risk factor for periodontitis The relative risk is twice as smokers than nonsmokers There is some evidence that smoking could increase the dental deposits and calculus accumulation and gingival inflammation Smoking is thought to suppress the vascular reaction that follows gingivitis 3) Nutrition 4) Systematical disease Diabetes 主要教学内容及时间分配第三节龋病流行病学总计 40 分钟一龋病常用指数 30 分钟 1 龋失补指数: 龋 (decayed) 失 (missing) 补 (filled), 分为恒牙龋失补指数 (DMF index), 乳牙龋失补指数 (dmf index) D=Decay M=Missing due to caries F=Filled due to caries 2 龋均和龋面均(DMFT & DMFS): 龋 (decayed) 失(missing) 补(filled) 牙数和牙面数 3 患龋率(caries prevalence rate): 指在调查期间某一人群中患龋病的频率, 常以百分数表示 4 龋病发病率(caries incidence rate): 通常指至少在一年时间内, 某人群新发生龋病的频率 5 无龋率(caries-free rate): 指全口牙列均无龋的人数占全部受检查人数的百分率二流行特征及其有关因素 1. 地区分布 2. 时间分布 3. 人群分布 10 分钟第四节牙周病流行病学总计 80min 简介 8min 牙周健康指数 1. 简化口腔卫生指数 8min 1) 简化软垢指数 A. 方法检查牙面 : 牙面 : 唇面,36 46 舌面检查方法 : 视诊, 探诊计分方法 : 软垢牙石指数, 个人口腔卫生指数 ; 群体口腔卫生指数 B. 指标 0 = 牙面无软垢 1 = 软垢覆盖面积占牙面 1/3 以下 2 = 软垢覆盖面积为牙面 1/3 与 2/3 之间 3 = 软垢覆盖面积占牙面 2/3 以上上海交通大学医学院教案 5

6 2) 简化牙石指数 A. 指标 0 = 龈上龈下无牙石 1 = 龈上牙石面积占牙面 1/3 以下 2 = 龈上牙石面积占牙面 1/3~2/3 之间, 或牙颈部有散在的龈下牙石 3 = 龈上牙石面积占牙面 2/3 以上, 或牙颈部有连续而厚的的龈下牙石 2. 菌斑指数 8min 1) Silness & Loe 菌斑指数 A. 方法检查方法 : 视诊 + 探诊检查时用探针轻划牙面, 根据菌斑的量和厚度记分 PLI 可以检查全口牙面, 也可检查指数牙每颗牙检查 4 个牙面 B. 指标 0 = 龈缘区无菌斑 1 = 龈缘区的牙面有薄的菌斑, 但视诊不可见, 若用探针尖的侧面可刮出菌斑 2 = 在龈缘或邻面可见中等量菌斑 3 = 龈沟内或龈缘区及邻面有大量软垢 2) Turesky 改良指数, 1970 *( 重点掌握 ) A. 方法 Ramfjord 指数牙 :16, 21, 24, 36, 41, 44 B. 指标 0= 牙面无菌斑 1= 牙颈部龈缘处有散在的点状菌斑 2= 牙颈部连续薄带状菌斑宽度 <1mm 3= 牙颈部菌斑面积 1mm~ 牙面 1/3 4= 菌斑覆盖面积占牙面 1/3~2/3 5= 菌斑覆盖占面积 2/3 或以上 3. 牙龈指数 *( 重点掌握 ) 6min A. 方法检查方法 : 钝头牙周探针, 结合视诊和探诊全口牙或指数牙, 每颗牙周围的牙龈 ( 近中唇 / 颊乳头正中唇 / 颊缘远中唇 / 颊乳头舌侧龈缘 ) 上海交通大学医学院教案 6

7 计分方法 B. 指标 0 = 牙龈健康 1 = 牙龈的色有轻度改变并轻度水肿, 探诊不出血 2 = 牙龈中等炎症 : 牙龈色红, 水肿光亮, 探诊出血 3 = 牙龈明显红肿或有溃疡, 并有自动出血倾向群体牙龈炎程度衡量标准牙龈指数牙龈炎流行程度轻度中度重度由于牙龈指数能反映牙龈炎症的有无与程度, 且临床应用简便, 无论在牙周疾病的现况调查中或实验流行病学研究中, 多采用此标准 4. 龈沟出血指数,1970 3min A. 方法检查方法 : 视诊 + 探诊检查时观察牙龈颜色和形状, 牙周探针轻探龈沟, 观察出血情况不用菌斑染色 B. 指标 5. 社区牙周指数 **( 重点掌握 ) 27min 1) 定义 2) 检查方法 A. 器械 CPI 探针 B. 检查项目牙龈出血牙石牙周袋深度 C. 方法 1) 检查方法 : 探诊为主结合视诊 2) 探诊力量 : 应在 20g 以下, 简单测试方法是将 CPI 探针插入拇指甲沟内, 轻轻压迫显示指盖发白且不造成疼痛和不舒服的感觉为适宜力量 3) 指数牙 : 上海交通大学医学院教案 7

8 D. 指标 0 健康 1 - 牙龈探诊后出血 ( 直接或口镜观察 ) 2 - 探诊有牙石存在, 但探针黑区全部可见 3 - 牙周袋 4-5 毫米 ( 探针黑区部分在龈下 ) 4 - 牙周袋 6 毫米或以上 ( 探针黑区全部在龈下 ) X - 除外区段 ( 余留牙不足 2 颗 ) 9 - 不做记录 E.Rules 1) 成年人的后牙区段, 有时缺失一颗指数牙或有拔牙指征, 则只检查另一颗指数牙 2) 如果一个区段内的指数牙全部缺失或有拔牙指征时, 则检查此区段内的所有其余牙齿, 以最重情况记分 3) 每颗指数牙的所有龈沟或牙周袋都须检查到 4) 每个区段两颗功能牙检查结果, 以最重情况记分 5) 六个区段中记分最高区段的记分则作为个人 CPI 记分 F. 举例流行病学特征及相关影响因素 3. 流行病学特征 10min 1) 全球分布全世界超过 70% 的成人患有不同程度的牙龈炎和牙周炎在发展中国家, 牙龈炎和牙石更为多见, 并较为严重在严重牙周炎的患病率方面, 各国家差异不大 2) 地理分布在我国, 牙周病的流行情况农村比城市严重牙石平均检出区段数农村高于城市所有年龄组软垢指数都较高, 但仍然是农村高于城市 3) 时间分布工业化国家的儿童青少年在 60 年代初, 牙龈炎的患病率也相当高 ; 70 年代后, 由于牙科公共卫生学的发展, 人群中的牙病不但得到控制, 且预防工作的开展逐年有所提高, 青少年儿童的龋病牙龈炎患病情况持续下降, 然后扩大到成年人 4) 年龄分布随着年龄的增长, 疾病逐渐加重 5~6 岁时开始出现牙龈炎, 并可逐步发展为牙周炎牙周炎岁年龄增长而加重 5) 性别分布流行病学证据表明男女之间对于牙周炎的易感性无明显差别一般而言, 男性的牙周状况比女性差女性更加注重口腔卫生 6) 种族分布不同民族间牙周病患病情况差异大上海交通大学医学院教案 8

9 4. 相关影响因素 10min 1) 口腔卫生菌斑是牙龈炎的病因更好的口腔卫生和更多的专业口腔护理, 龈上和龈下牙石才会更少菌斑和牙石与严重牙周炎关系不密切菌斑控制对牙周健康的维护非常重要口腔卫生在牙周炎中的作用与糖在龋齿中的作用是一样的 2) 吸烟吸烟是牙周炎的一个非常重要的危险因素吸烟者患牙周病的危险度是非吸烟者的两倍有证据表明吸烟会提高菌斑和牙石的沉积, 增加牙龈炎患病几率吸烟被认为会抑制牙龈炎发生后的血管反应 3) 营养营养缺乏将造成牙周组织功能降低蛋白质缺乏可使牙周结缔组织变性, 牙槽骨疏松还可影响抗体蛋白合成, 免疫能力下降维生素与牙周组织胶原合成有关, 它们的缺乏会造成牙周组织创伤愈合困难 4) 系统性疾病糖尿病课程总结 2min 上海交通大学医学院教案 9

10 本 Summary: Part 1 Epidemiology of Caries 1. The definition of DMFT/DMFS, the calculation method of mean DMFT/DMFS. Part 2 Epidemiology of periodontal diseases 1. The definition, examination and calculation method of Gingival index. 2. The definition, examination and calculation method of Plaque index. 3. The definition, examination and calculation method of Community periodontal Index. 次小结要点 : 第一学时龋病流行病学 1. 掌握龋失补牙数龋失补牙石数的定义, 龋均和龋面均的计算方法课第二三学时牙周病流行病学 1. 掌握牙龈指数定义检查方法和计算方法 2. 掌握菌斑指数定义检查方法和计算方法小 3. 掌握社区牙周指数定义检查方法和计算方法结要点上海交通大学医学院教案 10

11 Questions: 本 1. What are the criteria of Plaque index, Gingival index and Community periodontal Index? 次课复问题 : 1. 简述菌斑指数, 牙龈指数和社区牙周指数的各级标准. 习思考题下次课预习 : 其他口腔疾病流行病学口腔健康状况调查预习要点上海交通大学医学院教案 11

牙周病预防及刷牙

牙周病预防及刷牙口腔预防医学陈曦 2016 年 2 月 Periodontal diseases Gingivitis is defined as an inflammatory process of the gingival in which the junction epithelium, although altered by the disease, remains attached to the tooth