Caries (lat. caries "rotting") yog txheej txheem qeeb ntawm depolarization thiab kev puas tsuaj ntawm cov nqaij tawv tawv ntawm cov hniav nrog tsim cov kab noj hniav carious hauv cov hniav. Cov kws tshawb fawb tseem tsis tuaj yeem muab cov lus xaus tseeb txog qhov ua rau cov hniav caries.
Nyob zoo
Cov kab mob ntawm kev kho hniav mus tob rau yav dhau los. Nyob rau hauv chav kawm ntawm kev tshawb fawb archaeological, nws tau ua pov thawj tias cov kab mob no tshwm sim hauv cov neeg uas nyob txog 5,000 xyoo dhau los. Cov kab mob no feem ntau niaj hnub no (muaj feem cuam tshuam ntau dua 93% ntawm cov neeg). Hauv cov menyuam yaus, nws ua rau cov kab mob ntev thiab tshwm sim 6-8 zaug ntau dua li cov mob hawb pob bronchial, uas nyob qhov thib 2. Thaum lawv tawm hauv tsev kawm ntawv, 80% ntawm cov tub ntxhais hluas twb muaj caries, thiab 98% ntawm cov neeg tau sau. Raws li kev txheeb cais, caries tsawg dua hauv Africa thiab Asia.
Etiology ntawm qhov tshwm sim
Tam sim no, qhov tshwm sim ntawm cov kab mob hniav yog txuam nrog qhov tseeb tias pH ntawm cov qaub ncaug hloov ntawm nws qhov chaw, muaj kev kho hniav.plaque nrog cov kab mob, fermentation ntawm carbohydrates (glycolysis) tshwm sim. Rau qhov no yog ntxiv cov kev ua ntawm acid-forming microflora. Thiab twb dhau los ntawm cov organic acids, cov hniav puas tshwm sim yav tom ntej.
cov kab mob Cariogenic lub qhov ncauj muaj xws li acid-forming streptococci (Streptococcusmutans, Str. sanguis, Str. mitis, Str. salivarius) thiab qee cov lactobacilli.
Txawm hais tias cov hniav enamel suav hais tias yog cov ntaub so ntswg nyuaj tshaj plaws hauv lub cev, zoo li feldspar, nws cov hydroxypatites yog cov rhiab heev rau cov kua qaub thiab pib crumble nyob rau pH 4.5. Tom qab txhua qhov raug ntawm cov tshuaj tiv thaiv txheej, nws cov inorganic Cheebtsam. yaj thiab nyob twj ywm hauv qhov mob no 2 teev. Yog tias qhov no tshwm sim tsis tu ncua txhua hnub, ces pH yuav nyob twj ywm hauv thaj tsam acid ntev, nyob rau hauv ib puag ncig zoo li cov qaub ncaug tsis muaj sijhawm los kho nws, thiab cov enamel pib irreversibly vau.
Cov kab noj hniav carious nyob rau nruab nrab hauv 4 xyoos. Thiab txij li cov hauv paus hniav ntawm cov hniav yog softer, ntawm no cov txheej txheem tshwm sim 3 zaug sai dua. Yog tias koj nyiam cov hniav lwj tuaj yeem tsim nyob rau ob peb lub hlis.
yam khoom ntawm caries tsos
Lub ntsiab rau qhov tshwm sim ntawm caries yog 4 lub ntsiab lus pib:
- caries susceptibility ntawm tus hniav nto;
- glycolysis;
- kab mob cariogenic;
- sijhawm.
Kev tawm tsam rau cov yam tsis zoo no yog:
- Txhua hnub txhuam kom tshem cov quav hniav.
- Saturation thiabenamel fluoridation - los ntawm kev hloov cov dej muaj pes tsawg leeg los ntawm kev ntxiv cov tshuaj no, nrog rau nws muaj nyob rau hauv cov tshuaj txhuam hniav. Nws yog ib qho tseem ceeb tshwj xeeb uas yuav tsum tau ua cov kev ntsuas no rau cov me nyuam. Raws li WHO cov lus pom zoo, fluoridation ntawm cov dej haus ua rau txo qis ntawm cov kab mob caries los ntawm 30-50%.
Kev xav ntawm keeb kwm ntawm caries
Tam sim no, muaj ntau dua 400 txoj kev xav ntawm caries. Txhua tus ntawm lawv muaj qee qhov tseeb, tab sis lawv tsis tuaj yeem cuam tshuam txhua yam ntawm cov kab mob pathogenesis.
Cov kws sau ntawv tsuas xav txog tus kheej xwb, yog li txhua txoj kev xav ntawm caries tuaj yeem muab faib ua ob pawg. Cov neeg tsim ntawm lub hauv paus ntsiab lus piav qhia txog keeb kwm ntawm kev puas tsuaj los ntawm kev cuam tshuam ntawm exogenous yam (qaib, quav hniav thiab calculus, kab mob, raug rau acids, thiab lwm yam). Cov kws sau ntawv ntawm kev tshawb xav lom neeg tham txog kev cuam tshuam ntawm endogenous disorders.
Qhov ua rau caries tau sim los ntawm cov kws kho mob thaum ub - Hippocrates thiab Galen.
In the XVII-XVIII centuries. Ib txoj kev xav tseem ceeb tau nrov, raws li kev kho hniav pathology tshwm sim los ntawm cov hniav lwj.
In the XVIII century. chemical theories ntawm qhov tshwm sim ntawm caries tshwm sim. Yog li, Birdmar (1771) tau tham txog cov nyhuv ntawm inorganic acids los ntawm cov zaub mov ntawm cov hniav. Qhov kev tshawb pom ntawm lub tshuab tsom iav tso cai rau A. Leeuwenhoek (1681) kom pom "cov tsiaj me tshaj plaws" hauv cov ntaub so ntswg ntawm cov hniav lwj.
Ob centuries tom qab, Leber thiab Rottenstein (1867) tau piav txog ib hom microbe uas lawv ntseeg tias yog lub luag haujlwm rau caries.
Lawv kuj tsis lees paub cov kua qaub. Ntawm lawvlub hauv paus tau tsim nyob rau hauv 1881, Miller txoj kev vam meej heev tshuaj-parasitic tswvyim nyob rau hauv nws lub sij hawm. Raws li txoj kev xav no ntawm caries, cov txheej txheem kev puas tsuaj mus txog 2 theem.
Thaum pib, qhov tsis muaj qhov chaw ntawm cov hniav enamel dissolves nyob rau hauv kev cuam tshuam ntawm lactic acid, uas yog tsim nyob rau hauv lub qhov ncauj raws li qhov tshwm sim ntawm fermentation ntawm qab zib nrog kev koom tes ntawm acid-forming microorganisms.
Ntxiv mus, cov tshuaj no txo qis pH ntawm cov qaub ncaug, thiab cov ntaub so ntswg tawv yog demineralized. Thiab nyob rau theem 2, dentin twb raug rhuav tshem los ntawm cov enzymes tsim los ntawm cov kab mob.
Acid nws tus kheej tsis tuaj yeem ua rau dentin, vim nws muaj cov protein ntau molecules.
Tom qab ntawd, Miller qhov yuam kev tau tshwm sim - cov kab mob twb tau koom nrog los ntawm theem 1 ntawm kev puas tsuaj. Txhawm rau paub meej tias nws qhov kev xav, tus kws tshawb fawb tau ua qhov kev sim nthuav dav heev: xyoo 1884 nws tau tswj hwm los tsim cov kab mob hauv cov hniav - nws coj cov hniav noj qab haus huv thiab tso lawv nyob rau hauv ib qho sib xyaw ntawm cov chewed qhob cij, nqaij thiab ib feem me me ntawm cov suab thaj (2- 4%) - rau 3 lub hlis ntawm qhov kub thiab txias 37 ºС. Thiab kho hniav pathology manifested nws tus kheej.
Caries tiag tiag txhim kho ntau zaus ntawm zom thiab ze ze, piv txwv li qhov twg cov kab mob nyob ntau dua thiab cov zaub mov tseem nyob. Tab sis txoj kev xav tsis tau piav qhia ntau lub ntsiab lus: nws tau tsim tias cov tshuaj tiv thaiv ntawm qaub ncaug yog nruab nrab lossis me ntsis alkaline (pH - 6.8-7.0), thiab nws tsis tuaj yeem ua rau enamel demineralization.
Miller txoj kev xav tsis tau piav qhia qhov tseeb xws li kev loj hlob ntawm caries hauv cov neeg uas tsis noj khoom qab zib thiab, ntawm qhov tsis sib xws, nws tsis nyob hauv cov neeg noj zaub mov loj.qhov ntau. Txwv tsis pub: cov xwm txheej hauv lub qhov ncauj tsis zoo ib yam li qhov kev paub.
Qhov ua rau cov kab mob hauv ncauj tsev menyuam yog qhov kev xaiv qhov txhab ntawm qee cov ntsiab lus ntawm cov hniav ntawm cov hniav yog vim demineralization, uas tshwm sim los ntawm kev tsim cov kua qaub hauv cheeb tsam hauv cheeb tsam uas muaj cov quav hniav (yog li- hu ua "dental plaques"). Thiab lawv tsuas yog tshwm sim ntau zaus hauv cheeb tsam tsev menyuam. Raws li kev tshawb fawb ntawm Soviet cov kws sau ntawv (VF Kuskov li al.), tsis tsuas yog streptococci, tab sis kuj muaj lwm cov kab mob muaj peev xwm ferment polysaccharides. Tsis tas li ntawd, "cov quav hniav" tsim cov xwm txheej rau kev kis cov hniav tsis yog rau cov kua qaub xwb, tab sis kuj muaj ntau cov enzymes los ntawm microbes.
Qhov ua rau cov kab mob hauv ncauj tsev menyuam thiab kev kho mob txiav txim siab ib leeg, thiab kev kho tom qab pib nrog kev ntxuav cov hniav sib sib zog nqus.
Hauv kev ua haujlwm xyoo 1928, D. A. Entin tau qhia txog kev nyob ze ntawm cov hniav thiab cov enamel ntawm lub cev muaj pes tsawg leeg ntawm cov qaub ncaug (ib qho cuam tshuam sab nraud cuam tshuam rau cov hniav) thiab cov ntshav (qhov tseem ceeb sab hauv). Nov yog lub hauv paus ntawm nws txoj kev xav ntawm caries.
Nqaij thiab ntshav yog qhov tsis ruaj khov, lawv hloov nrog ntau yam txheej txheem tsis zoo hauv lub cev. Hauv cov kab mob, cov khoom noj khoom haus zoo tshaj plaws ntawm cov ntaub so ntswg cuam tshuam, thiab nws dhau los ua cov kab mob cariogenic.
Tus kws tshawb fawb suav tias cov hniav yog ib qho kev ua rau cov kab mob ib nrab permeable ntawm ciam teb ntawm 2 qhov chaw:
- external - qaub ncaug;
- internal - ntshav thiab qog nqaij hlav ntawm tus hniav.
Nyob ntawm qhov muaj pes tsawg leeg thiab cov khoom qaub ncaug, nws hloovLub xeev ntawm enamel colloids (lawv o los yog wrinkle), thiab lawv permeability kuj hloov.
Cov txheej txheem tiv thaiv nyob rau hauv rooj plaub no hloov nws cov nqi thiab electroosmotic tam sim no, uas ib txwm txav centrifugally los ntawm cov hniav txhuam hniav mus rau enamel thiab muab cov ntaub so ntswg zoo li qub, ntawm no qhov kev txav rov qab pib - centripetal - los ntawm qaub ncaug mus rau lub pulp.
Thaum qhov muaj peev xwm hloov pauv, cov kab mob tau nyiam rau cov enamel, thiab nws cov permeability nce ntxiv ua rau lawv nkag mus.
Nws tau raug pov thawj tias cov txheej txheem no tshwm sim tiag tiag, tab sis tsis muaj cov kab mob hauv zos lawv tsis tshwm sim. Kev vam meej ntawm txoj kev xav - hauv kev piav qhia ntawm kev sib txuas ntawm lub xeev ntawm lub cev thiab kev puas tsuaj, rho tawm - hauv kev xav txog bioprocess nkaus xwb raws li lub cev thiab tshuaj tiv thaiv.
Biological theory
Xyoo 1948, tus kws tshawb fawb Lavxias I. G. Lukomsky tau tso nws txoj kev xav txog qhov tshwm sim ntawm cov kab mob hniav, uas nws tau sib cav tias tus kab mob pib nrog kev tsis txaus ntawm cov vitamins D thiab B1. Kev noj haus ntawm cov hniav hlwb (odontoblasts) yog li cuam tshuam, thiab caries tshwm sim.
Nws cov ntsiab lus yog tias cov enamel tseem nyob nrog kev ua haujlwm zoo ntawm odontoblast. Txoj kev xav tsuas yog keeb kwm txaus siab xwb.
Tseem muaj lub tswv yim ntawm A. E. Sharpenak (1949) - nws tau sib cav tias qhov txuas tseem ceeb hauv kev loj hlob ntawm caries yog kev puas tsuaj ntawm cov protein matrix ntawm cov hniav tawv nqaij. Nws tshwm sim thaum muaj qhov tsis txaus ntawm cov amino acids lysine thiab arginine, nrog rau cov vitamins B.
Tab sis nws tau raug pov thawj tias qhov kev hloov pauv ntawm cov hniav tsis tshwm sim nyob rau theem stain. Kev puas tsuajdentin proteins tsis yog thawj txheej txheem, tab sis nws muaj lub luag haujlwm tseem ceeb hauv kev loj hlob ntawm caries. Kuj tau kuaj pom tseeb los tiv thaiv kab mob ntawm cov vitamin B.
ZNIIS tau tsim lub tswv yim ua haujlwm ntawm cov kab mob ntawm cov hniav caries los ntawm ntau cov ntaub ntawv sib txawv (AI Rybakov, 1967). Nws yog raws li cov ntaub ntawv ntawm qhov tsis sib xws ntawm cov txheej txheem hauv lub neej sib txawv ntawm txoj kev loj hlob. Ntawm no, kev sib cuam tshuam ntawm sab hauv thiab sab nraud yog sau tseg.
Kev tsim ntawm cov kab mob dentoalveolar pib hauv embryogenesis, thiab txij li lub sijhawm ntawd nws yuav tsum xav txog kev kawm txog caries.
4 lub sijhawm tseem ceeb yog qhov txawv:
- intrauterine (txij li 5 lub lis piam mus rau 5 lub hlis);
- lub sijhawm me nyuam yaus thiab hluas, qhov kev hloov kho lub cev loj tshaj plaws (los ntawm 6 hli mus txog 6 xyoo thiab tom qab ntawd mus txog hnub nyoog nees nkaum);
- qhov zoo tshaj plaws lub cev sib npaug hauv lub sijhawm neeg laus (los ntawm 20 txog 40 xyoo);
- ib lub sijhawm nrog los ntawm kev ua haujlwm tsis txaus ntawm lub cev (tom qab 40).
txheej txheem carious yog suav tias yog polyetiological pathological.
Nyob rau theem thawj (los ntawm 6 lub hlis mus rau 6 xyoo), cov kab mob yav dhau los uas tsis muaj kev saib xyuas qhov ncauj, tom deformities, thiab raug mob tuaj yeem ua rau cov kab mob caries.
Thaum muaj hnub nyoog 6-7 xyoo muaj kev noj zaub mov ntau ntxiv thiab muaj cov tshuaj fluorine hauv lub cev tsis txaus. Muaj kev ua txhaum ntawm salivation thiab hloov pauv hauv pH ntawm qhov ncauj kab noj hniav.
Nyob rau lub sijhawm ntawm 12 txog 14 xyoos, cov hniav nyiaj hniav kub ua qhov tseem ceeb dua, feem ntau nyob rau lub sijhawm no. Qhov tshwm sim rau qhov no yog hormonalperestroika.
Thaum muaj hnub nyoog 17-20, hnyav hnyav ntawm lub siab, lub tshuab nqus tsev pib.
Thaum muaj hnub nyoog 20-40 xyoo, cov kab mob somatic, pathologies ntawm cov kab mob dentoalveolar tuaj yeem tshwm sim (cov hniav ntawm cov hniav feem ntau nyuaj, cov ntaub so ntswg raug mob, malocclusion yuav tshwm sim).
Lub sijhawm ntawm lub cev qhuav dej (40 xyoo lossis ntau dua) yog qhov txo qis hauv kev ua haujlwm ntawm kev sib deev thiab lwm cov qog endocrine, kab mob ntawm qhov ncauj.
Lub luag haujlwm ntawm qhov teeb meem no yog kev noj zaub mov tsis txaus thiab kev hloov hauv zos hauv lub qhov ncauj.
Xaus: ob qho tib si dav dav thiab hauv zos provocative ua rau lub luag haujlwm loj hauv keeb kwm ntawm caries.
Cov xwm txheej ntawm caries muaj ntau:
- functional state of the paj hlwb;
- muaj cov kab mob uas ua rau muaj kev hloov pauv hauv cov txheej txheem metabolic;
- kev tsis zoo ntawm kev noj haus;
- kev hloov pauv;
- hormonal ntshawv siab.
Local factor:
- enzymes;
- kab mob cariogenic;
- khoom noj carbohydrate ntau dhau;
- muaj cov quav hniav lossis cov quav hniav;
- malnutrition;
- malaligned hniav nrog neeg coob coob;
- hloov pauv ntawm qhov zoo thiab qhov ntau ntawm cov qaub ncaug;
- kev tsis zoo ntawm cov qauv kho hniav.
Rau qhov tshwm sim ntawm cov kab mob pathology, cov kev pheej hmoo ntawm cov kab mob caries yuav tsum tau suav nrog rau qee theem pib, tom qab ntawd cov enamel pib tawg. Qhov tsis zoo ntawm lub tswv yim ntawm A. I. Rybakov yog kev nplua nuj ntawm lub npe hu ua etiological ua, tab sis lawv tsuas yogpab txhawb es tsis yog qhov laj thawj.
kev txhais lus tam sim no
Txoj kev xav niaj hnub no ntawm qhov tshwm sim ntawm caries, nrhiav tau los ntawm E. V. Borovsky thiab lwm tus kws sau ntawv (1979, 1982), sau txog kab mob raws li qhov tshwm sim ntawm kev cuam tshuam thiab kev cuam tshuam ntawm ntau pawg ntawm yam - dav thiab hauv zos.
Qhov no txhais li cas? Rau cov txheej txheem kev puas tsuaj, yuav tsum muaj kev cuam tshuam rau qhov tshwm sim ntawm cov hniav caries. Qhov no yog qhov yuav tsum tau koom nrog microflora hauv lub qhov ncauj, ua ke nrog glycolysis.
Txoj Cai Kev Kho Mob
Remineralizing kho yog ua nyob rau hauv lub stain theem. Cov kev kho mob muaj 10 cov txheej txheem, thaum lub sij hawm cov hniav yog nourished nrog calcium daim ntaub ntawv, Remodent solutions (ib tug natural kho) thiab fluorine-muaj kev npaj (sodium fluoride 2-4%). Nws yog qhov zoo dua los kho los ntawm kws kho hniav hauv tsev kho mob, leej twg yuav ua ntej ntxuav cov hniav, tom qab ntawd etch lub ntsej muag nrog citric acid, yaug nrog dej thiab siv cov tshuaj 10% calcium gluconate lossis hydrochloride rau 15 feeb.
Ua tiav nrog ntau qib ntawm cov txheej txheem tsis zoo: kab mob sab nraud, nruab nrab thiab tob. Cov ntaub so ntswg raug tshem tawm, thiab cov kab noj hniav nws tus kheej raug kaw.
kauj ruam:
- Ntxuav tus neeg mob cov quav hniav thiab cov hniav uas nyob ib sab. Muaj ntau txoj hauv kev: ultrasound rau cov quav hniav tawv, rau cov quav hniav mos - abrasive pastes lossis txhuam.
- Cov xim ntawm cov hniav yog txiav txim siab ntawm qhov tshwj xeeb - qhov no yog qhov tsim nyog rau kev xaiv qhov ntxoov ntxoo ntawm cov khoom ntim.
- pain nyem - tshuaj loog hauv zos.
- Drilling ntawm carious cov ntaub so ntswg - kab noj hniav yog muab qhov tseeb zoo nrog drilling ntawm overhanging npoo ntawm cov enamel.
- Tom qab ntawd txhua qhov carious dentin raug tshem tawm. Yog tias tsawg kawg yog ib qho khoom seem, pulpitis lossis periodontitis yuav tsim nyob rau hauv qhov txhaws.
- Kev sib cais ntawm cov qaub ncaug yog ib theem tseem ceeb! Yav dhau los, qhov no tau ua tiav nrog cov paj rwb tsis zoo, rau 10 xyoo dhau los los ntawm Cofferdam. Nws yog ib zaj duab xis latex nrog lub qhov rau cov hniav.
- Tom ntej no, cov kab noj hniav uas twb muaj lawm yog kho nrog tshuaj tua kab mob.
- Tom qab ntawd etching cov enamel nrog phosphoric acid gel kom cov nplaum (qee yam zoo li cov kua nplaum) tuaj yeem xa mus rau hauv cov ntaub so ntswg. Tom qab soaking, nws yog illuminated los ntawm ib tug photopolymerization teeb.
- Siv lub gasket nyob rau hauv lub foob - nws muab tso rau hauv qab thiab ua hauj lwm raws li ib tug insulator. Qhov no yog tsim nyog los tsim ib lub foob.
- Filling - nws rov kho cov hniav ntawm cov hniav thiab nws zom zaws. Cov khoom muaj pes tsawg leeg yog tsim los ntawm cov khoom siv photopolymer composite. Txhua txheej yog siv ua ntu zus thiab kho nrog lub teeb kho kom kho.
- Sib tsoo thiab txhuam hniav ua tiav cov txheej txheem kho.
Laser kho mob
Lub ntsiab ntxiv yog tias nws tsis mob kiag li thiab tsis muaj microtraumas ntawm cov enamel. Nyob rau tib lub sijhawm, kev ua kom tsis muaj menyuam tshwm sim, yog li microbes tsis nkag mus rau hauv lub foob.
Ozone kho
Ozone rhuav tshem cov kab mob tag nrho. Cov ntaub so ntswg noj qab haus huv tsis cuam tshuam. Txoj kev siv taurau thawj kab mob.
Infiltration
Ib qho tshwj xeeb gel yog siv rau cov hniav uas cuam tshuam, cov khoom ntawm cov tshuaj tiv thaiv nrog cov enamel. Lawv tsuas yog yaj cov chaw cuam tshuam. Tom qab ntawd, qhov saum npoo yog ntxuav nrog cawv thiab qhuav. Tsis muaj qhov mob, thiab tag nrho cov txheej txheem yuav kav tsis ntev tshaj 15 feeb.
Air blasting
Yog tias cov kab mob tseem tsis tau nyob rau hauv daim ntawv siab, cov kab noj hniav me tuaj yeem ntxuav tau los ntawm kev ua pa tawm ntawm cov enamel. Lub dav hlau muaj zog ntawm aluminium oxide hais nrog lub dav hlau ncaj qha nyob rau hauv lub siab tsoo tawm cov ntaub so ntswg puas, thiab cov khoom noj qab haus huv tseem nyob.
Tam sim no koj paub txog qhov ua rau caries thiab kev kho hniav pathology. Caries yog kab mob polyetiological. Niaj hnub no, kev kho mob nrog kev xyaum ua tiav txhua qhov chaw. Cov txheej txheem niaj hnub no tsuas yog siv los tiv thaiv.
