S T O M A T O L O G Y

MASARYK UNIVERSITY
Faculty of Medicine
S T O M A T O L O G Y
FOR STUDENTS OF GENERAL MEDICINE
Authors: Professor Josef Bilder, M.D.
Assoc. Prof. Boris Bílý, M.D.
Assoc. Prof. Zde?ka Hala?ková, M.D.
Vladimír Ko?ut, M.D.
Professor Martina Kukletová, M.D.
Assoc. Prof. Milan Machálka, M.D.
Marie Pokorná, M.D.
V?ra Sazmová, M.D.
Assoc. Prof. Ji?í Van?k, M.D. 1997 TABLE OF CONTENTS 1. Introduction to Stomatology (V. Ko?ut) 6
1.1 Classification of Stomatology 6
1.2 Examination of Patients 7
1.3 Biological Testing of Dental Materials (J. Van?k) 9
2. Basics of Restorative Stomatology (Z. Hala?ková) 14
2.1 Dental Caries and Associated Issues 14
2.1.1 Diseases of the Pulp 19
2.1.2 Periodontitis 21
2.2 Focal Dental Infections 23
2.3 Special Aspects of Children's Treatment (M. Kukletová) 24
2.3.1 Restorative Stomatology 26
2.3.2 Surgical Stomatology 28
2.3.3 Stomatologic Prosthetics 30
2.3.4 Periodontics 31
2.3.5 Treatment of Non-cooperating Patients 32
2.3.6 Disorders of Teeth Development 32
3. Periodontal Diseases (V. Sazmová) 33
3.1 Factors Causing Parodontopathies 35
3.2 Classification of Parodontopathies According to the Czech
Nomenclature 36
3.3 Prevention of Parodontopathies 43
4. Diseases of Oral Mucosa (V. Sazmová) 45
4.1 Etiology of Mucous Diseases 45
4.2 The Selected Disorders of Oral Mucosa 45
4.3 Profession-related Changes in the Oral Cavity 50
4.4 Manifestations of AIDS on the Oral Cavity Mucosa 51
5. Prosthetic Dentistry (B. Bílý) 52
5.1 Types of Dentures: Fixed Dental Prostheses 53
5.2 Removable Prostheses 54
5.3 Surgical
Dentures....................................................................
................58
5.4 Damage of Tissues by Dentures and Its Prevention 58
6. Dental Implantology (J. Van?k) 60
6.1 Classification of Implants, Properties of Materials, Biocompatibility
61
6.2 Indication, Contraindication 63
7. Orthopedics of Jaws (M. Pokorná) 66
7.1 Orthodontic Anomalies 66
7.2 Classification of Orthodontic Anomalies 68
7.2.1 Anomalies of Teeth Positions 68
7.2.2 Anomalies of Dental Arches Relationships 68
7.2.3 Disorders of the Facial Skeleton Structure and Growth 69
7.3 Therapy of Orthodontic Anomalies 70
7.4 Cleft Disorders 72
8. Basics of Dento-alveolar Surgery (V. Ko?ut) 76
8.1 Teeth Extraction 76
8.2 Anesthesia at Dentistry 77
8.3 Complications of Teeth Extractions 81
8.4 Diseases of the Mandibular Joint 84
8.5 Contracture of Jaw Muscles 85
8.6 Inflammations Around the Jaws 86
8.7 Osteitis and Osteomyelitis of the Jawbones 89
9. Diseases of Salivary Glands (V. Sazmová) 92
9.1 Salivary Glands Functions 92
9.2 Examinations of Sialopathies 92
9.3 Inflammations of Salivary Glands 93
9.4 Sialoses 97
9.5 Sialolithiasis 98
9.6 Tumors of Salivary Glands 99
9.7 Cysts of Salivary Glands 100
9.8 Injuries of Salivary Glands 101
10. Traumatology of the Facial Skeleton and the Teeth (M. Machálka)
102
10.1 Statistical Analysis of Causes of Facial Injuries 102
10.2 First Aid During Facial Injuries 103
10.3 Mandibular Fractures 105
10.4 Luxation of the Lower Jaw 113
10.5 Injuries of the Middle Third of the Face 114
10.5.1 Classification of Fractures of the Middle Facial Third 117
10.5.2 Therapy of Fractures of the Middle Facial Third 123
10.6 Healing of Fractures 126
10.7 Injuries of the Teeth 129
10.8 Injuries of Soft Tissues 130
10.9 Brain Damage 131
10.10 A Traumatic Shock 134
10.11 Polytraumas 136
11. Tumors of the Head and the Neck (J. Bilder) 138
11.1 Epidemiology 138
11.2 Diagnosis and Staging 139
11.3 Oncological Prevention in Stomatology 141
11.4 General Rules of Tumor Therapy 146
11.5 Oro-facial Precancerous States 149
11.6 Survey of the Oro-facial Tumors 155 1. Introduction to Stomatology
Stomatology is one of the basic medical fields. It studies
diagnostics, treatment and prevention of diseases affecting teeth, oral
cavity and tissues and organs which are topographically associated with it.
Stomatology services are provided mainly in the form of an outpatient care,
just a small part of the care is provided by inpatient stomatological
facilities.
Today's stomatology is a field that employs exclusively university-
educated professionals, i.e. doctors after graduation from five to six
years long studies at a university.
A doctor-stomatologist's coworkers are health services staff: a
nurse, a dental technician, an X-ray technician, and a dental hygienist.
1.1 Classification of Stomatology Among the basic stomatological fields there are therapeutic
stomatology, orthopedic stomatology, and surgical stomatology. Therapeutic
stomatology (protective, conserving stomatology) deals with the
diagnostics, treatment and prevention of a dental decay and its
complications. Associated with this basic stomatology branch there are:
children's stomatology (pedostomatology, pedodontics) that deals with the
care of the milk dentition or the developing permanent dentition of
youngsters.
Periodontics deals with diseases of the periodontium tissues and the oral
cavity mucous membrane diseases.
Orthopedic stomatology (dental prosthetics) deals with the replacement of
parts of crowns, individual teeth losses or provides for the total
replacement of lost teeth by the production and application of various
dental prostheses (crowns, bridges, removable dentures). An individual
specialty is orthodontics (othopedics of jaws) that deals with the
diagnostics, treatment and prevention of irregularities of the individual
teeth, groups of teeth and anomalies of jaws.
Surgical stomatology deals with the surgical treatment of the oral cavity
diseases (dentoalveolar surgery) or as a specialty (maxillofacial surgery)
provides for surgical treatment of larger orofacial diseases, mainly in the
form of the inpatient care.
A graduate of the stomatology studies is prepared both theoretically and
practically for the praxis in prevention and cure in the basic stomatology
fields. He or she receives only general knowledge in the specialized
disciplines that allow for a responsible decision of a consequent treatment
at highly specialized dental offices. As a graduate student he or she can
receive a higher degree of qualification after passing necessary
examinations and continue to work as a specialist in othodontics or
maxillofacial surgery fields.
1.2 Examination of Patients An examination should be conducted under a proper lighting, with a
patient sitting at the chair of the stomatological unitunit, by examination
tools (dental mirror, dental probe, dental forceps). Results of an
examination should be entered into a patient's medical record which serves
for preparing a treatment plan. The first part of an examination is the
anamnesis (case history). This part collects data that are related to a
patients current illness and could influence a way of patient's treatment.
Social anamnesis. Some data may indicate professional risks: e.g. higher
cariousness at bakers or confectioners. Data about a patient's habits may
also be significant (smoking, drinking hard spiritsliquors), in relation to
pre-cancerous states and malignant tumors.
Family anamnesis collects data on previous illnesses, surgeries and
injuries. Data on cardiovascular diseases, metabolic disorders (diabetes,
thyropathy), blood or hemocoagulation changes, allergic or paroxysmal
states etc. Sometimes it is necessary to request a written report on a
patient's condition from a specialist. This report must state a proposed
extent of a surgical treatment to be conducted.
Stomatologic anamnesis focuses on previous illnesses, surgeries or
injuries of the orofacial area, about previous orthodontic, prosthetic
treatments or dental surgeries, and about hygiene habits.
Extra-oral examination uses methods that are common in medicine, e.g.
aspection, palpation, and also auscultation in the mandibular joint area.
Careful examination and a qualified evaluation of its results may suggest a
lot on the nature of a patient's illness.
During an intra-oral examination, an attention is paid to the whole oral
cavity. Not only the teeth should be examined, but also the mucosa of
alveolar ridges, the tongue, the oral cavity base and the cheeks.
Attention should also be paid to the ducts of large salivary glands and the
appearance of saliva. Individual teeth are examined with the aid of the
dental mirror and the probe so that all tooth surfaces can be inspected.
The teeth of the permanent dentition are labeled with Arabic numbers from 1
to 8, milk dentition teeth are labeled by roman numerals from I to V. At
present, the most frequently used numbering is that recommended by the
international stomatology organization FDI (F(deration Dentaire
Internationale). The quadrants of upper and lower jaws are labeled with
numbers both for milk and permanent teeth. The permanent dentition
quadrants are labeled as follows: upper jaw right side left side
1 2
lower jaw 4 3 The milk dentition quadrant labeling is the following: upper jaw right side left side
5 6
lower jaw 8 7 The quadrant num