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口腔护理与保健(下)
作者:home99
发表时间:2015-12-25
更新时间:2015-12-25
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这是最后一部分,但愿对大家有些参考啊,呵呵。

●Oral Treatments口腔治疗
●Oral Health Care during Pregnancy怀孕期间的口腔护理

―――――――――――――――――――――――――――――――――――――――
Oral Treatments口腔治疗

★Oral Treatments─Filling – restore decayed tooth 口腔治疗─补牙─修补蛀牙
★Filling – to restore the aesthetics of teeth 口腔治疗─补牙─修复牙齿外观
★Oral Treatments─Dental Implant 口腔治疗─种牙
★Oral Treatments─Laminate Veneer 口腔治疗─贴面修复
★Oral Treatments─Scaling 口腔治疗─洗牙
★Oral Treatments─Bleaching 口腔治疗─牙齿漂白
★Oral Treatments─Orthodontic Treatment 口腔治疗─牙齿矫正治疗
★Oral Treatments─Extraction 口腔治疗─脱牙
★Oral Treatments─Crown 口腔治疗─镶配人造牙冠
★Oral Treatments─Bridge 口腔治疗─镶配牙挢
★Oral Treatments─Denture 口腔治疗─镶配假牙托

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Oral Treatments─Filling – restore decayed tooth 口腔治疗─补牙─修补蛀牙

A. Purpose  目的
●To restore the anatomy and function of the tooth 恢复牙齿的形状和功能
●To preserve the tooth and prevent complications 防止牙齿组织继续受破坏
●To control pain 止痛
●To prevent early loss of deciduous teeth that may result in alignment problem in the permanent teeth 修补乳齿以免乳齿过早脱落导致恒齿排列不整齐

B. Materials 物料

1. Amalgam 汞合金
Amalgam has been used as a dental filling material for more than 150 years. 历史悠久,用作补牙物料已有150年

Composition: An alloy of mainly silver, tin, copper and mercury 成分:由银、锡、铜及水银混合而成

Properties 特性
●Hard and durable; high wear resistance 坚固、不易耗损
●Easy to use 容易使用
●Safe 安全

Amalgam safety: 汞合金的安全性
The followings are some queries about amalgam: 以下是一般人对汞合金的疑问:
●Mercury, which is poisonous, is used in dental amalgam. Is amalgam filling safe? 汞合金含有水银,而水银是有毒的,用汞合金是否安全?
Amalgam contains various metals such as silver, copper and tin, as well as mercury. When mercury is combined with these metals, it becomes an inactive stable substance. Only under unusually great pressure or abrasion will the amalgam release a minute amount of mercury vapour. As compared to the daily dosage of mercury being absorbed from the environment, such as food, water and air, the minuscule amount of mercury released from the amalgam fillings is insignificant. 汞合金是由不同成分的金属混合而成,如白银 、铜、锡及水银等 。水银与其他金属混合後,会变得十分稳定。只有在巨大的压力和磨损下,汞合金才会释出非常微量的水银。相比人体每天从食物、食水及空气所吸收的水银分量, 汞合金所释出的水银含量是微不足道的。
●Should people have the amalgam fillings in their mouths removed in order to prevent certain serious illnesses such as Alzheimer's disease? 病人应否移除口腔内的汞合金,以免患上一些严重疾病如老人痴呆症等?
There is no scientific literature or evidence which shows that the removal of amalgam fillings helps patients recover from their illnesses, nor is there any evidence which suggests such a relationship. Unless there is an allergic reaction, it is not advisable to have amalgam fillings replaced because of the following reasons: 暂时没有科学文献证实移除汞合金能使病人所患的疾病痊愈,亦没有证据显示两者有直接关系。除非病人对汞合金有过敏反应,否则都不适宜把汞合金更换。原因如下:
──Replacement of filling materials will lead to further loss of tooth structure. 更换补牙物料会导致更多牙齿组织受破坏
──Amalgam is still the most preferred filling material owing to its safety and effectiveness. Tooth-coloured filling material such as composite is not as resistant to stress as amalgam and is not suitable for large cavities. Gold is an effective material, but it is expensive. 到现时为止,汞合金是最安全和有效的补牙物料。其他补牙物料如复合树脂,耐用程度不及汞合金,亦不适用於填补太大的牙洞。一些金属物料如黄金,亦是有效的补牙物料,但价钱却十分昂贵。
●Are some people allergic to amalgam?  是否有些人对汞合金会产生过敏反应?
Allergic reaction to amalgam is very rare. Within 150 years of usage, there were only 100 documented cases. This type of patients should use other filling materials.  只有极少数的人会对汞合金有过敏反应 (在使用超过150年内,只有100宗个案纪录)。这类病人应选择使用其他补牙物料。

Disadvantage:  缺点
The greyish-silver colour of amalgam is not aesthetically appealing.  银灰色,作为补牙物料则不太美观

Application:  应用
It's mainly used for restoring back teeth where stress load is high.  修补後面的牙齿,可承受较强咬合力

Procedures for amalgam filling:  治疗程序
●First remove decayed tooth substances 先把牙齿蛀坏的部分除去
●Amalgam is placed into the tooth cavity 用汞合金充填牙洞
●The filling is shaped, excessive material is trimmed off and the filling is polished 修饰及打磨补牙物料

2. Composite  复合树脂
It has been in use for over 40 years and has been undergoing improvement in the past 10 years. 面世约40年,在近10年内不断改善

Composition 成分
A substance made up of acrylic resin filled with inorganic substances such as glass, quartz as additives to enhance the strength 以丙烯酸树脂为基础,加入玻璃、石英等微粒作强化用途

Properties 特性
Aesthetic; colour is similar to natural tooth, but will be stained by food colour after having been in use for a period of time 美观,接近牙齿天然的颜色,适合修补前面的牙齿

Disadvantage 缺点
Not as hard as amalgam 强度比汞合金稍弱

Application 应用
●To restore decayed teeth 修补蛀牙
●To restore the aesthetics of the teeth, such as to modify the shape, size and colour of the teeth 修复牙齿外观,例如改善牙齿的形状、大小和颜色

Procedures for composite filling 治疗程序
●Decayed or weakened portion of the tooth is removed 假如用作修补蛀牙的话,先把牙齿蛀坏的部分清除,或把牙齿极脆弱的部分除去
●Tooth surface is etched with diluted acid (for example, 30% phosphoric acid) 用稀释的酸液 (例如30%磷酸) 酸蚀牙齿表面,然後再冲洗吹乾
●Tooth adhesive is applied on the prepared tooth 在已酸蚀的牙齿表面涂上黏固剂
●Composite is placed onto the prepared tooth and the restoration is shaped 用复合树脂充填牙洞,修补牙齿缺失部分
●Filling is hardened by using a light curing instrument 用光固化仪器使复合树脂凝固
●Excessive material is trimmed off and the restoration is polished 修饰及打磨补牙物料

3. Glass Ionomer Cement 玻璃离子水门汀
It has been in use for over 20 years and has been improved in recent years. 面世约20年,近年不断改进

Composition: A substance is made up of aluminosilicate glass powder and a liquid polyacrylic acid 成分:主要由铝 玻璃和多丙烯酸混合而成的化合物

Properties:  特性
●Aesthetic; colour is similar to natural tooth, but lack of translucency 美观,接近牙齿天然的颜色,但不像牙齿般通透
●Bonds to the tooth 能黏贴牙齿表面
●Fluoride releasing — prevents recurrent Dental Caries around the filling material 能释出氟化物,防止物料与牙齿连接处发生蛀牙

Disadvantage:Inadequate strength, low wear resistance, not durable 缺点:物料强度较低,容易耗损,不耐用

Application 应用
To restore abraded teeth 修补耗蚀的牙齿
Because it is not durable, it serves as a transitional filling for deciduous teeth 由於耐用性较低,多用作半永久物料修补乳齿,因为乳齿会在年幼时替换

Procedures for Glass Ionomer Cement filling:  治疗程序
●Decay is removed 把牙齿蛀坏的部分清除
●Glass ionomer cement is placed onto the prepared tooth and the restoration is shaped 用玻离子水门汀充填牙洞
●Filling is hardened by a light curing instrument 用光固化仪器使物料凝固
●Excessive material is trimmed off and the restoration is polished 修饰及打磨补牙物料

4. Compomer 玻璃离子树脂
A newly developed material in recent years 是近年面世的产品

Composition: It is a mixture of composite and glass ionomer cement. 成分 : 由玻璃离子水门汀和复合树脂混合而成

Properties 特性
●It possesses the properties of both composite and glass ionomer cement 具有玻璃离子水门汀和复合树脂的特性
●Improved aesthetics and better wear resistance than glass ionomer cement but not as good as composite 美观、耐损程度比玻璃离子水门汀优胜,但比不上复合树脂
●Easy manipulation — as easy as glass ionomer cement but not as critical as composite 较复合树脂容易使用

Application 应用
Used as transitional filling for deciduous dentition 作为半永久物料修补乳齿,因为乳齿会在年幼时替换

Procedures for Compomer filling  过程
●Decay is removed 先把牙齿蛀坏的部分清除
●Tooth adhesive is placed on the prepared tooth 在牙齿表面涂上黏固剂
●Compomer is placed onto the prepared tooth and the restoration is shaped 用玻璃离子树脂充填牙洞
●Filling is hardened by using a light curing instrument 用光固化仪器令物料凝固
●Excessive material is trimmed off and the restoration is polished 修饰及打磨补牙物料

5. Stainless Steel Crown  镶配不锈钢人造牙冠
Silver in color, fixed sizes, and usually used for molars of deciduous teeth 颜色:银色,有固定的尺码,通常用於乳齿的臼齿。

Procedures for stainless steel crown:  镶制程序
●A thin layer of the tooth is removed. 适当地磨细牙齿
●The stainless steel crown with the right size that fits the tooth most is chosen. 选择最合尺码的不锈钢人造牙冠
●The crown is then trimmed according to the contour of the tooth. 根据牙齿形状裁剪不锈钢人造牙冠
●The tooth surface is cleaned. 清洁该牙齿
●The crown is cemented onto the tooth. 用黏合剂把人造牙冠固定在牙齿上

C. Discomfort after filling 补牙後感到牙齿不适

Generally speaking, it may take several days to one week's time to get used to the new filling. Since decayed tooth structure is removed during the filling process, the tooth may become more sensitive. The discomfort should subside as time goes by. If the situation doesn't improve or even worsens, you should see a dentist to seek for a detailed check-up. 一般而言,牙齿经过修补後可能需要几天到一星期时间适应新的补牙物料。此外,在修补蛀牙的过程中,需要先清除已蛀坏的牙齿组织,因此, 亦可能导致牙齿对外界的刺激比较敏感,容易感到酸软、无力。然而这些不适是会随着时间而减少。但如果情况持续没有改善,或愈来愈严重,就应往见牙科医生, 作详细检查。

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Filling – to restore the aesthetics of teeth 补牙─修复牙齿外观

A. Purpose  目的
●To restore a fractured tooth 把崩缺的牙齿修补,使它回复原来形状
●To build up an unusually small tooth to improve appearance 把细小的牙齿增大,以改善外观
●To close an interdental space by building up the two adjacent teeth 把牙缝两旁的牙齿增大一点,使牙缝缩小
●To cover a discolored tooth 遮盖牙齿的色斑

B. Materials  物料

1. Composite  复合树脂

2. Porcelain  瓷

Properties 特性
●Aesthetic — the colour and translucency can match the natural teeth 美观,颜色及通透程度接近真牙齿
●The material is not easily stained 牙渍不容易沉积
●Hard and high in wear resistance 坚硬,不易耗损

Disadvantage  缺点
●Brittle and suitable for non-stress bearing area only 质地较脆弱,容易碎裂
●Certain thickness of tooth substance has to be removed in order to provide enough bulk of the material 需要一定厚度,因此要把牙齿多磨去一些

Application  应用
●Tooth veneer or crown 可用作瓷贴面或瓷人造牙冠
●To restore teeth with high aesthetic requirement, especially the front teeth 适用於前面的牙齿,因为前牙在美观方面的要求较高

Procedures for porcelain laminate veneer  瓷贴面 (烤瓷贴面/瓷片) 镶制程序
●A thin layer of tooth substance is removed from the facial surface of the tooth. 在前面的牙齿表面磨去少许
●Impressions of the upper and lower teeth are taken and the bite registration is recorded. 印制牙模及套取牙齿咬合位置
●The veneer is fabricated in the dental laboratory. 在牙科工场内铸做瓷贴面
●Tooth surface is cleaned before cementing the veneer. 配前,清洁有关的牙齿
●Tooth surface is etched and treated with diluted acid such as 30% phosphoric acid. 用稀释的酸剂 (例如30%磷酸)酸蚀牙齿表面
●The veneer is cemented onto the tooth. 利用复合树脂把牙齿及瓷贴面黏合一起

Procedures for porcelain crown  瓷人造牙冠镶制程序
●A layer of tooth substance is removed. 磨细牙齿
●Impressions of the upper and lower dental arches are taken and the bite registration is taken. The prepared tooth will be protected by a temporary crown. 印制上下牙模及套取牙齿咬合的位置,磨细的牙齿需要套上临时牙冠
●The porcelain crown is fabricated in the dental laboratory. 在牙科工场内铸造瓷人造牙冠
●Temporary crown is removed and the tooth surface is cleaned. 拆除临时牙冠,清洁该牙齿
●The crown is cemented onto the tooth. 用黏合剂把人造牙冠固定在牙齿上

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Oral Treatments─Dental Implant 口腔治疗─种牙

A dental implant is a biocompatible (titanium) structure implanted in the jawbone which is used to support false teeth, such as denture, bridge or crown.  种牙是把身体能接受的物料如钛金属,植入牙槽骨内,作为口腔内支撑假牙的部分,然後在植体上镶嵌人造牙冠、牙挢或放置假牙托

Properties  特点
●Do not need to remove tooth substances from neighbouring teeth. 不需磨损邻近牙齿
●Can be cleaned just like any tooth. No special cleaning method is needed. 不需使用特别的方法清洁,如清洁真牙齿一样便可

Disadvantage  缺点
●Relatively expensive 价钱比较昂贵
●Surgical procedure is needed 需要接受小手术
●Not everyone is suitable to have an implant 不是每一个人都适合接受种牙

A. Purpose  目的

To provide anchor and support to the false teeth without injuring the remaining teeth in the mouth 以不需要磨损邻近牙齿的方法,填补失去的牙齿,或配合牙挢或假牙托的使用,填补多只或全部失去的牙齿。

B. Mechanism  原理

Owing to the biocompatibility of titanium implants, the bone becomes united with the implants and the implants can serve as the roots to retain and support false teeth. 利用金属植体放在牙槽骨内,作用就如牙齿的牙根一样,作假牙的锚基,令假牙稳固。

C. Material  物料
Titanium 钛金属

D. Procedures for dental implant  植牙程序

★A standard procedure 一般植牙程序

●Thorough examination 详细检查
First of all, a detailed oral examination is performed including X-ray examination, and CT (Computerised Tomography) scan to determine the position and angulations to place the titanium implants. 先进行详细的口腔检查,包括X光检查、上下颌骨横切面电脑扫描等,以确定钛金属植入颌骨的位置及角度。

●Surgery 手术部分
──The gum flap is raised and holes are drilled into the jawbone at the pre-determined positions and angulations. Then the dental implants are inserted into the holes and the gum flap is closed and held to the original position by sutures. 翻开牙龈,并在预定的位置及角度钻洞,嵌入植体,然後把牙龈缝合。
──The jawbone will unite with the dental implants within 3 to 6 months. At this time, the small piece of gum covering the dental implant will be removed and a healing component will be inserted onto the dental implants. This allows the gum to heal in a better shape around the dental implants. 在3 至6 个月内,牙槽骨会和植体愈合,连结成一体。这时便可把植体上的一块牙龈切除,然後在植体上套上牙龈愈合装置,让环绕着植体的牙龈愈合

●False teeth fitting 假牙部分
──When the gums around the dental implants heal, the healing component will be replaced by an impression component. Impressions of the dental arches are taken. The impression component transfers the position and the angulations of the dental implant to the dental impression. 当牙龈愈合後,植体上的牙龈愈合装置会被印模装置代替,以便把植体的位置及角度复印到牙模上
──In the dental laboratory, the false teeth (denture, crown or bridge) are fabricated. 在牙模上铸造假牙
──The false teeth are fixed onto the dental implants. 把假牙固定在植体上

★The other method 其它方法
●The One-Stage Surgical procedure is done by placing the healing abutment onto the implant at the same time during the first surgery. 一次性种植系统的手术是在同一次手术中嵌入植体并装上愈合装置
──Eliminates the need for a second surgery 不需要进行另一次手术
●The immediately loaded implant procedure is done by placing the prosthesis at the same time when the implant is inserted. 当嵌入植体后,立即装上牙套
──Patient makes only one trip to the dentist and leaves with “teeth” inserted 只需接受一次治疗便可完成整个植牙过程
●Immediate implant procedure is done by immediately inserting the implant into the socket right after an extraction. 于脱牙后即时放入植体

E. Which kind of dental implant is suitable for you? 那一种植牙方法适合你?

The choice of implant systems and procedure depends on the condition of the jaw bone and the patient, the training of the dentist, cost, etc. Please discuss with your dentist to make the appropriate choice. 采用那一种植牙方法及治疗程序,须视乎个别人士的身体及颌骨状况、牙科医生所接受过的专业训练以及费用而定。你可先向你的牙科医生查询,然后作出选择。

F. Points to note after insertion of dental implant  种牙後注意事项
●Teeth must be cleaned thoroughly to avoid gingival infections around the implant which can cause the implant to loosen. 必须彻底清洁牙齿,避免环绕着植体的牙龈发炎,导致植体松动。
●Regular recall and cleaning by dental professionals is also very important after inserting dental implant. 接受植牙手术之后,你必须定期往见牙科医生,接受跟进和洗牙以保持口腔卫生。

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Oral Treatments─Laminate Veneer 口腔治疗─贴面修复

Laminate veneer is a technique that involves bonding of a veneer onto the tooth surface by composite resin. It requires just very little removal of tooth structure. 贴面修复是采用黏合技术,在不耗损或尽量减少耗损牙齿表面的情况下,用复合树脂把贴面黏合在牙面上。

A. Purpose  目的
●To improve the aesthetics of teeth, such as shape, size and colour 改良牙齿外观,如形状、大小和颜色
●To close up space between teeth 收窄牙缝
●To cover discoloured teeth 遮盖已变色的牙齿
●To restore the strength of teeth 使牙齿回复强度

B. Application  应用
Front teeth - the outer surface 前面的牙齿 外侧面

C. Material  物料
Porcelain 瓷

D. Procedures for porcelain laminate veneer 瓷贴面 制程序
●A thin layer of tooth substance is removed from the facial surface of the tooth. 在前面的牙齿表面磨去少许
●Impressions of the upper and lower teeth are taken and the bite registration is recorded. 印制牙模及套取牙齿咬合位置
●The veneer is fabricated in the dental laboratory. 在牙科工场内铸做瓷贴面
●Tooth surface is cleaned before bonding the veneer. 镶配前,清洁有关的牙齿
●Tooth surface is etched and treated with diluted acid such as 30% phosphoric acid. 用稀释的酸剂 (例如30%磷酸)酸蚀牙齿表面
●The veneer is bonded onto the tooth. 利用复合树脂把牙齿及瓷贴面黏合一起

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Oral Treatments─Scaling 口腔治疗─洗牙

Scaling involves the removal of dental plaque, calculus and stains from the tooth surfaces so that the teeth become clean and smooth. 洗牙是清除黏附在牙齿表面的牙菌膜、牙石和牙渍,使牙齿乾净和平滑。

A. Purpose  目的
To remove dental plaque, calculus and stains to prevent periodontal disease 清除积聚在牙齿表面的牙菌膜、牙石和牙渍,减少患上牙周病的机会。

B. Procedures for scaling  治疗程序
●Hand instrument or ultrasonic cleaning device is used to remove plaque, calculus or stain from the tooth surfaces. 用牙科工具或超声波洗牙机,将牢固的牙石清除
●A special cleaning paste is used to polish the tooth surfaces until they are clean and smooth. 以牙科用浮石粉打磨牙齿表面,或利用空气将细小的苏打粉末﹝碳酸氢钠﹞混合物与水混合後,由喷嘴高速喷向牙齿表面,去除牙渍及保持牙面平滑。

C. Points to note after scaling 洗牙後注意事项
If you have Periodontal Disease, you may experience slight discomfort and gum bleeding for a few days after scaling. However, you should still pay attention to clean your teeth properly. The situation will gradually get better. 若患上牙周病,洗牙後的数天内,可能感到口腔轻微不适及有牙龈出血的现象,但仍需注意口腔卫生,口腔不适及牙龈出血现象便会逐渐消失,牙龈亦会回复健康。

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Oral Treatments─Bleaching 口腔治疗─牙齿漂白

Bleaching refers to the process of lightening the stains or colours inside enamel or dentine by using chemical agents. 牙齿漂白是利用化学剂淡化牙齿的珐琅质或象牙质内的色素或色斑

A. Purpose  目的
To whiten teeth and regain the normal colour of the teeth 令牙齿美白,回复牙齿正常的颜色

B. Application  应用
Vital tooth 牙髓未坏死的牙齿
Non-vital tooth treated by root canal therapy 牙髓已坏死 / 曾接受牙髓治疗的牙齿

C. Mechanism  原理
Bleaching agents are used to oxidize the colour pigments in the discoloured teeth in order to whiten these teeth. 利用漂白剂氧化导致牙齿变色的色素,达到漂白效果

D. Material  物料
Bleaching agents contain chemicals such as Carbamide Peroxide, Hydrogen Peroxide Hypochlorite, etc. 牙齿漂白剂含有氧化功效的化学物质,例如:过氧化碳醯二胺、过氧化氢、低氧化氯等

E. Procedures for bleaching 治疗程序
●Bleaching vital tooth 牙髓未坏死的牙齿漂白
Dentist will use different bleaching methods according to various oral conditions: 牙科医生会因应不同的口腔情况而采用不同的漂白治疗方法:
──Impressions of teeth are taken to make a model. A custom whitening tray is constructed from this model. The trays are filled with a gentle whitening solution, and are inserted and worn over the teeth overnight. The patient should wear the tray every night according to the dentist's instructions and return to the dentist for follow-up appointments according to schedule. 牙科医生替病人印牙模,然後度身订造一个盛载牙齿漂白剂的托盘。病人须按照指示,每晚把牙齿漂白剂放在托盘内漂白牙齿,并且在指定疗程後覆诊。
──In the dental clinic, the dentist will use a strong light to catalyse the highly concentrated bleaching agents to whiten teeth. 牙科医生利用强光催化高浓度的牙齿漂白剂使牙齿变白。
Treatment duration: 3 to 6 months 疗程:3至6个月
●Bleaching of non-vital tooth treated by root canal therapy  牙髓已坏死 / 牙齿曾接受牙髓治疗的牙齿漂白
──Endodontic treatment(Root canal therapy) of the tooth must be completed. 牙齿必须先接受牙髓治疗
──A cotton pellet with whitening agent is first placed inside the pulp chamber and the tooth is then filled. 在牙冠髓腔内放置吸满牙齿漂白剂的棉花球,然後把牙齿填封
──Visit dentist periodically to check the progress of bleaching, and change the cotton pellet with whitening agent according to needs. The cotton pellet is removed after the bleaching process is finished and the tooth is then restored. 定期往牙科诊所检查漂白效果,视乎情况需要更换吸满牙齿漂白剂的棉花球。直至漂白进程完成,便可取出棉花球,把牙齿修补。
Treatment duration: The treatment ends when the stains or colours are lightened, which takes approximately 1 - 3 months 疗程:直到色素淡化停止便告完成,大约需1 至3 个月

F. Points to note before using bleaching agents  使用牙齿漂白剂前注意事项
●Not all stains/colours could be removed. 不是所有色斑或色素都可以淡化
●Improper use of bleaching agents will damage gums and tooth supporting tissues. Be careful when using bleaching agents and consult your dentist for proper usage of bleaching agents. 使用牙齿漂白剂前,必须先向牙科医生徵询正确的使用方法;使用时必须小心,否则牙齿漂白剂会伤害牙龈和牙周组织
●Harmful to health if bleaching agent is ingested accidentally. 意外吞服牙齿漂白剂会影响身体健康

G. Points to note after bleaching  牙齿漂白後注意事项
●Visit your dentist for check-up as advised. 依照牙科医生指示覆诊
●Bleaching can only keep the teeth white for a period of time. Repeated bleaching treatment is needed to keep the teeth white. 漂白治疗只能维持牙齿净白一段时间,需要重复接受漂白治疗来保持牙齿净白

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Oral Treatments─Orthodontic Treatment 口腔治疗─牙齿矫正治疗

Orthodontic treatment is a series of processes that move the teeth to the desired positions in the mouth by orthodontic appliances. 牙齿矫正治疗是借助牙齿矫正器把牙齿移至一个理想的位置。

Orthodontic treatment is a complex dental treatment. Before commencing an orthodontic treatment, you should consult an orthodontist to understand your oral condition and the details of the treatment involved. 牙齿矫正治疗是一项复杂的牙科治疗,接受此治疗前应先见牙齿矫正科医生,清楚了解自己的口腔情况及牙齿矫正治疗的细节。

Purpose A. 目的
●To improve aesthetics 美化仪容
●To improve the occlusion between the upper and lower teeth in order to improve the masticatory function 改善牙齿咬合位置,改善咀嚼功能
●To improve the alignment of teeth so that a well-support denture / bridge can be fitted 改善牙齿的排列,使假牙托得到良好的承托

B. Types of orthodontic appliances  牙齿矫正器的种类

1. Fixed orthodontic appliance 固定牙齿矫正器

Materials and mechanism 物料和原理
●Orthodontic brackets are attached to the tooth surfaces in appropriate positions so that when the orthodontic brackets and orthodontic wire are tied up, the spring back action of the orthodontic wire will move the teeth. 先在牙齿上放置牙齿矫正器 (牙箍),当牙齿矫正金属弓丝和这些牙齿矫正器连系时,牙齿便会按金属弓丝的回弹途径移动
●Gradually, the teeth are moved to the desired positions determined by the shape of the orthodontic wire. 牙齿根据牙齿矫正器的金属弓丝的形状,渐渐移动到预期的位置

Procedures for fixed orthodontic appliance 治疗程序
●Placement of orthodontic brackets 放置牙齿矫正器
●The orthodontic wire and orthodontic brackets are connected by elastics and stainless steel wire (ligatures). 利用橡筋圈和钢丝,连系牙齿矫正金属弓丝和牙齿矫正器
●Regular dental visit should be made according to the instruction of the orthodontist to: 按牙齿矫正科医生指示,定期覆诊及进行下列各项治疗:
●Check the movement of the teeth 检查牙齿移动进度
●Change the elastics or stainless steel wire 更换橡筋圈或钢弓丝
●Change the orthodontic wire 更换牙齿矫正金属弓丝
●After the teeth have moved to the desired positions, a retainer is inserted to hold and stabilize the tooth positions. 当牙齿移动至理想位置後,戴上牙齿固定器稳定位置

Treatment duration 治疗时间
Overall treatment duration lasts for about one and a half to three years. The actual time needed depends on the complexity of treatment. 整个疗程大约1 年半至3 年,实际时间需视乎治疗的复杂程度而定

2. Removable orthodontic appliance  活动牙齿矫正器

Materials and mechanism 物料和原理
Springs or screws are embedded in an acrylic plate, which is held in place by clasps, to move the teeth to their desired positions. 藉着藏在牙齿矫正器内的钢线弹弓或利用镙丝推动活动牙齿矫正器的胶托,令牙齿移动到一个理想位置

Procedures for removable orthodontic appliance 治疗程序
●Impressions of the teeth are taken. 印取牙模
●The removable orthodontic appliance is fabricated in the dental laboratory. 在石膏模上,按牙齿矫正科医生指示制造活动牙齿矫正器
●Adjust the springs and screws and let the patient try on the appliance. 调校弹弓或镙丝,让病人试戴牙齿矫正器
●Regular dental visits to check the tooth movements and adjust the springs. 定期检查牙齿移动进度和调校弹弓
●After the teeth have moved to the desired positions, the removable orthodontic appliance will serve as a retainer to stabilize the tooth positions. 当牙齿移至理想位置後,活动牙齿矫正器可保留作牙齿固定器,帮助固定牙齿的位置

Treatment duration 治疗时间
The overall duration lasts for about 6 to 12 months. The actual time needed depends on the complexity of treatment. 整个疗程大约 6 个月至1 年,实际时间需视乎治疗的复杂程度而定

C. Points to note on orthodontic treatments 按受牙齿矫正治疗注意事项
●If you are wearing orthodontic appliances, you should pay extra attention towards oral hygiene to prevent dental caries and periodontal disease.  装上牙齿矫正器後,必须加倍注意口腔卫生,否则容易患上蛀牙和牙周病
●If you are wearing a removable orthodontic appliance, the appliance and teeth must be thoroughly cleaned every morning and evening before wearing it again. Leave the appliance in plain water when it is not worn. 如果配戴活动牙齿矫正器,每天早上、睡前必须清洗牙齿矫正器及彻底清洁牙齿,然後再戴上。如果不配戴时,必须将牙齿矫正器放在清水中
●If severe discomfort is felt when wearing orthodontic appliances, consult your orthodontist immediately. 配戴牙齿矫正器後有严重不适,应立即往见牙齿矫正科医生检查

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Oral Treatments─Extraction 口腔治疗─脱牙

The aim of extraction is to take out the designated tooth so as to remove the root cause of the oral problem, or to pave for the subsequent dental treatments. 脱牙的目的是把指定的牙齿除去,消灭口腔问题的根源或为跟进的牙科治疗作准备。

A. Conditions leading to extraction include: 需要脱牙的情况包括:
●A badly decayed/broken/fractured tooth that cannot be restored, or even turns into a breeding ground for bacteria 牙齿因严重蛀坏或崩裂以致无法修补,甚至成为细菌温床
●An extremely mobile tooth resulting from severe periodontitis 严重牙周病,牙齿变得十分松动
●A tooth to be extracted for pathological reasons, e.g. a tooth involved in tumor 因病理原因牙齿需要除掉,例如牙齿与肿瘤有关
●A tooth fails to erupt in a right place and causes damages and inflammation to the nearby tissues 牙齿在不理想的位置长出,令附近组织受损及感染
●A tooth that is abnormal in its appearance and structure 牙齿的外观及结构有问题
●A tooth to be extracted for orthodontic need 配合牙齿矫正治疗的需要
●A tooth that may bring about other health problems, e.g. a tooth with an exposed pulp will increase the chance of bacterial infection in the heart of a patient with rheumatoid heart diseases 预防牙患带来其它身体问题, 例如牙髓外露会增加类风湿心脏病患者心脏受细菌感染的危机

B. Extraction Methods 脱牙进行的方式

★Non-surgical method  非手术方式
●This is suitable for most of the normally erupted tooth. 适合脱掉大部分正常长出的牙齿
●Local anesthesia is given and that makes the tooth and the surrounding tissues numb. 过程是先注射局部麻醉药,使牙齿和口腔组织麻痹
●Then an appropriate forcep or dental instrument is used to rock the tooth gently and pull the loosened tooth out of the mouth. 然后用适合的工具把牙齿摇松并直接从口腔取出

★Surgical method 手术方式
●This is used when the tooth cannot be extracted by the usual dental instrument. This includes badly decayed/ fractured tooth, impacted tooth, crook-rooted tooth, tooth in inelastic surrounding bone (common in elderly persons), etc. 适用于一般牙科工具不能实时把牙齿整颗拔出来的情况,包括:牙齿严重蛀坏及崩断、牙齿阻生、牙根形状令牙齿不易拔除,牙槽骨缺乏弹性 (年长者较普遍)等
●Local anesthesia is given and that makes the tooth and the surrounding tissues numb or upon special conditions, general anaesthesia is administered. 过程是先注射局部麻醉药,使牙齿和口腔组织麻痹或视乎情况进行全身麻醉
●Then the gum is cut open and reflected. The covering bone is removed to expose the tooth. The tooth is then rocked, loosened and pulled out or depends on the tooth condition, it is cut into pieces and taken out bits by bits. 然后把牙龈翻起,除去覆盖牙齿的牙槽骨,使牙齿外露,继而把牙齿摇松或视乎情况把牙齿分割成几部分,以逐一取出
●The wound is rinsed and closed by sutures. 清洗伤口并用手术线缝合
●About a week, the wound is inspected and sutures are removed by the dentist. 约一星期后让牙科医生检查伤口及拆线

C. Points to note for extraction 脱牙要注意的事项
★The dentist will assess and discuss the possible risks with the patient before proceeding extraction. Generally speaking, the risks are minimal. The most common risk is fracturing a tooth during extraction and may need surgical procedures to complete. 牙科医生会评估及跟我们商量脱牙的风险,然后才进行。一般而言,脱牙的风险很低。最常见的风险是在脱牙过程中牙齿崩碎,需要以手术方式完成

★In some special occasions, after extraction, a patient may bleed or may have wound swelling and pain continually or even may have wound infection. So he/she should seek for dentist’s help as soon as possible if the wound continues to have profuse bleeding, abnormal swelling and pain for more than three days without any sign of improvements, foul smell and pus running and if they have fever. 可能在某些个别情况下, 脱牙后会持续流血,伤口肿痛或受感染。如果发觉伤口持续大量流血,过分肿痛并且持续三数天仍未改善,甚至发出异味,流脓或发热等,便须尽快向牙医求助

★In the very rare occasion, the nearby teeth, soft tissues or nerves may get damaged during extraction. If this happened, the patient needs referral to specialist, e.g. oral & maxillofacial surgeon for intensive care. 在极少情况下,附近的口腔组织包括牙齿、口腔软组织、神经线等会在脱牙的过程中受损。遇到这些情况时便须转介给专科医生如口腔及颌面外科医生治理

★If the patients have other systemic diseases, they should consult their medical doctors before extraction to understand whether extraction can be proceeded, whether they need to take antibiotic, steroid or adjust the dosage of anticoagulants, etc. in order to ensure extraction can be done safely. 若身体有其他毛病,脱牙前应谘询主诊西医的意见,燎解脱牙是否可以进行,又或是否需要事前服食抗生素或类固醇,或调校药物的分量如薄血丸等,以确保脱牙过程安全

★Post-extraction care 脱牙後的护理
Nowadays, the advancements in medical technology, anesthesia, analgesia and wound aftercare can greatly minimize the discomfort during and after the extraction. 现代的医疗技术、麻醉和止痛药物及伤口护理已能大大降低脱牙带来的不适。
●After extraction, we should bite on a gauze pack for 15 to 20 minutes to arrest bleeding from the tooth socket. Meanwhile we should swallow the saliva normally. In order to avoid bleeding from the socket again, the blood clot in it should not be touched or disturbed. Within 3 hours after extraction: 脱牙后,一般需要紧咬棉花约十五至二十分钟,帮助伤口止血,其间可如常吞口水。之后,为免触碰伤口内凝固的血块而引致再度出血,应在脱牙后三小时内:
──Do not rinse the mouth - 不要漱口
──Do not eat hard or rough food - 不吃坚硬和粗糙的食物
●Within 24 hours after extraction 及应在脱牙后二十四小时内:
──Do not touch the blood clot by the tongue or fingers - 不要用舌头或手指触碰血块
──Do not drink alcohol containing beverages - 不饮用含有酒精的饮料
──Do not attempt vigorous exercise - 不做剧烈运动
If there is profuse wound bleeding, the patient should immediately see his/her dentist or depends on the bleeding severity, seek for emergency care in the A&E of the nearby hospitals. 如伤口大量出血,便须尽快见牙科医生或视乎严重程度,前往附近的医院急症室求诊
●As the tissues nearby the extraction site are still numb for some time, in order to avoid hurting them, we should not eat within 3 hours after extraction, should not bite or unduly touch that areas until the sensation is fully back. 由于脱牙邻近的组织仍暂时麻痹,为免令这些地方受伤,脱牙后的三小时内避免进食,不要咬到或过度触碰这些部位
●It is normal to have some swelling in the extraction site and it would subside in about 3 days. We may follow the dentist’s instruction to take the medication or use cold pack to relieve it. 脱牙邻近部位肿胀是正常的,一般于三数天后便会开始消退,并可按牙科医生处方服药或用冷敷方法加以纾缓
●We should take the prescription as instructed. 按牙科医生指示服药
●As food debris would trap in the tooth socket, 24 hours after extraction, we should rinse the mouth with lukewarm water or saline when finishing eating in order to keep the wound clean. 由于进食后食物渣滓会藏在伤口内,脱牙二十四小时后便可用温水或盐水漱口,保持伤口清洁

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Oral Treatments─Endodontic treatment 口腔治疗─牙髓治疗〈杜牙根〉

Endodontic (pulp) treatment involves the partial or total removal of infected or injured pulp tissue. The pulp chamber and root canal(s) are then cleaned and sealed. 牙髓治疗是把受感染或坏死的牙髓组织部分或全部清除,然後用补牙物料把牙髓填封。

A. Purpose 目的
To prevent tooth loss as a result of damage to the bone around the tooth caused by the bacterial infection of the pulp 阻止牙髓感染蔓延至牙周组织和牙槽骨,以免这些组织受破坏,使牙齿得以保存。

B. Treatment Procedures 治疗程序

1. Partial removal of pulp tissues  清除部分牙髓的治疗过程
Application 应用:
Deciduous teeth that have vital pulp tissues 牙髓未坏死的乳齿

Procedures for partial removal of pulp tissues 过程
●Tissues inside the pulp chamber are removed. 把牙冠髓除去
●Pulp chamber is rinsed and cleaned. 清洁牙冠髓腔
●Appropriate medicament is placed in the pulp cavity. 视乎情况放置不同药物
●Pulp cavity is filled. 把牙冠髓腔填封及覆盖牙洞

2. Total removal of pulp tissues  清除全部牙髓的治疗过程

Application 应用
●Deciduous teeth with non-vital pulp tissues 牙髓已坏死的乳齿
●Permanent teeth with non-vital pulp tissues 牙髓已坏死的恒齿

Procedures for total removal of pulp tissues 过程
●Tissues inside the pulp chamber are removed. 把牙冠髓除去
●Tissues inside root canal(s) are thoroughly cleaned out. 把牙根管髓刮净
●Pulp chamber and root canal are cleaned. 清洁牙齿整个髓腔
●Appropriate medicament is placed in the pulp cavity. 视乎情况放置不同药物
●Root canal(s) and the pulp cavity are filled and sealed. 把髓腔填封及覆盖牙洞
●If the tooth structure is too weak after treatment, extra protection is needed by putting on a crown. 若果做了杜牙根的牙齿太脆弱,便有需要镶配牙套来加强保护牙冠

C. Points to note on pulp treatment  接受牙髓治疗注意事项
●It requires a few visits to the dentist to complete a pulp treatment; remember to keep the appointments for treatments. 必须接受数次的治疗程序才可以完成牙髓治疗,紧记依时覆诊
●See the dentist immediately if the temporary filling material has fallen off, in order to prevent bacteria in the saliva from entering the pulp chamber. 如果临时补牙物料脱掉,须尽快往见牙科医生,以免唾液中的细菌渗入牙齿髓腔。
●If local anaesthesia is used, do not bite your lips or tongue before the numbness has completely worn off. 如果在治疗过程中曾接受局部麻醉药注射,在咀唇或舌头未完全恢复知觉前,不要咬咀唇或舌头。

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Oral Treatments─Crown 口腔治疗─镶配人造牙冠

A crown refers to the placement of an artificial crown on a tooth. It acts as a 'cap' that fits over the tooth which has been previously shaped and contoured. 人造牙冠是利用修复牙齿的物料,做成牙冠套,套在经过修改的牙冠上。

A. Purpose  目的
●To restore the original shape and function of teeth 修复牙齿形状及恢复牙齿功能
●To improve the aesthetics of teeth, such as shape, size and colour 改善牙齿的外观,如颜色、形状和大小
●To fix a bridge onto the teeth — a fixed bridge is supported by crowns on either / both side 把牙挢固定在牙齿上

B. Materials  物料

1. Porcelain  瓷

2. Gold alloy  K金

Properties 特性
●Durable 坚固耐用
●High wear resistance 坚硬,不易耗损
●Gold alloy crown can be quite thin — only a small amount of tooth substance needs to be removed to accommodate it 需要的厚度较薄,因此只需把牙齿磨细少许

Disadvantage  缺点
Metallic colour, poor aesthetics 金属颜色,不美观

Application  应用
Used at high stress bearing area where good aesthetics is not a must. For example, posterior teeth 适用於後面的牙齿,因为後牙需要承受强大咬合力,而对美观方面的要求不高

Procedures for gold alloy crown  K金人造牙冠镶制程序
●A thin layer of tooth substance on all surfaces of the crown is removed. 把牙齿表面磨细
●Impressions of the upper and lower teeth are taken and the bite registration is recorded. The prepared tooth is protected by a temporary crown. 印制牙模及套取牙齿咬合位置,磨细的牙齿需要套上临时牙冠
●The gold alloy crown is fabricated in the dental laboratory. 在牙科工场内铸造K金人造牙冠
●Temporary crown is removed and the tooth surface is cleaned. 除去临时牙冠,清洁该牙齿
●The crown is cemented onto the tooth. 用黏合剂把人造牙冠固定在牙齿上

3. Porcelain fused to gold  搪瓷

Properties 特性
●Aesthetic — colour of outer surface is similar to natural tooth 瓷面美观,接近真牙齿的颜色
●Strong and durable because of the gold alloy base 坚固耐用,因为底部是K金
●Hard 质地坚硬

Disadvantage : More tooth substance needs to be removed from the facial surface of the tooth. 缺点:需要一定厚度,因此要把牙齿磨去多一些

Application : Used on anterior teeth 应用:适用於前面的牙齿

Procedures for porcelain fused to gold crown  搪瓷人造牙冠镶制程序
●A thin layer of the tooth is removed. 磨细牙齿
●Impressions of the upper and lower teeth are taken and the bite registration is recorded. The prepared tooth is protected by a temporary crown. 印制上、下牙模及套取牙齿咬合位置,磨细的牙齿需要套上临时牙冠
●The porcelain fused to gold crown is fabricated in the dental laboratory. 在牙科工场内铸造搪瓷人造牙冠
●The temporary crown is removed and the tooth surface is cleaned. 除去临时牙冠,清洁该牙齿
●The crown is cemented onto the tooth. 用黏合剂把人造牙冠固定在牙齿上

4. Stainless steel 不锈钢

Properties 特点
●Stainless steel crown is not custom-made. It is preformed with several sizes. 这类人造牙冠不是度身制造的,有固定的尺码
●Since the crown is not custom-made, the procedures of fitting are simple and the time taken is relatively short. 由於不是按个别牙齿情况铸造, 配这类人造牙冠的时间就比较短,工序亦较简单

Disadvantage  缺点
●Silvery colour, unaesthetic 银色,不美观
●Non-stress bearing, not lasting 较易耗损
●Since the crown margin is not closely adapted to the tooth, the margin is prone to accumulation of dental plaque which causes dental caries and periodontal disease 牙冠边缘不太紧贴牙齿,容易积藏牙菌膜,引致蛀牙、牙龈发炎及牙周病

Application 应用
Used on molars of deciduous teeth 乳齿的臼齿

Procedures for stainless steel crown  不锈钢人造牙冠 制程序
●A thin layer of the tooth is removed. 适当地磨细牙齿
●The stainless steel crown with the right size that fits the tooth most is chosen. 选择最合尺码的不锈钢人造牙冠
●The crown is then trimmed according to the contour of the tooth. 根据牙齿形状裁剪不锈钢人造牙冠
●The tooth surface is cleaned. 清洁该牙齿
●The crown is cemented onto the tooth. 用黏合剂把人造牙冠固定在牙齿上

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Oral Treatments─Bridge 口腔治疗─镶配牙挢

A bridge is a fixed prosthesis that is used to replace one or more missing teeth. 牙挢是牢固地镶配在口腔内的固定假牙,以取代已失去的一颗或多颗牙齿

A. Purpose  目的
●To replace missing teeth in order to prevent the drifting of neighbouring teeth into the tooth space, which will result in crooked teeth or abnormal bite 填补牙齿缺失的位置,防止邻近牙齿移位,避免牙齿不整齐及咬合不正常
●To restore the functions of teeth, including mastication, speech and aesthetics 恢复牙齿的咀嚼、发音和保持仪容的功能

B. Mechanism 原理
●A bridge is being anchored by the teeth on either side of the tooth space; it can also be fixed by a metal wing extending from either side of the bridge. 以牙挢两旁伸出的部分作挢趸,固定在邻近或馀下的牙齿上
●A bridge can be used together with crowns. 可与人造牙冠配合使用

C. Material  物料
Porcelain fused to gold 搪瓷

D. Types 种类

★Conventional Bridge  传统式牙挢

Mechanism 原理
The crowns on both ends of the bridge act as anchors and hold the bridge in place. 利用牙挢两端的牙冠套在邻近牙齿上,以固定牙挢

Properties 特性
●Suitable for stress bearing area 适用於需承受强大咬合力的位置
●Bridge can be relatively longer 挢身可较长

Procedures for conventional bridge 过程
●The neighbouring teeth on both sides of the tooth space are shaped according to the design of the bridge. 把两端用作固定牙挢的牙齿磨成适合的形状
●Impressions of the upper and lower dental arches are taken and the bite registration is recorded. 印取上、下牙模及套取牙齿的咬合位置,套上临时牙挢。
●The bridge is fabricated in the dental laboratory. 在牙科工场内铸造牙挢
●The finished bridge is tried in the patient's mouth and adjustment is made accordingly. 除去临时牙挢,让病人试戴牙挢并作出调校。
●The bridge is cemented onto the prepared teeth. 用黏合剂把牙挢固定在牙齿上

★Cantilever Bridge  单端固定挢

Mechanism 原理
The bridge is only supported or fixed on one neighbouring tooth. 这种牙挢只有一端固定在邻近牙齿上,就像跳板一样悬挂着

Properties 特性
●Suitable for low stress bearing area 只能用於承受较小咬合力的位置
●Can only replace one missing tooth 牙挢只可连着一只假牙
●For example, replacement of a lateral incisor by a cantilever bridge anchored by the central incisor 例如:人造牙冠套着上门牙再连着一只假牙,以填补失去了的侧门牙

Procedures for cantilever bridge 过程
●The neighbouring tooth of the missing tooth is shaped according to the design of the bridge. 把一端用作固定牙挢的牙齿磨成适合的形状
●Impressions of the upper and lower dental arches are taken and the bite registration is recorded. 印取上、下牙模及套取牙齿的咬合位置,磨细的牙齿需要套上临时牙冠
●The bridge is fabricated in the dental laboratory. 在牙科工场内铸造牙挢
●The finished bridge is tried in the patient's mouth and adjustment is made accordingly. 除下临时牙冠,让病人试戴牙挢并作出调校
●The bridge is cemented onto the prepared tooth. 用黏合剂把牙挢固定在牙齿上

★Maryland Bridge  树脂黏合式牙挢

Mechanism 原理
The bridge is anchored by metal wings extending from both ends, and composite resin is used to bond the metal wings to the neighbouring teeth. 使用复合树脂把牙挢两侧经过处理的金属片黏合在邻近牙齿上,以固定牙挢

Properties 特性
●Only suitable for low stress bearing area 只能用於承受较小咬合力的位置
●The teeth used to support the bridge should have enough enamel structure 黏上金属片的牙齿表面要有完好的珐琅质

Procedures for Maryland bridge 过程
●The inner surfaces of neighbouring teeth of the missing tooth are shaped according to the design of the bridge. 把两端用作固定牙挢的牙齿内侧面磨成适合的形状
●Impressions of the upper and lower dental arches are taken and the bite registration is recorded. 印取上、下牙模及套取牙齿的咬合位置
●The bridge is fabricated in the dental laboratory. 在牙科工场内铸造牙挢
●The finished bridge is tried in the patient's mouth and adjustment is made accordingly. 让病人试戴牙挢并作出调校
●The bridge is bonded onto the prepared teeth. 用黏合剂把牙挢固定在牙齿上

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Oral Treatments─Denture 口腔治疗─镶配假牙托

A denture is a removable set of false teeth that is used to replace missing teeth in the mouth. 假牙托是可以随意戴上或除下的假牙,作用是取代口腔内失去的牙齿

A. Purpose  作用
●To restore chewing function 恢复咀嚼功能
●To help articulation 使发音准确
●To restore a normal facial profile 回复原本的面貌
●To correct abnormal bite 避免咬合不正常

B. Types  种类

★Complete denture 全口假牙托
●To replace all teeth in a dental arch 用作代替全口失去的牙齿
●A complete denture is held in the dental arch by the oral musculature; hence the denture must fit the oral mucosa well 利用口腔的肌肉把假牙托固定在颌骨上。因此,假牙托与口腔黏膜会吸附一起
●A complete denture can be placed over dental implants by screw attachment devices 如果颌骨已植入钛植体 (种牙) ,全口假牙托可以利用镙丝的接合装置固定在钛植体上

Materials 物料
●The denture base can be made of acrylic polymers or gold alloy. 假牙托底部可用丙烯聚合体或K金制成
●The false teeth on the denture base can be made of acrylic or porcelain. 假牙可用丙烯聚合体或瓷制成

Procedures for making a complete denture 假牙托镶配过程
●Impressions of the upper and lower dental arches are taken and the bite registration is recorded. 印取上下牙模及套取牙齿的咬合位置
●A mock up denture in wax is fabricated in the dental laboratory. 在牙科工场内铸造牙托底部,用蜡把假牙固定在牙托底部
●The waxed denture is tried in the patient's mouth and adjustment is made accordingly. 让病人试戴并作出调校
●The denture is processed and finished in the dental laboratory. 在牙科工场内把假牙托加工
●The finished denture is inserted in the patient's mouth and adjustments are made accordingly. 假牙托完成後再让病人试戴,并作出调校

★Partial denture  部分假牙托
●To replace some missing teeth in a dental arch 用作代替口腔内失去的部分牙齿
●The denture is stabilized in the mouth by metal clasps which extend from the denture base, holding onto the natural teeth 利用牙托底部伸延出来的金属扣环,把假牙托固定在牙齿上
●A partial denture can also be held by screw attachment devices to implants. 如果颌骨已植入钛植体 (种牙),部分假牙托可以利用镙丝的接合装置固定在钛植体上。

Materials 物料
●The denture base can be made of acrylic polymer, cobalt chromium or stainless steel. 假牙托底部可用丙烯聚合体、钴铬合金或钢制成
●The false teeth can be made of acrylic or porcelain. 假牙可用丙烯聚合体或瓷制成

Procedures for partial denture 假牙托镶配过程
●Some of the natural teeth need to be slightly prepared by judicious grinding to suit the denture design. 视乎情况把口腔内一些牙齿磨去少许
●Impressions of the upper and lower dental arches are taken and the bite registration is recorded. 印取上下牙模及套取牙齿的咬合位置
●The metallic frame of the denture is fabricated in the dental laboratory, and the false teeth are fixed onto the frame by wax. 在牙科工场内铸造牙托底部,用蜡把假牙固定在牙托底部
●The denture frame is tried in the patient's mouth and adjustment is made accordingly. 让病人试戴并作出调校
●The denture is processed and finished in the dental laboratory. 在牙科工场内把假牙托加工
●The finished denture is inserted in the patient's mouth and adjustments are made accordingly. 假牙托完成後再让病人试戴,并作出调校

C. Points to note about wearing dentures  戴假牙应注意事项
●Initially it may be difficult to get use to a new denture, but you will soon be accustomed to it after wearing it for a period of time. 戴新镶配的假牙托初期可能不习惯,要慢慢适应
●A new denture may be uncomfortable to wear within the first 6 months. It is not unusual to require some adjustments on the new denture. 在开始戴假牙托的 6个月内可能会感到不适,需要请牙科医生调校假牙托
●Since oral conditions may change with time, a denture may gradually become loose and unfit. Therefore, an oral check-up should be done at least once a year so that the dentist can adjust the denture according to the oral condition. 由於口腔情况会随着时间改变,假牙托会变得不合戴。因此配戴者需要定期检查口腔,让牙科医生按情况调校或修改假牙托

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Oral Health Care during Pregnancy怀孕期间的口腔护理

★Oral Health Care during Pregnancy─Common Oral Diseases during Pregnancy  怀孕期间的口腔护理─怀孕期间容易患上的口腔疾病
★Oral Health Care during Pregnancy 怀孕期间的口腔护理─怀孕期间如何护理口腔
★Oral Health Care during Pregnancy─Queries of the Expectant Mothers 怀孕期间的口腔护理─怀孕期间口腔疑问

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Oral Health Care during Pregnancy─Common Oral Diseases during Pregnancy  怀孕期间的口腔护理─怀孕期间容易患上的口腔疾病

A. Pregnancy Gingivitis 妊娠期牙龈炎

1. Cause: 成因:
During pregnancy, the hormonal changes exaggerate the response of the gum tissues to the plaque bacterial toxins, resulting in the development of “Pregnancy Gingivitis". 怀孕期间,由於荷尔蒙分泌的改变,孕妇的牙龈(牙肉)会对牙菌膜内的细菌所分泌的毒素产生过度反应,这现象称为「妊娠期牙龈炎」。

2. Symptoms: 徵状:
Gingival inflammation and gingival bleeding when brushing 牙龈红肿及刷牙时牙龈容易出血。

3. Prevention and treatment:  预防及治疗:
●Pregnancy Gingivitis can be prevented if the expectant mother can effectively brush her teeth with fluoride toothpaste in the morning and before bed at night and floss her teeth daily to thoroughly remove dental plaque. This oral hygiene habit can also promote healing of mild gingival inflammation. 起床、睡前用含氟化物牙膏刷牙,并用牙线彻底清除牙菌膜,便可以预防「妊娠期牙龈炎」,亦可以藉此令轻微的牙龈发炎自然痊愈。
●Pregnant women can receive scaling between the 4th to 6th month during pregnancy because within this period, the foetus is more stable. Hence it is more convenient for expectant mothers to receive treatments. 孕妇亦可於怀孕期四至六个月往见牙医接受洗牙治疗,因为在这段期间,胎儿的情况比较稳定,而准妈妈接受治疗时亦比较方便。

B. Tooth sensitivity 牙齿敏感

1. Cause: 成因:
During pregnancy, an expectant mother may crave for acidic food or vomit easily. These acidic food and vomit will erode the outer layer of the teeth (enamel) and expose the inner layer (dentine), resulting in tooth sensitivity. 在怀孕期间,孕妇可能偏吃甜酸食物或容易呕吐,酸性食物和呕吐物会直接侵蚀牙齿外层 ( 珐琅质) ,使内层 ( 象牙质 ) 外露,造成「牙齿敏感」。

2. Symptoms: 徵状:
If the expectant mother has no tooth decay or pulp inflammation, but feels sharp pain in her teeth which is triggered by hot, cold, sour or sweet food, or by toothbrushing and flossing, she may have got tooth sensitivity. 如果孕妇没有蛀牙或牙髓炎,但是在刷牙、用牙线,进食冷、热、甜、 酸等食品时感到牙齿刺痛,那麽牙齿可能已经出现敏感情况。

3. Prevention and treatment:  预防及治疗:
●Avoid eating sweet and sour food 避免进食甜酸食物
●Consult the dentist if the expectant mother has tooth sensitivity 如果孕妇有「牙齿敏感」,可请教牙科医生及接受适当的治疗。

C. Dental Caries 蛀牙

Pregnant woman often crave for sweet and sour food due to dietary change. Food and drink intake may also become more frequent. Therefore, the chance of getting Dental Caries may increase. 妇女怀孕时,胃口会改变,喜欢吃甜酸的食物,吃喝的次数亦变得频密,患上蛀牙的机会便增加。

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Oral Health Care during Pregnancy 怀孕期间的口腔护理─怀孕期间如何护理口腔

A. Dietary Advice Dietary Advice 饮食建议

During pregnancy, a balanced diet is essential for the development of the foetus. The expectant mother should have well balanced meals. She should also take sufficient quantities at meal times and avoid frequent in-between meals. However, if she happens to feel hungry in between meals, she should take nutritious yet non-cariogenic (not causing tooth decay) snacks such as boiled egg, cheese, milk and some raw vegetables. She should take sufficient quantities to avoid the need for frequent snacking in-between meals. In addition, she should try to refrain from taking acidic foods such as preserved plums, lemons, tangerine skins...etc. to prevent the teeth from being eroded by acids, which leads to "tooth sensitivity". 孕妇要有均衡的饮食,以确保胎儿发育正常。在正餐时,孕妇宜吃饱,以免因饿了而需在短时间内再度进食。如果在两餐之间真的感到饿,就应选择吃烚蛋、芝士或喝牛奶以补充体力。每次吃的时候,尽量多吃一些,不要频频进食。同时,孕妇应避免进食酸性食物如话梅、 柠檬、陈皮等,以免牙齿受到严重侵蚀,造成「牙齿敏感」。

B. Oral Care Habits 口腔护理

To maintain good oral hygiene, the expectant mother should brush her teeth in the morning and before bed at night with fluoride toothpaste and use dental floss everyday. If she vomits or needs to eat more frequently, she should use fluoride mouthwash to get additional protection against tooth decay. 保持口腔清洁,孕妇应起床及睡前用含氟化物牙膏刷牙及用牙线彻底清除牙菌膜。孕妇如果有呕吐或需要经常进食,便要加强保护牙齿,使用含氟化物漱口水漱口,增加牙齿抵抗酸素侵害的能力 。

C. Dental Check-up  口腔检查

Even if the expectant mother has had a pre-pregnancy dental check-up and had all the dental problems treated, she still needs to have another dental check-up during pregnancy. This is because expectant mothers may have a higher risk of getting dental problems. The best timing is at 4th to 6th month of pregnancy, because at this stage the foetus is most stable. She should also inform the dentist that she is pregnant. If dental treatment is necessary, she should choose the simple, palliative treatment and leave the more complicated treatment after giving birth. This could avoid discomfort during lengthy treatment procedures. She should wait until she has given birth to receive comprehensive dental treatment. If it is not necessary, she should not take X-ray. 即使妇女在计划怀孕前已接受口腔检查,让牙医把所有牙患治理妥当,在怀孕期间,她们仍需接受一次定期检 查,以确保口腔健康。这是因为孕妇有牙患的机会一般都比较高。口腔检查最宜於怀孕4至6个月期间进行,因为这段时期胎儿比较稳定。在接受检查时,孕妇须告 知医生已经怀孕。倘若怀孕期间发现有牙患需要接受复杂的治疗,孕妇宜选择简单治标的疗程,避免因疗程复杂需时而感到不适。要把牙患根治,必须待宝宝出生後 才进行,如非必要,请不要拍X-光片。

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Oral Health Care during Pregnancy─Queries of the Expectant Mothers 怀孕期间的口腔护理─怀孕期间口腔疑问

1. Would the foetus absorb calcium from the mother's teeth and make them weaker? 胎儿会否吸收母亲牙齿的钙质,令孕妇的牙齿变差?

The foetus does not absorb calcium from the mother's teeth. The calcium of the foetus comes mainly from the mother's bones and to a lesser extent, from her normal diet. Hence, her teeth could not be weakened because of her foetus. However her teeth may be weakened because most expectant mothers fall into a habit of frequent snacking in between meals and this habit causes tooth decay. 胎儿不会吸收母亲牙齿的钙质。胎儿吸取的钙质,主要来自母亲日常的饮食,亦有部分来自母亲的骨骼。因此胎儿是不会令孕妇的牙齿变差的。孕妇的牙齿容易蛀坏其实是由於频频进食的缘故。

2. Would medication during pregnancy affect the tooth development of the foetus? 怀孕期间服药会否影响胎儿的牙齿发育?

From the 5th to 6th week of pregnancy, teeth begin to develop in the foetus. If the expectant mother takes tetracycline during pregnancy, the teeth of the foetus may be affected and become discoloured. Hence she has to tell the doctor that she is pregnant, so that the doctor will take care in prescribing the appropriate medication if necessary. 怀孕期第 5 至 6 周,胎儿的牙胚便开始发育,若孕妇在怀孕期间服食四环素,胎儿的牙齿就有机会在钙化时受四环素的影响,出现颜色改变。所以,孕妇见医生时应告知医生已怀孕,让医生按情况用药。

3. What should be done when expectant mothers suffer from a painful wisdom tooth? If tooth extraction is needed, would the anaesthesia affect the foetus? 当孕妇遇有智慧齿疼痛的问题,如何处理?若要将智慧齿脱掉,所用的麻醉药对胎儿有影响吗?

The first three months of pregnancy is an important development stage for the foetus. To avoid possible risks cause by dental treatment, dentists usually suggest to put off dental treatments until the 4th to 6th month of pregnancy, and the non-urgent dental treatments can be done after the baby is born. 在妊娠期的首三个月,是胎儿器官发展形成的重要阶段。为避免口腔治疗可能引致的风险,牙科医生会建议将治疗时间延至妊娠期的四至六个月,而那些并不紧急的口腔治疗更可推迟至胎儿出生後才进行。

It is not advisable for expectant mothers to receive dental treatment after the 7th month of pregnancy. Because the supine (laying) position of a dental chair will not only cause discomfort to expectant mothers, it is even possible that the major veins from the lower limbs can be pressed by the weights of the uterus and the foetus, which will block the blood from returning to the heart. 妊娠期七个月或以上的妇女并不建议接受治疗,因为牙椅的仰卧位置除了引起孕妇不适外,更可能因子宫及胎儿令静脉受压,而堵截下肢的血液回流心脏。

Due to the above reasons, expectant mothers should have wisdom tooth extraction after the baby is born. If the expectant mother must have her wisdom tooth removed because of urgent oral problems, dentist will first assess the risks of the treatment in advance. Otherwise, expectant mothers may have her wisdom tooth extracted under local anaesthesia during the forth to sixth month of pregnancy. 基於以上原因,孕妇可於产後才将智慧齿拨除。如妊娠期妇女因急性口腔感染,或有迫切需要将智慧齿拨除,牙科医生会预先对该项治疗可能产生的风险作出评估,否则孕妇可於妊娠期四至六个月接受局部口腔麻醉,将牙齿拨掉。

In fact, if good disinfecting and preventive measures are carried out, oral treatments such as filling and root canal treatment are safe for expectant mothers. Should expectant mothers feel worried or uncomfortable towards having dental treatments, the dentist may apply temporary dressings to stabilize the situation, and treat the situation after the baby is born. 其实只要能确切执行消毒及相关的预防措施,妇女於妊娠期间接受牙齿治疗,如补牙及根管治疗是安全的。但孕妇如有忧虑或对牙齿治疗感到不安,牙科医生会用临时敷料将受感染的牙齿情况稳定,待孕妇产後才进行彻底治疗。

To keep the gingival health of both the expectant mother and the foetus, expectant mothers with periodontal disease or symptoms of gingival inflammation should visit the dentist regularly for check-ups. Medications must be used with care during pregnancy. Although local anaesthetics can enter the placenta, the amount of anaesthetics needed for most of the dental procedures is safe for pregnant women because the placenta can filter out most anaesthetics. 为确保胎儿及孕妇的牙龈健康,患上牙周病或有牙龈发炎徵状的孕妇有需要经常到访牙科医生。怀孕期间必须小心用药,虽然麻醉药能够进入胎盘,但大部分口腔治疗所需的麻醉药剂量对孕妇是安全的,因为胎盘能够过滤大部分麻醉药。

According to research results, some antibiotics are suitable for pregnant women. They include Penicillin, Amoxicillin, Clindamycin, etc. Pain killers such as Paracetamol could also be used. Medications such as Tetracycline will affect the tooth calcification of the foetus, which will change the tooth colour of the foetus. Medication used by expectant mothers must be prescribed by doctors or dentists. Do not purchase over-the-counter drugs from pharmacies. You may consult your doctor or dentist for further details. 研究显示部分消炎药适用於孕妇,包括青霉素 (Penicillin), 羟氨苄青霉素(Amoxicillin)及克林达霉素 (Clindamycin)等,还有扑热息痛(Paracetamol) 的止痛药亦可服用。有些药物如四环素(Tetracycline),会令胎儿的牙齿在钙化时受四环素影响,出现颜色改变。孕妇所服的药物必须经牙科医生处 方,切忌私下到药房购买药物。详情可请教你的医生或牙科医生。

4. What should be done when an expectant mother is experiencing a fever caused by wisdom tooth infection? 孕妇因为出智慧齿而发烧,应如何处理?

If an expectant mother is suffering from Pericoronitis with symptoms such as fever and pain, these treatments may help: 若孕妇因为出智慧齿引致急性智慧齿冠周炎 ,出现发烧及疼痛徵状,以下的措施会有帮助:
●Irrigate the gap between the crown of wisdom tooth and the surrounding gingivae, and use mouthwash prescribed by the dentist 冲洗智慧齿的牙冠与覆盖牙龈间的缝隙及使用牙科医生处方的漱口水
●Extract the upper wisdom tooth that causes damage to the gingivae covering the lower wisdom tooth 拨除因咬合而导致覆盖智慧齿牙龈创伤的上颌牙齿
●Take antibiotics and pain killers prescribed by the dentist 服用牙科医生处方的消炎及止痛药物

5. How long does it take for expectant mothers to recover after a wisdom teeth extraction? How should the wound be treated? Are there any differences from other people? 孕妇脱掉智慧齿後,约多少时间才可痊愈?应如何处理伤口?方法跟一般人有分别吗?

The post-extraction wound care for expectant mothers is the same as other people. Dentist will dress the wound appropriately to avoid further bleeding. Expectant mothers should pay attention to the followings on the day of the extraction: 孕妇於脱牙後的伤口护理与其他人没有分别。牙科医生会为伤口作出适当的护理及止血。为避免伤口再度流血,孕妇只需於脱牙当天注意下列各点:
●Do not rinse your mouth or spit on the day of extraction 请勿漱口及吐口水
●Do not touch the wound with your finger or tongue 请勿用手指或舌头碰触伤口
●Do not drink alcoholic beverages 请勿喝含有酒精的饮料
●Take medication prescribed by the dentist when needed 如有需要,依指示服用牙科医生处方的药物

Time needed for wound healing varies according to different situations. Expectant mothers should consult the dentist if they have any queries. 伤口的痊愈时间要看情况而定,孕妇如有疑问,可谘询牙科医生。

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