The structure and functions of periodontal in humans. Neck massage restores blood pressure
Periodonts - Complex closely interconnected tissues surrounding and fixing teeth (gums, periosteum, bone of alveolar process, periodontal and coating cement tooth root). The biological and pathological connection of tissues fixing their teeth has been established for a long time.
Periodontal fabrics are embryology, physiological and pathological unity. There is a close connection between the development, functions and diseases of periodontal, despite the various structures of the components of its elements.
The embryological connection indicates that all periodontal tissues (with the exception of gums) are developing from connective tissue surrounding the tooth increment, and have a general blood supply. Physiological communication manifests itself in the fixing function of periodontal tissues. With the loss of tooth, the entire periodontal is absorbed. Pathological connection is manifested in the fact that the pathological processes arising in individual periodontal tissues are usually quickly moving to the rest of it. Periodonts are rather a functional, physiological and pathological concept than anatomical.
The separation of the chewing apparatus on the teeth and periodontal and the allocation of the concept of periodontics violates the idea of \u200b\u200bthe tooth as an anatomical unit, since the cement tooth covering the root (although it is closely associated with the tooth) still be attributed to periodontal, because its development differs from the development of other solid tissues. Tooth - Enamel and Dentin. Enamel and dentin develop from dentition, and cement from the connecting shell surrounding the tooth germ. The cement function consists of fixing the tooth, it is attached to the locking tooth of the periosteum fibers. Thus, the pathological processes of cement are associated with periodontal diseases.
Periodont is a connecting tissue located between the wall of the dental alveoli with the tooth root surface in the so-called periodontal slit. The periodontal connecting tissue is directly related to the jaw bone, through the apical hole - with a pulp of the tooth, and the edges of the tooth hole-with the gums and periosteum of the jaw
Periodontal functions. Periodonts perform a variety of features: the supporting, distributing pressure, chewing pressure regulator, plastic, trophic, etc.
Periodonts fixes teeth in jaws. The teeth acts in both chewing and without chewing load, with other functional states. These forces are trying to shift their teeth from their own place.
Periodonts transfers power to jaw bones acting on teeth. Forces arising from the reduction of chewing muscles are called chewing forces.
The transfer of chewing forces is performed primarily through the periodontal fibers, which are located in different directions in such a way that the tooth in the dental is tightly fixed. They mainly stretch in the oblique on the board at an angle of 45 ° in the direction of the root of the root - the tooth seems to be hanging in the Alveol. In the neck of the tooth, these fibers take almost a horizontal direction and, rushing with bunches of fibers, which come from the top of the alveolar partition and gums, form a circular bundle, covering the neck tooth in the form of a ring.
In the top of the root, as in the tricky periodontal department, a certain amount of fibers goes in the radial direction, which prevents the lateral movements of the tooth and limits them. The vertical location of the fibers at the day of the alveoli in the upheat periodonta prevents the nomination of teeth from the well.
Slightly wavy course of beams of collagen fibers Periodonta makes it possible a slight displacement of the teeth: with a load acting on the teeth, the fibers are not stretched, but straightened, strain. Under the influence of the suddenly large power of the fiber can be broken, and part of the cement will break off from dentin. The direction of force acting on the tooth can be parallel to the longitudinal axis of the tooth; This power presses the tooth in Alveola. In most cases, however, the current force forms a greater or smaller angle with the longitudinal axis of the tooth and has a tipping effect on the tooth.
The pressure falling on any tooth applies not only to its roots on the alveolar process, but also for interdental contacts to neighboring teeth.
The distribution of chewing force contributes to the fact that large molars are tilted in the medial direction, and therefore the forces acting on chewing on their longitudinal axis are partly transferred to small molars and cutters.
Thus, these teeth perceive part of the load of large molars. With the loss of each individual tooth, the neighboring tooth loses the tool, leans towards the resulting gap. Therefore, the removal of the teeth is very undesirable in terms of their fixation.
The correct contact of the tonel side (approximal) surfaces is also a significant factor in the distribution of chewing force. Is it completely contact with contact points
(shifted toward the neck of the tooth or in the lateral direction), the effect of chewing force may cause the teeth offset (Fig. 2).
Chewing movements, creating increased pressure in the periodontal, cause emptying of blood vessels. Reducing the volume of blood in periodontal vessels reduces the periodontal slit width and contributes to the immersion of the tooth in the well. When pressure is not available on a periodontal, the vessels are filled with blood, and the peridontal slit is restored until the previous sizes, putting kicking to the tooth and returning it to its original position. Thus, the change in the width of the peridontal crack ensures the physiological mobility of the tooth, and the change in the volume of the vascular channel creates a partial depreciation of the chewing pressure, which is experiencing tooth during the closure of dental rows and chewing food.
This is also facilitated by a less sweaty arrangement of periodontal fibers and a significant amount of loose connective tissue in the top of the root of the tooth.
The force of chewing pressure on the tooth is regulated by mechanoreceptors - terminal sprigs of grinding nerve endings located in a periodontal. Receptors are given a signal, in particular, to chewing. This regulates the force of chewing pressure on the teeth.
The plastic function of periodontal is carried out by cell elements available in it. Thus, the cementurbists take part in the construction of secondary cement, osteoblastov-in bone formation. Thus, tissue lost as a result of physiological or pathological processes is restored.
A significantly developed network of vessels (periodontal capillaries have a winding point like the glomers) and the nerves of periodontal causes it to r about f and the function - the power of the tooth cement and the alveoli walls.
In addition to the functions listed, periodontal participates in growth, teething and dental change, and also performs barrier and sensory functions.
The duration of the load on the teeth created by chewing and swallowing is on average about half an hour (no more than 2 hours). During sleep, the lower jaw is usually descended, so that the teeth do not come into contact, there is no load on the tooth lobby. The magnitude of the chewing force usually changes between 50 and 100 kg, sometimes it can be significantly larger. The effect of force depends on the magnitude of the gum covered and fixed to the dental cell of the root as a clinical concept. The longer the "clinical root", the stronger the support of the tooth and can shift only significant strength. On the other hand, the greater the "clinical crown" compared to the "clinical root", the smaller the power can be shifted from the dental cell. Forces acting at functional load, rebuild the bone.
The bone tissue of alveolar processes of the jaws consists of a compact and spongy substance. The bone marrow cavities of various sizes are filled with fat bone marrow. The base of bone tissue is protein - collagen. A feature of the bone matrix is \u200b\u200bthe high citric acid content necessary for mineralization, as well as alkaline and acid phosphatase enzymes involved in the formation of bone tissue.
In the alveolar process there is a gradual formation and destruction of the bone. This process depends on the strength acting on the tooth and on the overall condition of the body. Under normal conditions, there is a physiological equilibrium between the formation and destruction of the bone, i.e. the lost bone is replaced by a new one. Increased pressure in physiological limits contributes to the formation of bones. Around the well-functioning tooth arise conquered, thick bone trabecules. In the bone, the stroke of the bone trabecul corresponds to the direction of forces acting on the bone, while the bone fixes the tooth is most strongly. Reducing pressure (for example, with a decrease in chewing) leads to a change in bone trabeculae to a decrease in their number and their atrophy. Morphofunctional disorders in the jaw bone may have different severity. With the loss of teeth that do not have antagonists and not performing chewing functions, only the number of bone trabeculs around the tooth decreases, but the dental cell itself is not atrophily.
Atrophy is observed after the loss of one or several teeth, in pathological conditions (periodontal, periodontitis, diabetes mellitus, etc.), as well as in people over the age of 60 years. Atrophy after removing the teeth occurs immediately and first manifests itself in reducing the height of the tooth's hole by one third. In the future, atrophy proceeds more slowly, but does not stop, but only somewhat slows down.
In the formation of the internal structure of the bone, not only mechanical factors play a certain role, but also other effects on the part of the body. The formation of a new bone depends not only on the voltage and on the magnitude of the forces acting on the bone, but also on the general condition of the body, from transferred general and local diseases, on the intensity of metabolism, etc.
The resistance of periodontal to the load in ontogenesis increases in series, respectively, the growth and development of all elements constituting the dental system. However, the maximum vertical endurance of periodontal, determined by the rutodinameometer, does not characterize all the forces arising from chewing and clamped from successive rhythmic crushing and grinding movements of the lower jaw. In physiological conditions, periodontal has a significant reserve of reserve forces, without which the chewing process would be impossible.
The periodontal load arising from chewing depends on the nature of food, muscle strength, the type of closure of the jaws, but almost always during chewing uses only a part of the possible endurance of periodontal. Parodont reserve forces can be increased by training the chewing machine (for example, by chewing coarse food).
In case of periodontal diseases, its physiological reserves gradually disappear, functional failure develops to the loss of teeth.
Physiological changes in teeth and periodontics. The form, the structure of the teeth and the state of the periodontal is not constant, they change under the influence of various functional conditions. These changes are manifested in erasing (abrasion) of teeth, in the appearance of their mobility, in the occurrence of pathological bite, in peeling the epithelium and in atrophy of dental cells (Fig. 3).
Fig. 3. Erasing tooth crowns at different ages.
Erasing occurs both in chewing and side (approximal) surfaces. As a result of the erase, the chewing surfaces of the teeth are gradually polished, the coolness of their bugs decreases, the coals of the chewing surface becomes less and gradually disappear. As a result of this erasure, the bite becomes deeper, most of the chewing surfaces come into contact.
Erasing depends on the type of chewing, from the composition of food and from the state of the bite. Thus, with a direct bite, the chewing surfaces of the molars and premolars and cutting edges of the cutters and fangs are faster, with deep \u003d the paternal surface of the top jaws and vestibular teeth of the lower jaw. Some teeth or groups of them with a braid or mixed bite are exposed to rapid erasure. With the loss of any group of teeth, the preserved teeth are intensively erased as a result of overload. According to the degree of erasure, it is possible to draw conclusions regarding human age. Until 30 years of age, it is limited to enamel. Approximately 40-60 years old, Emale Bugrov is erased to dentin, which is visible in his yellowish color; It becomes brilliant and pigmented.
Fig. 4. Four teething stages.
Attaching the epithelium: 1 - only on enamel; 2 - on enamel and on
cement; 3 - only on cement (covers the whole root);
4 - on cement (the cervical root is free).
The core of the tooth is slightly shortening. To the 70-year-old, the erase approaches the pulp cavity (Fig. 3).
The pronounced spray of all teeth leads to a decrease in the bite, as a result of which pains in the temporomandibular joint may appear.
As a result of erasing the approximal surface of the teeth, the nature of their contact is changing. Interdental contact points are compiled, contact surfaces are formed. The occurrence of the contact surface to a certain extent prevents an increase in interdental spaces and as a result - to enter the dietary mass.
Erasing the side surfaces causes the mobility of the teeth and the displacement of their medial direction. As a result of erasing, the dental arc to the 40-year age is shortened by approximately 1 cm.
Teething and their location in the dental arc is called the active teething of the teeth. The nomination of teeth from jaw bones continues throughout life, although it is significantly slow. Continuous teething may be accompanied by the formation of the bone at the edge of the alveoli and the constant formation of cement on the root of the tooth.
Attaching the epithelium with teething tooth is observed on the border of the middle and lower third of the tooth crown. The place of attachment of the epithelium, however, is impermanent and over time very slowly shifts towards the top of the root. Thanks to this, in the oral cavity there is an all large part of the tooth crown, and then the root. This process is called a passive teething.
According to the position of the attachment of the epithelium, 4 stages of teething (Fig. 4) differ (Fig. 4). In the first stage of the epithelium attached only to the enamel of the tooth. The gums cover, thus, approximately one third of the enamel. The clinical crown is less anatomical. This stage continues from the time of teething tooth approximately 25 years. In the second stage, the attachment of the epithelium is available not only for enamel, but partly and on cement. However, the clinical crown is still less anatomical. Such a picture is usually observed aged 25-35 years. During the life, the epithelium separation from enamel continues, attachment shifts to cement, but it still does not completely cover the root. The clinical crown coincides with the anatomical. This provision corresponds to the third stage and is observed approximately at the age of 35-45 years. In the fourth stage, the attachment of the epithelium shifts towards the top of the root, and the connection with which part of the root remains free. The clinical crown is greater than anatomical. The combination of these signs is characteristic of persons over 45 years old. Thus, in the stages of passive teething, it is possible to draw conclusions regarding the age of a person.
Permanent restructuring - the destruction and formation of cells and fibers flows in the tissues of periodontics. On the roots of a functioning tooth, a continuous laying of cement is found. On the site of the dead fibers of the periodonta are formed new fibers. Only on a properly functioning tooth detects the characteristic distribution of periodontal fibers. If the chewing force does not act on the tooth and it loses its antagonist, then parallel surfaces of the tooth loose connective tissue is formed on the site of the space of passing dense fibrous connective tissue. If the function of the tooth is resumed (the antagonist is replaced), the initial structure of the periodontal fibers is restored, and a gradual rearrangement of the chewing force occurs in the bone. As long as regeneration is in a state of equilibrium and compensates for destruction, periodontal remains intact. If destruction prevails over the restoration, the death of periodontal occurs.
Periodontal functions. Periodonts are constantly exposed to external environmental and internal factors. Sometimes these effects are so strong that periodontal fabrics are experiencing extremely greater overload. At the same time, damage does not occur. This is explained by the fact that during the life of periodonts constantly adapts to new conditions. An example is: teething of dairy and constant teeth, turning off the tooth from bite, changing the nature of food, disease of the body, injury, etc. All of this testifies to the large adaptive possibilities of periodontal.
Periodonts possesses the following functions: barrier, trophic, reflex regulation function of chewing pressure, plastic, shock-absorbing.
Barrier function. Periodontal integrity is a reliable protection of the entire body from the action of adverse environmental factors. Periodonts transfers significant physical overloads, resistant to infection, intoxication, etc. Adams (1975), in particular, with the help of fluorescent microscopy, showed the value of the barrier function of mucopolysaccharides and saliva. The barrier function has a certain meaning and in preventing the sensitization of the body during an odontogenic infection. Currently, it has been established that in the appearance of allergic diseases, a certain role is played by preceding the sensitization of the organism at the expense of a focal odontogenic infection.
The barrier function of periodontal is determined by: a) the ability of the epithelium of the gums to the energization (in periodontal cause, this ability is broken); b) a large number and features of the direction of bunches of collagen fibers; c) turgn gums; d) the state of mucopolysaccharides of the connecting educations of periodontal; e) the characteristics of the structure and the functions of the physiological seashenty pocket; e) antibacterial function of saliva due to the presence of such biologically active substances such as lyso-qum, inhibin; g) the presence of obese and plasma cells in periodonts that play an important role in the development of autoan-titel.
Studies of the Academician school A. S. Stems found that the endothelium capillary, the basal membrane, the main substance of the connective tissue belongs to the hysto-hematic barriers, the protective function of which is the protection of the inner medium of cells and tissues from the admission of alien organisms of substances.
Trophic function. It is one of the main functions of periodontal. The trophic function is due to the widespread network of capillaries in nerve receptors. Near the authors (Grigoriev T. A., 1959; Kupriyanov V. V. et al., 1975) found that the capillary with a portion of the tissue in contact with it is considered as a structural-functional unit of tissue trophic. This feature largely depends on the preservation or restoration of normal microcirculation in the functioning periodontal.
The function of reflex regulation of chewing pressure. In periodontal there are numerous nervous endings, receptors, the irritation of which is transmitted to the most diverse reflex highways. I. S. Rubinov showed the course of one of the reflexes - periodontomskular, which regulates the power of the reduction in chewing muscles (chewing pressure), depending on the state of the periodontal nerve receptors.
Plastic function of periodontal. Lies in the constant recreating of periodontal tissues, lost during physiological or pathological processes. Realize this function of cement and osteoblasts; Other cellular elements are played a certain role - fibro-blasts, fat cells, etc.
Depreciation function. This function is performed by collagen and elastic fibers of periodonta. In case of chewing, they protect the tissue tissue tooth, periodontal vessels and his nerves from injury. Existing different views on the depreciation mechanism are reduced to the fact that in this process, the liquid contents and the colloids of the interstitial slots and cells are involved, as well as changes in the volume of vessels. It should be noted that it is unlikely that it will be correct to attribute depreciation only to the account of the periodontal liquid medium or to attribute it to the fibrous structures, apparently, in this process, the entire complex of structural factors of periodontal is involved.
Thus, periodontal functions are to fulfill the complex of important protective and adaptive and compensatory reactions in which the entire body is sometimes interested. If any function of periodontal falls out, the relationship between local and society gomeostasis systems is disturbed and this predisposes the periodontal disease.
Periodontal functions, interconnecting each other, maintain physiological equilibrium between the outer and internal medium, thereby maintaining the morphological structure and functional adequacy of periodontal.
The gantry fluid is normalized by an important part of the protective mechanism of marginal periodontal due to the immunological properties of the transudate and phagocytic activity of cell elements in it (Löe, PE-Derson, 1965, etc.). In addition, due to the macromolecules included in its composition of protein substances, it is involved in the physi-co-mechanical (adhesive) connection between the epithelium of the des is the gap and the surface of the tooth (SGAP, 1972, etc.). The separation of the liquid from the gums pocket occurs weakly, but increases with mechanical stimulation and inflammation, while the high-quality composition of the liquid also changes. The local administration of any substances (including drugs) leads to the fact that they are quickly removed due to the gum fluid, if you are not kept in situ mechanical (Brill, 1959). This should be borne in mind when drug therapy gums pockets. To create a long-term contact, they should be recorded on the site by a bandage or paraffin (especially in the treatment of sewage pockets on the upper jaw).
From the above, it follows that the physiological characteristics of the periodontal change depending on the state of the body and in turn can affect the functional indicators outside the maxillofacial region.
The periodontal includes a set of fabrics with genetic and functional community: periodont, alveoli bone, gums with periosteus. Some authors include in the periodontal complex and tooth fabrics (cement, on-example). But in this case, the meaning of the word (Para - about and Odontos - the tooth) is changing. Thus, the concept "PERODONT" - This is an artificially dedicated structural element of the chewing system (near-block fabrics), under which N. K. Loginova proposes to understand the interaction of various elements (teeth, chest bones, temporomandibular joints, chewing muscles, tongue, salivary glands) aimed at achieving the final The result is the Obroquinization of the food lump, suitable for swallowing.
If you meet this section in literary sources, you may encounter such as:
- alveolar Comb - Theft region of the alveolar process, ending close to the contours of the enamel-cement border;
- connectual attachment - The fibers of the connective tissue of the gums and periodontal ligaments that germinate in the root cement;
- swancing Connection - The jumper between the tissue of the gums and the part of the tooth, which is covered with gums;
- desna - Epithelial-connecting fabric, surrounding the tooth and al-feling process, attached to them and extending to a muccohy-hydhyer compound (i.e., to a clinically distinguishable line between the gum and mucous membrane of the alveolar process);
- g1the line of the guming fabric, which is co-unity of the gum epithelium and the epithelium of the groove;
- groom groove (gantry gap) - Small grooves between the tooth and most of the gums, located between the epithelial attachment (the biological mechanism of attaching epithelial cells of the connecting epithelium to the surface of the tooth), i.e. The bottom of the groove and the edge of the gums. This is an anatomical concept;
- clinical gantry groove - The space that is created by the introduction of the probe between healthy or slightly inflamed gums and the surface of the tooth. It is always deeper than an anatomical groove;
- interdental nipples - Speaking over the crown part of the gantry fabric, the fill-sprained between the contact surfaces of the tooth both with a lip (peel) and the side (sky) side.
With terms for the characteristics of diseases (diseases) of periodontal, we will get acquainted as a further issue of this problem. Periodontal functions:
1) Barrier function that is provided:
· the ability of the Epithelial Desds to the Ebaw (in case of periodontal diseases, this function is broken);
· large number and features of the direction of bunches of collagen fibers;
· turgor gums;
· the state of the mucopolysaccharides of the United Nations Education of Periodonts;
· features of the structure of the gum groove;
· antibacterial function of saliva due to the presence of such biologically active substances as lysozyme, inhibin, etc.;
2) the trophic function is provided by a wide network of capillaries and non-rational endings;
3) the reflex regulation function of chewing pressure - the irritation of numerous nerve endings is transmitted by a variety of reflex highways;
4) The plastic function consists in constant recreating the fabrics, in the course of physiological or pathological processes (osteo-blasts, fibroblasts, etc.);
5) The shock-absorbing function is provided by the presence of collagen, elastical fibers of periodonta and fluid contained in vessels and tissues.
In the development of the problem of periodontal diseases, such domestic scientists contributed great contribution as: A. I. Evdokimov, E. E. Platonov, NF Danilevsky, G. D. Ovrucksky, G. N. Vishnyak, T. F. Vinogradova, T. I. Lemetskaya, E. V. Borovsky, V. with . Ivanov, M. M. Tsarinsky, T. V. Nikitina, A. P. Beruckova, L. A. Dmitry-Va, A. I. Grudyanov, A. P. Kankanyan, V. K. Leontyev, etc.
At the Department of Therapeutic Dentistry of the Smolensk State Mea-Ditin Academy over the indicated problem, worked and work: L. M. Sigsov, V. G. Morozov, E. V. Petrova, N. S. Levchenkova, S. N. Lozbanev, A. I. Nikolaev, L. B. Turgeneva, A. P. Khromchenkov, E. N. Zhazkov, N. N. Usoltseva. They are protected by the dissertations, prepared and published monographs, reference and methodological provisions, methodical recommendations, development, letters, prepared patents on items.
On systematization and classifications of periodontal diseases there is a lot of data. Systematization of diseases in general and periodontal diseases in particular provides for the assignment of individual nosological forms of pathology to basic (typical) pathological processes - inflammation, dystrophy, tumors and tumor-like defeats. As for classifications, some of them represents historical interest, part is set out in textbooks on therapeutic dentistry. You need to stay on more detail on domestic classification adopted in November 1983XVI Plenum of Board Deposit in Yerevan. This classification uses in Russia and now.
This classification involves the separation of inflammatory (gingivitis, periodontitis), dystrophic (periodontal), idiopathic and tumor (tumor-like) in their morphological and clinical entity of periodontal lesions.
1) Gingivitis - The inflammation of the gums caused by the adverse effects of common and local factors and flowing without disrupting the integrity of the sedentine attachment. Forms: Catarial, hypertrophic (more correctly - hyperplastic), ulcerative. Flow: acute, chronic, aggravated, remission. Prevalence: Localized, generalized. Severity: Easy, medium, heavy.
2) Periodontitis - Inflammation of periodontal tissues, characterized by progressive degradation of periodontal and bone. As can be seen from the definition given by the authors of the classification to this type of pathology, for some reason "fell" to the cause of it. Only the hara-katerics of the pathological process is given. Flow: acute, chronic, overacted (including abscess), remission. Prevalence: Localized, generalized. Severity: Easy, medium, heavy.
3) Periodontortosis - Distrophic lesion of periodontal. Here, as you can see, there is no reference to the cause of the disease, and Hara Cateriberistics of it (except for indicating the morphological essence of the process). Flow: chronic, remission. Prevalence: generalized (it was easier to point out this, giving the definition of the disease). Severity: Lea-kaya, medium, heavy.
4) Eidiopathic diseases of periodontal with progressive lysis of periodontal tissues (papiona-lephather syndrome, histiocytosis X, Akatalazia, neutropenia, Aghamaglobulinemia, sugardiabeatnosomes-breed). We divide the point of view T. I. Lemetskoy about the inappropriateness of the introduction of the concept of "idiopathic diseases", since it removes the responsiveness with a dentist's doctor for finding out the general disease, which caused the cause of periodontolis. The concept of "idiopathic" implies non-clarity of etiology. And here not everything is consistent with logic, since etiology, for example, diabetes is known.
5) Periodontoms - Tumor and tumor-like processes in periodontal.
Thus, the main categories used by the authors of this classification in the systematization of periodontal diseases were: the clinical form of the disease, indicating the morphological essence of the lesion, prevalence, severity and the staging of it under this form. At the same time, there is no sequence in its compilation: with more than a detailed output of data relating to many aspects of gingivitis, in characteristics of the 5 group (periodontal), the well-known fact is stated that "periodontal" is tumor and tumor processes in periodontal.
This classification, unfortunately, does not include other forms of periodontal pathology (for example, fast-crossing periodontitis, other "aggressive" manifestations), nor the complication of periodontal diseases, nor the outcome of them nor the forecast or the possibility of combined defeat.
From the point of view of formal logic, the main task of the classification is to systematize the accumulated knowledge by drawing up a more or less strict system of coinled concepts (classes). The classification is based on the logical rules for dividing the scope of concepts and orderly distribution, combining objects to classes on the signs of their similarity and difference [Tarasov K.E. and Sov., 1989]. The natural classification of diseases can advocate more adequate recognition of diseases, because without it, it is impossible, but the proper substantiation and differentiation in the diagnosis of bole.
Properly compiled classification should meet a number of requirements relating to the division of concepts.
1. The division into classes should be carried out according to a single base (feature). Failure to comply with a single base makes the division of a knocking and cross-cross, thus erroneous and all classification turns out.
2. The division should always be proportionate. This means that the sum of all division members must fully exhaust the entire amount of its class (generic concept). Otherwise, the division is obtained incorrect - either too wide, or too narrow
3. Members of division of one row should exclude each other. Incidentally, each of the items entering this class can only be attributed to one of the members of the division and in no case to several members of this series immediately (as it, for example, is made for periodontitis in 2 and 4 groups of the specified classification ).
4. The basis of division must be a sign indicating a significant difference between members of division.
In the classification of periodontal diseases, such signs should be the basis of etiology, pathogenesis, localization of the pathological process, some clinical features of the disease, i.e. Signs characterizing the essence and specificity of the nosological form. Significant signs may also be the features of the flow, the presence of complications, etc. It seems completely natural that the final member of division in the classification of periodontal diseases should be individuals of nosological forms of co-temporal clinical medicine.
It is necessary to recall that the nosological signs for the designation of the disease are diverse, and their values \u200b\u200bare defined extremely incredible. The authors of the monograph mentioned above (Tarasov K.E. and Sovut., 1989) "Logic and semiotics of di-agnosis" offer the following notation:
- The pathological process is the inner essence and course of the disease.
- The disease is an external manifestation of the pathological process.
- Disease - detection of the beginning of the disease phenomena and the fact of the existence of the disease in this person,
- The nosological unit (nosological form) is the designation of the disease, according to the existing nomenlate and classification of diseases, which should be updated every 10 years.
SPARCL study: in high-risk patients with type 2 diabetes, recently undergoing stroke, Lipririmar reduced the risk of coronary events twice, and the risk of stroke is almost a third
iD \u003d "0"\u003e Pfizer announced the results of a new analysis of the SPARCL epocal study ("stroke prevention through an aggressive decrease in cholesterol level"), which showed that the drug Liprimar reduced the risk of coronary specials twice, and the risk of re-stroke is almost a third In high risk patients with type 2 diabetes, recently undergoing stroke.In patients with metabolic syndrome, recently undergone a stroke or a traganitory ischemic attack (TIA), but not having a diagnosed coronary heart disease, Liprimmar significantly reduced the risk of insoles of coronary heart disease.
Liprimmar (Atorvastatin Calcium) at a dose of 80 mg reduces the risk of re-stroke, and serious coronary events in patients with type 2 diabetes mellitus, without a previously diagnosed ischemic heart disease (IBS), but recently undergoing stroke or TIA. These data obtained as a result of the SPARCL study ("stroke prevention through an aggressive reduction in cholesterol level") were presented at the 67th annual scientific session of the American Diabetes Association.
According to the National Institute of Sugar Diabetes, diseases of the digestive system and kidney disease, in people suffering from diabetes mellitus, the risk of stroke is 2-4 times higher, and almost two-thirds of deaths in these people occur due to heart or stroke disease. "Type-diabetes mellitus and undergoing strokes have a much greater risk of re-stroke, the development of a coronary event or a revascularization operation compared to people who do not have type 2 diabetes mellitus," said Dr. Michael Welch, lead researcher SPARCL, neurologist And President of the University of Medicine and Science Rosalind Franklin. - Analyzing the condition of patients with diabetes mellitus 2 without diagnosed IBS, we found that Liprimmar effectively reduces the risk data. "
In the above analysis (N \u003d 794), it was found that Lipririmar reduced the risk of re-stroke by 30%, and the risk of developing IHD and serious coronary events is 51% compared with placebo. Coronary events include heartfelt death, heart attack, successful resuscitation after stopping the heart, unstable angina, revsacularization surgery and angina, requiring emergency hospitalization. Serious coronary events include hearty death, heart attack and successful resuscitation after stopping the heart.
In an additional analysis, an estimate of the 781 patient's examination of SPARCL, having a metabolic syndrome and recently transferred stroke (as well as mini-stroke), but without diagnosed IHD. These Liprimar patients have significantly (by 43%) reduced the risk of developing IBA compared with patients who took placebo. The risk of re-stroke decreased by 12 percent, and the risk of serious coronary events - by 26 percent, but the decrease in these indicators was not statistically significant.
"The results of this study remind us of the importance of managing the factors of the general cardiovascular risk of patients in order to reduce the risk of developing serious cardiovascular complications," said Dr. Welch.
About SPARCL study
The SPARCL study published in the "New England Journal of Medicine" in 2006, to date is the only study that estimated the use of statinate therapy in the group of patients with a recently transferred stroke or TIA, non-IBS (N \u003d 4731). Liprimmar 80 mg is the only static confirming the effectiveness of reducing the risk of re-stroke in this group of patients. Compared with the Liprimar Placebo, 80 mg reduced the risk of re-stroke by 16 percent, and the risk of serious coronary events is 35 percent.
The SPARCL study demonstrates good tolerability of Liprimary.
The frequency of side effects (for example, an increased level of liver enzymes) was low and corresponded to a well-known security profile; Intergroup differences regarding the frequency of muscle weakness or rabbdomyolysis were absent. The dose of 80 mg is not a starting dose of Liprimary.
About the drug "Liprimmar"
Liprimar is an actively studied drug. It is the most commonly prescribed lipid-lining drug in the world, the experience of using the use of which is currently almost 139 million patient-years. Clinical experience in the application of Liprimar is confirmed by the results of an extensive program of clinical research, which includes more than 400 ongoing and completed studies with the participation of more than 80,000 patients.
Important safety information
Liprimmar is a drug released by a doctor's prescription. It is used in patients with several risk factors for middle-vascular diseases, such as family history, high blood pressure, age, low HDL ("good" cholesterol) or smoking, to reduce the risk of developing myocardial infarction, stroke, some acute cardiovascular States and angina, in cases where diet and exercise are insufficient. Liprimmar is used in combination with a low-calorie diet and is used to reduce cholesterol.
Liprimmar also applies in patients with type 2 diabetes and, at a minimum, one cardiovascular risk factor, such as high blood pressure, smoking or complication of diabetes, including eye damage, proteinuria, to reduce the risk of myocardium infarction and stroke.
Lipririmar is contraindicated in patients with increased sensitivity to any of the components of the drug; with active liver diseases or an increase in the activity of transaminase serum unclear genes (more than 3 times compared to the upper limit of the norm); Pregnant or lactating women, as well as women of reproductive age, not using adequate methods of contraception. Patients need to be warned that they should immediately consult a doctor when the muscles appear unexplained or weakness, especially if they are accompanied by ailment or fever.
Doctors must control blood tests to monitor the liver function before and if necessary, corrected the prescribed dose. Liprimmar is usually well tolerated. Adverse reactions are usually light and transient. Unwanted effects that met in the treatment of Liprimar most often (\u003e 1%) were: insomnia, headache, asthenic syndrome, nausea, diarrhea, abdominal pain, dyspepsia, constipation, meteorism, Malgy.
Information about the drug Liprimmar (Atorvastatin) can be found at www.lipitor.com
Pfizer announces the first inhabitant of his scientific incubator
id \u003d "1"\u003e The first company placed in the Incubator PFizer - Fabrus LLC is formed to develop new antibody-based technologies to create innovative drugs.In July 2007, the first inhabitant appeared in the "incubator" Pfizer - a new division of the company, in which scientists will be able to work on the incarnation of their ideas and plans to create innovative drugs and methods for treating serious diseases.
Vogn Smyder, doctor of medicine, Associate Professor of Scientific Research Institute of Skipps in La Hoya, California, will develop a unique antibody identification technology, on the basis of which new types of therapy may appear. It organizes a new Fabrus LLC company in the Incubator, located on the territory of the Center for Research and Development of Pfizer in La Hoya.
"The community of biotechnologists and academic scientists has had a truly warm welcome to us," said Alex Polynsky's incubator, Pfizer. - We support scientists and help finance their scientific work in the early stages. With the help of the "Incubator", new developments will become one step closer to patients. In particular, with successful development, Fabrus technology can offer new types of therapy in many areas of medicine. "
Pfizer plans to invest in the development of new promising scientific companies placed in the Incubator, a total of 10 million US dollars per year. Pfizer continues to consider the proposed projects of scientific papers and expects the arrival of the new inhabitants of the complex in the near future.
"" Incubator "will allow me to focus on science," says Dr. Smyder. - We will not have to spend time on complex aspects of business - such as financing and purchase of equipment, design of payment statements and other necessary procedures necessary for business. We also win thanks to the proximity to Pfizer and the enormous scientific resources of this company. "
Fabrus is going to hire six to eight scientists who will be provided with laboratories and offices in the new complex "Incubator". Pfizer plans to finance Fabrus for two years, after which it will be able to purchase a company and its technology, or Fabrus will turn out to be an independent enterprise.
During the two-year "incubation period" Fabrus will develop a library of new antibodies and methods for conducting their screening on biological objects. Pfizer will provide part of its laboratories for the study of infectious diseases to test new technology.
About the "incubator" of Pfizer
Pfizer Incubator offers science figures the opportunity to embody their ideas to medical innovation for the benefit of patients. Incubator scientists provide "incubator" of their revolutionary ideas and scientific and technical solutions, while the Incubator provides all the necessary resources to transform the theory into practice.
Additional information on the site: www.thepfizerincubator.com
Forty percent of people die from environmental pollution
iD \u003d "2"\u003e Forty percent of deaths in the world are caused by air pollution, water and soil. These environmental problems are associated with a rapid increase in population, lead to an increase in the number of diseases, reported in the press release of Cornell University.Professor David Pimentel (David Pimentel) with a group of graduate students analyzed about 120 printed works devoted to the influence of demographic and environmental factors for the prevalence of disease. In his report, which will be published in the December issue of Human Ecology magazine, they argue that the lack of water resources, land and energy, which is aggravated, on the one hand, the growing population, with the other, pollution, leads to an increase in the number of diseases.
According to Paimatel, 57 percent of the population of the globe, which is 6.5 billion people, suffer from hunger (in 1950, starved 20 percent of 2.5 billion). Six million children die annually from hunger, and besides, malnutrition weakens the body and is an indirect cause of many deaths from ORZ, malaria and other diseases. Paimatel highlights a few major causes of disease growth.
Approximately half of all mankind lives in cities where sanitary standards are often not respected and the population density is too high, which can lead to outbreaks of diseases such as cortex and flu.
80 percent of all infectious diseases are transmitted through water, while a lack of clean water is experiencing more than a billion people. In addition, water pollution leads to the reproduction of malaria mosquitoes, because of which about two million people die every year.
Poisonous emissions into the atmosphere kill about three million people per year. Among the main causes of deaths are cancer, congenital pathology, impaired immune system. Soil contamination leads to the fact that poisoning substances are absorbed by a person with food and water.
Paimametel urge to use intelligent strategies for demographic and environmental regulation, and not hope that the growth of diseases and food shortages will lead to the necessary reduction in the population. "It worsens the quality of life and is a very risky strategy," the researchers conclude.
Neck massage restores blood pressure
iD \u003d "3"\u003e doctors practicing manual therapy, long well known that the removal of pain and immobility of the neck muscles by massage can reduce blood pressure, but the reasons for such an effect were not clear.
A group of scientists from the University of Leeds, United Kingdom (University of Leeds) showed how the state of the neck muscles affects blood pressure, pulse and breathing. The brain area where signals from the neck are completed, was determined more than 100 years ago, although it functions remained unclear. Now the researchers have found the connection between the cells of this area and the Tractus Solitarius core (single path) - the brain area that controls the autonomous features of the body. Scientists suggest that the signals from the neck can play a key role in ensuring a normal blood supply, which is regulated by the brain when the poses change. If such signals are violated, a person may lose its equilibrium and its blood pressure can go beyond the norm. The findings of scientists offer a clear rationale for the effectiveness of manual therapy.
Invented a device for combating icota
iD \u003d "4"\u003e There are many homemade tools to combat the icota. Plato in the dialogue "PIR" suggests in order to combat Ikota to ripped a throat in the nose. Some people delay their breath, others are asked to frighten them well, sometimes it is offered to drink some water, deeply bending over the saucer.
All these tools help not always. Inventor Philip Ehlinger (Philip Charles Ehlinger, Jr.) patented a device for the treatment of Icotes. The device is a metal cup from which two electrodes come out. When a cup is full of water, and man begins to drink, one electrode touches the cheek, and another temple. At this moment the electrical circuit is closed, and weak current affects the wandering and diaphragmal nerves, interrupting the reflex arc of the Icotes.
4 million pairs in Russia suffer infertility
id \u003d "5"\u003e According to the Russian Association of Man's Reproduction, in Russia, more than 4 million pairs of reproductive age or more than 15% of the population suffer from infertility.
According to the World Health Organization classification, the infertility factor significantly affects the demographic situation in Russia. Artificial fertilization is recognized as the main method of treating infertility in the world. In Russia, this method is used in 20 times less often than, for example, in Denmark. The reasons for such rare use of artificial fertilization a lot. This is the low solvency of the population, the lack of state support in many types of infertility and the insufficient number of embryologists-clinicians. The President of the Russian Association of Reproduction of Man Professor Vladimir Korsak believes that the law on the protection of the reproductive rights of citizens is necessary, "Science and Life" reports.
In the brain found the center of fever
iD \u003d "6"\u003e Scientists from the Beth Israel Deacone Medical Center revealed a brain section responsible for increasing body temperature. The selective blocking of this center, located in the hypothalamus, can be the basis for creating highly specific antipyretic drugs, reports Nature Neuroscience magazine.
Previously, scientists were known that inflammation is accompanied by the production of biologically active substance - prostaglandin E2. This compound acts on the hypothalamus - the brain department responsible for the vegetative regulation of body temperature, appetite, water balance, sexual activity, vascular tone, etc.
Clifford Saper and his colleagues set out to establish a specific section of the hypothalamus, responsible for increasing body temperature. Experiments were carried out on mice, which were alternately "turned off" genes encoding EP3 receptors to forebanding E2. These receptors are available in many brain cells, and respond not only for the development of fever, but also for other symptoms of the disease, in particular weakness and loss of appetite, said Seitaper.
According to the scientist, ultimately, they managed to detect a brain section with a pin-head size, "Turning off" of the EP3 receptors of which blocked the development of fever. The area that plays a key role in increasing the body temperature was the medial precortic core located in the middle zone of the hypothalamus.
"We assume that everything is also happening in the human brain," said Seyper.
The antipyretic agents currently used (for example, aspirin) affect all prostaglandic receptors in the body - due to this there is a significant number of side effects. New data allow you to begin developing safer preparations that affect specific receptors, summarized the scientist.
GOU VPO Saratov Medical University.Department of therapeutic stomatologists
Periodontal diseases.
Methodical manual for students, interns and coordinators of the dental profile.
.Tea: Anatomy and periodontal physiology. Periodontal functions.
Targets: To study the structure of all fabrics that are part of the periodontal, and periodontal functions.
Required source level of knowledge:
1) The structure of the gum mucosa.
2) Alveola bone bone structure.
3) the structure of periodonta.
4) the structure of cement.
Questions to prepare for the lesson:
1) What is perodont?
2) Fabrics included in the periodontal.
3) The gum mucosa, the normal type of gum mucosa.
4) The zones of the gum: marginal gum, alveolar gum, sulcular gums,
transitional fold
5) Layers of the gums.
6) the histological structure of the gum epithelium, its blood supply and innervation.
7) the histological structure of the proper plate of the gum mucosa, its blood supply, the microcirculatory course of the gums, plasma capillaries, innervation.
8) gantry groove (sulcular Dums (gums), depth, histological and clinical gantry groove, biological width of the gums: epithelial attachment, connecting and intrinsic attachment; Features of blood supply and innervation.
9) GUERE LIQUID. Local immunity of the oral cavity (cellular and humoral, secretory immunoglobulin a).
10) Boundary apparatus gums.
11) Periodont, the direction of the periodontal fibers, the form and width of the periodontal gap. The composition of the periodonta: fibers, basic substance, cells (fibroblasts, cement cloves, histiocytes, fat, plasma, osteoblasts, osteoclasts, epithelial cells, mesenchymal cells), blood supply, innervation.
12) cement (primary, secondary), composition, blood supply, innervation.
13) Alveola bone tissue, alveoli structure, dice plate, spongy substance, bone marrow, direction of trabecul, bone cell cells (osteoblasts, osteoclasts, osteocytes), blood supply, innervation.
14) age-related changes in periodontal.
15) periodontal functions: trophic, supporting, depreciation, barrier (external and internal barrier), plastic, reflex adjustment of chewing pressure.
Equipment of classes.
Table No. 71. "The structure of periodontal".
Table No. 72. "The blood supply to the periodontal and bone of the Alveola."
Table number 59. "Seashenty attachment".
Table No. 73. "The blood supply to the gum papillary".
Table No. 90. "The structure of bone tissue of interdental partitions of lateral teeth."
Table No. 100. "The structure of bone tissue of intersubolic partitions of the front teeth."
Periodonts - This is a complex of tissues surrounding the tooth constituting a single integer having genetic and functional community.
The term "periodontal" comes from the Greek words: para. - around, around; and odontos. - Tooth.
The fabrics that are part of the periodontail:
gum,
alveoli bone tissue (along with the perception),
periodontium,
tooth (cement, dentin root of the tooth, pulp).
GUM - mucous membrane, covering alveolar jaw processes and encompasizing teeth necks. Fine The mucous membrane of the gums of pale pink color, its surface is uneven, it looks like an orange crust (the so-called "spinning") due to small retractions, which are formed on the site of attaching gums to alveolar bones with bunches of collagen fibers. With an inflammatory energetic eternity, the gum mucosa disappear, the gums becomes smooth, smooth, shiny.
Gum zones:
marginal gum, or free edge of the gums;
alveolar gum, or attached gums;
sulcular gums, or gum-groove;
transitional fold
Alveolar Desna - Desna, covering the alveolar process of jaws, 1-9 mm wide.
Sulcular gum (Garrozda) is a wedge-shaped space between the surface of the tooth and marginal gum, a depth of 0.5-0.7 mm.
Garrozda gantry Welered by furrowed epithelium, which is attached to the cuticle enamel. The place of attachment of the epithelium to enamel is called dutch attachment. The desirable attachment is considered as a functional unit consisting of 2-parts:
epithelial attachment, or connecting epithelium, which forms the bottom of the gantry groove, is over the enamel-cement compound on enamel. The width of the epithelial attachment is from 0.71 to 1.35 mm (on average -1mm);
connecting fibrous attachmentwhich is located at the level of the enamel-cement connection on the cement. The width of the coupling attachment is from 1.0 to 1.7 mm (on average - 1mm).
Depth anatomical gantry groove Less than 0.5 mm is determined only histologically.
Clinical gantry groove 1-2 mm depth is determined by sensing.
Epithelial attachment is weak, can be destroyed during probing or operation by other tools. For this reason, the clinical depth of the guro-groove is greater than the anatomical depth. The connection between the epithelium of the attachments and the cuticle enamel indicates the beginning of the formation of the periodontal pocket.
The histological structure of the gums.
Histologically gum consists of 2 layers:
multilayer flat epithelium,
lamina Propria's own plate of the mucous membrane.
The structure of a multi-layered flat oral epithelium:
basal layer - consists of cylindrical cells located on the basal membrane;
hipgy layer - consists of polygonal cells, which are interconnected using hemidesmos;
granular layer - cells are flat, contain grain coratogial;
horny layer - Cells are flat, without cores, oroging, constantly lunch.
In the cytoplasm of cells of all layers of the epithelium (except the horn layer) there are a large number tonophylamans. They define tour The gums that opposes the mechanical load on the mucous membrane and determines its extensibility. With age, the number of tonophylamans increases 3 times. Epithelium marginal gums - introgatoryWhat makes it more resistant to mechanical, temperature and chemical impacts during feeding.
Between the cells of the multilayer flat epithelium is gluing main substance connective tissue (matrix), which includes glycosoaminoglycans (including hyaluronic acid). Haluronidase (microbial and tissue) causes depolymerization glycosoaminoglykanov The main substance of the connective tissue, destroying a hyaluronic acid connection with a protein - a hyaluronic acid molecule changes its spatial configuration, as a result of which the pores increase, and the permeability of the connective tissue for various substances, including microbes and their toxins, increases.
Histological structure of the attachment epithelium.
The attachment epithelium consists of several (15-20) rows of oblong cells located parallel to the surface of the tooth. In the epithelium of the mucous membrane of the gums of blood vessels and the nerve ending.
Histological structure of the proper plate of the gum mucosa.
Own record - This is a coupling education, consists of two layers:
superficial (papilla),
deep (Mesh).
Mesh layer It is formed by a more dense connective tissue (contains more fibers).
Component fabric composition:
main substance - Intercellular matrix (35%) is formed by macromolecules proteoglycans and glycoproteins. The main glycoprotein is fibronctinwhich provides a connection of protein with cell matrix. Another type of glycoprotein - laminin - ensures the addition of epithelial cells to the basement membrane.
fiber (collagen, arganophilic) - 60-65%. Fibers are synthesized by fibroblasts.
cells (5%) - fibroblasts, polymorphic-nuclear leukocytes, lymphocytes, macrophages, plasma cells, fat cells, epithelial cells.
The gums are bustling from substitute vessels, which are finite sprigs of sub-speaking, chin, facial, large, root, porgaznichny and rear top dental arteries. There are many anastomoses through the periosteum with vessels of alveolar bone and periodonta.
Microcirculatory river The gums are represented by: arteries, arteriols, prokapillars, capillaries, postcases, venues, veins, arterio-vesular anastomoses.
Features of the capillaries of the gum mucosa.
For the capillaries of the gum mucosa characteristic:
the presence of a continuous basal membrane,
the presence of fibrils in endothelium cells,
lack of endothelium cells. (All this testifies to the big exchange between blood and tissues).
the diameter of the capillaries is 7 microns, that is, the gum capillaries are true capillaries.
in the marginal gum, the capillaries have the appearance of capillary loops ("studs") located right.
in the alveolar gum and transitional fold there are arterioles, arteries, venules, veins, arterio-vesular anastomoses.
Blood intensity The gum is 70% of the intensity of blood flow of all periodontal tissues.
The partial pressure of oxygen in the gum capillaries is 35-42 mm mercury post. In the mucous membrane gums also have non-functioning capillarieswhich contain only blood plasma and do not contain erythrocytes. These are the so-called plasma capillaries.
Features of blood flow in the region of the sedental furrow.
In the region of the seashene grooves, the vessels do not form capillary loops, and are located flat layer, being postcase Venulauswhose walls have increased permeability, the blood plasma transduction and its transformation goes through them g1 liquid. The gum liquid contains substances that provide local immune protection of the oral mucosa.
Local immunity of oral cavity - This is a complex multicomponent system, including specific and nonspecific components, humoral and cellular factors that ensure the protection of the oral cavity and periodontacts from microbial aggression.
Gumoral factors of local immunity oral cavity:
lizozyme - causes depolymerization of polysaccharides of the cell shell of microorganisms;
lakenoperoxidase - forms aldehydes that have a bactericidal action;
laktorrin - competes with bacteria for iron, having a bacteriostatic action;
muzin - contributes to gluing bacteria to epithelial cells;
β-lysine - act on the cytoplasm of microorganisms, contributing to their autolysis;
immunoglobulins (A, M, G) - fall from the serum by passive diffusion through the intercellular spaces of the gum dust and through the cells of the epithelium. The main role is played immunoglobulin A. (IGA). The secretory component S C is immunoglobulin, but is synthesized by epithelial cells of output ducts of salivary glands. Immunoglobulin A is connected to a secretory component in the oral fluid and fixed on epithelial cells, becoming their receptor, and gives the epithelial cell immunospecification. Immunoglobulin A is connected to a bacterial cell, thereby predicating bacteria on the surface of the teeth, and reduces the rate of the formation of dental tax.
polymorphic nuclear leukocytes - Allocated in the composition of the gums of the gum in inactive state. Neutrophilic leukocytes have special F C and C receptors to connect with a bacterial cell. Leukocytes are activated in aggregate with antibodies, complement, lactoferrin, lysozyme, peroxidase.
monocytes (macrophages) - Phagocytic oral microorganisms are phagocytic, substances stimulating leukocytes are isolated.
epithelial cells The gum mucosa - have special F C and C receptors for a compound with a microbial cell.
muzin Saliva - contributes to the adhesion of microbial cells and fungi to the surface of the epithelial cell. Permanent lunch Epithelial cells with microorganism blocked on them contribute to the elimination of microbes from the body and prevents them in the gum-groove and deeper in periodontal tissue.
Nerve fibers The gums (myelinized and nonyelinized) are located in the connective tissue of the propnant gums.
Nerve endings
free - Interoreceptors (fabric),
encapsulated (Treecuffs), which with age turn into small loops. These are sensitive receptors (which react to 2 types of stimuli - pain and temperature) - the so-called polymodal receptors. These receptors have a low irritation threshold, which goes to weakly adapting neurons of nuclei V pair (triple nerve). Sensitive receptors react to valp irritation. The largest number of these receptors is in the marginal zone of the gum.
The bone alveoli tissue consists of outer and inner cortical plates and the spongy substance between them. The spongy substance consists of their cells separated by bone traccules, the space between the trabecules is filled with the bone marrow (red bone marrow - in children and young men, the yellow bone marrow - in adults). Compact bone is formed by bone plates with the osteon system, permeated with channels for vessels and nerves.
Direction of bone trabecul Depends on the direction of mechanical load on teeth and chewing jaws. Lower jaw bone has a small structure with mainly horizontal Direction Trabec. Upper bone jaw has a largest structure with mainly vertical The direction of the bone trabeculus. Normal Bone Fabric Function Determined by the activities of the following cell elements: Osteoblasts, osteoclasts, osteocytes under the regulatory influence of the nervous system, the hormones of parathyroid glasses (parathgort).
The roots of the teeth are fixed in the alveoli. The outer and inner walls of the alveoli consist of two layers of compact substance. The linear dimensions of the alveoli are less than the length of the tooth root, therefore the edge of the alveoli does not reach the enamel-cement compound per 1 mm, and the top of the tooth root does not fit the Alveola tightly due to the periodonta.
Periosteum Corresponding cortical plates of alveolar arcs. The periosteum is a dense connecting tissue, contains a lot of blood vessels and nerves, participates in the regeneration of bone tissue.
Chemical composition of bone fabric:
1) mineral salts - 60-70% (predominantly hydroxyapatitis);
2) organic substances - 30-40% (collagen);
3) Water - in small quantity.
The processes of remineralization and demineralization in bone tissue are dynamically balanced, are regulated by a parathgamon (a hormone of parachitoid glasses), also the effect of thyroallycitonin (thyroid hormone) and fluorine.
Features of the blood supply to the jaw bone tissue.
The bustling of the bone tissue of the jaws has a greater degree of reliability due to collateral blood supply, which can provide a pulse influx of blood by 50-70%, and through the periosteum into bone tissue of the jaws there are another 20% of the chewing muscles.
Small vessels and capillaries are in the rigid walls of the gaverc canals, which prevents the rapid change in their lumen. Therefore, the blood supply to bone tissue and its exchange activity is very high, especially during the growth of bone tissue and the fracture instractions. In parallel, the blood supply to the bone marrow, performing a hematopoietic function.
Bone marrow vessels have wide sines with slow blood flow due to a large cross-sectional area of \u200b\u200bsinus. The sinus walls are very thin and partially absent, the capillary lumens are widely contacted with the output space, which creates good conditions for free plasma metabolism and cells (erythrocytes, leukocytes).
There are many anastomoses through the periosteum with a periodontal and the gum mucosa. Bloodstock in bone tissue provides cells and transport to them from minerals.
The intensity of blood flow in the bones of the jaws is 5-6 times higher than the intensity in other bones of the skeleton. On the work side of the jaw blood flow by 10-30% more than on the non-working side of the jaw.
The vessels of the jaws have their own milk tone for the regulation of blood flow in bone tissue.
Along the blood vessels there are nervous vasomotor fibers for regulating the lumen of the vessels by changing the tonic voltage of smooth muscles. To maintain the normal tonic voltage of vessels from the cortex of the brain, there is 1-2 pulse per second.
Innervation of the mower vessels It is carried out by sympathetic vesseloring fibers from the upright sympathetic node. The tone of the vessels of the lower jaw can quickly and significantly change when the lower jaw movement during chewing.
Innervation of the Vessels of the Upper Jaw It is carried out by parasympathetic vasodinous fibers of a trigeminal nerve cores from Hasserov Knot.
The vessels of the upper and lower jaws can be in the same time various functional states (Vasoconstriction and vasodilation). The vessels of the jaws are very sensitive to the mediator of the sympathetic nervous system - adrenaline. Thanks to this, the vascular system of jaws has shunt propertiesThat is, it has the ability to quickly redistribute blood flow through arterio-venular anastomoses. The shunting mechanism is turned on with sharp change shows (during food intake), which is protection for periodontal tissues.
PERIODONTIUM(Desmodont, periodontal bunch) is a tissue complex located between the internal compact alveoli plate and the tooth root cement. Periodont is a decorated connective tissue.
Width of periodontal slit is 0.15-0.35 mm. The formontal slit form is "hourglass" (there is a narrowing in the middle part of the tooth root), which gives the root of great freedom to move in the shelf-third periodontal crack and even greater - at the top of the periodontal crack.
The composition of periodonta. Periodont consists of:
fibers (collagen, elastic, reticulin, oxytalan);
cells
intercellular main substance connective tissue.
Highlight 4 periodontal fibers zones:
in the sherial region - horizontal direction of fibers,
in the middle part of the root of the tooth - the oblique direction of the fibers, the tooth is hung in the Alveol,
at the top of the area - the vertical direction of the fibers,
in the top area - the vertical direction of the fibers.
Cells periodonta:
fibroblasts - Participate in the formation and decay of collagen fibers included in the main substance of the connective tissue.
histiocytes,
fat cells,
plasma cells (perform the function of immune protection of tissues),
osteoblasts (synthesize bone tissue),
osteoclasts (participate in bone resorption),
cementoblasts (participate in the formation of cement),
epithelial cells (the remains of the chubmer epithelium are the islands of the Malyass - under the influence of pathogenic factors, cysts, granules, tumors can be formed;
mesenchymal cells - (Unfifferentiated cells from which various cells of connective tissue and blood cells can be formed).
Normal tooth root has inclipable In the Alveol at an angle of 10 o. Under the action of power at an angle of 10 o to the longitudinal axis of the tooth, there is a uniform distribution of stresses throughout periodontal.
For increasing the angle of inclination The tooth up to 40 o increases the stress in marginal periodontal on the pressure side. The elasticity of collagen fibers and their inclined position in the periodontal contribute to the return of the tooth at the starting position after removing the chewing load. The physiological mobility of the tooth is 0.01 mm.
Features of the blood supply periodonta.
Periodonta vessels have a glomerular character, are in the bone wall niches of the Alveola. The capillary network goes parallel to the surface of the tooth root. There is a large number of anastomoses between periodontal vessels and bone tissue vessels, gum, bone marrow, which contributes to the rapid redistribution of blood during the compression of periodontal vessels between the root of the tooth and the alveoli wall during chewing pressure. When squeezing the periodontal vessels arise foci of Ischemia. After removing the chewing load and eliminate ischemia comes jet hyperemiawhich is small and briefly, which helps the tooth return to its original position.
With the oblique position of the root of the tooth in the Alveole at an angle of 10. about In case of chewing in a period, 2 focus of ischemia arises, with opposite localization (one - in the pener, the other - at the top of the top region). Area sites arise in various places of periodonta due to the movements of the lower jaw during chewing. After removing the chewing load, reactive hyperemia occurs in two opposite areas and contributes to the establishment of the tooth to its original position. Blood outflow is carried out on intra-apartments.
Innervation periodonta It is carried out of a trigeminal nerve and the upright sympathetic node. At the top of the periodontal area are mechanoreceptors (baroreceptors) Between bunches of collagen fibers. React to touch to the tooth (pressure). Mechanoreceptors are activated in the phase of incomplete closure of the jaws, providing a reflex chewing process. With a very hard food and a very strong closure of the dentition, the pain threshold of irritation of the periodontal mechanoreceptors is overcome, and a protective reaction is included in the form of a sharp opening of the mouth due to braking of the parcel of pulses to chewing muscles (periodontito-muscular reflex is suppressed).
Cement - solid fabric of mesenchymal origin. Covers the root of the tooth from the neck to the top. Provides the attachment of periodontal fibers to the root of the tooth. In structure, cement resembles a rough fiber bone tissue. Cement consists of a basic substance impregnated with calcium salts, and collagen fibers. Cement thickness in the neck of the tooth neck is 0.015 mm, in the region of the middle part of the root of the tooth - 0.02 mm.
Types of cement:
primary, caseless - It is formed before the teething of the tooth. Covers the dentin root for 2/3 lengths in the subrian area. The primary cement consists of a basic substance and beams of collagen fibers that are parallel to the tooth axis in radial and tangential directions. Collagen cement fibers continue in Chapes Periodonta fiber and collagen bone bone fibers Alveola.
secondary, cellular - It is formed after the teething of the tooth when the tooth entry into occlusion. The secondary cement is located on the primary cement, covers the dentin in the top-end third of the root of the tooth and the intercane surface of multi-corneus teeth. The formation of secondary cement continues all his life. The new cement is located on the surface of an existing cement. Cells participate in the formation of secondary cement cementoblasts. The cement surface is covered with a thin, even unusual cement-shaped layer.
collagen fibers,
bonding basic substance
cells cementoblasts - Process cells of the star-shaped form, are in the cavities of the main substance of cement in individual lacuna. With the help of a network of tubules and processes, cement climbs are connected to each other and with dentine tubes, the diffusion of nutrients from the side of the periodonta is carried out. Cement does not have blood vessels and nerve endings. The thickness of the secondary cement in the neck of the tooth is 20-50 microns, in the root top area - 150-250 μm.
Test control questions.
1.Parodont is:
a) tooth, gum, periodontal. 1 answer
b) tooth, gum, periodontal, alveoli bone.
c) tooth, gum, periodontal, alveoli bone, root cement.
2. Alveolar gum is:
b) gums surrounding tooth 1 answer
3.Magginal gum is:
a) Gounts and gums around the tooth.
b) the gums surrounding the tooth. 1 answer
c) Desna, covering alveolar process.
4. In the norm, the epithelium is not burned:
a) gums of groove.
b) papillary gums. 1 answer
c) alveolar gums.
5. Alveolar gum consists of:
a) Epithelium and periosteum.
b) epithelium and actual mucous membrane 1 answer
c) epithelium, actually mucous and submucosal layer.
6. In the intact periodontal, the groove groove contains:
a) microbial associations.
b) Exudate. 1 answer
c) G1 liquid.
d) granulation tissue.
7. In the intact periodontal, the groove groove is determined:
a) clinically.
b) histologically. 1 answer
c) X-ray.
Independent work of students.
Students are receiving patients with periodontal diseases, examine the gums, detect the zones of the gums and determine the presence of a normal state or pathological changes in periodontal tissues. It is necessary to correctly define the gums zones, determine the color of the gums, the presence or absence of the edema of the gum mucosa, determine the depth of the gum and the integrity of the chub-gantry attachment.
Answers to test control questions:
1B, 2B, 3B, 4A, 5B, 6B, 7B.
Main literature.
1. Borovsky E.V. Therapeutic dentistry. M.: TELLIT.-2006.-554С.
2. Danilevsky N.F., Magid E.A., Mukhin N.A. and others. periodontal diseases. Atlas. M.: Medicine.-1993.-320c.
3. Diseases of periodontal edited by prof. L.Yu. Yojova. M.: Poly-mediapress.-2004.-432c.
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Additional literature.
1. Ivanov V.S. Periodontal diseases. M.: Mia.-1998.-295С.
2. Balin V.N., Jordanishvili A.K., Kovalevsky A.M. Practical periodontology. S-PT.: "Peter" .- 1995.-255С.
3. Loginova N.K., Volozhin A.I. Pathophysiology of periodontal. Educational and methodical manual. M.-1995.-108С.
4. Kuryakina N.V., Kutepova T.F. Periodontal diseases. M.: Medkniga. N.Novgorod. NGMA.-2000.-159С.
5. Storm A.A. Periodontology - yesterday, today and ... // Perodontology.-1996.-№1.-C.26.
6. Straka M. Periodontology-2000. // New in Stomatology.-2000. -№4.-C.25-55.
7. Kirichuk V.F., Chesnokova N.P. and others. Physiology and pathology of periodontal. Tutorial. Saratov: SGMU. - 1996.-58C.
The structure of periodontal. In the development of the disease, the anatomy-physiological features of the structure of perodont play a major role. I. V. Davydovsky gives essential importance in the pathogenesis of any pathological process to the most substrate, where the clinical picture is developing. In addition, deep knowledge of periodontal morphology and understanding of its relationship with the function is one of the main conditions for the proper compilation of the plan and the choice of the most adequate method of treatment.
The periodontal includes a fabric complex with genetic and functional community: periodont, alveoli bone with periosteum, gums and tooth tissue.
The mucous membrane surrounding the tooth - the gum during life is exposed to various factors: mechanical, temperature, chemical. The structure of the gum shows that it is well adapted to these effects. It is customary to distinguish between the free and attached gum, the latter is fixedly attached to the tissues to be tissues due to the connection of the fiber of his own shell with the periosteum of alveolar jaw processes. In the neck of the tooth, the fibers of the circular (circular) tooth bundles are invested. The latter, together with other fibers, forms a thick membrane designed to protect periodonta from mechanical damage. Part of the gums, which adjacent to the tooth, separating from it with a gueser groove, is called free gums. The main mass of the marginal gums is collagen fibers, but besides them, reticular and elastic fibers are detected. The gums are well inner-visible and contains various types of nervous endings (Maisner Taurus, loops, thin fibers included in the epithelium, etc.). Multilayer flat gum epithelium has an excretory and suction ability (Marchenko A. I. et al., 1965).
The dense fit of the marginal part of the gums to the neck of the tooth and the resistance to various mechanical exposure is due to the tour, i.e., urban pressure due to the high molecular weight interfibrillary substance. The intermediate substance is considered as a very subtle indicator of endogenous, mainly microbial influences, on the one hand, and the activities of the cells of the connective tissue - on the other (Haim, 1956).
Microscopically, the gum consists of a multilayer flat epithelium, its own (Lamina Propria) and submucosa (submucosa) shell. In the norm of the epithelium, the gums is keen and contains a grain layer, in the cytoplasm of the cells of which contains keratogial. The Epithelium Epithelium Most of the authors is considered as a protective function in connection with frequent mechanical, thermal and chemical irritation during chewing.
An important role in the protective function of the gum epithelial, especially in terms of resistance to the penetration of infection and toxins to the toed fabric, playing mucopolysaccharides, which are in the composition of the bonding substance between the cells of the multilayer flat epithelium. It is known that mucopolysaccharides (chondroiteric acid A and C, hyalurono-water, heparin), being complex high molecular compounds, play a large role in the trophic, transport and protective functions of the connective tissue, in the processes of regeneration and growth of tissues.
The histochemical study of periodontal tissues in the norm showed the presence of neutral mucopolysaccharides (glycogen) in the gum epitheliums. Glycogen is localized mainly in the cells of the cylinder layer, the amount of it is slightly reduced with age. Neutral mucopolisaccharides are also detected in the endothelium of blood vessels, in leukocytes that are inside the vessels. RNA is found mainly in the cytoplasm of cells of the basal layer, plasma cells.
In a periodontal, neutral mucopolysaccharides are detected along the beams of collagen fibers throughout the periodontal line. In the primary cement of neutral mucopolisaccharides, there are few in a slightly larger quantity in secondary cement; In bone tissue, they are mainly located around Osteon channels.
The study of the distribution of acidic mucopolysaccharides in periodontal tissues showed the presence of acidic mucopolysaccharides in the gum, especially in the field of connective tissue papillars, the basal membrane. In the collagen fibers of the vascular walls in the norm of acidic mucopolysaccharides, the main substance contains some of their quantity, obese cells are carried in their cytoplasm heparin - one of the important factors of homeostasis. Thus, in a periodontal, acidic mucopolysaccharides are located mainly in the walls of the vessels, along the beams of collagen fibers across the entire periodontal ligament. In the area of \u200b\u200bthe circular bundle of the tooth, their number increases somewhat.
Cement, and especially secondary, with a specific color, toluidin blue detects a constant methahro-ointment. Acid mucopolysaccharides in the bones are found around osteocytes, gaverca channels, at the osteon border; In the fields of restructuring the bone, the amount of metakhromatic substance increases.
Currently, there are indisputable data on the significant role of the hyaluronic acid system - hyaluronide, in the regulation of the permeability of vascular and, in particular, the capillary walls, as well as the main substance of the connective tissue stroma. Hyaluronidase, generated by microbes, or tissue origin causes depolymerization of mucopolysaccharides, destroys the connection of hyaluronic acid with protein (hydrolysis), thereby increasing the permeability of the connective tissue that loses the properties of the barrier. Consequently, mucopolysaccharides protect periodontal tissues from the action of bacterial and toxic agents.
In the marginal gum, under the epithelium around the neck of the tooth, clusters of lymphocytes are always detected and to a lesser extent of plasma cells (lymphocyte-plasmocyrtar-naya infiltration) (Fig. 31, a, b).
Since there is no place for true lymphatic follicles in the gum, some authors compare it with lymphatic infiltration in other digestive tract departments, attributing to it a protective function consisting of a delay in microbes and toxins.
In connection with the accumulation of new data on the role of autoimmune processes in the pathogenesis of periodontal diseases, the question of lymphoplasmocyte infiltration in the stroma of the gum mucosa is currently being revised.
There is no doubt that the formations that carry certain functions cannot be considered isolated, out of connection with the influence of local and general factors. The state of mucopolysaccharides, an intercellular substance, etc. Plays a huge role in maintaining the homeostasis of periodontal tissues, which is determined at the same time the reactivity of the body and primarily nervous and endocrine systems.
A large role in the protection of the subjectable tissues from infections belongs to a sedental compound, on the very existence of which, and especially the mechanism of the epithelium connection with the enamel of the tooth, the opinions of scientists differ significantly. Most of the authors are called a seashest pocket space in the form of a slit, lying above the circular bundle of the tooth between enamel and gums (Fig. 32).
The depth varies depending on the age, the teeth group, the type of bite, etc. represents a certain interest of the formation of physiological gums pocket. This is how it describes this ORBAN process. After the formation of the enamel mat-rix, the enameloblasts produce a thin membrane on the surface of the enamel - the primary enamel cuticle associated with the substance of the enamel prism membrane, in the future, the enameloblasts are shown shorter and turn into the so-called reduced enamel epithelium. Before the teething of the tooth, he covers the entire surface of the enamel before the cement-enamel compound, being connected to the enamel cuticle. During the teething of the tooth, the crown part of the latter is shown in the oral cavity and the reduced enamel epithelium merges with the multi-layered flat epithelium of the oral mucosa, forming "epithelial attachment" 1. At this stage of teething, the epithelial attachment on one side is organically connected with an unspoken part of the tooth crown. In teething, the epithelial attachment is gradually separated from the surface of the enamel. In the tooth, which is in occlusion, the epithelial attachment is installed at the level of the enamel-cement compound. Thus, the bottom of the gum-th pocket is always there, where the epithelial attachment departs from the surface of the tooth, the method of attaching a shell (connecting) epithelium to enamel is still not entirely clear.
Electron microscopic studies of recent years have shown that there is a close connection between the surface of the tooth and epithelial attachment (Listgarten, 1966). Some authors based on the data of optical and electron microscopy, believed that the gum epithelium joins the structures of solid tooth tissues through a layer of organic material by hemidesmos (Listgarten, 1972; Cimasoni, 1974). However, CRAN (1972), neiders (1972) do not share this point of view, they believe that the relationship between the epithelium I. Fast tooth physico-chemical-skye. Moreover, the adhesion of epithelial cells to the surface of the tooth is normally carried out by means of a macromolecules of a guro fluid. The modified physicochemical properties of the gum liquid do not provide the necessary adhesion and this close connection is violated during inflammation.
Histologically epithelial attachment consists of several (10-20) rows of oblong cells located parallel to the surface of the tooth. Radiographic studies Stallard et al. (1965) And Skougnard (1965) showed that epithelial attachment cells are updated every 4-8 days, i.e., much faster than the cells of the gum epithelium. The cuticular layer of enamel is rich in neutral mucopolysaccharides (Sicher, Toto, 1964) and contains keratin (SGAP, 1972). The above data indicate the presence of certain regenerator capabilities of this education. Violation of the epithelial attachment attachment with the Cuticular layer of enamel can contribute, and, perhaps, it is the beginning of the formation of a pathological toothing pocket.
From the periodontal complex, the fabrics of the periodontal actually should be isolated, to which collagen, elastic and oxytalan fibers, vessels, nerves, RES elements, lymphatic vessels and cellular elements, conventional for connective tissue.
Periodont is a complex anatomical formation, located between the root of the tooth and the wall of its well. The magnitude and form of this formation is inconsistent. They may vary depending on the age and all kinds of pathological processes localizing both in the oral bodies and beyond.
Periodontal function to hold the tooth and the redistribution of chewing pressure Sicher (1959), Kerebel (1965) is associated with the characteristic features of the periodontal collagen structures.
In the middle third of the periodonta there is a thick intermediate plexusion from argicil fibers; However, its presence in the periodon is some of the researchers challenge (Zwarych, Quigley, 1965, etc.). In our opinion, today there are every reason to agree with the opinion of V. G. Vasilyeva (1973), and T. V. Kozlovitzer (1974), which believe that the fact of the detection of the mentioned plexus in young age and its disappearance after 20-25 years is associated with The end of the evolution and differentiation of the structural elements of the periodonta. That is why various types of orthodontic treatment in adults and even more so the restructuring of bite in periodontal disease after 25 years should, apparently, it seems to be considered not sufficiently reasonable and little promising.
The cellular composition of the periodonta is represented by the most diverse cells: plasma, fat, fibrobla stories, histiocytes, cells of vasogenic origin, elements of the RES, etc., they are located in the advantage of the upheat periodontight, near the bone and are characterized by a high level of metabolic processes.
In addition to these cells, the epithelial residues (the islands of the Malyassa) - the expansion of the epithelial cells differ in periodontal. In their origin today is not all clear. Most researchers refer them to the remnants of a chub emergency epithelium. These formations can be in a period one's for a long time, without showing themselves. And only under the action of any causes (irritation, the effect of bacteria toxins, etc.) they can become a source of various formations - epithelial granuloma, cyst, etc.
In the structural elements of periodonta, such an oxidation-reduction cycle enzymes are detected as succisionhydehydrogenase, lactate dehydrogenase, oxide and nadf-diaphorazes, glucose-b-phosphate dehydrogenase, as well as enzymes from phosphatase hydrolyz group, collagenase, etc., cell enzymes are the greatest activity, Localized near cement and bones during the period of the histo-functional restructuring of periodontal and in development in this area of \u200b\u200bthe pathological process (Kozlovezer T. V., 1974).
Considering the structure of the periodontal, it should be paid to his some features. Periodonta fabrics due to good vascularization and innervations in various influences are quickly adapted and restore the impaired equilibrium with the external environment, which is undoubtedly a positive way reflected at the rate of reverse development of pathological processes.
At the same time, precisely in the period is the inflammatory processes have a tendency to delay and proceed energly. In addition, it is known that even a minor damage to the vessels of this region causes long-term bleeding, and the injury of the nervous barrel can lead to persistent and severe neuralgia.
The bone of the interdental partition consists of a compact bone substance forming a cortical plate, which consists of bone plates, circularly embracing vascular channels; These systems are called osteo. The compact bone of the edge of the alveoli is permeated with numerous holes through which blood vessels and nerves pass. Under the cortical plate there is a spongy bone, in the intervals between the beams of which the yellow bone marrow is located.
In the bone tissue of alveolar processes of the jaws, neutral and sour mucopolisacha-rides are detected, which are found mainly around the vascular canals of osteonov in areas with signs of bone restructuring. The activity of acidic and alkaline phosphatase is determined at a young age in the periosteum, around the vascular channels of osteonov, in Osteoblasts.
On radiographs, the cortical plate of the bone looks like a clearly defined strip along the edge of the alveoli, the spongy bone has a petrose structure.
It is known that in the well of the tooth, the processes of physiological resorption and the conjunction of the bone, which are depending on the functional load of the tooth. If, for example, one of the teeth is removed, its antagonist begins to extend precisely due to the prevalence of the conversion process. On the contrary, when converting the process of resorption (overload) may appear tooth mobility.