1 口腔醫學英文 牙科英文會話 牙醫學系:周肇茂 教授 分機:7003口腔醫學英文 牙科英文會話 牙醫學系:周肇茂 教授 分機:7003

2 Chapter 1 At the reception desk (在接待處) 1. Making an appointment (約診)

3 重要單語 Check-up 檢查 Fully booked 預約排滿了 Cancel an appointment 取消預約

4 1.Making an appointment 約診Miss Suzuki(鈴木)：Hello, this is Dr. Sato(佐藤) and Dr. Richard’s Dental Clinic. How can I help you ? Mr. Abe：Good morning. I am ringing (calling or phoning) to ask if I could make an appointment for a check-up ? Miss Suzuki：Unfortunately Dr. Sato(佐藤) and Dr. Richard are both busy all this week. Is next Monday OK ? We have some spaces in the morning. Mr. Abe：Next Monday morning is fine for me. Could it be early in the morning ?

5 1.Making an appointment 約診Miss Suzuki：The first available space is 8:30. Is 8:30 am alright for you ? Mr. Abe：8:30 am is perfect, thank you. Miss Suzuki：Could I have your name again, please ? Mr. Abe：Yes of course. My name is Kenji Abe(阿部健二).

6 Chapter 1 At the reception desk (在接待處) 2Chapter 1 At the reception desk (在接待處) 2. Cancelling an appointment (取消預約)

7 2.Cancelling an appointment 取消預約Miss Suzuki：Good afternoon, Dr. Sato and Dr. Richard’s Dental Clinic. Can I help you ? Mr. Otake：Hello this is Kenichi Otake(大竹健一). I would like to cancel an appointment if possible. Miss Suzuki：Could you tell me when is your appoint Mr. Otake ? Mr. Otake：It’s this Friday at 4 pm. Miss Suzuki：That’s no problem. I will cancel it for you. Would you like to make another one ?

8 2.Cancelling an appointment 取消預約Mr. Otake：Yes please. Dr. Richard was going to do a filling so I need to come again. Could I come in next week ? Miss Suzuki：I am sorry. Dr. Richard is fully booked (預約排滿; no more spaces were available) next week. Because you need a filling, a longer appointment is necessary. The next time Dr. Richard can see you will be a week on Tuesday. Will that be alright ? Mr. Otake：Yes, that’s fine thank you.

9 Chapter 1 At the reception desk (在接待處) 3 .Changing an appointment (改約)

10 3.Changing an appointment 預約的變更Miss Suzuki : Dr. Sato and Dr. Richard’s Dental Clinic, how can I help you? Mrs. Sayama : My name is Mrs. Sayama(佐山) and I have an appointment this afternoon with Dr. Sato but I have to change it because I don’t feel well. Miss Suzuki: Oh dear I’m sorry to hear that you are not feeling well. Would you like to make another appointment?

11 3.Changing an appointment 預約的變更Mrs. Sayama : Can I call you back because I’m going away for a few days? Miss Suzuki: That’s fine. We look forward to seeing you again, Mrs. Sayama.

12 Chapter 2 Emergency (牙科急診) 1. Broken tooth (牙齒斷裂)牙醫學系:周肇茂 教授 分機:7003

13 重要單語 Composite filling, composite resin: 複合樹脂充填, 複合樹脂Metal crown: 金屬牙冠 White crown: 白色金屬牙冠 Ceramic matertals: 陶瓷材料 Zirconia: 氧化鋯 Prepare the tooth: 修磨牙齒; 預備牙齒 Emergency: 急診 Chew: 咀嚼

14 1.Broken tooth 牙齒斷裂 Dr. Sato: You’re back again, Mr. Ishida. Is it the same tooth? Mr. Ishida: I’m not sure. I bit (past tense of bite) on a yakitori(燒 鳥: 把雞肉或鳥、豬等的內臟切成小塊用籤子穿起來烤的食品。烤雞肉串。烤雞雜(豬雜)串。) last night then I heard a crack and felt something sharp in my mouth. I think it is either the tooth you worked on or the one next to it. I can’t say.

15 1.Broken tooth 牙齒斷裂 Dr. Sato: Well, luckily the tooth I rebuilt last time is OK. It is the tooth behind. You also had a composite filling in that tooth but now the remaining bit of enamel has broken off. Mr. Ishida: Is it serious? Dr. Sato: Yes and no. (used to show that there is not one clear answer to a question 即是又不是﹝表示難以明確答覆﹞)

16 1.Broken tooth 牙齒斷裂 Mr. Ishida: What do you mean?Dr. Sato: Well , yes in the sense that if we do what we did last time and repair the broken enamel with composite resin all your tooth will consist of composite. Mr. Ishida: That is good, isn’t it?

17 1.Broken tooth 牙齒斷裂 Dr.Sato : Not really. If all of the tooth consists of composite resin, it can easily break again and all the filling may break off. We will need to place a crown on the tooth. Mr.Ishida : I don’t want a metal crown. Some of my friends have metal crowns and they don’t look very nice. Can I have a white crown?

18 1.Broken tooth 牙齒斷裂 Dr. Sato: Yes, that’s no problem. There are some new ceramic materials available, which can be used to make the crown. Because you have a tendency to break your teeth we will need to use a strong ceramic. Something like a Procera high strength alumina coping or one made of zirconia.

19 1.Broken tooth 牙齒斷裂 What we’ll do today is put some composite resin on as a temporary measure and give you another appointment. Mr. Ishida: Can’t you prepare the tooth today? Dr. Sato: Unfortunately you were seen as an emergency and I have another patient waiting. Sorry.

20 1.Broken tooth 牙齒斷裂 Mr. Ishida: It’s just that I have to go Italy for a business trip. I’ll be out of the country fir a mouth. So I‘m worried that the composite resin won’t last. Dr. Sato: If you are careful not to eat anything very hard on those teeth you should be fine.

21 1.Broken tooth 牙齒斷裂 Mr. Ishida: I’ll make sure I chew on the other side. Thanks for what you have done today .I’m sorry for all the trouble I have caused you. Dr. Sato: It’s my pleasure Mr. Ishida(吉田).

22 Chapter 2 Emergency (牙科急診) 2Chapter 2 Emergency (牙科急診) 2.A denture tooth has broken off (活動假牙的人工牙齒斷裂)

23 重要單字 She has broken a tooth off her upper. denture: 她上顎的活動人工假牙斷裂.What can I do for you?: 我能為你做些什麼? A front tooth has broken off my upper denture.: 我上顎活動假牙的一顆人工前齒斷裂了.

24 2.A denture tooth has broken off 活動假牙的人工牙齒斷裂Miss Suzuki: Sorry to trouble you Dr. Richard, a lady called Mrs. Kawajima(川島女士) has come in and would like to know if someone could see her. She is very distressed. She says she has broken a tooth off her upper denture. Dr. Richard: Could you see if Dr. Sato is free?

25 2.A denture tooth has broken off 活動假牙的人工牙齒斷裂Miss Suzuki: Yes certainly. Dr. Richard: I have just finished so I can see Mrs. Kawajima. Could you call her in please Miss Kato(加藤)? Miss Kato：Would you like to come through please Mrs. Kawajima(川島)？

26 2.A denture tooth has broken off 活動假牙的人工牙齒斷裂Dr. Sato：What can I do for you Mrs. Kawajima？ Mrs. Kawajima：A front tooth has broken off my upper denture and now I can’t smile. It’s terrible. I must give a presentation this afternoon in front of 200 people. If this tooth can’t be fixed everyone will laugh at me！

27 2.A denture tooth has broken off 活動假牙的人工牙齒斷裂Dr. Sato：Let me have a look. Ah no problem. The tooth just needs to be stuck back on. It will take me just a few minutes. Mrs. Kawajima：Thank you so much.

28 Chapter 2 Emergency (牙科急診) 3. Pericoronitis (牙冠周圍發炎)

29 重要單字 Patient’s file 病歷資料 Wisdom tooth 智齒; 第三大臼齒 Bite 咬 Gum 牙齦Lower third molar 下顎第三大臼齒 Swollen / Swell 腫脹 Crown 牙冠 Pericoronitis 牙冠周圍發炎 Flap of gum 牙齦瓣 Infection 感染 Erupt 萌發 Radiograph 放射線照片 Impacted tooth 埋伏齒

30 重要單字 Mesially 近心側 Refer 轉診 Oral surgeon 口腔外科 Second opinion 第二意見Extract 拔牙 Sterile water 滅菌水 Antibiotics 抗生素 Allergic to Penicillin 盤尼西尼過敏 White spot 白斑 Have a sweet tooth 喜好吃甜食 Hygienist 口腔衛生師

31 3. Pericoronitis 牙冠周圍發炎 Miss Suzuki：Your first patient has just cancelled so you have a bit more time. However, there is an emergency patient on the way. I will call you when I have made the patient’s file. Miss Tanaka(田中)：Dr. Richard, we will be working in Dr. Sato’s surgery today. We are lucky. He is not in today.

32 3. Pericoronitis 牙冠周圍發炎 Dr. Richard ：That’s good. Has someone been called to come and check the autoclave(高壓蒸氣消毒鍋)? Miss Tanaka ：Yes. Your first patient Cancelled. But there is an emergency patient on the way. Miss Suzuki ：The emergency patient has come. The patient’s name is Miss Komata (小俁ㄩˇ). Here is her file. Miss Tanaka ：Dr. Richard, are you ready for the emergency patient? Her name is Miss Komata. Dr. Richard ：Yes. Can you call her in please? .

33 3. Pericoronitis 牙冠周圍發炎 Miss Tanaka ：Good morning Miss Komata(小俁ㄩˇ). Could you come this way please. Dr. Richard ： Good morning Miss Komata, please come in and have a seat. What can we do for you? Miss Komata ：Thank you for seeing me at such short notice. I think it’s wisdom tooth. The back of my mouth hurts when I try to bite together. The pain has been getting worse and I couldn’t sleep last night. I am also having difficulty opening my mouth.

34 3. Pericoronitis 牙冠周圍發炎 Dr. Richard ：Ok. Let’s have a look. Yes, the gum around your lower third molar is swollen. Part of the crown is visible. You have pericoronitis. Miss Komata ： Pericoronitis ？What’s that ？ Dr. Richard ：There is a flap of gum overlying the wisdom tooth. Food has got stuck underneath and an infection has started. It looks like your third molar is having trouble erupting. We need to take a radiograph to check its position.

35 3. Pericoronitis 牙冠周圍發炎 Dr. Richard :Your tooth is impacted mesially. Let me show you. Miss Komata: Will it come through later on? Dr. Richard :I don’t think so.It is tilted against the molar in front. I will refer you to an oral surgeon for a second opinion. He may recommend you have it extracted. I will wash under the gum with sterile water and give you some antibiotics. They will reduce the infection. Are you allergic to Penicillin?

36 3. Pericoronitis 牙冠周圍發炎 Miss Komata : No. I have had Penicillin before. Dr. Richard :I have noticed a couple of other things. You have several white spots on your teeth and there is some calculus behind your lower incisors. Do you like to eat a lot of sweet thing. Miss Komata : Yes I do. My friends have told me I have a “sweet tooth”. Dr. Richard: I will give you another appointment so we can talk about your diet and give you some advice and also I will book(預約) you in with our hygienist. Miss Komata : Thanks very much.

37 Chapter 2 Emergency (牙科急診) 4 . An allergic reaction (過敏反應)

38 重要單字 Allergic reaction 過敏反應 Wisdom tooth 智齒 Swelling 腫脹 Rash 濕疹Go and see a doctor 看醫生 Alternative antibiotics 替代抗生劑 oral surgeon 口腔外科醫生 Have one’s wisdom tooth removed 拔掉某人的智齒 Indication 適應症

39 4 . An allergic reaction 過敏反應Miss Suzuki: Miss Tanaka, do you think Dr. Richard can see an emergency patient? Miss Tanaka: Yes I’m sure he can. What’s the problem? Miss Suzuki: Mrs. Komata has returned. She thinks that she’s had an allergic reaction to the antibiotics Dr. Richard gave her for her wisdom tooth trouble Miss Tanaka: I remember Mrs. Komata. She came in yesterday as an emergency. I’ll let Dr. Richard know that she’s in the waiting room. .

40 4 . An allergic reaction 過敏反應Miss Tanaka: Dr. Richard. We have an emergency patient. You remember Mrs. Komata who came in yesterday with the wisdom tooth swelling? Well she thinks she’s had an allergic reaction to the antibiotics you gave her. Dr. Richard: that doesn’t sound good. We had better bring her in the straight away. Miss Tanaka: Please come this way, Mrs. Komata. Dr. Richard: I hear things aren’t going well for you, Mrs. Komata.

41 4 . An allergic reaction 過敏反應Mrs. Komata: Unfortunately no they aren’t. I have developed a rash on my arm and I think it’s an allergic reaction to the antibiotics you gave me. Dr. Richard: yes I can see the rash. I gave you penicillin. When I asked you if you had any allergies you said you hadn’t. Mrs. Komata: That’s right I don’t. Dr. Richard: Have you had penicillin before? Mrs. Komata: No I haven’t.

42 4 . An allergic reaction 過敏反應Dr. Richard: well it looks like you have had an allergic reaction. You must go and see your Medical Doctor for further tests. In the meantime, please stop the penicillin and I will give you an alternative antibiotic. You have a review (follow-up) appointment next week don’t you? Mrs. Komata : Yes I do. Dr. Richard: I will see you then and decide if we need o refer you to the oral surgeon to have your wisdom tooth removed. If you have an infection that requires antibiotics then that is an indication to have the tooth removed.

43 4 . An allergic reaction 過敏反應Mrs. Komata: Thanks for seeing me so quickly. I’ll go straight to my Doctor. Dr. Richard: Before you leave, I will write a letter for you to give to your Doctor explaining what has happened. Please take a seat in the waiting room for a few minutes.

44 Chapter 2 Emergency (牙科急診) 5. An avulsed tooth (脫落齒)

45 重要單字 Upper central incisor 上顎正中切齒 Come through 長出(牙齒)Surgery (British dental clinical or手術) Splint the tooth (靠相鄰牙齒的連結)固定牙齒 Periodontal membrane 牙周膜

46 5. An avulsed tooth 脫落齒 Miss Suzuki : Miss Kato, could you see if Dr. Sato can come to the phone please? Mrs. Ogata(緒方) would like to speak to Dr. Sato urgently. Apparently her front teeth was knocked out. Miss Kato : I’ll get him at once. Miss Suzuki : Dr. Sato, Mrs. Ogata’s daughter has had an accident at school and has had her front tooth knocked out and she wants to know what to do. Dr. Sato : Hello Mrs. Ogata. This is Dr. Sato speaking. I hear your daughter has had an accident.

47 5. An avulsed tooth 脫落齒 Mrs. Ogata : Yes. I remember you telling me her upper central incisors have come through. It is one of those. Dr. Sato : the best thing to do is to put the tooth back if you can. Is there some milk anywhere? If so put the tooth in milk and gently move it around. Try not to touch or clean the root. Mrs. Ogata : Ok. Yes there is some milk and I shall do that now. Dr. Sato : Good.

48 5. An avulsed tooth 脫落齒 Dr. Sato : Now the next part is the hard bit(part). You need to put the tooth back in the socket. But please be careful to put the tooth back the right way around. The flat part faces to the front. Push the tooth in as quickly as you can then ask her to bite gently on something soft like a piece of cotton. Dr. Sato : Then bring her straight to the surgery(British dental clinical) and I shall have a look at her when she is here. I’ll splint the tooth for a few days just to keep it in position while hopefully a new periodontal membrane will grow.

49 5. An avulsed tooth 脫落齒 Mrs. Ogata: I have cleaned her face and wiped the blood away so I am ready to try to put the tooth back. Once I have done that I’ll bring her straight to you. Thank you so much for your advice.

50 Chapter 3 Treatment (牙科治療) 1. Composite filling (複合樹脂充填)

51 重要單字 Premolar 小臼齒 Palatal cusp 顎側咬頭Light-cured composite resin 光聚合型複合樹脂 Glass particle 玻璃顆粒 Polymerize 聚合 Restoration 補綴物 (贋復物或修復物) Set 聚合 Adhesion 接黏劑 Indirect onlay 間接法製作的冠蓋體 Metal-ceramic crown 金屬-陶瓷牙冠 Calculus 牙結石

52 1. Composite filling 複合樹脂充填Miss Kato: Good morning Dr. Sato. Ready for this morning？ Dr. Sato : Absolutely. How many patients do we have？ Miss Kato: Five this morning. The first patient is Mr. Ishida. He has broken a tooth. Are you ready？ Dr. Sato :Yes. Can you call him in？ Mr. Ishida: Thanks for seeing me Dr. Sato. I was eating some Yakitori when I heard a crack and then noticed a piece of tooth in my mouth. I think it is one of my premolars.

53 1. Composite filling 複合樹脂充填Dr. Sato :I’ll have a look. Ah yes, you have broken the palatal cusp of your second premolar. We can rebuild it with light-cured composite resin. Mr. Ishida: What is light-cured composite resin？ Will it last for a long time？ Dr. Sato : Light-cured composite resin is a resin, which contains glass particles of different sizes. We use a blue light to polymerize(聚合) it. The material has a long working time to give it the correct shape. When we are happy with the shape of the restoration then we set it with the light. It relies on adhesion to stay in place.

54 1. Composite filling 複合樹脂充填Dr. Sato : How long will it last？ Dr. Sato : Well that is difficult to say. It depends on many things. If it breaks again then we could either place an indirect onlay or prepare the tooth for a metal-ceramic crown. These are more expensive and time-consuming long-term options. I noticed that you also have some calculus on your teeth. I will arrange for you to see your Dental Hygienist, Miss Yoshida(吉田).

55 Chapter 3 Treatment (牙科治療) 2Chapter 3 Treatment (牙科治療) 2. A painful tooth, endodontic treatment (牙痛, 根管治療)

56 重要單字 Amalgam filling 汞齊充填 Pulp 牙髓 Radiograph X光照片Endodontic treatment 根管治療 Secondary caries 二次齲齒 Bacteria 細菌 Toxins 毒素 Drop out 脫離 Inflamed 發炎的 Non-vital 非活性的 Dental abscess 牙(齒)膿瘍

57 重要單字 Pulp extirpation 牙髓摘除術 Local anesthetic 局部麻醉 Numb 使…麻醉 Clamp夾Rubber dam 橡皮障 Root canal(s) 根管 Antibiotic paste 抗生素糊劑 Temporary filling 暫時性充填 Topical anesthetic 表面麻醉

58 2. A painful tooth, endodontic treatment 牙痛,根管治療Miss Yoshida: Good morning Mr. Santana, how are you today？ Mr. Santana: Not too good actually. Miss Yoshida: Why？ What’s happening？ Mr. Santana: Well one of the teeth, which you were going to clean, is hurting me. It’s the first upper big tooth on the left. Miss Yoshida: Oh dear. How long has it been hurting you？

59 2. A painful tooth, endodontic treatment 牙痛, 根管治療Mr. Santana: Since last week. Now it’s starting to keep me awake at night. I also can’t chew on it. Something broke last week. I think it was the filling. Miss Yoshida: I’ll have a look. Yes, you have broken an amalgam filling in the upper first molar. I will call Dr. Sato in to have a look…

60 2. A painful tooth, endodontic treatment 牙痛, 根管治療Dr. Sato: Miss Yoshida is right. The amalgam filling has broken. The reason is that the tooth became soft underneath and could not support the filling. It looks like the soft tooth has reached the pulp and now the pulp is dying, which is why you have pain. We need to take a radiograph to see how deep the soft tooth is.

61 2. A painful tooth, endodontic treatment 牙痛, 根管治療Dr. Sato: Unfortunately the soft tooth has affected the pulp and the tooth needs endodontic treatment. Mr. Santana: Sorry could you explain that again？ Dr. Sato: Yes certainly. I’ll go slowly and show you some pictures. Sometimes fillings can become decayed. This is called secondary caries because it is the second time the tooth has become decayed. Dental caries is caused by bacteria releasing toxins, which dissolve the mineral part of the tooth. Then the tooth becomes soft.

62 2. A painful tooth, endodontic treatment 牙痛, 根管治療Dr. Sato: This can cause the filling to drop out because it has no firm support. The bacterial toxins eventually reach the pulp, which is in the middle of the tooth. The pulp becomes inflamed, which is why you feel pain. Unfortunately in your case it is impossible to keep your pulp alive. We need to remove the inflamed pulp to stop your pain.

63 2. A painful tooth, endodontic treatment 牙痛, 根管治療Dr. Sato: If we don’t do it, the infection will go further and all the pulp will die. In other words it will become non-vital. This will give rise to infection in the bone around the tooth. This is called a dental abscess. Mr. Santana: Can you get rid of the pain？ Dr. Sato: Yes, we can carry out endodontic treatment. In other words we can remove the pulp and clean out the inside of the tooth so there is nothing left to cause pain. This procedure is called pulp extirpation.

64 2. A painful tooth, endodontic treatment 牙痛, 根管治療. Mr. Santana: Is it painful when you clean out the tooth？ Dr. Sato: No, I will give you a local anesthetic, which will numb the tooth. Dr. Sato: It will be numb for a few hours so you must be careful with hot drinks and eating. You may bite your lip or burn yourself if you are not careful.

65 2. A painful tooth, endodontic treatment 牙痛, 根管治療Mr. Santana : How do you clean out the tooth? Dr. Sato : After your tooth has gone numb we clamp a piece of rubber over the tooth. This is called a rubber dam. It stops you swallowing anything. We then remove all of the old filling and decayed tooth. The upper first molar has 3 roots and at least 3 root canals, which are channels inside the roots. Dr. Sato: We use small, very narrow files to remove the contents of the root canals. After we have cleaned the root canals we put in some antibiotic paste and a temporary filling. You will need to come back so we can continue with the treatment.

66 2. A painful tooth, endodontic treatment 牙痛, 根管治療Mr. Santana : Sorry for asking so many questions. I feel less nervous now that I know what is going to happen. Dr. Sato: First, I’ll put some cream on the gum to numb the surface. Can I have the topical anesthetic please Miss Kato…

68 重要單字 Surgery 診療室 Appointment 來院的預約 Wax-up 築蠟Porcelain laminate veneer 陶瓷片狀鑲面 Prepare Upper incisor上顎切齒 Silicone index 矽化物指標 Transparent acrylic template 透明壓克力模板

69 3. porcelain veneer: (1) preliminary discussion with the dental technicianDr. Richard : Good morning Miss Suzuki. How are you? Miss Suzuki : I’m fine thanks. Kaz Yoshida of Hi-Ceramics asked you to call him.。 Dr. Richard : I will call him right way. Have you seen Dr. Sato? Miss Suzuki : Yes, he is in his surgery. By the way, your first patient Mr. Jones rang to say that unfortunately he has been called to an urgent meeting and cannot come this morning. He apologized and asked if he could make another appointment.

70 3. porcelain veneer: (1) preliminary discussion with the dental technicianDr. Richard: I’ll call Kaz and see what he wants…Is that Mr. Yoshida? Kaz Yoshida : Hi Dr. Richard. Thanks for calling back. I rang regarding the Wax-up for Miss Ito(伊藤). You plan to make her four Porcelain Laminate Veneers. Dr. Richard : That’s right. We are going to prepare the upper incisors for Porcelain Laminate Veneers. I will show Miss Ito the Wax-up on Wednesday. Then if she is happy with it, I will ask you to make a silicone index and transparent acrylic template. Could you come in on Wednesday to talk to Miss Ito? Kaz Yoshida : Wednesday is fine. See you then.

72 重要單字 Porcelain veneers: 陶瓷貼片 Dental Technician: 牙科技工師Labial surface: 唇側面 Enamel: 牙釉質 Anterior teeth: 前牙 Treatment: 治療 Wear: 裝著

73 重要單字 Mold:模型 Silicone putty:矽化物油灰 Set:硬化 Trim:修整Clear acrylic mask:透明的丙烯酸面罩 Prepare the teeth:支台齒形成

74 3. porcelain veneer: (2) Wax-upDr. Richard: did you have any trouble with the trains this morning, Miss Tanaka? Miss. Tanaka: No. but I heard there were delays on the Yamanote line(山手線). Your first patient Miss Ito is here. Dr. Richard: Ah yes. We are going to show her the wax-up for her new porcelain veneers. Could you have a look to see if Kaz has also come? I asked him to come when Miss Ito was due in.

75 3. porcelain veneer: (2) Wax-upMiss Tanaka: I'll go and have a look...Yes, he is here. He is talking to Miss Suzuki at the reception desk. Dr. Richard: Good. I'll ask him in...How's it going Kaz? Kaz Yoshida: Very well thanks. Dr. Richard : Could you ask Miss Ito to come please, Miss Tanaka? Miss Tanaka: Please have a seat, Miss Ito. Dr. Richard: Good morning, Miss Ito. I have asked our Dental Technician, Kazuo Yoshida(吉田和夫) to join us to discuss the wax-up of your teeth.

76 3. porcelain veneer: (2) Wax-upMiss Ito(伊藤) : Nice to meet you. Dr. Richard: Well this is the wax-up. Because you have lost some of your enamel, we have been able to build out the teeth a little. This will make them more like they were before you began losing the surface enamel. Miss Ito: Yes, unfortunately too many soft drinks and fruit juices. Well I have followed your advice and stopped drinking soft drinks and cut down on the fruit juice.

77 3. porcelain veneer: (2) Wax-upThe teeth look a little bigger now and also slightly longer. But they seem to look more like how they used to look. Kaz Yoshida: I looked at the photograph, which you gave me of your teeth a few years ago and compared it with the photo, which Dr. Richard took last time. I have added wax where you have lost some of the enamel and also lengthened the teeth slightly so that you show a little more tooth when you smile. Miss Ito: Yes, they look much nicer now.

78 3. porcelain veneer: (2) Wax-upDr. Richer: Do you want us to proceed with the treatment? The next stage would be for you to wear a clear acrylic mask, which will be lightly stuck to your teeth. You will then wear the mask for a couple of weeks to get used to your new smile. After that, if you are happy with your new smile then we can go head and prepare the teeth. If you do not like your new appearance, then we will not proceed with the preparations.

79 3. porcelain veneer: (2) Wax-upMiss Ito :What is an acrylic mask? Dr. Richard :What we do is we copy the wax up in dental stone. We then make a mold of the labial surfaces of the anterior teeth using silicone putty. When you come back we fill this silicone putty mold with clear acrylic and hold it against the teeth while it sets. It does not stick to the teeth. It is carefully trimmed so that it clips onto the teeth. It allows you to check your new smile at home. Of course, the color will not be perfect but it will allow you to check what the final shape of the teeth will be…

80 3.Porcelain Veneer: ③Tooth preparationDr. Richard: What do you think of the acrylic mask? Miss Ito: It looked a bit strange at first but I have got used to it. I like the new shape of the teeth. Dr. Richard: Are you happy for me to prepare your teeth for porcelain veneers on your upper central incisors? Miss Ito: Do you have to remove much enamel? Dr. Richard: No. Your teeth incline inwards and you have composite fillings in both teeth so we only have to remove a few fractions of a millimeter. My technician, Kaz, has made me a putty matrix.

82 重要單字 Porcelain veneer:陶瓷鑲面 Matrix:基質或成形帶 Acrylic mask:丙烯酸面罩Cast the impression in plaster:注入石膏於印象 Prepare:支台齒成形 Central incisor:中切齒 Adhesive resin cement:黏著樹脂黏著劑

83 3.Porcelain Veneer: ③Tooth preparationMiss Ito: Sorry, why do you need a putty matrix? Dr. Richard: The putty matrix is very useful. It will make sure I do not remove too much enamel. Kaz made an impression of the wax-up of your central incisors. He then cast the impression in plaster. This gave him a model of how you wish your teeth to look. A putty matrix was made on this model. As we adjust the surfaces of your central incisors we place the putty matrix against the preparations. We can then see how much space there is for the porcelain veneers. We need about mm of space.

84 3.Porcelain Veneer: ③Tooth preparationMiss Ito: It all sounds very complicated. I’m not sure I understand but you seem to be taking great care. Dr. Richard: Yes, I am. But this way we can ensure that the veneers will look like the acrylic mask but a better color. Miss Ito: Will they fail off the teeth? Dr. Richard: We use a special adhesive resin cement so it is unlikely they will fall off. We shall give you an appointment in a week’s time. Will that be alright for you? Miss Ito: That will be great thank you.

85 Cheap 3 Treatment 4.Making a new denture: (1)Complaints about old dentures

86 重要單字 Denture:義齒 False teeth: 假牙 Set: 義齒上下一組 Appearance: 外觀Preliminary impression: 初次印模 Cast (up):灌模 Model : 模型 Laboratory: 技工室 Technician:牙科技工師(齒模技術員) Special tray( custom or individual tray):個別模托 Fitting: 適合

87 4.Making a new denture: (1)Complaints about old denturesMiss Kato: Dr. Sato, Mrs. Kawajima is here. Dr. Sato: Oh, no, don’t tell me the tooth on her denture has fallen off again. Miss Kato: No, she wants you to make her a new denture. Shall I call her in? Dr. Sato: Yes please. Mrs. Kawajima: Thanks for seeing me Dr. Sato. Dr. Sato: How can I help you? Mrs. Kawajima: it’s my false teeth. They are getting quite loose and the top one keeps dropping down.

88 4.Making a new denture: (1)Complaints about old denturesDr. Sato: How long have you had them? Mrs. Kawajima: Oh, it’s so long ago I can’t remember. Over 20 years I think. Dr. Sato : Would you like me to make you a new set? Mrs. Kawajima: Yes please. Dr. Sato : Are you happy with the appearance of the teeth of your current set? Mrs. Kawajima: Not really. I think the teeth are a little small. Also, I would like whiter teeth. Will it take long to make me a set of new teeth.

89 4.Making a new denture: (1)Complaints about old denturesMrs. Kawajima: Can you make a start today? Dr. Sato: Yes, we can make the preliminary impressions today. After taking the impressions, we will cast them up and then send the models to the laboratory. The technician will then make some special trays. Mrs. Kawajima: May I ask why you need to make special trays? Dr. Sato: Special trays are custom-fitted to your mouth. They will enable me to take some accurate impressions of your mouth. Accurate impressions will help in making better fitting denture.

90 Cheap 3 Treatment 4.Making a new denture: ② Making an impression

91 重要單字 Special tray( individual or custom tray ) : 個別模托 Treatment : 治療Impression material : 印象材 Zinc oxide-eugenol impression paste : 氧化鋅丁香油酚印模糊劑 Vinyl polysiloxane (addition silicone) (乙烯聚矽氧烷)(加成式矽化物印模材) Acrylic : 丙烯酸的 Alveolar ridge (齒槽骨脊) Denture flange : (義齒凸緣) Peripheral seal : 周邊封鎖 Insert : 裝入

92 4.Making a new denture:② Making an impressionDr. Sato: Have Mrs. Kawajima’s special trays come bake? Miss Suzuki: Yes, they have. Mrs. Kawajima: Good morning Miss Suzuki, good morning Dr. Sato. I think I’m a little early. Dr. Sato: I’ve already finished my previous treatment so it won’t be too long. My asistant, Miss Kato will call you in a few minutes.

93 4.Making a new denture:② Making an impressionMiss Kato: which impression material will you be using? Dr. Sato: I will use Exadenture. Miss Kato: Don’t you usually use zinc oxide-eugenol impression paste? Dr. Sato: I do but I will try this new vinyl polysiloxane impression material, today. I will use Exadenture Border type first, the Exadenture paste.

94 4.Making a new denture:② Making an impressionMiss Kato : Shall I call her in? Dr. Sato : Yes please. Mrs. Kawajima: I’m really happy you can see me again so soon. Could you tell me what are you going to do today? Dr. Sato: We are going to make the final impressions. We have made upper and lower acrylic special trays in which we will place the impression material. We make each impression in two stages.

95 4.Making a new denture:② Making an impressionMrs. Kawajima: May I ask why two stages are necessary? Dr. Sato : We must first record the shape of the tissues surrounding the alveolar ridges. If the denture flanges accurately reproduce the shape of the surrounding tissues a good peripheral seal will be obtained when the denture is inserted. This means it will stay in better.

96 4.Making a new denture:② Making an impressionMrs. Kawajima : That makes sense (那是合乎情理的). I was just asking because my previous dentist just took one impression. Dr Sato: First I will check the fit of the trays then make any necessary adjustments.

97 Cheap 3 Treatment 4.Making a new denture: ③ Jaw registration( 咬合採得 )

98 重要單字 Jaw registration (bite registration):咬合採得Fox’s occlusal plane guide:咬合平面板 Wax rim:蠟堤 Instrument:道具,器具 Imaginary line:假想線 Pupil:瞳孔 Inter-pupillary line:瞳孔間線

99 重要單字 Alar of the nose:鼻翼 Tragus of the ear:耳珠 Ala-tragus line:鼻翼耳珠線Freeway space (Interocclusal space)休憩間隙 或 咬合間隙 Measurement:計測,測定

100 4.Making a new denture:③ Jaw registrationDr. Sato : Are you ready for Mrs. Kawajima? Miss Kato : Is it the jaw registration stage, isn’t it? Dr. Sato : Yes, I will need the Fox’s occlusal plane guide and Willis bite gauge. Miss Kato : Would you like to come through, Mrs. Kawajima? Dr. Sato : Good afternoon Mrs. Kawajima, how are you today? Mrs. Kawajima : I’m fine thanks.

101 4.Making a new denture:③ Jaw registrationDr. Sato : Today, we are going to measure up two wax rims, which we will be placing in your mouth. First we will put the upper wax rim inside your mouth to determine how much tooth you will show and then trim the wax rim so that teeth do not appear to be sloping to one side. Mrs. Kawajima : How do you do that? Dr. Sato : We use this plastic instrument, which is called the Fox’s occlusal plane guide. We place it against the wax rim and line it up with two imaginary lines.

102 4.Making a new denture:③ Jaw registrationDr. Sato : An imaginary line between the pupils called the inter-pupillary line and a line between the ala of the nose and the tragus of the ear called the ala-tragus line. We then trim the wax rim so that the Fox’s occlusal plane guide is parallel to these lines. Mrs. Kawajima : That sounds difficult. Dr. Sato : I also must trim the lower wax rim so that I can determine the free way space.

103 4.Making a new denture:③ Jaw registrationMrs. Kawajima : Could I ask what the freeway is? Dr. Sato : We must make sure that there is a small gap of a couple of millimeters between the teeth when you are not eating, otherwise you will get pain beneath the dentures. Next time you come we will make another measurement. Mrs. Kawajima : You certainly seem to be taking a great deal of care.

104 Chapter 3 治療 4.Making a new denture: ④ retruded contact position 後縮接觸位置

105 重要單字 Mandible: 下顎 Retruded contact position: 後縮接觸位置 Measurement: 測定，測量Gothic arch tracer: ↓哥德氏弧形描繪器 Wax rim: 蠟環 Mold: 型, 形 Artificial teeth: 人工牙齒

106 重要單字 clicking sound: (擬聲)滴答,滴答 的聲音 bite: 咬合high quality acrylic teeth: 高品質樹脂牙 realistic: 實際 set up: 設置，排列 processing ( 重合, 煮聚)

107 4.Making a new denture:④ retruded contact positionMrs. Kawajima: What’s happening today, Dr Sato? Dr. Sato: We are going to record the relationship of the mandible to the maxilla. It is called the retruded contact position.

108 4.Making a new denture:④ retruded contact positionMrs. Kawajima: Didn’t you do that last time? Dr. Sato: No. We made some different measurements at your last appointment. Today, I am going to use a device called a Gothic arch tracer(哥德式弓), which has been fitted to the upper and lower wax rims. I will put the wax rims in your mouth and then ask you to move your mandible forwards and backwards and side to side. Also, we need to select the correct mold and shade of artificial teeth.

109 4.Making a new denture:④ retruded contact positionMrs. Kawajima: I would like white teeth. My existing teeth are starting to look yellow. Also, is it possible to have porcelain teeth? Dr. Sato: You can definitely have whiter teeth, however, I wouldn’t recommend porcelain teeth. They are difficult to adjust and can make a ‘clicking sound’ when you bite together. I suggest high quality acrylic teeth. They look quite realistic.

110 4.Making a new denture:④ retruded contact positionMrs. Kawajima: That sounds fine. Dr. Sato: Next time you come the teeth will have been set up in wax. While the teeth are in wax, it is possible to change them if you are not happy. Once you are happy with them we will process the wax trial dentures into acrylic.

111 4.Making a new denture:④ retruded contact positionMrs. Kawajima: How long do I have to wait until my next appointment? Dr. Sato: We can have the wax trial dentures ready in one week. However, they may need some adjustments so they may not be ready for processing next time. Mrs. Kawajima: I appreciate all the trouble you are going to. Thank you.

112 Chapter 3 治療 4.Making a new denture: ⑤ Try-in試戴

113 重要單字 set-up: 排列 prominent: 突出 process: 重合,煮聚 acrylic: 丙烯酸的，壓克力的

114 4.Making a new denture:⑤ Try-inDr. Sato: How do you like the set-up of your new teeth? Mrs. Kawajima: I like the color and shape of the teeth. It’s just the two front teeth… they look a little prominent. Dr. Sato: Yes, I agree. I will alter the positions of the upper incisors. Mrs. Kawajima: Do you think they will be ready next time?

115 4.Making a new denture:⑤ Try-inDr. Sato: Yes. The technician has done a good job. The bite is correct and you are happy with the shape and color of your teeth. So if you are happy with the position of the teeth once I have altered them, I can request them to be processed into acrylic.

116 Chapter 3 治療 4.Making a new denture: ⑥ Insertion

117 重要單字 Laboratory 實驗室(技工所) Set 一對 Insert 裝入 Hurt 痛 Gum 牙齦Fitting surface 黏膜面 Pressure indicating paste( 壓力顯示膏) Follow-up appointment 追蹤約診 Wear 戴 Ulcer 潰瘍

118 4.Making a new denture:⑥ InsertionDr.Sato: Good news Mrs. Kawajima, your new dentures have come back from the laboratory Mrs. Kawajima: I hope they fit better than my current set. They have been giving me a lot of trouble recently. Dr. Sato: I will insert the upper denture first and make sure it doesn’t hurt you before I insert the lower denture. Do you feel any pain when I press on the top denture ? Mrs. Kawajima: No, it feels fine.

119 4.Making a new denture:⑥ InsertionDr. Sato: Ok. I will insert the lower denture and then you can tell me if it hurts. Mrs. Kawajima: It feels as if it’s digging in the gum on the right-hand side. Drs. Sato: Before I adjust the denture I am going to paint a white paste on the fitting surface of the denture. Mrs. Kawajima: What’s the white paste for? Dr. Sato : It’s called Pressure Indicating Paste and can help identify which area of the denture is causing the pain. Then, I can carefully adjust the denture, Otherwise I might cut away too much.

120 4.Making a new denture:⑥ InsertionDr. Sato : How do they feel now? Mrs. Kawajima: Much better. The dentures are not rubbing now. Dr. Sato : This hand mirror will let you see how the dentures look. Mrs. Kawajima: They look nice. I like their color and appearance. Thank you.

121 4.Making a new denture:⑥ InsertionDr. Sato: I am pleased that you like them. There are some instructions, which you need to obey for the next few days. You may find eating difficult at first. Please’ cut your food into small pieces and eat soft things first. If you start getting any pain, please take them out. I will give you a follow-up appointment in a few days. If keep wearing them when they are hurting, you may get an ulcer. Mrs. Kawajima: I understand. Thank you.

122 Chapter 3 治療 4.Making a new denture:⑦ Denture adjustment

123 重要單字 hurt 痛 dig 插入 post-dam (posterior palatal seal) 後障 (後顎封) seal 封鎖Ridge 齒槽脊 Acrylic 樹脂 posterior border後緣 soft-tissue軟組織 hard and soft palate硬、軟顎 plaster model石膏模型 reduce減少

124 4.Making a new denture:⑦ Denture adjustmentDr. Sato: So, how have your dentures been? Mrs. Kawajima: Quite good. All my friends have said how much younger I look, which is very nice. I am slowly beginning to eat better with them. However, you did say to take care eating because it might be a little difficult at first. Dr. Sato: Do they hurt anywhere? Mrs. Kawajima: It’s just the top one. It seems to be digging in a little at the back.

125 4.Making a new denture:⑦ Denture adjustmentDr. Sato : I’ll have a look. Ah yes. It’s the post-dam we made. It’s a little deep. Mrs. Kawajima: Sorry did you say post-dam? Dr. Sato: Yes. In order to get a good seal at the back, we added a thin ridge of acrylic to the back of the denture. The back of the upper denture is called the posterior border. A couple of visits previously, I took some soft-tissue measurements at the junction of your hard and soft palates. These measurements told me how deep to make the ridge of acrylic. I then altered the plaster model according to the measurements.

126 4.Making a new denture:⑦ Denture adjustmentMrs. Kawajima: Ah, I think I understand. Dr. Sato: It appears the ridge is a little too deep so I will reduce it very slightly. Mrs. Kawajima: Thank you.

127 Chapter 3 治療 5. Metal-ceramic crown replacement: ① Black margin

128 重要單字 Certainly當然 How can we help you?我們如何幫你 Cap(crown) 帽冠Front teeth前齒 What’s wrong with them?他們出了什麼問題 Metal-ceramic crown陶瓷冠 Ceramic陶瓷 Metal金屬 Ceramic material陶瓷材料 Porcelain瓷器 Fracture斷裂

129 重要單字 Fitted密合 Prepare the teeth 牙齒的形成 Margins of preparation牙齒形成的邊緣Gum margins牙齦邊緣 Cemented黏合劑的 Gingivae牙齦 Recede退縮 Collar of metal 金屬領 Replace代替 Periapical radiograph根尖X光片

130 5.Metal-ceramic crown replacement:① Black marginDr. Richard: Who is our next patient Miss Tanaka? Miss Tanaka: It’s Mrs. Shioda(鹽田) Dr. Richard: Could you ask her in please? Miss Tanaka: Certainly. Dr. Richard: How can we help you, Mrs. Shioda? Mrs. Shioda: It’s my caps on my two front teeth? Dr. Richard: What’s wrong with them? Mrs. Shioda: I think they are going bad. They are going black around the edges. Do you know what’s happening with them?

131 5.Metal-ceramic crown replacement:① Black marginDr. Richard: Your caps are what we called metal-ceramic crowns. They have an outer covering of ceramic on top of a thin layer of metal. Mrs. Shioda: May I ask why it is necessary to use metal in the crown? Dr. Richard: The outer ceramic material is porcelain, which is brittle and can easily fracture. The metal strengthens the porcelain so that it doesn’t fracture easily. The black line, which you can see is metal.

132 5.Metal-ceramic crown replacement:① Black marginMrs. Shioda: Why is the metal showing? I couldn’t see it when the crowns were first fitted. Dr. Richard: We prepare the teeth so that the margins of the preparation lie just below the gum margins so when the crowns are cemented you can’t see their margins. However, over a period of years the gums or gingivae may recede slightly. If the gingivae recede then the crown margins will be exposed. If the crown is a metal ceramic crown and has been designed such that there is a collar of metal all the way round then the metal may be visible.

133 5.Metal-ceramic crown replacement:① Black marginMrs. Shioda : I would like you to replace these two old crowns with new crowns. Dr. Richard : First we must take some periapical radio graphs of the teeth to see what is beneath the crowns.

134 Chapter 3 治療 5. Metal-ceramic crown replacement (2) Getting a nice appearance

135 重要單字 Central incisors中央門齒 Root treated根管治療完畢 Cast metal posts鑄造金屬柱子Apical infection根尖感染 Cut off切斷 Root fracture牙根斷裂 All ceramic material全瓷材料 High strength alumina高強度氧化鋁

136 重要單字 Zirconium oxide氧化鋯 All ceramic全瓷 Metal post金屬柱 Recede(動詞)退縮Recession(名詞)退縮 Electric toothbrush電動牙刷 Collarless metal ceramic crown領金屬烤瓷冠 Nature teeth乳牙

137 Shade:色調 Technician: 齒模技術員 Face-bow: 面弓 Ear tube (external auditory meatus):外聽道 Iner-condylar axis: 髁間軸 Palatal surface: 顎側面 Articulator : 咬合器 Informed consent: 充分了解情況後的同意

138 5.Metal-ceramic crown replacement(2) Getting a nice appearanceMrs. Shioda: Can you see anything on the radio-graphs? Dr. Richard: Yes, a few things. Your two central incisors have been root treated and cast metal posts fitted. These cast posts are quite long. The good news is that there is no apical infection around the roots of the teeth. If we are to replace the two crowns we would need to cut them off but leave the cast posts in the roots. If we try to remove the posts there is a risk of root fracture.

139 5.Metal-ceramic crown replacement(2) Getting a nice appearanceMrs. Shioda: Can you replace the old crowns with ones without metal? Dr. Richard: There are all ceramic materials available such as high strength alumina and zirconium oxide, which are very strong. However, because we must leave the metal post in the roots, an all ceramic crown may not possess good esthetics because the metal may show through. Therefore, we would need to make two metal ceramic crowns.

140 5.Metal-ceramic crown replacement(2) Getting a nice appearanceMrs. Shioda: I understand that it would not be a good idea to replace the meter-ceramic with all ceramic crowns because the metal posts might be visible through the ceramic. You said that the reason why I can see the metal is that my gums have receded. Would this happen if I have new crowns made?

141 5.Metal-ceramic crown replacement(2) Getting a nice appearanceDr. Richard: Yes, it is possible that you may get some more recession. The amount the gums may recede depends on several factors. For instance, if you brush your teeth vigorously in a sideways motion, the brushing action may accelerate gum recession. Could I ask how you brush your teeth, Mrs. Shioda?

142 5.Metal-ceramic crown replacement(2) Getting a nice appearanceMrs. Shioda: I use an electric toothbrush. I hold it lightly against the teeth and let the bristles do the work. You also said that you would make new metal-ceramic crowns. Does that means the metal will be visible. Dr. Richard: What I propose is that we make collarless metal ceramic crowns. The underlying metal will not extend to the crown. The crown margin will be all in porcelain.

143 5.Metal-ceramic crown replacement(2) Getting a nice appearanceMrs. Shioda: How will you get the color of the new crowns to match my natural teeth? Dr. Richard: We use a machine, which takes a digital reading of the color of your natural teeth. The reading is then matched with a shade of porcelain. If the color of your natural teeth is difficult to match then I will ask my technician to come in and look at your teeth. While you are here today I will take some digital photographs of your teeth and also some impressions of your upper and lower teeth. I will also take a face-bow recording.

144 5.Metal-ceramic crown replacement(2) Getting a nice appearanceMrs. Shioda: Sorry, did you say face-bow recording? What’s one of those? Dr. Richard: I will put some wax on your upper teeth and them use a device, which consists of a metal fork and an arm, which rests in your ear tubes. This is a face bow. Its purpose is to relate the relationship of the maxilla with the inter-condylar axis. The face bow is then attached to an articulator, which enables us to study the relationship of the upper and lower teeth. When we make new upper anterior crowns, it is very important to get the slope of the palatal surface correct.

145 5.Metal-ceramic crown replacement(2) Getting a nice appearanceMrs. Shioda: It sounds very complicated. I am sorry I will stop asking so many questions. Dr. Richard: That’s no problem. It is important that you understand the treatment we are proposing so you can give informed consent.

146 Chapter 3 治療 5.Metal-ceramic crown replacement: (3) Crown removal

147 重要單字 Numbed up麻痺 Administer a local anesthetic使用局部麻醉 Anaesthetize(麻醉)Lidocaine(商品名, 指麻醉藥) Adrenaline 腎上腺素 Alginate impression(藻膠印模) Temporary crown臨時牙冠 Gingival retraction cord牙齦排開線 Preparations支臺齒形成 Addition silicone加成式矽化物 Glaze瓷釉

148 5.Metal-ceramic crown replacement:(3) Crown removalDr. Richard: Would you like to come through, Mrs. Shioda? Mrs. Shioda: Thanks for seeing me early. Dr. Richard: How are you today, Mrs. Shioda? Mrs. Shioda: Not very well unfortunately. Dr. Richard: What’s wrong? Mrs. Shioda: It’s my ankle. I twisted it a few days ago and now it is all bandaged up.

149 5.Metal-ceramic crown replacement:(3) Crown removalDr. Richard: What happened? Mrs. Shioda: I was play tennis last Saturday and during the match I slipped while trying to reach a ball. Dr. Richard: Oh dear, I’m sorry to hear that. Mrs. Shioda: What’s happened today? Dr. Richard: We are going to remove your old crowns and take some impressions for your new crowns. Mrs. Shioda: Will I need to be numbed up?

150 5.Metal-ceramic crown replacement:(3) Crown removalDr. Richard: Yes, unfortunately we need to administer a local anesthetic. We need to anaesthetize your two upper incisors. The local anesthetic agent is a mixture of lidocaine and adrenaline. Your lip will feel numb for about two to three hours so please avoid hot drinks. Mrs. Shioda: Why’s that? Dr. Richard: You will not have any feeling in your upper lip so you might burn it. Also you must be careful you don’t bite it if you are going to try to eat.

151 5.Metal-ceramic crown replacement:(3) Crown removalMrs. Shioda: I much prefer you to my last Dentist. He never told me anything. I always got quite worried abut what he was going to do. Could you tell me what you are going to do today so I know what to expect. Dr. Richard: Certainly. While the teeth are going numb, I will take an alginate impression. We will use this to make the temporary crowns. After that I will cut the old crowns so they can be carefully removed from the teeth. Mrs. Shioda: Sorry to interrupt you, but is that a piece of string you are cutting off?

152 5.Metal-ceramic crown replacement:(3) Crown removalDr. Richard: It is like string but a bit thicker. It’s called gingival retraction cord. We have removed both crowns and tided up the preparations. Before I take the impressions I am going to place this gingival retraction cord around the preparations. Mrs. Shioda: May I ask why? Dr. Richard: The retraction cord keeps the edge of the gum away from the tooth. It is soaked in a solution, which stops any bleeding. This way we can make a good impression. Mrs. Shioda: Which impression material are you going to use?

153 5.Metal-ceramic crown replacement:(3) Crown removalDr. Richard: I think I will use the addition silicone sample, which the sales representative gave me last week. It’s in the drawer on your right. Dr. Richard: You are doing well Mrs. Shioda. We are on the last stage now. I just need to make some nice temporary crowns for you. Mrs. Shioda: I hope they are better than the ones my last Dentist made for me. They went yellow. Dr. Richard: Don’t worry that shouldn’t happen with these. I will put a special glaze on them so that food won’t stain them…

154 Chapter 3治療 5.Metal-ceramic crown replacement (4) Characterization

155 重要單字 metal-ceramic crown 金屬瓷冠 Porcelain butt margin 陶瓷方形邊緣 Shade 色調Characterization 特徵 Staining 染色 Natural teeth 自然牙 Ultrasonic scaler 超音波結石刮 Internal characterization 內部特徵 Surface texture 表面組織構造 Mimic 模仿 I am looking forward to ~ing 我正期待著…

156 5.Metal-ceramic crown replacement (4) CharacterizationDr. Richard: How are things, Kaz? Kaz Yoshioda: Fine thanks, I stopped by to talk to you about Mrs. Shioda’s new crowns. Dr. Richard: Yes, we are making two new metal-ceramic crown with porcelain butt margins for her upper central incisors. Kaz Yoshida: I wanted to discuss the shade and shape of these crowns with you. You wanted some special characterization.

157 5.Metal-ceramic crown replacement (4) CharacterizationDr. Richard: Yes. Her adjacent lateral incisors exhibit some staining. Mrs. Shoida would like the new crowns to also have some staining. Her existing crowns are all one color and do not blend in with her natural teeth. Kaz Yoshioda: I have printed out the digital photos, which you ed me. They clearly show that the existing crowns appear to stand out from the surrounding natural teeth. The lower anterior teeth also have some staining. Is the staining permanent or can it be removed with an ultrasonic scaler(超音波結石刮)?

158 5.Metal-ceramic crown replacement (4) CharacterizationDr. Richard: It’s permanent. It would not come off with an ultrasonic scaler. Mrs. Shioda says they have been stained for many years. Kaz Yoshioda: I will need to add some internal characterization using different shades of porcelains. It is important that I also create some surface texture. It looks from the photos that the adjacent lateral incisors have some vertical dark lines so these will need to be mimicked in the crowns. I will put a faint brown stain in the porcelain to mimic the brown lines in the lateral incisors.

159 5.Metal-ceramic crown replacement (4) CharacterizationDr. Richard: That sounds very good. I took several photographs at different exposures to try to give you a good idea of the different colors. I am looking forward to seeing the finished crowns.

160 Chapter 3 Treatment 5.Metal-ceramic crown replacement (5)Cementation

161 重要單字 Temporary crown :暫時性牙冠 Cement :黏合劑 Cementation :黏合Zinc phosphate cement :磷酸鋅黏合劑 Glass ionomer cement :玻璃離子黏合劑 Resin cement : 樹脂黏合劑 Consistency :稠度 Film thickness :膜厚度 Restoration :補綴物 (贋復物或修復物) Adjacent natural teeth :鄰接天然齒

162 5.Metal-ceramic crown replacement (5)CementationDr. Richard : We have your new crowns, Mrs. Shioda . Mrs. Shioda : Very good. I’m looking forward to seeing how they look. Dr. Richard : The plan today is to remove the temporary crowns and then let you see the new crowns in place before cementation … . So, what do you think of them ?

163 5.Metal-ceramic crown replacement (5)CementationMrs. Shioda : I’m really pleased with them. Their color is very good. They don’t stand out anymore. They blend in with the other teeth. Dr. Richard : I am pleased to hear that . Are you happy for me to go ahead and cement them in place ? Once they have been cemented , the only way to change them would be to cut them off.

164 5.Metal-ceramic crown replacement (5)CementationMrs. Shioda : Yes, please go ahead . May I ask a question ? Dr. Richard : Of course. Mrs. Shioda : What kind of cement do you use to cement the crowns? Dr. Richard : There are many different cements. There are basically three types of cements ; Zinc phosphate, glass ionomer or resin cement. Each one has advantages and disadvantages .

165 5.Metal-ceramic crown replacement (5)CementationMrs. Shioda: Which one will you use today ? Dr. Richard: I think I will use a resin cement . Resin cements stick well to both tooth and metal .Their main disadvantage is that they are a little thick in consistency and have a high film thickness. Mrs. Shioda: Is that a problem ? Dr. Richard: It can be sometimes .

166 5.Metal-ceramic crown replacement (5)CementationDr. Richard: Because resin cements are quite thick in consistency and have a high film thickness, sometimes it can be a little hard to cement the restoration exactly in place. Mrs. Shioda: Well, I’m sure you know what you are doing. I am attending a party tonight so I wonder if anyone will notice my new crowns . Dr. Richard: Hopefully no one will. If the crowns blend in with the adjacent natural teeth then they will not be so visible.

167 Chapter 3 Treatment 6. New technology (1)Microscope

168 重要單字 Loupes 放大鏡 Microscope 顯微鏡 openings of the root canals 根管口Eye surgeons 眼科醫生 Radiograph X光照片 Anaesthetize 麻醉 Extirpate the pulp 拔牙隨 Prepare and dress the root canals 根管形成 Symptomless 無症狀 Root fill 根管充填

169 6. New technology (1)MicroscopeDr. Richard: How are you doing, Mrs. Watanabe? Mrs. Watanabe: To tell the truth, I’m feeling a bit nervous about today. Dr. Richard: I’ll try to explain what’s going to happened so you’ll feel more relaxed. Today, I’m going to begin cleaning the roots of your lower right first molar then you’ll get no more pain from the tooth.

170 6. New technology (1)MicroscopeMrs. Watanabe: How can you see what you are doing because a tooth is so small? Dr. Richard: I have a pair of loupes, which can magnify the tooth about 2 times. The practice also has an operating microscope . The microscope is excellent for locating the openings of the root canals. That is the microscope over there. It is just like the operating microscope eye surgeons use.

171 6. New technology (1)MicroscopeMrs. Watanabe: It’s big isn’t it? How powerful is it? Dr. Richard: It can magnify the tooth about 12 times. It is on wheels so it can be easily moved around the surgery. I will be using it today. Before we do any work on your tooth we must first take a radiograph and then anaesthetize the tooth. Dr. Richard: Miss Suzuki, can you start getting the microscope ready while I am taking the radiograph?

172 6. New technology (1)MicroscopeMiss Suzuki: I’ll ask Miss Kato to just come in and help me move it across the surgery. Will you be filling the roots today? Dr. Richard: No, I’ll just extirpate the pulp, and try to prepare and dress the root canals today. If the tooth stays symptomless, I’ll root fill it next time.

173 Chapter 3 Treatment 6. New technology (2)Ni-Ti file

174 重要單字 The anesthetic wore(wear) off:麻醉劑逐漸消失 Channel : 根管Root canal : 根管 Rotary instrument : 迴轉器具 File : 銼 Nickel-Titanium : 鎳鈦合金 Handpiece : 牙科用手機 Endodontic treatment : 齒內療法 Microscope : 顯微鏡 Fiber optic illumination : 光纖照明

175 6. New technology (2)Ni-Ti fileDr. Richard: How has your tooth been, Mrs. Watanabe? Mrs. Watanabe: It was a bit sore the first few days. After the effects of the anesthetic wore off, it was a bit tender when I chewed on it. Now it’s better. Dr. Richard: your tooth is quite difficult. It has three roots and the cannels inside the roots are very narrow. One was blocked and it took some time to clear the blockage. We didn’t have time to finish cleaning and shaping of the root canals. Today we are going to use some special rotary instruments in the root canals.

176 6. New technology (2)Ni-Ti fileMrs. Watanabe: They look like miniature files. Dr. Richard: They are miniature files. They are made of Nickel-titanium, which makes them flexible. This allows them to negotiate curved root canals. We use them in a special handpiece, which rotates at a constant speed of a few hundred revolutions per minute. Mrs. Watanabe: Do you think you will finish preparing the tooth this morning?

177 6. New technology (2)Ni-Ti fileDr. Richard: Yes, I will. The most difficult part of endodontic treatment is probably trying to find and negotiate the root canals. We managed to do this at the last appointment so we just have to carefully enlarge the canals. Mrs. Watanabe: Are you going to use your microscope again? Dr. Richard: Dr. Sato is using it at the moment so I’ll use my loupes. They are quite good. I have 3 times magnification and fiber optic illumination of the tooth.

178 6. New technology (2)Ni-Ti fileMrs. Watanabe: Are they the same as what surgeons use? Dr. Richard: Yes indeed.

179 Chapter 3 Treatment 6. New technology (3) Periodontal surgery

180 重要單字 Periodontal surgery 牙周手術 Calculus 結石 Put stitches in 縫合Suture (s) 縫合線 Heal up 痊癒 Local anesthetic 局部麻醉 Resorbable sutures 可吸收縫合線 Gingivial papilla 牙齦乳頭 Periodontal pack 牙周敷料 Remove the sutures 去除縫合線 Painkillers 止痛藥

181 6. New technology (3) Periodontal surgeryDr. Sato: Are you OK, Mr. Okuda ? We have almost finished. I have removed all the calculus from around the roots of the teeth and we just need to put the gum back. Mr. Okuda: Are you going to put stitches in? Dr. Sato: Yes, I need to put some sutures in to hold the gum in the correct position so it will heal up nicely. Mr. Okuda: I can’t feel any pain.

182 6. New technology (3) Periodontal surgeryDr. Sato: That’s good. I gave you plenty of local anesthetic. The microscope helps things a lot, Miss Kato. It makes things so much easier. I can see the root surfaces much more clearly and it is easy to see any remaining calculus. I wish we had bought this microscope sooner! Miss Kato: Which suture material are you going to use? Dr. Sato: I won’t use resorbable sutures. I will use silk because we need to be very precise with the positioning of the gingival papillae.

183 6. New technology (3) Periodontal surgeryMiss Kato: I’ll get the periodontal pack out as well. Dr. Sato: Yes, that will be good. Dr. Sato: That’s it. We’ve finished, Mr. Okuda. We’ll need to see you again in a week’s time to remove the sutures and check how the gum is healing. I will also give you a list of instructions. You won’t be able to brush your teeth where we were working so you will need to use a mouthwash. It might be a good idea to take some painkillers before the local anesthetic wears off. Mr. Okuda: Thank you for all your hard work.

184 Chapter 3 Treatment 6. New technology (4)CAD/CAM

185 重要單字 Filling: 填補物 Fall out: 脫落 Cavity: 窩洞 Anesthetizing: 麻醉Take (make) an impression:印模 Ceramic: 陶瓷 Optical impression: 光學印模

186 重要單字 Milling machine 軋研機器 Glazed 上瓷釉 Tried in: 試戴Adhesive resin cement: 黏著樹脂黏著劑 Ceramic restoration: 陶瓷修復 Re- cemented 再黏著

187 6. New technology (4)CAD/CAMDr. sato : What’s happened, Mr. Yamada? Mr. Yamada: A filling has come out from one of my back teeth . Dr. sato: I’ll have a look . Ah yes . Quite a large filling has fallen out of your upper first molar. Mr. Yamada : Can I have a white filling this time please ? Dr. sato: You have three choices of white fillings , Mr. Yamada. First , we can use composite resin . We can either pack the resin directly into the cavity after anesthetizing and cleaning the cavity.

188 6. New technology (4)CAD/CAMDr. sato: Or we can take an impression and make a resin filling in the laboratory. The third choice is filling made of ceramic . Mr. Yamada : I would like a ceramic filling please . Will it take a long time to make ? Dr. sato: Actually no . We have purchased a new machine for making ceramic fillings. It is called Cerec 4D . It’s quite clever and uses CAD/CAM technology . You can watch your filling being made in the other room .

189 6. New technology (4)CAD/CAMMr. Yamada: Could you tell me a bit more about Cerec 4D. I have heard about CAD-CAM of materials before but did know it was used in Dentistry. Dr. Sato: Certainly. After we have prepared the cavity, we can take an optical impression of the cavity. We design the shape of the filling using special software. A ceramic block is placed in a separate milling machine and cut to the required shape. It takes about an hour in total. When the filling has been made it is glazed and is then ready to be tried in the cavity.

190 6. New technology (4)CAD/CAMMr. Yamada: That sound’s really good. Do the fillings fall out? Dr. Sato: We use a special adhesive resin cement, which cements the ceramic restoration in place. But yes, occasionally the fillings do fall out but they can be easily re-cemented.

191 Chapter 3 Treatment 7.Bleaching: (1)A consultation

192 重點單字 Whitening(美白) Bleach teeth(美白牙齒) Sensitive(敏感的)In the surgery(clinic) (在診療室) At home(居家) Gel(膠體) Tray(模托、托盤)

193 7.Bleaching (1)A consultationMiss Tanaka：Are you ready for the next patient, Dr. Richard. Dr. Richard：Indeed I am. Miss Tanaka：Please have a seat, Mrs. Ono(小野). Mrs. Ono：You’re very kind, thank you. Dr. Richard：Good afternoon, Mrs. Ono. What brings you to see us? Mrs. Ono：I am not happy with my yellow teeth. My daughter is getting married next month and I would like my teeth whitening. I read in a magazine that you can bleach teeth.

194 7.Bleaching (1)A consultationDr. Richard：Yes, I can bleach your teeth for you. It is not quite as simple as it seems. I have to warn you of a few things first. The first problem is that in some patients it is difficult to lighten the teeth. Also your teeth can become sensitive while we are bleaching the teeth. The other thing is that bleaching is not permanent. The teeth tend to darken again over time and you will need to have them bleached again.

195 7.Bleaching (1)A consultationMrs. Ono：I don’t mind having them bleached again. I heard that there are two ways you can bleach teeth. One way is in the clinic and the other is at home. Is that true? Dr. Richard：Yes. When the teeth are bleached in the clinic a gel is put on the teeth and a powerful light shone on the teeth. If the teeth are bleached at home you have to wear a bleaching tray to keep the gel against the teeth.

196 7.Bleaching (1)A consultationMrs. Ono：Which method do you prefer? Dr. Richard：I prefer to make you a bleaching tray. Then you can control how white you want your teeth. What I’ll do is give you these leaflets, which explain how bleaching works and Miss Suzuki, our receptionist will tell you how much it will cost. Mrs. Ono：Thank you for your time.

197 Chapter 3 Treatment 7.Bleaching (2) Home bleaching

198 重點單字 Bleaching trays (漂白模托、托盤) Bleaching gel (漂白膏)Fome bleaching (居家牙齒美白) Shade (色調) Alginate impressions (藻膠印模)

199 7.Bleaching (2) Home bleachingMiss Tanaka: Shall I call Mrs. Ono(小野) in? Dr. Richard: Yes please. Miss Tanaka: Please have a seat, Mrs. Ono. I’ll take your coat. Mrs. Ono: Thank you. Dr. Richard: So you have decided you would like me to bleach your teeth. Mrs. Ono: Yes, I have been reading the magazines, which your practice manager gave me and I definitely would like you to try to lighten them if you can.

200 7.Bleaching (2) Home bleachingDr. Richard: The way I prefer to bleach teeth is to make the bleaching trays first then give you the trays at your next appointment along with the bleaching gel. You can then continue using the gel until you feel your teeth have become lighter. Mrs. Ono: I read that you can bleach teeth in the clinic. Wouldn’t it be better if you did it? Dr. Richard: I prefer home bleaching. You have more control over any color changes. Is this OK for you.

201 7.Bleaching (2) Home bleachingMrs. Ono: If you think it’s better, I’ll follow your advice. Dr. Richard: What I will do today is to photograph your teeth so we have a record of the shade of your teeth before we start any treatment. Then I will take some alginate impressions of your upper and lower teeth so our technician Kaz can make the bleaching trays. Mrs. Ono: Do you know when the trays will be ready? Dr. Richard: Yes, they’ll be ready in three days time. Today is Monday so they will be ready for Thursday. When you come back on Thursday, I will give you a couple of boxes of the bleaching gel. Mrs. Ono: That’s great, thank you. My son, Hitohiro (仁弘), has an appointment with Dr. Sato mow.

202 Chapter 3 Treatment 7.Bleaching (3)Bleaching tray and gel

203 重點單字 Fit(適合) Side-effects(副作用) Sensitivity(敏感)Carbamide peroxide(過氧化尿素)

204 7.Bleaching (3)Bleaching tray and gelDr. Richard: Have Mrs. Ono bleaching trays come back? Miss Tanaka: Yes, Kaz brought them this morning. Shall I call Mrs. Ono in? Dr. Richard: Yes please. Mrs. Ono: Thanks for seeing me again so soon. Dr. Richard: No problem. These are the trays. I will check if they fit comfortably or not and I will show you where to put the gel…

205 7.Bleaching (3)Bleaching tray and gelMrs. Ono: How often shall I use them? Dr. Richard: As much as possible. Certainly at nighttime. I will see you again in a week’s time. Mrs. Ono: Are there any side-effects? Dr. Richard: Yes, it is possible you may get some sensitivity. This is temporary. Mrs. Ono: What is the gel made of? Dr. Richard: It is carbamide peroxide. If you don’t see much of an effect in a week you will need to continue using the trays for longer.

206 Chapter 3 Treatment 8. An orthodontic consultation: (1)Dracula’s teeth(小說中之吸血鬼主角)

207 重要單字 Canines(犬齒) Buccally(頰側) Orthodontist(齒顎矯正專科醫師) Specialist(專科醫生)Erupt(萌發) first premolars(第一小臼齒) Extract(拔牙) Arch(牙弓)

208 重要單字 Bracket(托架) Bond to(黏接著) Wire(金屬線) Elastics(彈性圈、橡皮圈)Living tissues(活組織) Biology of tooth movement(牙齒移動生物學) Study model(研究用模型)

209 8. An orthodontic consultation:①Dracula’s teethMiss Kato：You can come straight through, Mrs. Ono. We are ready for Hitohiro(仁弘). Dr. Sato：I hear you’re not happy with your front teeth, Hitohiro. Hitohiro Ono：No, they are horrible. I look like Dracula! Dr. Sato：How old are you, Hitohiro? Hitohiro Ono：12. Dr. Sato：Well, you are at the right age to have them straightened. Let me have a look. . .I see you keep them nice and clean. Hitohiro Ono：My mum makes me brush them three times a day.

210 8. An orthodontic consultation:①Dracula’s teethDr. Sato：That’s good. I see your upper canines don’t have much space. They are coming through buccally. Don’t worry Hitohiro. The situation looks worse than it is. Hitohiro Ono：Can you fix them? Dr. Sato：I can’t but I will refer you to an orthodontist. Hitohiro Ono：What’s an orthodontist? Dr. Sato：An orthodontist is a dentist who is a specialist in straightening teeth. Mrs. Ono, I tell you what is likely to happen. There is not enough space for Hitohiro’s upper canines. As a result, they are erupting buccally. To treat this problem, Hitohiro will have to have a couple of teeth taken out to make some space.

211 8. An orthodontic consultation:①Dracula’s teethMrs. Ono：Do you know which teeth? Dr. Sato：Usually both upper first premolars are extracted because they are in the middle of the arch but it will depend on the orthodontist. Mrs. Ono：How does the orthodontist straighten the teeth?

212 8. An orthodontic consultation:①Dracula’s teethDr. Sato：Brackets are bonded to the teeth and then a wire is attached to the brackets using elastics. This enables a controlled force to be applied to the teeth, which moves them through the bone. Mrs. Ono：Sorry did you say the teeth are moved through the bone? The bone is solid, how can that happen? Dr. Sato：Bone is a living tissue, which contains many cells. When a controlled force is applied to the tooth, bone is removed from around the tooth allowing the tooth to move to a new position. These movements are done very carefully. Once the tooth is in a new position, new bone is laid down.

213 8. An orthodontic consultation:①Dracula’s teethMrs. Ono：It sounds very complicated. Dr. Sato：Yes, the biology of tooth movement is very complex. I will need to send the orthodontist some study models and radiographs of Hitohiro’s teeth. You are coming back on Thursday to collect your bleaching trays aren’t you? Mrs. Ono：Yes, 4pm on Thursday. Dr. Sato：Well, to save you two visits, I will see Hitohiro after Dr. Richard sees you and then I take the impressions and radiographs. Mrs. Ono：That’s very kind of you.

214 Chapter 3 Treatment 8. An orthodontic consultation: (2)Cephalometrics( 測顱分析術 )

215 重要單字 Dental Pantomogram(環口斷層放射照片)Dephalometric lateral skull radiograph(側顱術側方頭部攝影) Erupt (萌出) Mandible (下顎) Maxilla (上顎). Decay (龋齒) Alginate impressions (藻膠印模) Models (模型)

216 8. An orthodontic consultation: (2)CephalometricsDr. Sato: Mrs. Ono, today we are going to take some radiographs of Hitohiro’s teeth. We are going to take two. One is called a Dental Pantomogram known as a DPT and another called a true cephalometric lateral skull radiograph. Hitohiro, would you like to follow me to the room in which we take the radiographs… Hitohiro Ono: Are those the machines(機械)? Dr. Sato: Yes. We will use one machine but we will take different views. We’ll take the DPT first. If you can move into machine and just gently bite on this bit of plastic. The top of this machine is going to move around your head. You just need to keep still for about 20 seconds. We’ll be watching you outside.

217 8. An orthodontic consultation: (2)CephalometricsHitohiro Ono: Ok. Dr. Sato: That’s great. Now we just need to take the lateral skull… Hitohiro Ono: Can I see the pictures when you have finished? Dr. Sato: Certainly, we can discuss them together. It will be about 15 minutes. So if you have a seat in the waiting room in the meantime. Miss Kato: Hitohiro, your radiographs have been developed. Would you and your Mum like to follow me? Dr. Sato: So these are the radiographs, which we have taken. Hitohiro Ono: What can you see?

218 8. An orthodontic consultation: (2)CephalometricsDr. Sato: These radiographs show us which teeth are present and the location of teeth, which are about to erupt. We can also see the relationship of the mandible to the maxilla. The good news is that I can’t see any decay in your teeth. Before you go I just need to take some alginate impressions of your upper and lower teeth. I will then send the models and radiographs to the orthodontist, who will send you an appointment in a few days.

219 8. An orthodontic consultation: (2)CephalometricsMiss Kato: Which size of trays would you like? Dr. Sato: Medium for both upper and lower will be fine. Miss Kato: Shall I start mixing? Dr. Sato: Yes please. Hitohiro Ono: Does it taste of anything? Dr. Sato: Peppermint. Ok, I’m going to take the lower impression first so try to relax and breathe through your nose …

220 Chapter 3 Treatment 9. Chrome denture(鈷鉻合金義齒) (1)Broken acrylic denture(破裂的丙烯酸的義齒)

221 重要單字 False teeth 假牙 (一般用語) Partial acrylic denture 局部丙烯酸的、壓克力的義齒Missing 缺失 Cobalt-chromium 鈷鉻合金 Bar 桿、槓 Framework 義齒支架

222 重要單字 Clasp 牙鉤 Replace 補綴取代 Implant 植體 Hygienist 口衛師 Scale 刮結石Primary impression 首次印模

223 9. Chrome denture: (1)Broken acrylic denture 鈷鉻合金義齒: (1)破裂的丙烯酸的義齒Miss Tanaka : Are you ready for your first patient? Dr. Richard : Just about. It’s Mr. Inoue(井上) and he’s broken his denture. Miss Tanaka : That’s right. Apparently you are the third dentist he will have seen this year! Dr. Richard : That doesn’t sound good. We had better see why he has come to see me … Dr. Richard : Mr. Inoue, good morning. Come in and make yourself comfortable… How can I help you? Mr. Inoue : It’s my lower false teeth. They keep breaking all the time. My friend recommended you. Here is my lower denture.

224 9. Chrome denture: (1)Broken acrylic denture 鈷鉻合金義齒: (1)破裂的丙烯酸的義齒Dr. Richard : I think I can help you. You have a lower partial acrylic denture, which replaces your missing right and left lower premolars and first molars. There is a thin piece of plastic, which runs behind your lower anterior teeth. What I suggest we do is to make you a lower partial cobalt-chromium denture. Instead of the bulky plastic behind your lower anterior teeth there will be a thin bar of mental. Because the framework of the denture is mental, it will be much stronger and less likely to break. Mr. Inoue : Will the mental be visible?

225 9. Chrome denture: (1)Broken acrylic denture 鈷鉻合金義齒: (1)破裂的丙烯酸的義齒Dr. Richard : We usually place a couple of clasp on the canines, one on each canine. These will stop the denture lifting up when your eating. These can be made in gold if you wish. The other option is to see if we can replace the missing teeth with implants but these are much more expensive. Mr. Inoue : A new lower denture in mental sounds fine. My lower teeth are not so visible when I speak so the mental clasps will not be a problem. When can you begin making them? Dr. Richard : First I need to carefully examine all your teeth and gums and maybe take some radiographs…

226 9. Chrome denture: (1)Broken acrylic denture 鈷鉻合金義齒: (1)破裂的丙烯酸的義齒Dr. Richard : Your fillings don’t need replacing but I can see that you have some calculus present so I will book you in with our hygienist to have your teeth scaled and polished. I will give you an appointment so we can make the primary impressions after you have seen the hygienist. I will also give you a treatment plan so you can see how much the treatment will cost. Mr. Inoue : That sounds fine. Thank you. I’ll see you next time.

227 Chapter 3 Treatment 9. Chrome denture(鈷鉻合金義齒): (2)Impressions for denture design (為義齒設計之印模)

228 重要單字 lower chrome denture 下顎鉻金屬活動假牙 primary impression 首次印象 Plaster 石膏design 設計 survey the model 測量模型 Undercut 倒凹 metal framework 金屬義齒支架 component 構成要素、元件 clasp 牙鉤 rest seat 鉤座 tray 模托、托盤

229 9. Chrome denture: (2)Impressions for denture design鈷鉻合金義齒:為義齒設計之印模Miss Tanaka : The weather’s terrible today. It’s causing all sorts of problems with the transport. Dr. Richard : Yes, my train was late this morning. Hopefully the rain will ease this afternoon. I guess some of patients may also be a little late. Who is our first patient? Miss Tanaka : It’s Mr. Inoue. He’s just arrived. The clinic is set up now so I’ll call him in if you want. Dr. Richard : Yes, we’re making him a new lower chrome denture. Today we’ll be making the primary impressions using alginate.

230 9. Chrome denture: (2)Impressions for denture design鈷鉻合金義齒:為義齒設計之印模Mr. Inoue : I almost couldn’t make it today because of the weather. Dr. Richard : Awful, isn’t it? Are you ready to have me make some impressions of your month? These will be the primary impressions. We take some more next time. Mr. Inoue : My last Dentist only took one lot of impressions? I didn’t have to come back twice! Dr. Richard : Making a well made, comfortable, good fitting lower chrome denture takes time. We will cast the primary impressions in plaster and then use the models to design the lower denture.

231 9. Chrome denture: (2)Impressions for denture design鈷鉻合金義齒:為義齒設計之印模Mr. Inoue : I didn’t know you have to design a denture. Dr. Richard : Yes, we first survey the model to find out which teeth have undercuts and then we design the metal framework. The framework has various components such as the clasps, which go around the teeth and rest seats. There will be small areas where the metal will rest on the teeth. Where this occurs we adjust the occlusal surface of the tooth slightly so the metal will not interfere when you bite together. I then send the design to my technician.

232 9. Chrome denture: (2)Impressions for denture design鈷鉻合金義齒:為義齒設計之印模Dr. Richard : Miss Tanaka, ready when you are for the alginate impressions. I’ll do the upper one first. Dr. Richard : Mr. Inoue, we’re going to make the upper impression first. So I will ask you to lean forwards slightly and when I put the tray in your mouth, to concentrate on breathing through your nose. Ok. Here goes…

233 Chapter 3 Treatment 9. Chrome denture(鈷鉻合金義齒): (3)Discussing denture design with the technician(跟齒模技術員討論義齒的設計)

234 重要單語 special tray(custom or individual tray) 個別模托 buccal surface 頰側面periodontal condition 牙周狀況 abutment teeth 支柱牙 handle 握柄 stub handle 粗而短之柄

235 9. Chrome denture: (3)Discussing denture design with the technician 鈷鉻合金義齒:跟齒模技術員討論義齒的設計Miss Suzuki : Miss Kato, could you let Dr. Richard know the technician Kaz is on phone? Miss Kato : I’ll ask him to take the call in his clinic Dr. Richard : Good afternoon Kaz, what can I do for you? Kaz: I’m calling you to talk about the design for Mr. Inoue’s lower cobalt-chrome denture and the special tray. I have surveyed the model and the lower second molars don’t have very much undercut. What do you think we should do?

236 9. Chrome denture: (3)Discussing denture design with the technician 鈷鉻合金義齒:跟齒模技術員討論義齒的設計Dr. Richard : I would like to clasp the lower second molars so I’ll add some composite to the buccal surfaces to create some undercut. Their periodontal condition is good so they are useful abutment teeth. Kaz: Also, how about the handles on the lower acrylic special tray? Would you like a single handle over the lower incisors or two stub handles in the premolar region? Dr. Richard : Two stub handles will be better, Mr. Inoue has a very active tongue, which will tend to dislodge the tray so I need good control of the tray in the posterior region.

237 9. Chrome denture: (3)Discussing denture design with the technician 鈷鉻合金義齒:跟齒模技術員討論義齒的設計Kaz : I think that’s it. The design looks straightforward and we are not replacing any anterior teeth. Does Mr. Inoue know the clasps on the canines may be visible? Dr. Richard : Yes, I have warned him and he is not worried about the clasps, Thanks for calling Kaz : It’s always better to discuss things if there is any doubt about something.

238 Chapter 3 Treatment 9. Chrome denture(鈷鉻合金義齒): (4) Final impression for lower chrome denture(下顎鈷鉻合金義齒的最後印模)

239 重要單語 make the final impression 做出最後的印象 special tray 個別模托prepare rest seats 做出鉤座 cobalt-chromium framework 鈷鉻義齒支架 gum 牙齦 tooth-supported 牙齒支持的 design (假牙)設計 cavities 窩洞 occlusal surface 咬合面 sensitivity 感覺、敏感性 silicone 矽化物 metal framework 金屬義齒支架 laboratory 牙科技工所(實驗室)

240 Dr. Richard : How are you today Mr. Inoue? 9. Chrome denture: (4) Final impression for lower chrome denture鈷鉻合金義齒:下顎鈷鉻合金義齒的最後印模 Dr. Richard : How are you today Mr. Inoue? Mr. Inoue : I’m fine thank you. May I ask what you plan to do today? Dr. Richard : We are going to make the final impression for your lower chrome denture. This is the special tray Kaz has made for us. Before I make the impression, I need to prepare some rest seats in a couple of your teeth. Mr. Inoue : Sorry did you say rest seats. What are they?

241 9. Chrome denture: (4) Final impression for lower chrome denture 鈷鉻合金義齒:下顎鈷鉻合金義齒的最後印模Dr. Richard : I’ll try to explain what rest seats are. The denture we are making for you has a cobalt-chromium framework. This means the denture will be stronger and less bulky. It also rests on your teeth and not the gums. We call this a tooth-supported denture. The advantage of a tooth-supported denture is that it will cause less damage to your gums. The design we have made for your new denture has three rest seats. I will cut some small cavities on the occlusal surface of three of your lower teeth.

242 Mr. Inoue : Will you be cutting a lot of the tooth away? 9. Chrome denture: (4) Final impression for lower chrome denture鈷鉻合金義齒:下顎鈷鉻合金義齒的最後印模 Mr. Inoue : Will you be cutting a lot of the tooth away? Dr. Richard : No, very little. The rest seats are quite thin so I just have to remove only a thin layer of enamel. You won’t have any sensitivity. After I have prepared the rest seats, I’ll make the final impression in silicone. Mr. Inoue : What is the next stage after the impressions? Dr. Richard : Next time you come I’ll hopefully have the metal framework back from the laboratory. I am just going to adjust the tray a little before I put the silicone in your mouth. Miss Tanaka : Can I mix the silicone?

243 9. Chrome denture: (4) Final impression for lower chrome denture鈷鉻合金義齒:下顎鈷鉻合金義齒的最後印模Dr. Richard : Yes please. If you can sit forward a little Mr. Inoue that will be great. The tray will be in your mouth. The tray will be in your mouth for about five to six minutes so if you can concentrate on breathing through your nose that will be good… Ok. Here we go( )…

244 Chapter 3 Treatment 9. Chrome denture(鈷鉻合金義齒): (5) Chrome denture try-in(鈷鉻義齒之試戴)

245 重要單字 Lower incisors: 下顎門牙 Acrylic denture:丙烯酸義齒 Arm:金屬製假牙掛勾 Try in: 試戴Occlusion:咬合 Process( ) Shade guide:選牙色板

246 9. Chrome denture: (5) Chrome denture try-inDr. Richard: This is the metal framework we have made for you, Mr. Inoue. Mr. Inoue: It looks very different from my denture. Will it fit? Dr. Richard: Yes, it’s thinner behind the lower incisors so it should feel less bulky. It shouldn’t break like your acrylic denture. Mr. Inoue: Are those little metal arms, the clasps? Dr. Richard: Yes, I’m just going to adjust them slightly before I try the framework in. Dr. Richard: That’s good. It goes in fine. Now we have to return it to the laboratory to put the teeth on. How does it feel?

247 9. Chrome denture: (5) Chrome denture try-inMr. Inoue: Quite good actually. It’s not hurting me and it feels better near my tongue. Dr. Richard: I’m pleased with this framework. Kaz has done a good job. So we’ll make you another appointment. Mr. Inoue: I’m not trying to rush you but do you know how many more visits will be needed? Dr. Richard: Hopefully just two more. The metal work fits. Next time, the teeth will be in wax. If you are happy with them and their occlusion is good they will be processes in acrylic. We just need to choose a shade…

248 9. Chrome denture: (5) Chrome denture try-inCould I have a shade guide please, Miss Tanaka? Are you happy with the color of the teeth on your existing denture? Mr. Inoue: Yes, but if possible, I’d like some lighter looking teeth. Dr. Richard: C2 seems a good match. I’ll let you have a look. Next time we’ll check how they bite together and let you check the color. Could you bring someone with you? It’s sometimes a good idea for a friend or family member to check the appearance as well. Mr. Inoue: Yes, I’ll bring my wife. Thanks' Dr. Richard, I’ll see you again.

249 Chapter 3 Treatment 9. Chrome denture: (6) Wax chrome try-in

250 重要單字 Trial denture 試戴假牙 Bracket table( ) Alignment 排序 Lirregular不規則

251 9. Chrome denture: (6) Wax chrome try-inDr. Richard: Good morning, Mr. Inoue( ). Mr. Inoue: Good morning, Dr. Richard. I’ve brought my wife as you suggested. Dr. Richard: Good morning, Mrs. Inoue. Very nice to meet you. Miss Tanaka: I’ll put the trial denture on the bracket table. Dr. Richard: Ok. Let’s see how it looks… What do you think Mr. Inoue? Mr. Inoue: You can hardly to see the claps. Dr. Richard: Yes, they’re hidden by your lower lip. What do you think about the color of the teeth?

252 9. Chrome denture: (6) Wax chrome try-inMr. Inoue: I like them. Dr. Richard: How about the color of the teeth, Mrs. Inoue? Mrs. Inoue: The color’s better than the current ones and I like their appearance. They look quite natural. Dr. Richard: I’m pleased you like them. I asked Kaz to make the alignment of the teeth slightly irregular. Do you want me to change anything? While they’re in wax we can make some alterations but once they are converted to acrylic it is much more difficult. Mr. Inoue: No, my wife and I are happy with them.

253 Chapter 3 Treatment 9. Chrome denture: (7) chrome fit

254 重要單字 Treatment 治療 Rub 假牙摩擦口腔黏膜 Ulcer 潰瘍,口內炎 Wear 裝戴假牙 Put in 裝戴假牙

255 9. Chrome denture: (7) chrome fitDr. Richard: Is Mr. Inoue here, Miss Tanaka? Miss Tanaka: Sorry, I forgot to tell you. He called to say that he’ll be a few minutes late. Dr. Richard: No problem. I can finish entering our previous patient’s treatment into the computer. Miss Tanaka: He’s here now. I’ll bring him in. Mr. Inoue: So sorry I’m late. There was an accident on one of the train lines and the trains are running a bit late. Dr. Richard: No, that’s fine. It gave me a chance to catch up with the paperwork. I have your new denture here so I’ll put it in and see how it is..

256 9. Chrome denture: (7) chrome fitDr. Richard: Does it hurt anywhere? Mr. Inoue: No. Not at the moment. Dr. Richard: You seem to be contacting both sides at the same time. Mr. Inoue: Yes, they feel very good. Dr. Richard: I have a few instructions for you. You probably know these already but please eat slowly at first and try to cut your food up. Eating may feel a bit strange at first but that’s normal. If they start rubbing please take them out otherwise you’ll develop an ulcer. Please be careful with the clasps. Please don’t adjust them yourself. They can correct anything. If you find you can’t wear them, please put your old denture in.

257 Chapter 3 Treatment 10. Implant overdenture: (1) A problem denture

258 重要單字 Waiting room: 候診室 Emergency patient: 急診病患 Dental implant: 牙科植入物Extensive exam: 精密檢查 Place: 置入植入物 CT scan: 電腦斷層掃描 Complete lower denture: 下顎全部假牙 Computerized tomography: 電腦斷層攝影(CT) Surgeon: 外科醫師( )

259 10. Implant overdenture: (1) A problem dentureDr. Sato: We seem to be doing well today, Miss Kato. Is there anyone in the waiting room. Miss Kato: Yes there is. Mr. Obata( ) is waiting to see you. He is an emergency patient. His lower denture has broken. Dr. Sato: Sorry I forgot that we had an emergency patient. Please could you bring Mr. Obata in. Miss Kato: Good afternoon, Mr. Obata. Please follow me. Dr. Sato: My receptionist tells me you are not happy with your lower denture, Mr. Obata.

260 10. Implant overdenture: (1) A problem dentureMr. Obata: Yes, that’s right. Ever since I had my first lower denture ten years ago I have not been happy. They are always loose and move around. Last week I read about Dental Implants in a magazine. I have come to ask if I could have a new denture fitted on implants. Dr. Sato: I do have a couple of patients who have had implants placed and then I made the new dentures on top. We will need to carry out an extensive exam before any implants can be placed. Mr. Obata: That’s fine.

261 10. Implant overdenture: (1) A problem dentureDr. Sato: I will let you know what happens in our practice. As part of the extensive exam we need to arrange for you to have a special radiograph of your mandible. The radiograph is a CT scan of your mandible. We can then examine the bone in detail and plan where the implants will be placed. For a complete lower denture we usually place four implants in the central region. Two will remain buried for future use and two will be use to support the denture. Mr. Obata: Excuse me what’s a CT scan? Also, do you place the implants yourself?

262 10. Implant overdenture: (1) A problem dentureDr. Sato: CT stands for computerized tomography. I have an experienced surgeon who I refer my patients to for placement of the implants. It is important that the implant is placed as carefully as possible otherwise it will not integrate with the bone and may become loose. I will carry out the oral examination today and then arrange for you to have a CT scan. Then I will give you another appointment to discuss the results and what stages are involved. In the meantime please take these leaflets home to read. They will give you an idea of what treatment to expect. Mr. Obata: Very good. Thank you.

263 Chapter 3 Treatment 10. Implant overdenture: (2) Implant planning

264 10. Implant overdenture: (2) Implant planningMiss Kato: Shall I call Mr. Obata in? Dr.Sato: Yes please. Miss Kato: How are you today, Mr.Obata? Mr.Obata: My shoulder is a bit sore. I think I hurt it while I was practicing my driving at the Golf centre last night. Dr. Sato: Do you have a chance to play a game of golf? Mr.Obata: Sadly not very often. I am a member of a golf club but usually I am busy at weekends so it is difficult to the driving range.

265 10. Implant overdenture: (2) Implant planningDr.Sato: Well, I have received a report on your CT scan and it seems you have enough bone fore four implants. To help the surgeon place the implants in the correct position in the mandible we need to go through the stages to make a wax trial denture. With the denture teeth in their correct position, we can then see where the implants should be placed. I will show you some pictures of what I mean. We can then duplicate the denture to make an acrylic stent. Mr. Obata: Ah yes, I see what you mean. How does the acrylic stent work?

266 10. Implant overdenture: (2) Implant planningDr.Sato: Once we have made the acrylic stent, which is similar in shape to how the final denture will be, we can drill holes in the stent. The surgeon will use these holes as guides for placing the implants. If the surgeon does not use a guide when drilling holes in the mandible then the implants may not be in the correct position. This may cause some major complications. Once the implants have been placed it is necessary to wait a few months. Mr. Obata: Oh, so I won't have the denture fitted on the implants straightaway?

267 10. Implant overdenture: (2) Implant planningDr. Sato: I prefer to wait four to six months. The implants are made of titanium and if the implants is going to be there a long time, bone must grow up against the surface of the implant. If this occurs then it is said that osseo-integration has occurred. The published long-tern studies show that it is better to wait few months. If the implant is loaded straight away, then there is a greater risk that osseo-integration will not happen and then the implant will fail. Mr. Obata: Yes, I see what you mean. What happens after we have waited for a few months?

268 10. Implant overdenture: (2) Implant planningDr. Sato : The surgeon will uncover the implants and then place what are called healing caps to give the surrounding soft tissues the correct shape. Then we take some impressions to make either a bar or magnetic attachments for the denture. The finished denture will either clip on the bar or rest on the magnets. Mr. Obata: It sound very complicated.

269 10. Implant overdenture: (2) Implant planningDr. Sato: There are many steps, which are needed in order to get a successful outcome. That‘s why implant treatment is expensive. We'll book a series of appointments for you to make the acrylic stent as soon as possible. Mr. Obata: Thanks very much.

270 重要單字 Wax trial denture:義齒蠟試驗 Duplicate: 複製 Acrylic stent: 壓克力支架Titanium: 鈦金屬 Osseo-integration: Load: Uncover: Healing cap: Surrounding soft tissue: 周圍軟組織 Bar: Magnetic attachment:磁性附著 Clip on: 固定

271 Chapter 3 Treatment 10. Implant overdenture: (3) Implant-supported lower overdenture

272 10. Implant overdenture: (3) Implant-supported lower overdentureMiss Kato: Shall I call our next patient in? Dr. Sato: Yes please. Ah yes, it‘s Mr. Obata. He had four lower implants placed six months ago and he's back for us to make him a complete lower overdenture. Mr. Obata: Good morning Dr. Sato. nice to see you again. Dr. Sato: I heard the surgery went well. How have you been? Mr. Obata: Very well thank you. I saw the surgeon last month and he is happy with the implants and for you to begin making the new overdenture. Am I right in thinking that you are going to make a bar for the denture to clip onto?

273 10. Implant overdenture: (3) Implant-supported lower overdentureDr. Sato: Yes. You have had four implants placed in the lower incisor region. The surgeon has placed healing caps on two of them and left the other two covered up by gum. These are so-called "sleepers" . They will be used only if the uncovered implants fail. Mr. Obata: How is the bar going to be made?

274 10. Implant overdenture: (3) Implant-supported lower overdentureDr. Sato: It will be made by Kaz, our technician. I am going to remove the healing caps and take an impression of the two implants. In order to get an accurate impression of the implants we use pick-up impression copings. These are screwed into the implant while we make the impression. After the impression has set, I will unscrew the retaining screws that hold the impression copings in place. Then I will remove the impression. Kaz will attach implant laboratory replicas to the impression copings before pouring the impression in stone.

275 10. Implant overdenture: (3) Implant-supported lower overdentureMr. Obata: I think I have an idea of how you are going to make the impression. I was wondering how is the bar going to be attached to the implants? Dr. Sato: Next time you come, we will screw abutments into the implants and then the bar will be screwed onto these. I will adjust your lower denture so that it fits over the bar The new denture will have some clips, which will clip onto the bar. Mr. Obata: That sounds really good. It’s a very complicated isn’t.

276 重要單字 Lower incisor region Healing cap SleeperTechnician, dental technician Take an impression Pick-up impression copings Screw Set Impression coping Implant laboratory replica Pouring the impression in stone灌模 Abutment支台齒

277 Chapter3 Treatment 10. Implant overdenture :(4) Overdenture try-in----

278 10. Implant overdenture : (4) Overdenture try-inDr. Sato: Is Mr.Obata here, Miss Kato? Miss Kato: Yes, but he hasn’t been waiting long. Shall I get him? Dr. Sato: Yes please. Mr. Obata: Good afternoon Dr. Sato. How are you? Dr. Sato: I’m fine thank you. Mr. Obata: Can you tell me what you have planned for today?

279 10. Implant overdenture : (4) Overdenture try-inDr. Sato: I’ll show you. This is the wax trial denture, which Kaz has made. It’s different from the denture you had before. You can see there is a bar on the model, which connects the two abutment. If you look on the fitting side of the wax denture you can see there is a gold clip. This will clip onto the bar. Mr. Obata: It looks as if it will stay in better than the one I have at the moment.

280 10. Implant overdenture : (4) Overdenture try-inDr. Sato: Yes, definitely. Your new denture has a bar to clip onto. Today, I will cement the bar in place then try the wax denture in. After the bar has been cemented in place, I need to adjust your existing denture. So, I’ll cut out a groove in your acrylic denture where the bar is and then reline it with soft acrylic. I will have your new denture back in two days… How does the wax denture feel? I have cemented the bar in place and I need to check how the wax denture bites together. How does the bite feel? Do you bite together evenly or is one side contacting first?

281 10. Implant overdenture : (4) Overdenture try-inMr. Obata: No, they feel great. The back teeth on both sides contact at the same time. I’m looking forward to getting the new one. They look great too!

282 重要單字 wax trial denture: 蠟的試用假牙 model: 模型fitting side: 黏膜面，又叫fitting surface clip: 夾子、鉗子、迴紋針 cement: 膠結材料、(牙科用來填補空洞的)黏固粉 adjust: 調整、改變、使…適應 groove: 溝、槽 reline: 重新規劃 soft acrylic: 軟性丙烯酸

283 Chapter3 Treatment 10. Implant overdenture : (5) Overdenture fit

284 10. Implant overdenture : (5) Overdenture fitMiss Kato: Shall I call Mr. Obata in? Dr. Sato: Is his denture back? Miss Kato: Yes, it’s in the disinfectant solution. Dr. Sato: Good. I was worried Kaz wouldn’t be able to get it back in time. Dr. Sato: Good new, Mr. Obata, we have your new denture! Mr. Obata: Excellent. Dr. Sato: First, I’ll make sure it doesn’t hurt you anywhere and that you bite together evenly. It’s very important we get your occlusion correct otherwise we might overload the implants.

285 10. Implant overdenture : (5) Overdenture fitDr. Sato: Good it fit well. How about the occlusion? Are you biting together evenly. Mr. Obata: Almost. I seem to be catching one of the back teeth first tough. Dr. Sato: Ok. If you can just bite on this piece of articulating paper… Ah yes. There is a slightly heavy contact on the lower first molar. Mr. Obata: May I ask how you know that. Dr. Sato: Can you see the blue marks? So this tells us that you have a premature contact. You are hitting this tooth slightly before the others.

286 10. Implant overdenture : (5) Overdenture fitMr. Obata: Does that mean you have to adjust the teeth? Dr. Sato: Yes, I shall just grind the tooth a little… Dr. Sato: How’s that now? Mr. Obata: Much better. Now I’m contacting both sides at the same time and the denture doesn’t rub anywhere. Dr. Sato: Ok. I won’t do any more adjustments. I’ll let you try the denture for a few days then I’ll see you again.

287 重要單字 disinfectant solution: 消毒水 occlusion: 咬合 overload: 使負荷過多、超載articulating paper: 咬合紙 heavy contact: 強力接觸 premature contact: 早期接觸 grind: 磨 rub: 磨擦、擦痛

288 Chapter3 Treatment 10. Implant overdenture : (6)review

289 10. Implant overdenture : (6)reviewDr. Sato：How’s the denture been Mr. Obata? Mr. Obata：It’s much more secure than my old one. I can eat many more foods than I could before. I’m really pleased with it. There’s just one area where it’s starting to rub a little. Dr. Sato：I’ll brush this white paste onto the fitting surface and see if I can detect the area that is rubbing. Mr. Obata：What’s that paste called? Dr. Sato：It’s called Pressure Indicating Paste. It’s quite useful. Dr. Sato：How’s that now?

290 10. Implant overdenture : (6)reviewMr. Obata：Ah yes. Much better. Dr. Sato：I must stress to you that it’s very important to keep the area around the implants very clean. Please also keep the denture clean. If plaque builds up around the implant, an infection may develop, which could affect the implant. Peri-implantitis is a condition in which the mucosa around the implant becomes inflamed. If this develops the implant may become loose. Mr. Obata：I’ll take great care. Thank you so much for all your help.

291 重要單字 fitting surface:黏膜面 Pressure Indicating Paste : PIP Plaque : 齒垢inflection: 感染 peri-implantitis: 周圍炎 mucosa:黏膜 inflamed:發炎的

292 Chapter3 Treatment 11. A Sore Mouth

293 重要單字 sore mouth: 口內炎 cancer:癌 lump:團；塊 hard palate:硬口蓋 ulcer:潰瘍apthous ulcer : apthous性潰瘍 medication:藥 prescibe:處方籤 Benzydamine oral spray( ) numb:麻痺 general health:全身健康狀況

294 11. A Sore Mouth Miss Tanaka：Your next patient, Mrs. Dejima( ), is here. Shall I call her in? Dr. Richard：Yes please. Do you know what she wants? Miss Tanaka：Apparently she has a sore mouth. Would you come this way Mrs. Dejima. Dr. Richard：Please have a seat Mrs. Dejima. How can I help you? Mrs. Dejima：The roof of my mouth has been quite sore for several days. I am a bit worried that it may be cancer.

295 11. A Sore Mouth Dr. Richard：When did your mouth begin to feel sore, Mrs. Dejima? Mrs. Dejima：About three days ago. I can also feel a slight lump. Dr. Richard：I’ll have a look. Ah yes. In the middle of your hard palate there is a reddish area. Mrs. Dejima：Is it serious? Dr. Richard：No. You have a large mouth ulcer. Also known as an apthous ulcer. Mrs. Dejima：Will it go away?

296 11. A Sore Mouth Dr. Richard：Yes, it will get better in a few days. You have a large ulcer. The tongue is very sensitive so the ulcer feels larger than it actually is. It is probably at its worse now. Mrs. Dejima：Is there any medication you can give me to stop it hurting when I eat? Dr. Richard：Yes, I can prescribe you a spray. It called Benzydamine oral spray. It will make your mouth feel numb. You should spray the ulcer a few minutes before you eat. Unfortunately the spray may affect the taste of the food. . .Would you mind me asking you a few questions about your general health, Mrs. Dejima?

297 11. A Sore Mouth Mrs. Dejima：No, not at all.Dr. Richard：Do you find your life stressful at the moment? Mrs. Dejima : No more than usual. Dr. Richard : How about your die? Are you eating a well diet? Mrs. Dejima：I think so. Can my diet be connected to my mouth ulcer? Dr. Richard：It can be. Nobody knows what exactly causes mouth ulcers. But certainly people who are stressed and not eating well may develop mouth ulcers. . .What I will also do is give you an appointment for two weeks time to see if the ulcer has healed up. In the meantime please make sure you eat plenty of fruit and vegetables. Mrs. Dejima：I will, thank you.

298 Chapter 4 Dental hygienist 1.Scaling, brushing (1)Bad brush

299 重要單字 appointment:會診 deposits:沈澱物 supra and subgingival:上下牙齦pocket charting:囊計表 halitosis:口臭 gum:黏液 bleeding:流血 bad breath:口臭

300 重要單字 Calculus牙結石 inflamed:發炎的 heal:癒合 ultrasonic scaler:超音波定標器hand scalers: periodontal probe:牙周探針 pocket depths:牙周囊袋深度 dental floss:牙線 interproximal brush:牙間刷 fluoride toothpaste:含氟牙膏

301 重要單字 swelling:腫脹 plaque:牙菌斑 scale:刻度 Caries齲齒 acid:酸 dissolve:溶解enamel:琺瑯質( ) remineralize:在礦化 check-up:核對 appointment:會診 cleaning and polishing:清潔與研磨

302 重要單字 Mouthwash, mouthrinse 刷牙 Disinfectant 消毒的 Inflamed gum牙齦發炎Fluoride氟化物 Electric toothbrush電動牙刷 Bristles( ) Sensitive toothpastes敏感的牙膏 Potassium nitrate硝酸鉀 Dentinal tubules( )

303 1.Scaling, brushing (1)Bad brushMiss Suzuki: Miss Yoshita( ), Mr. Ishida( ) has arrived. Shall I send him down? Miss Yoshida :Yes please …..How are you Mr. Ishita.? Mr. Ishida: Fine thanks. Dr. Sato( ) said there was some calculus on my teeth and booked an appointment for me with you. Miss Yoshida :Yes his clinical notes say that you have several deposits of both supra and subgingival calculus. Also, a couple of your teeth are getting loose so he would like me to carry out pocket charting of all your teeth.

304 1.Scaling, brushing (1)Bad brushMr.Ishida: I’m a little embarrassed to say this but my wife says I have halitosis. Also my gums have been bleeding. Can you do something about that? Miss Yoshida :Yes, once I have cleaned all your teeth your breath will smell better. Also your gums will stop bleeding. The reason for the bad breath and bleeding is your gums have become inflamed. Once all the calculus has been removed the gums can heal. Mr. Ishida: What is supra and subgingival calculus?

305 1.Scaling, brushing (1)Bad brushMiss Yoshida : Supragingival calculus is calculus that is found above the gum and subgingival calculus is found below the gum. Mr.Ishida: How are you going to clean the teeth? Miss Yoshida: I will use an ultrasonic scaler and hand scalers. We have a special probe called a periodontal probe to measure the pocket depths around the teeth. Mr.Ishida: Can you give some advice on how to clean my teeth properly?

306 1.Scaling, brushing (1)Bad brushMiss Yoshida: as well as using a toothbrush, it is important that you clean in between your teeth using dental floss and an interproximal brush. You can buy an interproximal brush at the reception desk if you wish. It is also important to have your teeth checked-up and scaled every 2 to 3 months. Mr.Ishida: I will try harder to keepe them clean. I don’t want to lose any more teeth.

307 Chapter 4 Dental Hygienist 1Chapter 4 Dental Hygienist 1.Scaling, brushing (2)After scaling and brushing

308 1.Scaling, brushing (2)After scaling and brushingMiss Yoshida: Your gums look better, Mr. Ishida. Mr. Ishida: Yes, following your advice I am now brushing my teeth three times a day using fluoride toothpaste. Miss Yoshida: Your gums are much pinker now. The redness and swelling has reduced. By brushing tree times a day you are preventing the build-up of plaque. Are you also using the interproximal brush and dental floss, which you bought last time.

309 1.Scaling, brushing (2)After scaling and brushingMr.Ishida: Yes I am. I have also noticed that since you scaled my teeth, the bleeding has stopped. And most importantly, my wife says my breath smells better! Miss Yoshida: That’s very important. Flossing your teeth regularly, removes plaque and food debris from between the teeth and beneath the gum line. It is also important to eat a balanced diet. Try not to eat too many sweet things and eat plenty of fresh vegetables. Do you smoke? Mr.Ishida: No I stopped a few months ago. The problem is that I have started eating more sweets.

310 1.Scaling, brushing (2)After scaling and brushingMiss Yoshida :You have to be careful with your sweet intake. If you have too many sweets, you will develop caries in your teeth. The best time to eat sweets is at meal times. When you eat something sweet, the sugars are broken down to acids, which dissolve the enamel surface. It take 3-4 hours for the enamel surface to remineralize. Mr. Ishida: Thanks for that advice. When should I see you next? Miss Yoshida: Please book a check- up appointment with Dr. Sato in about two months time and then he will make a treatment plan, which may include an appointment for cleaning a nd polishing. Mr. Ishida: I’ll do that.

311 Chapter 4 Dental Hygienist 2. How to use dental floss

312 -How to use dental floss-2.デンタルフの使い方 -How to use dental floss- 怎麼使用牙線 Miss Yoshida: Please have a seat, Mr. Obata( ). Mr. Obata: Thank you. Miss Yoshida: Dr. Sato has asked me to show you how to use dental floss. Do you floss your teeth,　Mr. Obata? Mr. Obata: Sometimes but I usually forget. It makes my gums sore. I prefer to use woodsticks.

313 -How to use dental floss-2.デンタルフの使い方 -How to use dental floss- 怎麼使用牙線 Miss Yoshida : I’ll show you an easy way. First take about 30cm and wrap it around one finger of each hand.　Then carefully slide it down between the teeth.　Don’t saw it from side to side otherwise you will wear away your teeth. After sliding it down between the teeth, gently pull it out. Have a go( ),　Mr. Obata. There’s a mirror over here.

314 -How to use dental floss-2.デンタルフの使い方 -How to use dental floss- 怎麼使用牙線 Mr. Obata: This way seems much better. How often should I floss? Miss Yoshida: At least once a day, please. Mr. Obata: Yes I’ll do that, thank you.

315 Chapter 4 Dental Hygienist 3. How to choose mouthwash

316 -How to choose mouthwash-3.マワスワオッシュの選び方 -How to choose mouthwash- 怎麼選擇漱口水 Miss Yoshida: Do you have any questions, Miss Jones? Miss Jones: I would like to know which mouthwash you recommend? There are several for sale in my local supermarket where I live but because my Japanese is not very good I get confused. Miss Yoshida: We sell mouthwashes here. I’ll show you which one to buy.

317 -How to choose mouthwash-3.マワスワオッシュの選び方 -How to choose mouthwash- 怎麼選擇漱口水 Miss Jones: That will be great. Miss Yoshida: There are basically two types. One group are disinfectants. They are helpful if you have inflamed gums. The other group contain fluoride. Miss Jones: what’s the difference?

318 -How to choose mouthwash-3.マワスワオッシュの選び方 -How to choose mouthwash- 怎麼選擇漱口水 Miss Yoshida: If you use a disinfectant type, your gums will be healthy but you will find your teeth will get stained after a while. I prefer to use a mouthwash that contains fluoride. Fluoride makes the surface of the teeth stronger. Fluoride is incorporated into the mineral structure of enamel. You rinse your mouth with the mouthwash for one minute then spit out.

319 -How to choose mouthwash-3.マワスワオッシュの選び方 -How to choose mouthwash- 怎麼選擇漱口水 Miss Jones: Do you sell fluoride mouthwashes at reception? Miss Yoshida: Yes, we do. They cost around 600 yen. We have a special offer at the moment. If you buy two you get one free.

320 Chapter 4 Dental Hygienist 4. How to choose toothbrush

321 -How to choose toothbrush-4.歯ブラシの選び方 -How to choose toothbrush- 怎麼選擇牙刷 Mrs. Kasahara( ): I’m thinking of buying an electric toothbrush, Miss Yoshida. What do you think? Are they better then manual toothbrushes?

322 -How to choose toothbrush-4.歯ブラシの選び方 -How to choose toothbrush- 怎麼選擇牙刷 If you had difficulty moving your hand it may be hard to use a manual toothbrush effectively. Miss Yoshida: That’s a difficult question to answer. Certainly an electric toothbrush would be better if you had difficulty moving your hand. If you had difficulty moving your hand it may be hard to use a manual toothbrush effectively. The aim is to make sure the bristles clean all the surfaces of the teeth. If you use dental floss once a day and brush all the surfaces of the teeth then that will be good. Mrs. Kasahara: What about the size of the toothbrush head and the bristles?

323 -How to choose toothbrush-4.歯ブラシの選び方 -How to choose toothbrush- 怎麼選擇牙刷 Miss Yoshida: Don’t buy a brush with a big head. Buy one that has a medium sized head and medium to soft bristles. If the bristles are too hard you may abrade the surfaces of the teeth. Mrs. Kasahara: Do sensitive toothpastes work, Miss Yoshida?

324 -How to choose toothbrush-4.歯ブラシの選び方 -How to choose toothbrush- 怎麼選擇牙刷 Miss Yoshida: They do actually. They contain chemical substances such as potassium nitrate. These chemicals can block exposed dentinal tubules and stop sensitivity. Mrs. Kasahara: Thank you so mush for your advice.

325 Chapter5 Equipment woes 1.Autoclave trouble

326 重要單字 autoclave : 滅菌鍋、高壓鍋 sterilization : 滅菌、消毒 attend meeting : 出席會議 dental unit : 齒科用具 waterline : 水線 handpiece : 手機、牙科用手機 cancel the appointment : 取消預約 rebook : 重新預約

327 1.オートクレーブの故障 -Autoclave trouble- 高壓鍋故障Miss Tanaka : Today is not starting well. The autoclave in Dr. Richard’s surgery is not working properly. I think we will need to call someone to come and look at it. Miss Suzuki : What happening with it? Miss Tanaka : It will not complete the sterilization cycle. I have looked through the hand-book, which was sent with the autoclave. However, it is indicating a fault, which is not listed.

328 1.オートクレーブの故障 -Autoclave trouble- 高壓鍋故障Miss Suzuki : Have you checked the door seal? Miss Tanaka : Yes, I have cleaned the door seal and dried it twice. I have talked to Dr. Richard and he agrees that we will have to contact someone.

329 1.オートクレーブの故障 -Autoclave trouble- 高壓鍋故障Miss Suzuki: OK. I will call the company with whom we have a service contract. We are lucky today. Dr. Sato is away today. He had to attend some meetings so you can use his clinic. Miss Tanaka: That’s good. I will let dr. Richard know we will be working in Dr. Sato’s clinic.

330 Chapter5 Equipment woes 2. Unit trouble

331 2.ユニットの水漏れ -Unit trouble- 設備故障Miss Kato：I think we’ll have to delay our next patient, Dr. Sato. Dr. Sato：Why’s that ? Miss Kato：Have you looked on the floor ? there’s A big puddle . I can see water coming out the dental unit .  

332 2.ユニットの水漏れ -Unit trouble- 設備故障Dr. Sato：Oh dear. You' re right. It's getting bigger. I‘ll get some towels. First, I’ll have A look at the waterlines to the handpieces. ‘ Miss Kato：I’ ll get A mop. Dr. Sato：It’s looks like a valve has broken. Can you switch off the unit and that will stop the water coming out. I‘ll have to call an engineer. I’ ll go to reception and apologize to our next patient.

333 2.ユニットの水漏れ -Unit trouble- 設備故障Dr. Sato ：Miss Suzuki, we have an emergency in my surgery. It is flooded. Miss Kato is mopping up water!   Miss Suzuki：Your next patient is setting in the waiting room, Dr. Sato. '

334 2.ユニットの水漏れ -Unit trouble- 設備故障Dr. Sato ：Oh dear, It's Miss Saito. She's not going to be happy when I tell her I am going to cancel her appointment today… Miss Saito, I'm afraid we have had an emergency in my clinic and it is flooded. I can't do anymore treatment until the engineer comes. I'm sorry but I'll have to cancel your appointment today and rebook you. I'm very sorry for wasting your time.

335 2.ユニットの水漏れ -Unit trouble- 設備故障Miss Saito ：That's ok. I wasn't feeling well anyway and was thinking of telling you that I didn't want much treatment done today. So actually, I'm quite relieved that I am not having treatment today. Thank you for telling me.