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牙髓病的分类、临床表现及诊断

牙髓病的分类、临床表现及诊断. 西安交大医学院 侯铁舟 Tel 02988088507. 分类. 组织病理学分类 临床分类. 临床分类. 临床分类 牙髓治疗需要 可复性牙髓炎 N 不可复性牙髓炎 Y 急性牙髓炎 慢性牙髓炎 逆行性牙髓炎 牙髓坏死 Y

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牙髓病的分类、临床表现及诊断

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  1. 牙髓病的分类、临床表现及诊断 西安交大医学院 侯铁舟 Tel 02988088507

  2. 分类 • 组织病理学分类 • 临床分类

  3. 临床分类 临床分类 牙髓治疗需要 可复性牙髓炎 N 不可复性牙髓炎 Y 急性牙髓炎 慢性牙髓炎 逆行性牙髓炎 牙髓坏死 Y 牙髓钙化 N/Y 髓石 弥漫性钙化 牙内吸收 Y

  4. 临床表现和诊断

  5. 可复性牙髓炎reversible pulpitis 症状 瞬间激发疼，冷刺激更明显，刺激去除后，疼痛立即消失，无自发性疼痛病史。

  6. 检查 有深龋或非龋性疾病、牙周袋、咬合创伤 牙髓活力测量一过性敏感，去除刺激后症状持续数秒钟缓解 叩诊阴性 诊断要点

  7. 鉴别诊断 深龋 冷热刺激或食物嵌入痛，刺激去除后症状立即消失 不可复性牙髓炎（慢性牙髓炎） 有自发性疼痛病史，刺激痛持续，可有叩痛 牙本质过敏症 患牙对机械化学刺激敏感

  8. 不可复性牙髓炎 irreversible pulpitis 急性牙髓炎 acute pulpitis 症状 剧烈疼痛 （1）自发性阵发性疼痛（2）夜间痛（3）温度刺激疼痛加剧（4）疼痛不能定位

  9. 检查、诊断要点 典型的疼痛特点 病因学阳性 温度刺激疼痛敏感、叩诊(±) 有助于定位患牙

  10. 鉴别诊断三叉神经痛龈乳头炎急性上颌窦炎

  11. 不可复性牙髓炎 irreversible pulpitis 慢性牙髓炎chronic pulpitis 症状 有阵发性隐痛或定时钝痛，长期的冷热刺激痛病 史及轻微叩痛， 能定位患牙

  12. 慢性牙髓炎可分为以下三种类型慢性闭锁性牙髓炎慢性溃疡型牙髓炎慢性增生型牙髓炎慢性牙髓炎可分为以下三种类型慢性闭锁性牙髓炎慢性溃疡型牙髓炎慢性增生型牙髓炎

  13. 慢性牙髓炎诊断要点有长时间冷热刺激痛和/或自发痛病史，可以定位查出引起牙髓炎病因 温度测验阳性叩诊是重要的参考指标

  14. 鉴别诊断深龋可复性牙髓炎 干槽症

  15. 残髓炎residual pulpitis症状 检查牙髓治疗史+根管内探痛诊断要点 不可复性牙髓炎 irreversible pulpitis

  16. 逆行性牙髓炎 retrograde pulpitis症状 检查重的牙周病+叩痛诊断要点 不可复性牙髓炎 irreversible pulpitis

  17. 牙髓坏死 pulp necrosis牙髓钙化pulp calcification

  18. 牙内吸收internal resorption

  19. 牙髓性疼痛Pulpal Pain 定位不明确Very poorly localized • 间歇痛Intermittent • 跳痛Throbbing • 遇冷热、咀嚼加重 Intensified by heat, cold and sometimes chewing • 有时遇冷缓解May be relieved by cold • 通常为剧痛Usually severe

  20. Symptoms None Radiograph No periapical change Pulp tests Responds normally Periapical tests Not tender to percussion or palpation Normal Pulp

  21. Symptoms May have thermal sensitivity Radiograph No periapical change Pulp tests Responds – sensitivity not lingering Periapical tests Not tender to percussion or palpation Reversible Pulpitis

  22. Symptoms May have spontaneous pain Radiograph No periapical change Pulp Tests Pain that lingers Periapical tests Generally not tender to percussion or palpation Irreversible Pulpitis

  23. Symptoms No thermal sensitivity Radiograph Dependent on periapical status Pulp tests No response Periapical tests Dependent on periapical status Necrotic Pulp

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