牙髓病的分类临床表现及诊断

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,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,牙髓钙化,N/Y,髓石,弥漫性钙化,牙内吸收,Y,临床表现和诊断,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,可复性牙髓炎,reversible pulpitis,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,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,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,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,鉴别诊断,三叉神经痛,龈乳头炎,急性上颌窦炎,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,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,鉴别诊断,深龋,可复性牙髓炎 干槽症,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,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,牙髓坏死,pulp necrosis,牙髓钙化,pulp calcification,牙内吸收,internal resorption,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,Normal Pulp,SymptomsNone,Radiograph No periapical change,Pulp testsResponds normally,Periapical tests Not tender to,percussion or palpation,Reversible Pulpitis,Symptoms May have thermal sensitivity,Radiograph No periapical change,Pulp tests Responds sensitivity not lingering,Periapical tests Not tender to percussion or palpation,Irreversible Pulpitis,SymptomsMay have spontaneous pain,Radiograph No periapical change,Pulp TestsPain that lingers,Periapical testsGenerally not tender to percussion or palpation,Necrotic Pulp,SymptomsNo thermal sensitivity,Radiograph Dependent on periapical status,Pulp testsNo response,Periapical tests Dependent on periapical status,。