Kev loj hlob ntawm caries yuav tsum tau kho raws sijhawm thiab tsis zam qhov tsis quav ntsej txog qhov teeb meem. Qhov tshwm sim ntawm kev tsis ua haujlwm thiab ncua sijhawm mus ntsib kws kho hniav tom qab qhov kub hnyiab thaum kawg ua rau mob ntawm cov hniav. Yog li ntawd, qhov mob tshwm sim, thiab hnyav heev uas tus neeg mob tsuas yog yuam kom tig mus rau tus kws kho mob tshwj xeeb. Thiab yog tias tus kab mob tsis tuaj yeem kho tau los ntawm kev siv tshuaj, ces nyob rau hauv rooj plaub no, devital amputation tuaj yeem raug tshuaj. Tab sis qhov txheej txheem yog dab tsi?
Kev faib tawm ntawm pulpitis
Ua ntej xav txog cov yam ntxwv ntawm kev ua haujlwm hauv kev cuam tshuam nrog kev kho hniav, nws tsim nyog tau txais kev paub ntau yam ntawm tus kab mob.
Zoo ntawm qhov ua rau, pulpitis tuaj yeem yog:
- Kev kis mob. Lub ntsiab ua rau yuav luag txhua tus txheej txheem inflammatory yog nyob rau hauv kev ua ntawm cov kab mob. Feem ntau, tus kab mob no muaj peev xwm nkag tau los ntawm sab hauv cariouskab noj hniav los ntawm cov hniav tubules.
- Retrograde. Qhov tseeb, qhov no yog hom kab mob sib kis. Nws qhov txawv yog tias cov kab mob nkag mus rau cov hniav los ntawm lub qhov hauv paus apex.
- Taumatic. Txhua yam kev puas tsuaj rau cov hniav ntawm ib qho kev kho tshuab tuaj yeem ua rau qhov no. Ntxiv mus, ob qho tib si los ntawm kev sib tsoo (chips, tawg, tawg), thiab vim yog kev kho mob caries (xws li qhib nrog lub burr).
- Nco ntsoov. Hauv qhov no, qhov ua rau ntawm cov txheej txheem inflammatory yog ib qho khoom tsim (denticle) nyob rau hauv cov kab noj hniav ntawm cov hniav. Hauv lwm txoj kev, nws yog hu ua "cov hniav hlaws". Nws tuaj yeem nyob ze ntawm phab ntsa los yog nyob rau hauv lub thickness ntawm lub pulp. Hauv plawv ntawm denticles yog ib qho amorphous dentine zoo li cov khoom. Qhov no piav txog lawv lub npe. Nyob rau tib lub sijhawm, cov txheej txheem ntawm lawv tsim yog pom tsis tau rau tib neeg. Lub "hniav hlaws" tuaj yeem kuaj pom thaum kho lossis thaum x-ray.
Tsis tas li ntawd, muaj cov mob hnyav thiab mob ntev. Tsis tas li ntawd, tej zaum yuav muaj exacerbation ntawm pulpitis. Raws li kev cai pulpitis raws li ICD 10, raws li kev faib tawm ntawm World He alth Organization (WHO) nws yog K04.
Cov ntaub ntawv dav dav txog kev txiav tawm ntawm cov pulp
Cov kab noj hniav sab hauv ntawm cov hniav yog ntim nrog cov tawv nqaij - qhov tseeb, qhov no yog ib qho khoom nruab nrog uas nyuaj heev. Nws lub hom phiaj yog muab khoom noj khoom haus rau cov ntaub so ntswg thiab, yog li ntawd, lawv txoj kev loj hlob. Qhov no yog tag nrho pawg, muaj cov paj hlwb, cov hlab ntsha, receptors. Qhov tseeb, lub pulp yog cov hlab ntsha nws tus kheej, thiab ntev npaum li nws tsis zoo, cov hniav tseem nyob.
Thaum muaj kab mob ntawm lub cev tseem ceeb thiab tsim nyog, feem ntau yuav tsum tau muab tshem tawm. Cov txheej txheem rau kev tu tag nrho cov kab noj hniav ntawm cov yas, nrog rau cov hauv paus hniav, hu ua extirpation. Txawm li cas los xij, muaj kev ua haujlwm yooj yim dua. Ntawm no nws tsuas yog hu ua amputation (pulpotomy). Thiab nyob rau hauv rooj plaub no, muaj ib feem tshem tawm ntawm lub pulp. Qhov ntawd yog, nws tsuas yog tshem tawm ntawm qhov kab noj hniav, thiab tseem nyob hauv cov hauv paus hniav.
Amputation muaj feem cuam tshuam rau qhov kev puas tsuaj me me rau cov tawv nqaij thiab curvature loj ntawm cov hauv paus kwj dej. Raws li txoj cai, nws yog nqa tawm rau cov neeg mob ntawm cov menyuam yaus, thaum cov hauv paus hniav ntawm cov hniav tseem tsis tau tsim tag nrho. Txog rau thaum muaj hnub nyoog 25 xyoo, txoj hauv kev ntawm kev kho mob kom zoo nrog kev txiav tawm tau nce ntxiv.
Muaj ob hom txheej txheem - tseem ceeb heev thiab devital amputation. Txhua tus muaj nws tus yam ntxwv.
Vimal amputation
Tam sim no, cov txheej txheem tseem ceeb tau siv dav hauv ntau lub chaw kho hniav. Hauv qhov no, kev kho mob yog nqa tawm, raws li txoj cai, thaum mus ntsib kws kho hniav. Cov neeg mob tau kho nrog ib qho kev siv tshuaj loog hauv zos - conduction, infiltration, intraosseous anesthesia. Feem ntau, tshuaj loog nrog articaine, mepivacaine, lidocaine yog siv.
Daim ntawv thov hom tshuaj loog tuaj yeem ua cov tshuaj loog ntxiv ua ntej txhaj tshuaj. Rau lub hom phiaj no, tshuaj loog raws li lidocaine lossis prilocaine hauv cov kua lossis gel yog siv. Thiab thaum poobrhiab heev nyob rau hauv lub zog ntawm ib qho tshuaj loog, tus kws kho hniav tseem tshem tawm cov hlab ntsha ntawm cov hniav ntawm theem ntawm cov hauv paus hniav.
Txoj kev ua txhaum cai
Thaum kho pulpitis los ntawm devital amputation, ib qho tshwj xeeb muab tshuaj txhuam yog muab tso rau hauv kab noj hniav ntawm cov hlab ntsha chamber, uas ua rau muaj kev cuam tshuam tag nrho ntawm nws cov dej num, suav nrog kev poob ntawm qhov mob rhiab heev. Hauv lwm lo lus, cov hlab ntsha ntawm cov hniav raug tua. Cov kev npaj no feem ntau yog ua los ntawm arsenic, thiab arsenic nws tus kheej yog tshuaj lom. Thaum nws tsoo cov paj hlwb, lawv cov hypoxia tau teeb tsa thiab cov ntaub so ntswg tawg.
Tib lub sijhawm, vim qhov tshwm sim ntev ntawm kev cuam tshuam rau arsenic muab tshuaj, necrosis ntawm cov ntaub so ntswg nyob ze txhim kho thiab cov txheej txheem inflammatory periodontal tshwm sim. Vim li no, cov txheej txheem no tsis tau pom daim ntawv thov dav hauv kev cuam tshuam rau kev kho hniav mus tas li vim nws qhov ua haujlwm qis.
Raws li tau sau tseg saum toj no, cov txheej txheem devital tsuas yog ua thaum cov hauv paus hniav ntawm cov hniav nyob rau theem ntawm kev tsim. Thiab thaum kawg ntawm lawv txoj kev loj hlob, lub pulp yog tshem tawm ntawm lub hauv paus kwj dej. Tsis tas li ntawd, cov txheej txheem siv tau rau cov neeg mob laus.
cov khoom xyaw ua cov tshuaj Arsenic
Nyob ntawm cov chaw tsim khoom, muaj pes tsawg leeg ntawm arsenic muab tshuaj txhuam rau pulp devitalization yuav txawv me ntsis. Txawm li cas los xij, cov khoom tseem nyob ib yam. Qhov txawv yog nyob rau hauv lawv cov concentration. Paste Bulk:
- Arsenic trioxide lossis anhydride - qhov kev npaj muaj txog li ib feem peb ntawm tag nrho cov ntim.
- tshuaj loog hauv zos - nrog nwspab txo qhov mob ntawm qhov mob ntawm daim tawv nqaij. Rau lub hom phiaj no, novocaine, lidocaine hydrochloride los yog dicaine feem ntau yog siv. Cov tshuaj loog nws tus kheej nyob rau hauv paste - 27-30%.
- Antiseptic. Nws lub xub ntiag yog vim qhov xav tau los tua cov ntaub so ntswg tuag thiab rhuav tshem cov kab mob microflora. Feem ntau thymol, carbolic acid los yog camphor yog siv rau lub hom phiaj no. Tsis pub tshaj 5% ntxiv rau nws muab tshuaj txhuam.
- Tanin. Nws yog ib qho astringent tivthaiv uas yuav pab kom qeeb ntawm kev sib kis ntawm arsenic nyob rau hauv lub pulp. Vim qhov no, lub sij hawm ntawm cov nyhuv ntawm cov muab tshuaj txhuam tuaj yeem nce ntxiv. Nws tsis muaj ntau tshaj 1%.
- Tshwj xeeb muab tub lim. Ua tsaug rau nws, nws muaj peev xwm tsim cov khoom noj hauv daim ntawv me me.
Nyob rau hauv rooj plaub uas tsis tuaj yeem siv cov tshuaj arsenic los tshem tawm cov tawv nqaij (rau ntau yam), nws raug hloov los ntawm ib qho analogue.
Raws li qhov piv txwv zoo ntawm qhov no - paraformaldehyde muaj pes tsawg leeg.
Indications rau devital pulp amputation
Daim ntawv teev npe kho mob rau kev phais mob vwm suav nrog cov xwm txheej hauv qab no:
- mob hnyav thiab ib nrab serous daim ntawv;
- mob hnyav serous theem;
- fibrous chronic ntau yam;
- hypertrophically chronic form of disease;
- exacerbation ntawm lub sijhawm ntev ntawm pulpitis, tab sis kom deb li deb ntawm qhov tsis muaj tus mob periodontitis;
- qhov chaw txawv txav ntawm lub hauv paus hauv kev kho hniav;
- ntau loj sab hauv pulp chamber;
- lub xub ntiag ntawm lub nti loj, uasnthuav tawm cov hlab ntsha.
Tsis tas li ntawd, cov txheej txheem zoo sib xws yog siv rau hauv rooj plaub ntawm cov hniav lwj lossis kev puas tsuaj loj.
Contraindications rau cov txheej txheem
Raws li nrog rau lwm cov txheej txheem kho mob (kev kho hniav tsis muaj qhov tshwj xeeb), muaj qee yam contraindications rau devital amputation method. Ua ntej ntawm tag nrho cov, nws yuav tsum tsis txhob ua rau cov neeg mob hypersensitivity rau devitalizing agents.
Ntxiv rau, cov txheej txheem raug txwv nyob rau hauv chav kawm ntawm purulent pulpitis. Tsis tas li ntawd, yog tias lub hauv paus ntawm cov hniav tseem tsis tau tsim, qhov no kuj yog ib qho contraindication ncaj qha.
Ua tus txheej txheem devital
Peb txhua tus paub zoo tias kev kho hniav yuav tsum tau ua raws sijhawm kom tsis txhob muaj teeb meem. Nws tuaj yeem ua rau cov hniav poob. Tab sis tsuas yog cov khoom noj siv mis tshiab tau rov ua dua tshiab, ces cov khoom mus tas li loj tuaj. Thiab yog ib tug poob lawm ces tus tshiab yuav tsis tshwm.
Cov txheej txheem ntawm kev txiav tawm ntawm cov pulp feem ntau cuam tshuam nrog qhov pib ntawm cov txheej txheem ntawm cov hniav. Tom qab tag nrho, tom qab nws siv, nws poob nws txoj kev vam meej. Thiab tag nrho vim hais tias nyob rau hauv tsis muaj cov ntaub so ntswg, khoom noj khoom haus tsis xa mus rau cov pob txha cov ntaub so ntswg. Thiab yog tias tsis muaj cov hlab ntsha, ces nws yog tsis yooj yim sua kom xa ib tug mob teeb liab nyob rau hauv cov ntaub ntawv ntawm kev puas tsuaj rau cov hniav. Vim li no, ntau tus kws kho hniav sim khaws cov pulp.
Yog tias qhov kev ua haujlwm no raug sau tseg, nws tau ua nyob rau hauv peb mus ntsib tus neeg mob mus rau tus kws kho mob tshwj xeeb (tsawg kawg). Cov theem ntawm devital amputation lawv tus kheej yog raws li nram no:
- Qhib cov hniav, siv cov khoom siv devitalizing thiab cov ntaub qhwv airtight.
- Bandage tshem tawm.
- Lub tshuab nqus tsev yog npaj.
- Qhov pom ntawm daim tawv nqaij raug tshem tawm.
- Khaub kwj dej yog tshuaj thiab qhuav.
- Keeb kwm yog obturated.
- Tau qhov chaw.
Cov txheej txheem no yuav tsim nyog rau cov neeg mob uas nquag ua xua rau tshuaj loog siv hauv kev kho hniav. Tam sim no nws tsim nyog nthuav tawm cov kauj ruam saum toj no hauv kev nthuav dav ntxiv.
thawj zaug
Nyob rau thawj zaug, tus kws kho hniav ua ib qho kev kuaj hniav sab nraud thiab, yog tias tsim nyog, ntxuav nws los ntawm kev tso nyiaj. Thiab txij li thaum devital amputation yog mob heev, daim ntawv thov tshuaj loog yog siv. Tom qab tshuaj loog, tus kws kho mob ua qhov kev npaj ntawm carious kab noj hniav. Qhov cuam tshuam dentin raug tshem tawm, kab noj hniav nws tus kheej yog kho nrog tshuaj tua kab mob thiab ziab nrog paj rwb swab.
Tom qab ntawd lub tshuab raj qhib thiab muab tshuaj txhuam tshwj xeeb tso rau ntawm cov hlab ntsha. Tom qab ntawd cov kab noj hniav raug kaw nrog cov hniav cuav. Nws yuav tsum tau muab sau tseg tias thaum lub sij hawm raug muab tso rau muab tshuaj txhuam, pulp irritation tshwm sim, thiab yog li ntawd qhov mob syndrome yuav nce. Vim li no, tus kws kho mob pom zoo kom noj qee yam tshuaj kho mob - Ibuprofen, Ketanov, Analgin, Paracetamol.
Thaum siv tshuaj arsenic, lub sijhawm mus ntsib tom ntej yog nyob ntawm qhov tshwj xeeb ntawm kev kho mob:
- cov hniav ib leeg - ntawmday;
- multi-root system (2 lossis ntau dua) - tom qab 2 hnub.
Yog tias thaum lub sij hawm kho mob ntawm cov kab mob ntawm cov kab mob paraformaldehyde tau siv, tom qab ntawd cov koob tshuaj ntxiv tau raug ncua rau lub sijhawm ntev me ntsis - txog ib lub lis piam lossis ob (6-14 hnub).
Lub sijhawm teem thib ob
Kev mus ntsib zaum ob yog qhov yuav tsum tau ua nruj me ntsis thiab ntawm no yog qhov tseem ceeb heev kom tuaj raws lub sijhawm teem tseg yam tsis muaj sijhawm ncua. Txwv tsis pub, qhov kev pheej hmoo ntawm kev tsim cov teeb meem loj ntxiv. Feem ntau, txhua yam yog txuas nrog kev siv cov tshuaj arsenic. Tom qab tag nrho, nws yog tshuaj lom. Tab sis raws li peb pom, cov muaj pes tsawg leeg kuj muaj lwm yam, ntawm cov uas yuav txwv tsis pub nws kis mus rau cov hlab ntsha.
Thaum tus neeg mob tuaj txog, tus kws kho mob tshem tawm qhov ntim ib ntus, tom qab ntawd nws txiav cov kab noj hniav rov qab. Ib feem ntawm cov tawv nqaij raug tshem tawm los ntawm cov kab noj hniav ntawm cov yas los ntawm kev khawb los yog cov hniav burr nws tus kheej, tom qab ntawd nws tau kho nrog tshuaj tua kab mob ("Chlorhexidine").
Thaum kawg theem thib ob ntawm kev kho mob ntawm cov hauv paus hniav ntawm cov hniav, sab hauv ntawm cov hniav yog qhuav. Tom qab ntawd ib qho tshuaj kho tau muab tso rau hauv kab noj hniav, thiab nws raug kaw ib ntus nrog kev txhaws ib ntus.
thib peb
Lub sijhawm thib peb tus neeg mob tau teem sijhawm kom tau txais tom qab qee lub sijhawm (los ntawm 3 txog 5 hnub). Qhov ntim ib ntus raug tshem tawm los ntawm tus kws kho mob. Tom qab ntawd, nws yog ib qhov tsim nyog los npog lub pob tw nrog cov tuab resorcinol-formalin paste (los yog "Forfenan"). Hauv qab ntawm cov hniav kab noj hniav yog kaw nrog ib tug insulating gasket. Thaum kawg, ib tug tas mus li filling yog twb muab tso rau thiab nrogtom raug kho yog tias tsim nyog.
Cov txheej txheem rau kev txiav cov hlab ntsha ntawm cov hniav yog qhov nyuaj heev rau cov kws kho mob. Thiab nyob rau hauv kev sib raug zoo rau cov neeg mob, nws yuav ua tau mob heev thiab ntev. Yog vim li no thiaj li yuav tsum tau kho cov kab mob ntawm cov hniav kom raws sij hawm, tsis txhob ua rau mob.
Hmo ntuj kho hniav
Txhua tus tau ntsib kev mob hniav, thiab tus uas vim qee yam dhau los ntawm qhov xwm txheej no tuaj yeem suav tias muaj hmoo. Tom qab tag nrho, txog qhov mob uas tshwm sim nyob rau hauv cov ntaub ntawv ntawm kev puas tsuaj rau cov hniav, nws tsuas yog kwv yees los ntawm cov lus xaiv ntawm lwm tus neeg. Txawm li cas los xij, tej zaum lawv tuaj yeem suav rau ntawm tus ntiv tes.
Ntxiv mus, qhov mob mob tuaj yeem ntes tau ntawm lub sijhawm tsis zoo tshaj plaws. Hauv cov xwm txheej zoo li no, ntau tus ua tau zoo los ntawm kev mus rau qhov chaw kho hniav ze tshaj plaws. Txawm hais tias tus hniav pib mob thaum nruab hnub ntawm kev ua haujlwm, koj tuaj yeem tau txais kev tso cai los ntawm cov tub ceev xwm kom tawm mus. Tab sis yuav ua li cas thaum muaj mob hnyav thiab mob tsis xis nyob tau ntes tus neeg hmo ntuj?
Hnub no, qhov no tsis muaj teeb meem ntxiv lawm, txij li yuav luag txhua lub nroog (hauv cheeb tsam loj, kom paub meej) muaj cov chaw kho hniav ib puag ncig. Nyob rau tib lub sijhawm, kev kho hniav hmo ntuj, tsis zoo li nruab hnub mus ntsib hauv tsev kho mob, muaj nws qhov zoo. Thiab qhov tseem ceeb tshaj plaws, tsis muaj qhov loj thiab ntxhov siab. Thiab yog tias koj muaj koj tus kheej lub tsheb, koj tuaj yeem mus rau qhov ntawd yam tsis muaj tsheb thauj mus los, txawm tias tsav tsheb hauv lub xeev no nyuaj heev, thiab txaus ntshai. Yog li ntawd, qhov kev xaiv zoo tshaj plaws yog tsheb tavxij.
Kev txhim kho ntawm cov teeb meem
Qee zaum tom qab qhov xwm txheejkev khiav hauj lwm tej zaum yuav pib muaj teeb meem. Tshwj xeeb, cov xwm txheej hauv qab no tau pom:
- Periodontal irritation yog ib qho lus teb rau kev sib cais ntawm paj hlwb, nrog rau kev hnov mob. Nws feem ntau daws tau tom qab noj tshuaj kho mob.
- Kev kub hnyiab ntawm mucosa. Tej zaum yuav tshwm sim thaum kev txiav tawm devital ua tsis raug. Hauv qhov no, thaj chaw cuam tshuam yuav tsum tau kho nrog tshuaj tua kab mob, nrog rau kev kho tshuaj tiv thaiv.
- Perforation ntawm cov hniav hauv paus system. Qhov teeb meem no yog txuam nrog kev ua txhaum ntawm cov txheej txheem ntawm kev kho hniav. Qhov tshwm sim ntawm qhov no yog perforation ntawm lub hauv paus phab ntsa. Qhov no xaus nrog kev txhim kho ntawm cov txheej txheem inflammatory, mus txog qhov tshwm sim ntawm osteomyelitis.
- Kev txhim kho ntawm kev raug mob periodontitis. Yog vim li cas tej zaum yuav ingress ntawm cov khoom filling tshaj lub hauv paus kwj dej cheeb tsam.
Tib lub sijhawm, cov teeb meem tseem tuaj yeem tshwm sim vim tsis ua raws li cov neeg mob uas tus kws kho mob cov lus pom zoo tom qab ua tiav. Piv txwv li, yog tias thaum kawg ntawm thawj theem ntawm kev kho mob (thaum muab tshuaj txhuam tshwj xeeb) koj tsis tuaj rau theem thib ob ntawm kev kho mob ntawm cov hauv paus hniav ntawm lub sijhawm, ces qhov no cuam tshuam nrog kev loj hlob ntawm periodontitis..
Hauv lwm lo lus, txawm li cas los xij, nws tsim nyog nrhiav kev pab tsim nyog los ntawm kws kho mob raws sijhawm. Thiab ntau dua li ntawd, tsis muaj teeb meem koj yuav tsum ua siab ntev rau qhov mob hniav, vam tias tsis yog tshuaj tshuaj. Yog lawm, lawv tuaj yeem nqa tau kev pab, tab sis qhov no yog ib qho kev ntsuas ib ntus kom koj tuaj yeem taug kev mus rau qhov ze tshaj plawschaw kho hniav.
