Granulating periodontitis yog cov txheej txheem inflammatory ntawm cov ntaub so ntswg sib txuas - periodontium, uas nyob nruab nrab ntawm cov cementum ntawm cov hauv paus hniav thiab cov phaj alveolar. Qhov no yog cov feem ntau inflammatory daim ntawv ntawm periodontal kab mob. Nws txawv ntawm ntau asymptomatic thiab ruaj khov granulomatous thiab fibrous periodontitis, muaj ib tug dynamic kev loj hlob nrog ib tug luv luv remission thiab loj exacerbations. Cov txheej txheem ntawm o txuas mus rau lub puab tsaig, cov hniav uas nyob ib sab, cov ntaub so ntswg ntawm cov pos hniav thiab lub puab tsaig, qee zaum mus txog ntawm daim tawv nqaij ntawm caj dab lossis lub ntsej muag. Hauv kev faib tawm thoob ntiaj teb ntawm cov kab mob ntawm ICD, mob granulating periodontitis yog suav nrog hauv chav kawm K04.5.
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Kev tshuaj xyuas ntawm daim duab kho mob, cov yam ntxwv ntawm morphological thiab cov lus sib liam ntawm cov kab mob ntev ntev ua rau nws ua tau kom nco ntsoov ntau yam hauv qab no:
- Granulating. Daim ntawv no ntawm tus kab mobcharacterized los ntawm qhov tseeb hais tias nyob rau hauv ib lub microscope nyob rau hauv cov hniav apical ib feem ntawm lub hauv paus ib tug yuav pom ib tug tseem ceeb thickening. Qhov saum npoo ntawm periodontium hloov, nws ua tsis ncaj. Granulation cov ntaub so ntswg loj hlob nyob rau lub sij hawm, vim hais tias cov pob txha cov ntaub so ntswg nyob rau hauv lub cheeb tsam ntawm lub inflammatory focus daws. Cov txheej txheem no feem ntau nrog cov tsos ntawm purulent foci, uas ua rau fistulas. Granulation hauv qee kis cuam tshuam rau cov ntaub so ntswg uas nyob ib sab ntawm thaj tsam ntawm qhov mob. Vim li no, ntau yam granulomas yog tsim (subcutaneous, subperiosteal, submucosal), tom qab lawv qhib, fistulas tshwm nyob rau hauv lub qhov ncauj kab noj hniav thiab ntawm lub ntsej muag, thiab unaesthetic nti tshwm nyob rau ntawm qhov chaw kho. Cov neeg uas tau ntsib granulating periodontitis muaj mob thaum zom cov khoom noj, uas ua rau lub siab hnyav, lub sij hawm exacerbations ntawm cov tsos mob tsis kaj siab.
- Fibrous. Nws txawv nyob rau hauv tsim ntawm ib tug txwv inflammatory tsom xam, vim hais tias ntawm kis ntawm cov ntaub so ntswg fibrous. Qhov no feem ntau tshwm sim tom qab siv kev kho mob rau granulomatous thiab granulating periodontitis, tab sis qee zaum muaj kev ywj pheej tshwm sim ntawm daim ntawv fibrous. Fibrous o feem ntau nrog cov cementum ntau dhau, qee zaum sclerosis ntawm cov pob txha cov ntaub so ntswg uas nyob ib sab.
- Nyob rau hauv daim tawv nqaij kab mob. Qhov no yog ib yam ntawm cov txheej txheem periapical o, uas yog tus cwj pwm los ntawm kev tsim cov ntaub so ntswg granulation nyob rau hauv cheeb tsam ntawm lub hauv paus apex. Lub maturation ntawm cov ntaub so ntswg raws thaj tsam periphery ua rau cov tsos ntawm fibrouscapsule, uas hloov mus rau hauv granuloma. Raws li qhov tshwj xeeb ntawm cov qauv, cystic, epithelial thiab granulomas yooj yim yog qhov txawv. Daim ntawv no feem ntau tshwm sim vim qhov mob, uas tau sau tseg los ntawm tus kws kho mob hauv keeb kwm kho mob. Kab mob granulating periodontitis tuaj yeem muaj ntau yam sib txawv ntawm txoj kev loj hlob. Qee lub sij hawm granuloma tsis nce ntxiv lossis loj hlob qeeb. Hauv qhov no, raws li txoj cai, nws tsis ua rau muaj cov tsos mob tsis zoo, thiab raug kuaj pom thaum lub sijhawm kuaj X-ray.
Hauv lwm tus neeg mob, granuloma tuaj yeem nce ntxiv, uas feem ntau tshwm sim nrog exacerbations ntawm cov kab mob ntev ntev, uas ua rau muaj kev hloov pauv hauv cov ntaub so ntswg granuloma.
Yog vim li cas thiab lub hauv paus ntawm kev txhim kho
Granulating periodontitis feem ntau tshwm sim los ntawm kev kho tsis tau zoo ntawm caries lossis pulpitis, raug mob lossis kis kab mob.
Nrog rau txoj kev sib kis ntawm txoj kev loj hlob, lub luag haujlwm tseem ceeb ntawm cov kab mob caries lossis pulpitis. Cov kab mob (staphylococci, streptococci, thiab lwm yam) feem ntau nkag mus rau hauv lub periodontium los ntawm cov hauv paus hniav nrog necrotic pulp. Tej zaum kuj yuav muaj txoj hauv kev tsis zoo ntawm tus kab mob - kev nkag mus ntawm cov kab mob mus rau hauv lub periodontium los ntawm cov hniav ligament thiab cov npoo ntawm cov pos hniav. Outwardly, ib qho yooj yim raug mob rau cov hniav tuaj yeem ua rau muaj teeb meem loj.
Taumatic periodontitis
Taumatic periodontitis tshwm sim vim lub cev cuam tshuam rau tus hniav. Piv txwv li, vim lub tshuab los yog qhov tsis raug muab tso rau sau lossis cov khoom siv dag zog.
TshuajLub hauv paus ntawm txoj kev loj hlob ntawm tus kab mob yog nyob rau hauv cov ntaub so ntswg raug mob nrog endodontic instruments los yog siv cov aggression npaj - arsenic muab tshuaj txhuam, thiab lwm yam.
Kev mob hnyav ntawm granulating periodontitis yog tshwm sim los ntawm kev saib xyuas qhov ncauj tsis zoo, qee qhov pathologies (mob ntshav qab zib, thiab lwm yam), malocclusion.
Tissue growth
Cov txheej txheem ua rau tus kab mob yog qhia nyob rau hauv daim ntawv ntawm kev loj hlob ntawm granulation connective cov ntaub so ntswg (feem ntau nyob rau hauv lub hauv paus ntsiab lus), resorption ntawm cement thiab dentin ntawm cov hniav, kev puas tsuaj ntawm periosteum, resorption ntawm alveolar daim hlau. Thaum cov kab mob kis mus rau cov nqaij mos ntawm lub puab tsaig thiab cov pos hniav, fistulas thiab abscesses yog tsim nrog kev tso tawm ntawm cov tshuaj serous-purulent los ntawm lawv. Kev loj hlob ntawm tus kab mob feem ntau tshwm sim nyob rau hauv cov kev taw qhia nram qab no: kev tsim cov ntaub so ntswg es tsis txhob ntawm cov ntaub so ntswg puas thiab cov pob txha; tsim ntawm purulent cysts; expansion ntawm qhov sib txawv ntawm lub cev.
Daim ntawv ntawm kev txhim kho tus kab mob: qhov tshwj xeeb ntawm cov tsos mob
Raws li pathomorphology thiab chaw kho mob, periodontitis tuaj yeem ua tau: mob ntev, mob hnyav thiab nyob rau hauv kev zam txim, nrog rau mob nyob rau theem mob. Lub tsev kho mob thiab cov tsos mob nyob ntawm tus kab mob.
Qhov tseem ceeb ntawm cov txheej txheem mob hnyav yog qhov mob ntev hauv cheeb tsam, thaum pib tsis muaj zog heev, tom qab ntawd ntau pulsating, khaus. Irradiation ntawm qhov mob qhia ib daim ntawv purulent. Lub sijhawm ntawm kev mob hnyav yog los ntawm ob peb hnub mus rau ob lub lis piam.
Stages
Muaj ob lub ntsiab lus ntawm cov txheej txheem:
- Phase ib. Kev mob yog qhov tshwm sim los ntawm kev mob ntev ntev uas nce ntxiv yog tias koj nias rau ntawm tus hniav cuam tshuam. Ua kom rhiab heev ntawm lub periodontium yog kho los ntawm percussion.
- Theem ob. Tus kab mob kis mus rau hauv lub exudative theem. Vim muaj kev sib kis ntawm serous-purulent infiltrate, o ntawm cov ntaub so ntswg zoo nkaus li, nce thiab rhiab heev ntawm cov qog ntshav hauv cheeb tsam. Kev mob tshwm sim tshwm sim los ntawm qhov mob hnyav, mob hnyav, yog tias koj nias ntawm tus hniav. Los ntawm lub teeb kov nrog tus nplaig, qhov mob hnyav tshwm sim. Muaj kev xav tias tus hniav zoo li yog thawb tawm ntawm cov ntaub so ntswg. Mob heev percussion, irradiation ntawm qhov mob yog sau tseg. General malaise yog yam ntxwv, qhov kub tuaj yeem nce mus rau 37-38 ° C. Kev kuaj ntshav qhia tau tias leukocytosis thiab nce ESR.
Lub Sijhawm Ntev thiab Lub Sijhawm tso tawm
Cov kab mob granular periodontitis yog tus cwj pwm los ntawm cov chav kawm dynamic, nrog rau luv luv remissions thiab nquag exacerbations.
Tus kab mob no tshwm sim los ntawm lub sijhawm, tsis hais qhov tsis xis nyob lossis qhov hnov mob me me ntawm qhov mob - tsis txaus ntseeg, hnyav, tawg. Vasoparesis thiab hyperemia tau sau tseg. Percussion thiab palpation tsis xis nyob. Nyob rau tib lub sijhawm, nyob rau hauv cov kab mob ntev ntev, cov kua paug yog tsim, cov kab mob fistula tshwm hauv cov ntaub so ntswg, carious kab noj hniav, thiab qhov ncauj. Qhov no feem ntau yog asymptomatic, tab sis tsuas yog thaum cov kua paug muaj peev xwm tawm mus tau ywj pheej, uas tau tshwm sim hauv keeb kwm kho mob.
Thaummob granulating periodontitis, yog hais tias cov channel raug thaiv, piv txwv li, los ntawm cov khoom noj khoom haus khib nyiab los yog kaw lub fistula, cov kua paug accumulates, ua rau kom mob thiab cov ntaub so ntswg o. Kev kis kab mob tsis zoo hauv kev tiv thaiv kab mob tuaj yeem kis tau ntau dua, ua rau muaj tus kab mob nce ntxiv.
Ntshai
Exacerbations tshwm sim thaum lub abscess capsule ruptures, kev tiv thaiv deteriorates thiab cov kua paug tiv thaiv kom tsis txhob tawm ntawm qhov chaw mob. Granulating granulomatous periodontitis nyob rau theem mob feem ntau nrog fistula. Lub fistula tuaj yeem tsim hauv lub qhov ncauj, ntawm lub ntsej muag (pob qhov muag, sab plhu, puab tsaig). Exudate los ntawm lub qhov ncauj ntawm lub fistula. Tom qab ntawd nws raug nruj los ntawm ib qho caws pliav.
Kev tshwm sim
Rau exacerbation ntawm granulating periodontitis nrog lub fistula, paroxysmal mob yog yam ntxwv, uas nce nrog lub cev thiab thermal cuam tshuam ntawm cov hniav. o, pastosity thiab hyperemia ntawm cov pos hniav yog pom pom. Ntawm palpation ntawm cov qog nqaij hlav ntawm lub puab tsaig qis los ntawm sab ntawm cov hniav, muaj qhov mob me ntsis thiab nce ntxiv. Cov hniav cuam tshuam yog me ntsis mobile. Thaum lub sij hawm exacerbation, cov cheeb tsam ntawm o yog tsim, los ntawm cov kab mob pathogenic thiab lawv cov khoom metabolic nkag mus rau hauv cov hlab ntsha, ua rau rhiab heev ntawm lub cev. Intoxication txo qis nrog kev tshem tawm cov kua paug, thiab tus kab mob kis mus rau theem asymptomatic. Thaiv ntawm fistula dua ua rau exacerbation, intoxication intensifies.
Diagnosis
Nrog granular periodontitis, kev kuaj mob sib txawv muaj nyob rau hauv kev cais ntawm fibrous thiabgranulomatous cov ntaub ntawv ntawm tus kab mob, osteomyelitis ntawm lub puab tsaig, pulpitis, actinomycosis ntawm lub ntsej muag thiab cysts nyob ze lub hauv paus. Cov kev kuaj mob hauv qab no yog siv:
- Clinical. Kev tshuaj xyuas, raws li txoj cai, kuaj xyuas cov hniav puas tsuaj ntawm cov xim hloov. Cov kab noj hniav ntawm caries feem ntau sib txuas lus nrog cov kwj deg. Kev soj ntsuam tsis ua rau mob hnyav, tej zaum yuav muaj mob me ntsis percussion. Thaum qhov kev sojntsuam yog nias rau ntawm cov pos hniav, nws tig daj ntseg, qhov tob zuj zus tshwm sim, uas nyob rau qee lub sijhawm tom qab lub siab, uas yog, vasoparesis. Qhov no kuj tseem txhawb nqa los ntawm cov ntaub ntawv keeb kwm ntawm granular periodontitis.
- X-ray kuaj. Radiography yog qhov tseem ceeb hauv kev kuaj mob sib txawv. Nws kho qhov chaw tsaus nti zoo li qhov tsis tshua muaj tshwm sim hauv lub hauv paus apex. Lub blackout muaj fuzzy contours. Kev nce hauv qhov sib txawv ntawm lub cev tau sau tseg, kev puas tsuaj ntawm cov cement thiab dentin yog pom tau.
- YElectroodontometry. Cov txheej txheem yog ua raws li qhov mob thiab tactile cov tshuaj tiv thaiv ntawm pulp receptors rau cov hluav taws xob tam sim no uas dhau los ntawm nws. Lub excitability ntawm cov hlab ntsha hauv daim ntawv granulating ntawm periodontitis nce mus txog 100 µA lossis ntau dua.
txoj kev kho
Granulating periodontitis yog kho phais (surgery) los yog kho (endodontic) txoj kev:
- Nyob rau theem. Kev ntsuas kev kho mob muaj xws li cov kev ua hauv qab no: tshem tawm cov exudate los ntawm qhov ua kom pom tseeb; tshem tawm cov kab mob uas muaj kab mob -lub kwj dej yog tshem tawm ntawm cov kab mob dentin thiab decayed pulp; Kev puas tsuaj ntawm cov tshuaj tiv thaiv kab mob thiab tshuaj tua kab mob uas tau muab tso rau hauv cov hauv paus hniav, tshuaj tua kab mob ntawm cov kab mob pathogenic, yog tias tsim nyog, siv cov tshuaj tua kab mob dav dav, sulfonamides, ultrasound (physiotherapy); nqa tawm cov dej num uas ua kom muaj kev rov qab los ntawm cov ntaub so ntswg periapical thiab cov pob txha; kwj dej filling. Yog tias tsim nyog, muaj kev cuam tshuam kev phais.
- Txhob Cia Siab. Cov tshuaj tiv thaiv kab mob hauv zos ntawm kev ua haujlwm nyuaj thiab kev kho lub cev yog siv. Cov vitamins raug sau tseg (tsuas yog pawg B thiab C), nrog rau cov tshuaj lom neeg biogenic.
- Exacerbation ntawm chronic granulating periodontitis. Mob yog muab thiab kho raws li nyob rau hauv ib tug mob ntev.
- Kev kho mob phais. Cov hniav raug tshem tawm nrog kev puas tsuaj loj ntawm ib feem ntawm cov yas; nrog kev txav siab (3-4th theem); Yog hais tias lub channel tsis tuaj yeem qhib vim curvature, kev cuam tshuam ntawm lumen lossis nqaim. Kev nyiam yog muab rau cov haujlwm uas txuag tus neeg mob cov hniav. Cov no suav nrog: amputation - lub hauv paus cuam tshuam raug tshem tawm ua ntej tsiv mus rau hauv lub crown; cystotomy - lub cyst raug tshem tawm ib nrab; hemisection - cov hauv paus hniav ntawm ntau cov hauv paus hniav yog txiav nrog lub crown; cystectomy - tshem tawm cov cyst tag; resection ntawm lub hauv paus ntsiab lus - tshem tawm ntawm thaj tsam ntawm o thiab kab mob.
kho kom raug ntawm granulating periodontitis nyob rau hauv feem ntau tso cai rau koj kom tag nrho cov ntaub so ntswg, txuaghniav raws li ib tug functional unit. Yog tias tsis muaj kev kho mob, tus kab mob no tshwm sim los ntawm qhov tshwm sim tas li, thiab cov hniav yuav tsum raug tshem tawm tag nrho.
Kev Tiv Thaiv
Kev Tiv Thaiv tau nkag siab zoo li: tshem tawm cov kev pheej hmoo xws li tsis muaj kev saib xyuas qhov ncauj; inattention rau pulpitis thiab caries; haus luam yeeb; deposits ntawm tartar. Kev noj zaub mov nrog cov ntsiab lus siab ntawm cov zaub mov nyuaj yog pom zoo, uas ua kom muaj kev koom tes sib npaug ntawm txhua tus hniav hauv cov txheej txheem zom. Koj yuav tsum mus ntsib koj tus kws kho hniav tsis tu ncua.
