Xav tsis thoob, qhov tseeb yog tias muaj kab mob xws li pulpitis muaj ntau dua 20 qhov kev faib tawm. Cov kws kho hniav lawv tus kheej siv ntau txoj hauv kev los ntsuas hom kab mob hauv lawv txoj haujlwm, tab sis nco ntsoov tias tsis muaj leej twg tuaj yeem 100% piav qhia meej txog txhua yam ntawm tus kab mob insidious no. Cov kws kho hniav nco ntsoov tias lawv xav tau kev faib tawm yooj yim dua thiab muaj peev xwm ntawm cov kab mob pulpitis, uas yuav tso cai rau tus kab mob los ntawm txhua txoj haujlwm tsim nyog.
Vim li cas thiaj faib pulpitis?
Qhov muaj xws li kev nthuav dav dav ntawm cov kab mob hniav no cuam tshuam nrog ntau txoj hauv kev los sim piav qhia cov duab ntawm tus kabmob. Ntau hom kev faib tawm ntawm pulpitis muab los xav txog lawv los ntawm ntau txoj haujlwm: qhov ua rau tshwm sim thiab kev loj hlob, daim duab kho mob, kev loj hlob, qhov xwm txheej ntawm cov txheej txheem sib sib zog nqus hauv cov kwj dej ntawm cov hniav, thiab lwm yam.
Kev piav qhia los ntawm txhua lub kaum sab xis pulpitis kev faib tawm tseem tsis tau tsim. Yog li ntawd, cov kws kho hniav yuav tsum tau embeddaim duab kho mob uas twb muaj lawm nyob rau hauv ib tug neeg mob nyob rau hauv lub moj khaum ntawm cov txheej txheem uas twb muaj lawm rau nws cov kev ntsuam xyuas. Qee cov txheej txheem kev faib tawm tau tsim tawm ntau xyoo dhau los, tab sis tseem siv rau hauv kev coj ua ntawm kev kuaj mob thiab kev kho mob ntawm pulpitis.
Thawj qhov kev sim ua kom muaj kab mob hniav no tau tsim nyob rau xyoo 20s ntawm lub xyoo pua xeem thiab tau tsim los piav qhia txog cov kab mob pulpitis kom raug li sai tau. Cov kev faib tawm no yog qhov nyuaj heev thiab cumbersome. Tias yog vim li cas cov kws tshaj lij tau ua haujlwm tsis tu ncua los txhim kho cov txheej txheem ntawm kev piav qhia tus kab mob. Nrog rau qhov zaus ntawm 5-10 xyoo, ib qho kev faib tawm tshiab tau thov, uas yog raws li cov txheej txheem ua ntej, tab sis muaj qee txoj haujlwm tshiab los piav qhia txog daim duab ntawm pulpitis.
WHO classification
Qhov kawg ntawm lub xyoo pua 20th, uas yog xyoo 1997, rau kev kho hniav tau raug cim los ntawm kev qhia txog International Classification of Diseases of the 10th revision, which is known by the abbreviation ICD-10. Nws tau pom zoo los ntawm Lub Koom Haum Saib Xyuas Kev Noj Qab Haus Huv Ntiaj Teb, thiab twb nyob rau xyoo 1999 nws tau pib siv dav hauv kev kho hniav rau kev kuaj mob thiab kev kho mob ntawm pulpitis. Cov kab ke no yog lub npe ntawm cov lis dej num thiab lawv cov kev txhais lus los piav txog cov duab kho mob ntawm tus kab mob. Kev faib tawm ntawm pulpitis raws li ICD suav nrog cov khoom hauv qab no:
- Cov kab mob ntawm cov tawv nqaij thiab cov ntaub so ntswg ntawm lub periapical hom yog npaj los tsim siv tus lej K04.
- Drectly pulpitis yog encrypted K04.0.
- pib theem ntawm tus kab mob, tus cwj pwm los ntawm hyperemia, raug xaiv K04.00.
- Acute pulpitis muajencrypt К04.01.
- Yog kuaj pom muaj abscess, ces tus lej K04.02.
- Daim ntawv mob ntev ntawm cov kab mob pulpitis yog K04.03, thiab yog tias kuaj tau cov kab mob, ces nws tau thov kom code qhov kev kuaj mob li K04.04.
- Yog tus neeg mob muaj pulpal polyp nyob rau hauv daim ntawv ntev, ces nws raug xaiv K04.05.
- Nyob rau hauv cov ntaub ntawv ntawm ib tug kab mob ntawm neurovascular ntaub so ntswg ntawm ib tug hniav ntawm lwm yam xwm txheej, kos K04.08.
- Yog qhov ua rau lub plab tsis meej, qhov no yog cim nrog tus lej K04.09.
- Necrotic lossis gangrenous phenomena nyob rau hauv lub pulp yog qhia los ntawm tus lej K04.1.
- Yog tus kws kho hniav pom cov txheej txheem degenerative, xws li cov hniav, pob zeb los yog calcifications, ces nws xaiv lawv nrog tus lej K04.2.
- Nyob rau hauv cov ntaub ntawv ntawm txawv txav ntawm cov ntaub so ntswg nyuaj nyob rau hauv lub cheeb tsam ntawm lub pulp, ib tug cim K04.3 yog ua. Ntxiv mus, yog tias nws yog qhov tsis xwm yeem (thib ob) dentine, ces nws raug xaiv los ntawm tus lej K4.3X. Nws yuav tsum raug sau tseg tias nyob rau hauv qhov xwm txheej no, calcifications thiab pob zeb hauv lub pulp raug cais tawm.
- Thaum mob apical periodontitis, tshwm sim los ntawm kev hloov pauv hauv cov ntaub so ntswg neurovascular ntawm tus hniav, tus lej K04.4.
- Yog tus kws kho hniav ntseeg tias nws muaj kab mob ntawm cov nqaij mos thiab cov nqaij mos uas tsis haum rau cov ntsiab lus saum toj no, nws muab lub cim K04.9.
Qhov kev faib tawm ntawm pulpitis raws li WHO, raws li kws kho hniav, tsis yooj yim heev. Txawm li cas los xij, los txog niaj hnub no nws tau siv los ua ib qho kev ua haujlwm rau kev sau cov ntaub ntawv txheeb cais ntawm cov kws tshaj lij ntawm cov haujlwm ua tiav rau lub sijhawm.gap.
Cov lej thiab cov ntawv cim raws li qhov kev faib tawm no, tus kws kho mob yuav tsum muab tso rau hauv tus neeg mob daim npav thiab daim coupon. Ntau tus kws kho hniav lees paub tias lawv feem ntau yuav tsum nkag mus rau cov kab mob uas lawv tau kho rau hauv cov phiaj xwm tau npaj los ntawm WHO, txawm hais tias lawv siv txoj hauv kev sib txawv yooj yim los ua tus yam ntxwv ntawm kev kho hniav hauv lawv txoj haujlwm.
yam ntxwv ntawm pulpitis los ntawm nws keeb kwm
Qhov kev faib tawm ntawm pulpitis thiab periodontitis siv rau hauv tus account ua rau tus kab mob no. Raws li qhov ntsuas no, cov kws kho hniav paub qhov txawv ntawm 4 hom kab mob:
- Taumatic.
- Nyob zoo ib tsoom phooj ywg.
- Tshuaj los yog tshuaj.
Cia peb saib ze dua ntawm txhua lub pulpitis, cov kev faib tawm uas piav qhia qhov ua rau nws tshwm sim.
Hom kab mob no yog tshwm sim los ntawm kev ua haujlwm ntawm cov kab mob uas tso cov co toxins thiab ua rau mob ntawm cov hlab ntsha thiab cov hlab ntsha ntawm cov hniav. Hauv 9 kis ntawm 10, cov kab mob nkag los ntawm cov kab noj hniav carious sab hauv los ntawm cov kwj deg hniav lossis cuam tshuam rau qhov qhib ntawm cov hlab ntsha. Tsis tshua muaj tshwm sim yog retrograde pulpitis, thaum microbes nkag mus rau hauv cov hniav los ntawm lub qhov nyob rau hauv lub hauv paus apex. Qhov no tshwm sim nrog cov kab mob sib kis xws li mob ntsws ua pa, rubella, osteomyelitis, sinusitis lossis periodontitis. Hauv cov xwm txheej cais, tus kab mob tuaj yeem ua hematogenous. Qhov tseeb tshaj plaws kom paub txog pulpitis yog etiology. Kev faib tawm raws li txoj cai no feem ntau sivcov kws kho mob.
Taumatic pulpitis
Nws tsim nyog sau cia tias kev raug mob ua rau muaj cov txheej txheem pathological uas tuaj yeem ua rau lub plab. Nyob rau hauv cov ntaub ntawv no, lub sterility ntawm cov kab noj hniav ntawm cov hniav yog ua txhaum thiab lawv kis tau tus kab mob nrog rau ntxiv kev loj hlob ntawm o ntawm cov hlab ntsha pob. Qee lub sij hawm nws tsis yog kev ncaj ncees ntawm cov hniav uas ua txhaum, tab sis nws qhov chaw raug (dislocation lossis subluxation). Nyob rau hauv cov ntaub ntawv no, lub pulpitis raug kaw thiab mus zuj zus yam tsis muaj kev koom tes ntawm microorganisms.
Kev raug mob tuaj yeem yog qhov xwm txheej hauv tsev, tau txais los ntawm kev sib tsoo lossis raug mob, lossis tuaj yeem yog los ntawm kev cuam tshuam kev kho mob tsis zoo.
Piv txwv li, thaum sib tsoo cov hniav "hauv qab lub kaus mom", pulpitis feem ntau tshwm sim los ntawm cov ntaub so ntswg perforation. Qhov tshwm sim no xav tau kev kho tam sim. Nws yog ib qho tseem ceeb heev rau tus kws kho mob ua raws li cov tswv yim: pulpitis - kev faib tawm - tsev kho mob - kev kho mob. Nrog rau kev ua haujlwm zoo ib yam ntawm tus kws tshaj lij, yuav luag txhua yam, txawm tias qhov teeb meem nyuaj tshaj plaws, tuaj yeem kho tau, zam ntau yam teeb meem tsis zoo.
Hom kab mob no tshwm sim vim qee qhov kev tsim hauv cov kwj dej ntawm cov hniav - cov hniav lossis cov petrificates. Lawv loj hlob nyob rau hauv cov kab noj hniav ntawm cov channel thiab nyem cov hlab ntsha. Yog li ntawd, microcirculation yog cuam tshuam, puffiness yog tsim. Qhov tshwm sim yog pulpitis.
Tshuaj kho mob lossis tshuaj lom neeg lub cev
Qhov kev faib tawm no feem ntau tsis tau piav qhia, tab sis qhov tseeb nws tshwm sim ntau zaus thiab yog vim kev kho mobyuam kev. Qhov no tshwm sim yog tias tus kws kho hniav siv cov tshuaj uas muaj zog (cawv lossis esters) thaum npaj cov kab noj hniav los yog lub hnab ntim hauv lub cev, lossis kev ua yuam kev thaum lub sij hawm txhaws.
YPlatonov classification
Txawm hais tias qhov kev ntsuam xyuas kab mob no tau thov los ntawm xibfwb Platonov rov qab rau xyoo 1968, nws tseem siv los ntawm kws kho hniav hauv kev xyaum mus txog niaj hnub no. Qhov kev faib tawm ntawm pulpitis thiab periodontitis muaj nws qhov tsis zoo, tab sis yog qhov zoo rau nws txoj kev yooj yim thiab yooj yim. Tus xib fwb hauv nws txoj kev ua ke ua ke peb txoj hauv kev: kev ntsuam xyuas ntawm cov txheej txheem pathological hauv cov ntaub so ntswg, qhov xwm txheej ntawm cov kab mob, nrog rau qhov chaw ntawm qhov tsis hnov tsw. Qhov no yooj yim, tab sis qhov kev ntsuam xyuas kab mob capacious tau thov rau ntau tus kws tshaj lij, uas piav qhia nws qhov tseem ceeb tam sim no.
Qhov systematization no suav txog qhov tseem ceeb ntawm qhov tshwm sim xws li pulpitis - etiology, pathogenesis. Platonov qhov kev faib tawm ntawm tus kab mob yog raws li nram no:
- Tus kab mob kis tau yooj yim: daim ntawv focal (mob mob, thaj chaw uas pom tseeb rau tus neeg mob) thiab nthuav dav (tsis muaj kev txheeb xyuas thaj chaw, tawg raws cov hlab ntsha trigeminal ntawm lub ntsej muag).
- Pulpitis ntawm qhov xwm txheej ntev: hypertrophic (kev loj hlob ntawm cov nqaij mos nrog sau cov kab noj hniav), gangrenous (necrosis ntawm cov ntaub so ntswg ntawm cov hlab ntsha thiab cov hlab ntsha) thiab fibrous (degeneration ntawm cov ntaub so ntswg).
- Exacerbation ntawm chronic pulpitis.
Qhov kev faib tawm thiab chaw kho mob ntawm cov kab mob pulpitisua kom yooj yim heev rau kev ua haujlwm ntawm kws kho hniav, tshwj xeeb tshaj yog nyob rau hauv cov chaw kho mob nyiaj txiag. Raws li txoj cai, nyob rau hauv cov xwm txheej zoo li no, tus kws kho mob tsis muaj sijhawm txaus los tshawb pom qhov ua rau mob hniav. Txhawm rau txiav txim siab hom kab mob, nws txaus los nug tus neeg mob ob peb nqe lus nug.
Gofung classification
Txoj kev no yog qhov nrov heev nrog kws kho hniav, raws li nws piav qhia txog qhov tseem ceeb tshaj plaws ntawm cov kab mob xws li pulpitis - kev faib tawm, chaw kho mob, kev kho mob. Nws muab lub tswv yim ntawm cov theem ntawm tus kab mob, yuav siv sij hawm mus rau hauv tus account ntau yam kev soj ntsuam ntsuas thiab lub morphology ntawm pulp hloov thaum lub sij hawm inflammatory txheej txheem. Raws li cov txheej txheem no, cov kab mob hauv qab no yog qhov txawv:
- Daim ntawv mob hnyav ntawm pulpitis: ib nrab (rov qab, tuaj yeem kho tau tshuaj lom neeg nrog cov hlab ntsha preservation), dav dav (diffuse, npog tag nrho cov pulp thiab kho los ntawm extirpation), purulent dav (kwv yees thiab irreversible pulp disorders, kho nrog tseem ceeb heev extirpation nrog prophylaxis tshwm sim ntawm periodontitis).
- Daim ntawv mob ntev ntawm pulpitis: yooj yim, hypertrophic (ob hom no teb zoo rau kev kho mob nrog rau kev khaws cov hauv paus), gangrenous (daim ntawv puas, kho los ntawm extirpation nyob rau hauv ob peb mus ntsib kws kho mob).
MMSI kev faib tawm
Txoj kev no ntawm cov kab mob neurovascular pob kab mob morphology yog kev txuas ncaj qha ntawm Gofung txheej txheem.
Kev faib tawm ntawm pulpitisMM suav nrog lub ntsiab lus ntawm exacerbation ntawm daim ntawv mob ntev ntawm pulpitis thiab coj mus rau hauv tus account qhov peculiarity ntawm o nyob rau hauv yav tas los kho hniav. Raws limuab morphology, tus kab mob yog subdivided rau hauv:
- Cov ntaub ntawv mob siab ntawm pulpitis: focal lossis diffuse purulent, serous.
- Cov hom kab mob ntsws ntev: gangrenous, fibrous lossis hypertrophic.
- Exacerbation of the course of the chronic form of pulpitis: fibrous or gangrenous.
Exacerbation ntawm gangrenous hom pulpitis tuaj yeem ua rau muaj teeb meem hauv lub cev, vim anaerobic microflora nquag tsim hauv nws. Yog tias ib feem ntawm cov hlab ntsha tshem tawm tsis daws qhov teeb meem ntawm qhov mob, ua kom tiav extirpation lossis rov mummification ntawm cov kwj dej feem ntau daws qhov teeb meem.
Kev faib tawm raws li Vinogradova
Kev faib tawm ntawm pulpitis hauv cov menyuam yaus yog ua raws li tus xibfwb Vinogradova, uas qhia meej meej cais cov kab mob ntawm cov hniav ib ntus los ntawm cov hniav mus tas li. Tus kws kho mob piav qhia tias cov txheej txheem inflammatory hauv cov mis thiab cov molars sib txawv. Tus kws tshaj lij pom zoo kom coj mus rau hauv tus account qhov tshwj xeeb ntawm qhov chaw ntawm sab saum toj ntawm cov hniav ib ntus thiab hais kom tsis kam ua kom dhau los ntawm kwj dej hauv txoj kev kho mob. Qhov no tuaj yeem ua rau tus menyuam mos cov hniav mus tas li.
Kev faib tawm ntawm pulpitis hauv cov menyuam yaus suav nrog cov khoom hauv qab no:
- Pulpitis ntawm cov mis nyuj cov hniav ntawm qhov mob hnyav: serous (nws ua sai sai, daim ntawv focal yuav diffuse), purulent (ceev npog tag nrho cov pulp thiab tuaj yeem ua mob ntev).
- Pulpitis ntawm ib kab mus tas li ntawm cov hniav ntawm qhov mob hnyav: mob serous general lossis ib nrab, mob purulent general lossis ib nrab.
- Cov kab mob ntev ntawm cov hniav ib ntus thiab mus tas li: yooj yim,proliferative los yog hypertrophic, gangrenous.
- Exacerbation ntawm daim ntawv mob ntev ntawm cov hniav ntawm cov hniav ib ntus thiab mus tas li: feem ntau tshwm sim tawm tsam keeb kwm ntawm cov kab mob yooj yim.
Qhov peculiarity ntawm cov txheej txheem inflammatory nyob rau hauv ib tug ib ntus tus hniav yog hais tias nrog ib tug siab probability txheej txheem yuav kis mus rau inter-root chaw.
Qhov no yog vim qhov tseeb tias cov dentin nyob rau hauv qhov chaw no muaj qib siab permeability. Xws li qhov tshwm sim yog qhov txaus ntshai, vim tias nws tuaj yeem ua rau muaj kev cuam tshuam hauv kev tsim cov rudiment ntawm molar, hloov lub sijhawm ntawm nws qhov tawg, thiab txo nws txoj kev tawm tsam.
Cov kab mob ntsws ntev ntawm cov hniav ib ntus yog tus cwj pwm los ntawm qhov tseeb tias nws tuaj yeem tshwm sim raws li thawj cov ntaub ntawv, hla dhau cov theem mob. Lawv tuaj yeem ua asymptomatic, tab sis lawv yog insidious nyob rau hauv uas lawv sai sai kis mus rau periodontal ntaub so ntswg. Yog li ntawd, koj yuav tsum ua tib zoo saib xyuas qhov mob ntawm lub qhov ncauj ntawm cov menyuam yaus thiab tsis txhob tso tseg kev kho cov hniav ntawm cov mis nyuj.
Txoj kev kho mob ntawm cov kab mob pulpitis
Kev faib tawm ntawm txoj hauv kev ntawm kev kho mob ntawm pulpitis yog ncaj qha ntsig txog kev kuaj mob. Txoj kev vam meej ntawm txoj kev kho yuav nyob ntawm qhov kev txawj ntse ntawm cov qib ntawm qhov nyuaj ntawm tus kab mob.
Yog tias qhov kev thov rov hais dua rau tus kws kho hniav tau ua thaum pib ntawm kev loj hlob ntawm pulpitis, ces tus kws kho mob tsim ib txoj kev lom rau nws txoj kev kho. Nws muaj cov hauv qab no: cov hlab ntsha tsis raug tshem tawm ntawm cov hniav, siv cov tshuaj calcium tshwj xeeb thiab tshuaj tiv thaiv kab mob. Raws li qhov tshwm sim ntawm xws li kev kho mob, o nyob rau hauv lub pulp disappears, ib tug hloov yog tsim.kho hniav. Ib qho filling yog siv rau cov kab noj hniav uas huv si.
Yog tias tsis muaj sijhawm mus ntsib kws kho mob, ces lub sijhawm rau kev kho kab mob lom tsis tau. Nyob rau theem no, tus kws kho hniav yuav tau txiav txim siab seb tus mob pulpitis yog dab tsi. Lub tswv yim, kev faib tawm thiab kev kuaj mob yuav pab ua qhov no kom raug raws li qhov ua tau.
Ntau zaus, txoj kev tshem tawm ib nrab ntawm cov tawv nqaij yog siv. Nyob rau hauv lub zog ntawm cov tshuaj loog, ib feem ntawm cov hlab ntsha raug tshem tawm ntawm theem ntawm lub crown, thaum lub hauv paus cheeb tsam tseem siv tau. Tom qab ntawd, ib qho kev npaj nrog calcium yog pw, thiab cov hniav raug kaw. Yog hais tias tsim nyog, physiotherapy yog nqa tawm, anti-inflammatory therapy yog muab. Txoj kev no raug pom zoo rau cov menyuam yaus uas cov hniav saum toj kawg nkaus tseem tsis tau ua tiav.
Raws li kev kho hniav qhia, feem ntau, siv cov hlab ntsha tshem tawm kom tiav. Qhov no tuaj yeem ua tau raws li kev siv tshuaj loog lossis los ntawm kev siv tshuaj loog uas muaj arsenic. Cov tshuaj no yog tshuaj lom heev, thiab cov ntaub qhwv yuav tsum tau muab tshem tawm raws li lub sijhawm tus kws kho mob tau sau tseg. Tom qab ntawd, kev kho mob endodontic tau ua tiav, thaum lub sijhawm cov kwj dej ntawm cov hniav tau ntim nrog gutta-percha.
Tom qab kev kho mob zoo li no, x-ray raug coj mus kuaj xyuas qhov zoo ntawm qhov kev tswj hwm tau ua hauv cov channel. Yog hais tias lawv tau ntim rau saum, yuav tsum tau muab foob.
Yog hais tias yuav luag tag kev puas tsuaj ntawm cov hniav, tus kws kho mob siv ib tug pin stump tab, uaskho hniav. Txhua tus kws tshaj lij yuav hais tias kev faib tawm yog lav los pab txiav txim siab pulpitis. Kev kho mob yog ib qho laj thawj txuas ntxiv ntawm kev kuaj mob zoo ntawm tus neeg mob cov hniav.
Kev thov rau tus kws kho hniav thaum ntxov ntawm cov kab mob pulpitis yog qhov zoo rau tus neeg mob nws tus kheej. Kev kho mob nyob rau theem no zoo li tsis mob thiab pheej yig. Yog tias koj pib tus kab mob, ces periodontitis tuaj yeem txhim kho, uas nyuaj thiab kho tau ntev dua.
