急慢性牙髓炎21例误诊原因探讨  

The Misdiagnosis Cause Analysis of Acute and Chronic Pulpitis(A Report of 21 Cases)

作　　者：张复兰 李昊[1] 罗晓冰[1] 

机构地区：[1]武汉市汉口医院口腔科,武汉430012

出　　处：《临床误诊误治》2011年第4期47-48,共2页Clinical Misdiagnosis & Mistherapy

摘　　要：目的分析急慢性牙髓炎的误诊原因,提高该病的诊治水平。方法对我院2006年1月～2010年6月误诊的21例急慢性牙髓炎的临床资料进行回顾性分析。结果本组急性牙髓炎8例,口腔检查发现龋齿11颗,牙髓活力测试对冷热刺激反应敏感,摄X线片示牙根周均有不同程度的暗影;慢性牙髓炎13例,其中2例口腔检查示龋齿,5例隐裂牙,牙髓活力检查均示牙髓反应迟钝,摄X线片均见根周暗影,6例见髓室、根管中有髓石存在。误诊为耳部疾病和颞颌关节疾病12例,三叉神经痛5例,神经性头痛、脑血管意外各2例。后检查发现均存在不同程度的急慢性牙髓炎,经根管治疗后疼痛好转,痊愈。结论急慢性牙髓炎疼痛定位困难、临床无明显阳性体征是造成误诊的主要原因。明确牙髓炎异位疼痛的原因及机制,必要时行试探性治疗,可避免或减少误诊误治。Objective To analyze the misdiagnosis causes of acute and chronic pulpitis,and to improve the treatment.Methods The clinical data of 21 patients with acute or chronic pulpitis misdiagnosed during January 2006 and June 2010 in our hospital was retrospectively analyzed.Results There were 8 cases of acute pulpitis,among whom,dental caries in 11 drop detected by oral examination,and pulp vitality test result showed sensitive reactions to hot and cold stimulation,and X-ray showed different degrees of shadow in periradicular;There were 13 cases of chronic pulpitis,among whom,2 cases were dental caries,5 cases were hidden crack teeth.Pulp vitality test result showed that dental pulp was unresponsive.X-ray findings showed periradicular shadow,and denticle in pulp chamb and root canal were seen in 6 patients.12 cases were misdiagnosed as ear diseases and temporal jaws joint disease,5 cases as tension headaches,2 cases as trigeminal neuralgia,and 2 cases as cerebrovascular accident.All the patients were found to have different degrees of acute or chronic pulpitis.After root canal therapy,the pain in the patients was alliviated,and all the patients were cured.Conclusion The causes of misdiagnosis of acute and chronic pulpitis include difficult localization of pain,and obsolete clinical positive signs.It is necessary to idenfify the causes and mechanisms of ectopic pain in pulpitis patients and tentative measures should be taken to avoid misdiagnosis.

关 键 词：牙髓炎 误诊 三叉神经痛 脑血管意外 头痛 颞颌关节疾病 

分 类 号：R781.31[医药卫生—口腔医学]