Pulpitis: ngezigaba, izinhlobo, umtholampilo. Ukwahlukanisa izindlela nokwelashwa pulpitis

Strange kodwa kuyiqiniso - isifo njengoba pulpitis, has ezingaphezu kuka-20 ngezigaba izindlela. Odokotela bamazinyo zisebenzisa ngokwabo ngokuhamba umsebenzi wabo ngezindlela ezahlukene uhlobo ukuhlolwa isifo, kodwa waphawula ukuthi akekho kubona kungaba 100% ngokunembile ukuchaza zonke izici yalesi sifo esikhohlisayo. Odokotela bamazinyo bathi badinga ngezigaba elula kakhudlwana futhi lesifinyetiwe ka pulpitis, esizokwenza ukuba njani isifo nazo zonke izikhundla kwesokudla.

Kungani ngidinga zokuhlukanisa epulpiti?

Ukuba khona nje systematization elikhulu kangaka yesifo zamazinyo elihlobene ne izindlela ezahlukene ukuzama ukuchaza isithombe lesi sifo. Tinhlobo letehlukene ngeengaba pulpitises nikeza ababheke ngezindlela ezahlukene: kwezimbangela kanye nentuthuko, kulandzelana kwetindzima yomtholampilo, izimo izinqubo ezihleli e umsele impande nabanye.

Echaza kuzo zonke engele ngeengaba epulpiti baye kodwa lakhiwe. Ngakho-ke, odokotela bamazinyo kufanele kufake ekhatsi ekhona isithombe wezempilo isiguli ngamunye ngaphakathi kohlaka izindlela ezikhona nokuhlola. Eziningana talamanye ziye Nokho athuthukile emashumini eminyaka adlule, futhi manje elisetshenziswa umkhuba ukuxilongwa kanye nokwelashwa pulpitis.

Imizamo yokuqala nokumisa lesi sifo zamazinyo athathwa e-20s kwekhulu elidlule futhi ziye zabizwa ngokuthi incazelo inembe kakhulu kunazo zonke uginindela. lezi ngeengaba babe kunalokho eziyinkimbinkimbi futhi nzima. Yingakho izazi olwenziwa umsebenzi okuqhubekayo ngcono amasu incazelo isifo. Ngezikhawu 5-10 iminyaka okuhlongozwayo ngezigaba entsha, ogxile izikimu ngaphambili, kodwa kwadingeka sengqondo esithile esisha ukuba incazelo emapulpiti isithombe.

UBANI ngezigaba

I ngasekupheleni kwekhulu lama-20, okungukuthi ngo-1997, amazinyo kwaphawulwa ukwethulwa International Ukwahlukanisa Diseases, Kubuyeketa 10th, okuyinto by isifinyezo ICD-10 ezaziwayo. Kulokhu semukelwa ngu-World Health Organization, futhi ngo-1999 waba esetshenziswa kabanzi umkhuba yamazinyo ukuze kuhlonzwe kanye nokwelashwa pulpitis. Lolu hlelo yigama amakhodi nencazelo yabo ukuchaza isithombe emitholampilo ye isifo. Ukwahlukanisa pulpitises ICD kuhlanganisa izinto ezilandelayo:

• Izifo kwengaphakathi futhi periapical izicubu uhlobo wanikela luchazwa ngegama K04 ikhodi.
• Ngqo epulpiti ngekhodi K04.0.
• Esigabeni sokuqala lesi sifo, libhekene hyperemia, okhonjiswe K04.00.
• pulpitis olunamandla ahlinzekwa wemfihlo K04.01.
• Uma ithumba kutholakala, kuba Ulungise ikhodi K04.02.
• Ifomu njalo pulpitis lumiswa K04.03, futhi uma lokhu kutholakala ukuthi uphethwe isilonda, kuphakanyiswa ukuthi ubethele sitholakele K04.04.
• Uma isiguli kutholakala uginindela polyp efomini okungamahlalakhona, esiqokiwe yayo K04.05.
• Lapho izifo ijwabu sezinzwa futhi semithambo of izinyo uhlobo ecacisiwe Isitembu K04.08.
• Uma imbangela pulpitis Akucaci, lithi ikhodi K04.09.
• mkhuba Necrotic noma gangrenous e slurry akhonjiswa ikhodi K04.1.
• Uma ngabe udokotela wamazinyo waphawula izinqubo esiwohlozayo ezifana dentikli, uginindela amatshe noma calcification, lisho ikhodi yabo K04.2.
• Endabeni i kumiswa okungavamile izicubu kanzima K04.3 uginindela isichasiselo. Uma kuba okungajwayelekile (zesibili) dentin, it is kuboniswa K4.3X ikhodi. Kufanele kuqashelwe ukuthi kulesi simo bayakhishwa calcification namatshe e uginindela.
• Ngo apical periodontitis imvelo acute, okuyizinto imbangela izinguquko emisipheni Neuro-semithambo of izinyo, ibekwe cipher K04.4.
• Uma ngabe udokotela wamazinyo ithola ukuthi phambi kwakhe isifo uginindela nezicubu periapical ukuthi musa angena amaphuzu oshiwo ngenhla, kwenza K04.9 inothi.

Lokhu kuhlukaniswa pulpitises UBANI, ngokuvumelana bamazinyo, zingavumi kakhulu. Nokho, isasetshenziswa njengoba uhlelo olusemthethweni ukulungiswa imibiko ezibalo lezazi umsebenzi kwenziwa phakathi nenkathi ethile yesikhathi. EMAKHODI Ciphers lokhu ngezigaba udokotela ubophekile lizoqeda ekhadini ikhadi nangesineke. odokotela bamazinyo abaningi baye baqaphela ukuthi ngokuvamile baphathwe kubo ukuba sigxilise isifo phakathi kohlaka isikimu ezihlongozwayo-WHO, nakuba zinezikhwepha ngezindlela ezahlukene ngokuphelele izici elula zokugula kwamazinyo.

Izici epulpiti lokuzalwa kwakhe

Lokhu kuhlukaniswa uyakucabangela pulpitis futhi periodontitis izimbangela zesifo. Ngokusho lokhu umbandela, odokotela bamazinyo 4 izinhlobo zesifo:

• Ukutheleleka.
• Esibuhlungu.
• Konkrementozny.
• Medical noma amakhemikhali.

Asixoxe uginindela ngamunye ukuthi ngezigaba uchaze izimbangela zalo.

pulpitis infective

Lolu hlobo sifo sibangelwa umsebenzi amagciwane bawenze abulale ibangele ukushisa bese semithambo emsipheni besigaxa izinyo. Ngo 9 Ezimweni aphume 10 kwala magciwane kuwela ngaphakathi komgodi we dentine emiseleni noma ezithinta ebusweni wadalula of emsipheni. Ngaphansi ezivamile pulpitis retrograde, lapho amagciwane engena izinyo ngokusebenzisa imbobo phezulu impande. Lokhu kwenzeka uma izifo ezithathelwanayo ezifana nezifo sibi zokuphefumula, rubella, osteomyelitis, sinusitis noma periodontitis. Ezimweni ezingavamile, ukutheleleka abagqoka uhlamvu hematogenous. Isici eziqinisekile ukuqaphela epulpiti - omsakazo. Ukwahlukaniswa lesi simiso ngokuvamile isetshenziswa odokotela ingasebenza.

pulpitis Kwenhlekelele

Kufanele kuqashelwe ukuthi ukulimala siyimbangela inqubo sokugembula okungaholela pulpitis. Kulokhu, inzalo siphukile izinyo izimbotshana futhi ukutheleleka kwabo kwenzeka nge ukuqhubeka ukuvuvukala emsipheni umqulu. Ngezinye izikhathi umthetho ubuqotho izinyo futhi indawo yayo efanele (luxation noma subluxation). Kulokhu, epulpiti siyimfihlo futhi uyathuthuka ngaphandle ukubandakanywa nezilwanyana ezincane.

Ukulimala abagqoka imvelo kwansuku, kanti lokho kungatholakala kuphela ngenxa ingozi noma ukulimala, kodwa kungase kubangelwe ukungenela yezokwelapha ezingasebenzi. Ngokwesibonelo, lapho ukugaya izinyo "ungumqhele" pulpitis ngokuvamile kwenzeka ngenxa perforating izicubu. Lesi simo esiyingqayizivele sibangelwa kudinga ukulungiswa ngokushesha. Kubalulekile kakhulu ukuhlonipha udokotela wesifunda: epulpiti - Ukubekwa - umtholampilo - ukwelashwa. Ukuze onguchwepheshe ukusebenza ochungechungeni cishe noma yikuphi, ngisho necala owaba umqansa kunayo yonke, ungalungisa futhi ugweme okuningi yezinkinga edabukisayo.

epulpiti Konkrementozny

Lolu hlobo pulpitis kwenzeka ngenxa yokuthi ezinye izinkampani umsele impande - dentikley noma petrifikatov. Zikhula eziteshini kanye izimbotshana cindezela imithambo yegazi. Ngenxa yalokho mikrotsirkullyatsiya siphukile, kwakhiwa ukuvuvukala. Umphumela kuyinto uginindela.

Medical zamakhemikhali noma uginindela

Lokhu kuhlukaniswa epulpiti ngokuvamile musa ukuchaza, kodwa eqinisweni kuvamile impela futhi kubangelwa yephutha wezokwelapha. Lokhu kwenzeka uma udokotela wamazinyo osebenza lapho ulungiselela caries wetemlomo nobe periodontal ephaketheni ejenti yemvelo anamandla (alcohols noma esters) noma iphutha lobuchwepheshe senziwe uphawu.

Kusigaba Platonov

Naphezu kweqiniso lokuthi kule hlobo lokuhlola yesifo kwahlongozwa uProfesa Platonov kufike emuva kuka-1968, futhi namanje esetshenziswa bamazinyo umkhuba. Lokhu kuhlukaniswa ka pulpitis futhi periodontitis unobuthakathaka yayo, kodwa okuhle alula kanye lula. Uprofesa e amasu nendlela yakhe kuhlanganiswe izindlela ezintathu: kuhlatiya izinqubo sokugembula e uginindela, ubunjalo balesi sifo, kanye kwasendaweni ekunciphiseni ukukhathazeka. This is a simple, kodwa ukuhlolwa isifo uhlelo capacious wawubheke esilindele lochwepheshe abaningi echaza ukuhlobana sayo samanje. Kulesi systematization waxoxa izici eziyinhloko zalesi simo, njengoba epulpiti - omsakazo, pathogenesis. Ukwahlukanisa izifo Platonov simiswe ngalendlela lelandzelako:

• Acute pulpitis lwemsebenti: ifomu lobular (ubuhlungu acute, okuyinto sobala kwasendaweni nesineke) kanye nohlobo ehlasela umzimba (kwasendaweni esingachaziwe, edlulisela kanye emsipheni trigeminal ebusweni).
• Pulpitis ezingamahlalakhona uhlamvu hypertrophic (ukuvuvukala kwengaphakathi ingaphakathi ngokugcwalisa caries), gangrenous (necrosis Izinzwa kwezicubu besigaxa semithambo) kanye fibrotic (zamazinyo izicubu ukuvuselelwa).
• Pulpitis exacerbation amafomu ezingamahlalakhona.

Lokhu kuhlukaniswa futhi emapulpiti Umtholampilo kakhulu lula umsebenzi odokotela bamazinyo, ikakhulukazi imitholampilo kwesabelomali. Ngokuvamile, izimo ezinjalo, udokotela akanayo isikhathi ukuphenya izimbangela zezifo zamazinyo. Ukuze izinhlangano zikwazi ukusungula uhlobo lwesifo, kwanele ukubuza isiguli eminye imibuzo.

Ukwahlukanisa Gofungu

Le ndlela zithandwa phakathi odokotela bamazinyo, ngoba uchaza izici ezibaluleke kakhulu yalolu zokugula njengoba epulpiti - ngezigaba, ukucinga indikimba yendaba yomtholampilo, ukwelashwa. Inikeza umbono mayelana izigaba zesifo ivumela nemingcele ahlukahlukene emitholampilo izinguquko morphology e uginindela ngesikhathi ukuvuvukala. Ngokusho lesi simiso, izinhlobo lesi sifo yilabo okulandelayo:

• Ifomu okukhulu pulpitis: esinqunyiwe (esethola, ingelapheka ngu esaziwa ezinzwa oyizalayo), isamba (ehlasela umzimba wonke, esehlanganise lonke uginindela, futhi iphathwa ngu extirpation), ubovu Imininingwane (olunzulu futhi engelapheki umonakalo uginindela iphathwa extirpation esibalulekile zokuvimbela okuvela periodontitis).
• Ifomu njalo pulpitis: elula, hypertrophic (lezi zinhlobo ezimbili esilaphekayo kahle ikhono ukusindisa impande), gangrenous (elimazayo zinhlobo extirpation baphathwe ezikhathini eziningana lapho sivakasha kudokotela).

Ukwahlukanisa the MMSI

Indlela morphology isifo neurovascular senqwaba oqondile ukuqhubeka Gofunga amasu. Ukwahlukanisa epulpiti MMSI lento kuhlanganisa exacerbation amafomu njalo pulpitis futhi uyakucabangela isici ukuvuvukala kule izinyo, ngaphambi kokuba ngayo. Ngokusho lokhu morphology, lesi sifo uhlukaniswe:

• amafomu okukhulu pulpitis: ebalulekile noma ubovu ehlasela umzimba wonke, serous.
• amafomu Okungalapheki ka pulpitis: gangrenous, fibrotic noma hypertrophic.
• Exacerbation amafomu njalo pulpitis: fibrous noma gangrenous.

Exacerbation ka gangrenous uhlobo pulpitis kungabangela izinkinga zesifo periodontal, njengoba uhlanganyela ngentshiseko ekuthuthukiseni microflora anaerobic. Uma ukususwa olungaphelele emsipheni akusho ukuxazulula inkinga ukuvuvukala, a hysterectomy ephelele noma okuphindiwe iziteshi mummification ngokuvamile uyayixazulula inkinga.

Kusigaba Vinogradova

Ukwahlukanisa emapulpiti ezinganeni ezivezwa UProfesa Vinogradova uhlelo enikeza izifo ngokucacile ahlukene amazinyo lezihlahla kusuka njalo. Udokotela uchaza ukuthi ukuvuvukala kule mammary futhi molars zenzeka ngezindlela ezahlukene. UProfesa uncoma ukuthi ngokucacile ilungiselelo temabhodlela ngamazinyo lesikhashana indlela yokwelapha ephikelela ukwenqaba ephelele ukudluliswa siteshi. Lokhu kungaholela ukulimala unomphela izinyo ihlumela wengane.

Ukwahlukanisa emapulpiti ezinganeni kuhlanganisa izinto ezilandelayo:

• Ubisi namazinyo pulpitis acute: serous (ukuqhutshwa ngokushesha, ifomu lobular iba ehlasela umzimba), ubovu (ngokushesha sihlanganisa lonke uginindela bangaba zezifo ezingelapheki).
• Acute pulpitis inombolo unomphela uhlamvu amazinyo: acute Imininingwane serous noma ngokwengxenye, acute ubovu nhlobo noma ngokwengxenye.
• Okungalapheki pulpitis isethi lesikhashana unomphela amazinyo: elula, proliferative noma hypertrophic, gangrenous.
• Exacerbation amafomu njalo pulpitis amazinyo lesikhashana unomphela, avame kwenzeka ngokumelene isizinda pulpitis elula ezingamahlalakhona.

I engavamile yenqubo ukuvuvukala kule izinyo sesikhashana ukuthi inqubo lasakazekela mezhkornevyh isikhala nge awokuthi. Lokhu kungenxa yokuthi i-dentin kule zoni has ngezinga eliphezulu permeability. Lesi simo esiyingqayizivele sibangelwa kuyingozi ngoba kungasenza yokuphazamiseka ekwakhekeni izinyo lomhlathi izinyo ihlumela, shintsha usuku kuqhuma yayo, kuchaye yayo.

pulpitis Okungalapheki namazinyo zesikhashana 'zinezikhathi ngalolo bangase bavele njengoba izinhlobo eziyinhloko ngokudlula isigaba oyingozi. Kungenzeka asymptomatic, kodwa ecashile ngokuthi iqiniso lokuthi ngempela ngokushesha lasakazekela kwezicubu periodontal. Ngakho-ke kubalulekile ukuba eduze ukuqapha isimo ngalo ingaphakathi ngomlomo izingane futhi akufanele singayinaki ukwelashwa amazinyo eyinhloko.

Izici nokwelashwa pulpitis

Ukwahlukanisa izindlela nokwelashwa pulpitis ngokuqondile okuhlobene uphethwe. Kuyinto onekhono ukucacisa degree obulukhuni isifo kuxhomeke ekuphumeleleni yokwelapha.

Uma ucingo wamazinyo kwenziwa ekuqaleni ukuthuthukiswa pulpitis, udokotela ulibangise ukuphathwa kwezinto eziphilayo. Siqukethe kulokhu okulandelayo: emsipheni we izinyo singasuki kinid, sebenzisa ezikhethekile calcium-protivogistaminnye izidakamizwa. Ngenxa yalokho zale ndlela yokwelapha yisishiso maqembu uginindela, yakheke dentin substitutive. Zifakwe the bahlanza uphawu izimbotshana.

Uma ukwelashwa esifike ngesikhathi kudokotela akuzange kwenzeke, khona-ke kungenzeka ukwelashwa begazi iye aphuthelwe. Kulesi sigaba, udokotela wamazinyo kuyodingeka ukuba baqonde lokho okufundiswa uginindela nesineke. Umqondo, ngezigaba kanye izindlela zokuxilonga ukwenza kube ngokunembe ngangokunokwenzeka.

Kaningi wasebenzisa indlela yokususa ngokwengxenye kwengaphakathi. Ngaphansi kwethonya izinzwa wenza ukuhoxiswa emsipheni ezingeni umqhele, ezonini impande uhlala iphila. Ngemva kwalokho wabeka ekwakhiweni ne-calcium, futhi izinyo selinqunyiwe. Uma kudingekile ukuba, kwenziwe Physiotherapy, linqume ukwelashwa eqeda ukuvuvukala. Le ndlela Kunconywa izingane esimazinyo aso eziqongweni namanje ayakhekanga.

Ibonisa umkhuba yamazinyo, ezimweni eziningi, kusetshenziswe nokususwa ngokuphelele emsipheni. Lokhu kungenziwa ngaphansi izinzwa noma Imbondela indlela devitaliziruyuschey nokunamathisela equkethe i-arsenic. Lokhu kwaziswa kuyinto enobuthi kakhulu, futhi ibhandishi kufanele kususwe nakanye isikhathi ebekwe udokotela. Ngemva kwalokho, le ukwelashwa endodontic, phakathi kwesikhathi lapho iziteshi ukugcwaliswa izinyo Gutta percha.

Ngemva ukwelashwa okunjalo Kwenziwa-X-ray ukuze uhlole isici izinga akhiqizwa iziteshi zokukhwabanisa. Uma zisuthe kuze kube phezulu, esikhulu uphawu.

Endabeni ukubhujiswa pheze ephelele udokotela izinyo isebenzisa i-pin -copings, elenziwe zokubuyisela izinyo. Njalo uchwepheshe uzokutshela ukuthi okuqinisekisiwe ukusiza ukuthola Ukwahlukaniswa epulpiti. Ukwelashwa kuyinto okunengqondo isandiso uphethwe obuphelele amazinyo lesiguli.

Ikhanga wamazinyo kusaqalwa pulpitis kuyazuzisa isiguli. Ukwelashwa kulesigaba cishe kobuhlungu futhi engabizi. Uma uphelelwa isifo angagcina periodontitis, okuyinto nzima kakhulu aphathe nokuningi.