牙髓炎患者的護(hù)理查房知識(shí)課件

牙髓炎的護(hù)理查房主講人：xxx疾病介紹A病史簡(jiǎn)介B護(hù)理原則C健康指導(dǎo)D目錄1相關(guān)知識(shí)牙髓炎

是指發(fā)生于牙髓組織的炎性病變。深齲、楔狀缺損等牙體硬組織疾病如不能得到及時(shí)有效地控制和治療，均可引發(fā)牙髓炎，成為口腔中最為多發(fā)和常見(jiàn)的疾病之一。概述急性牙髓炎急性牙髓炎可由牙髓充血發(fā)展而來(lái)，也可由慢性牙髓炎急性發(fā)作而來(lái)。包括：急性漿液性牙髓炎

病變范圍局限在冠部牙髓，為局部性漿液性牙髓炎。急性化膿性牙髓炎

在牙髓炎短暫的漿液期中，滲出的白細(xì)胞不斷壞死、液化，形成膿腫。臨床分類慢性牙髓炎慢性牙髓炎臨床上最常見(jiàn)，癥狀不典型，有些病例可沒(méi)有自發(fā)性痛。包括：慢性閉鎖性牙髓炎牙髓未暴露，可查及深齲洞、冠部充填體或近髓的牙體硬組織疾患，去凈腐敗物后無(wú)肉眼可見(jiàn)的露髓孔。慢性潰瘍性牙髓炎牙髓組織已暴露，表面形成潰瘍?；颊哂捎谂峦炊L(zhǎng)期廢用患牙，以至大量軟垢、牙石堆積。臨床分類慢性增生性牙髓炎

多發(fā)生于年輕人，牙髓已暴露，由于輕度而持久的刺激，引起增生反應(yīng)。患牙大而深的齲洞中有紅色的“蘑菇”形狀的肉芽組織叫牙髓息肉，探之無(wú)痛但極易出血。臨床分類最主要的病因就是感染。當(dāng)牙體硬組織因各種原因遭受破壞時(shí)細(xì)菌就可侵入并感染牙髓。齲病是引起牙體硬組織喪失的最常見(jiàn)病因其他原因包括：牙齒發(fā)育異常造成的牙體缺損；意外事故造成的牙冠折斷牙髓暴露；重度牙周病。病因牙髓受到刺激后，最初始的病理表現(xiàn)是血管擴(kuò)張，血液充盈。若及時(shí)去除病原刺激，這種單純的充血狀態(tài)可以得到緩解，牙髓恢復(fù)到原來(lái)的狀況。發(fā)病機(jī)制牙髓充血狀況持續(xù)時(shí)間較長(zhǎng)后，轉(zhuǎn)化為急性牙髓炎癥。若侵入牙髓的細(xì)菌毒力低，機(jī)體的抵抗力強(qiáng)，牙髓組織的炎癥多半表現(xiàn)為慢性過(guò)程。若急性炎癥的滲出物得到引流，但炎癥未能徹底消除時(shí)，也可轉(zhuǎn)化為慢性炎癥。若機(jī)體抵抗力減低，或局部引流不暢，慢性牙髓炎又會(huì)轉(zhuǎn)化為急性牙髓炎。發(fā)病機(jī)制1.急性牙髓炎急性牙髓炎（包括慢性牙髓炎急性發(fā)作）的主要癥狀是劇烈疼痛，具有典型的臨床特點(diǎn)。陣發(fā)性發(fā)作或陣發(fā)性加重；溫度刺激會(huì)加劇疼痛；表現(xiàn)為“熱痛冷緩解”及夜間痛；疼痛發(fā)作時(shí)，大多不能明確指出患牙所在；疼痛常放射至患牙同側(cè)上、下頜牙齒或頭面部。臨床表現(xiàn)2.慢性牙髓炎慢性閉鎖性牙髓炎

無(wú)明顯的自發(fā)痛或有偶發(fā)的鈍痛。有長(zhǎng)期的冷、熱刺激痛病史。慢性潰瘍性牙髓炎多無(wú)明顯的自發(fā)痛，常有當(dāng)食物嵌入患牙洞內(nèi)即出現(xiàn)劇烈的疼痛。當(dāng)冷、熱刺激激惹患牙時(shí)，會(huì)產(chǎn)生劇痛。慢性增生性牙髓炎

一般無(wú)自發(fā)痛，有時(shí)可有進(jìn)食時(shí)患牙疼痛或有進(jìn)食出血現(xiàn)象，長(zhǎng)期不敢用患側(cè)咀嚼食物。臨床表現(xiàn)牙髓炎治療的步驟第一次就診：開(kāi)髓、減壓第二次復(fù)診：封失活劑第三次復(fù)診：取出失活劑，根管預(yù)備第四次復(fù)診：充填治療原則應(yīng)急處理可以開(kāi)髓減壓，溫鹽水沖洗后，放置止痛藥物于齲洞內(nèi)，可以暫時(shí)止痛，同時(shí)服用消炎、鎮(zhèn)痛藥；疼痛緩解后1～2天，視患牙具體情況選用：活髓切斷術(shù)平髓術(shù)牙髓塑代或根管治療。無(wú)保留價(jià)值的患牙可拔除。治療原則2病史簡(jiǎn)介主訴：左上后牙冷刺激痛1周現(xiàn)病史：患者自述左上后牙冷刺激痛，隱痛1周，7年前曾補(bǔ)牙（具體不詳），未特殊處理今就診于我科。既往史：“乙肝”病史病史全口衛(wèi)生欠佳，牙結(jié)石（+++），26近中鄰牙合面齲壞穿髓，探痛，叩診（±），牙無(wú)松動(dòng)，牙齦略紅，牙齦萎縮至根頸1/3，X線示近中鄰面陰影穿透髓腔，根尖無(wú)明顯異常。口腔體格檢查診斷：26慢性牙髓炎/牙周炎；牙齦炎治療計(jì)劃：1.26根管治療+全冠修復(fù)2.牙周潔治處置：阿替卡因局部麻醉，降牙合，去除齲壞，開(kāi)髓，有血性滲出，顯微鏡下探及三根管口，拔髓3，NS沖洗，隔濕，干燥，CP棉枚，ZOE暫封。轉(zhuǎn)牙周行全口潔治。診斷與治療處置：3.一周后26去除原封物及棉球，根測(cè)儀測(cè)得長(zhǎng)度為近頰18mm,遠(yuǎn)頰和腭根均為19mm，EDTA+waveone預(yù)備至P#，NaC10沖洗，超聲震蕩，隔濕，干燥，大錐度牙膠+Ahplus+熱牙膠充填，X線提示恰填，聚羧酸墊底，3M復(fù)合樹(shù)脂充填，調(diào)牙合，拋光。建議：1.觀察二周后復(fù)診無(wú)不適建議行全冠修復(fù)26；2.隨診診斷與治療3護(hù)理原則一般情況患者文化背景，口腔衛(wèi)生習(xí)慣，健康史，過(guò)敏史，口腔局部癥狀等。心理

患者心理狀態(tài)，就診目的，治療的期望值。知識(shí)宣教對(duì)牙髓治療方法、預(yù)后、費(fèi)用的了解情況；指導(dǎo)患者術(shù)中積極配合，盡量保持最大的開(kāi)口度，使醫(yī)生有足夠的操作空間；治療過(guò)程中如有不適，不可轉(zhuǎn)動(dòng)頭與軀干，或直接用手阻止醫(yī)生操作，可舉左手示意?；颊咴u(píng)估1.治療前的護(hù)理問(wèn)題疼痛--與牙髓炎的炎癥反應(yīng)有關(guān)舒適度的改變--與牙髓炎疼痛不能入睡有關(guān)焦慮--與患者不了解疾病相關(guān)知識(shí)有關(guān)有黏膜受損的可能--與患者不配合有關(guān)護(hù)理問(wèn)題與措施2.治療前的護(hù)理措施護(hù)理人員做好椅旁的護(hù)理，配合醫(yī)生以最快的速度給患者開(kāi)髓，引流緩解疼痛。轉(zhuǎn)移患者的注意力，比如看電視，聽(tīng)音樂(lè)等

介紹疾病相關(guān)知識(shí)，避免吃過(guò)冷，過(guò)熱的食物護(hù)理問(wèn)題與措施3.治療中的護(hù)理問(wèn)題

焦慮

與患者擔(dān)心患牙能否治療好及能否保住患牙有關(guān)

；有藥物脫落的可能

與患者用患牙咀嚼食物有關(guān)；有黏膜受損的可能

與患者手術(shù)時(shí)配合不當(dāng)有關(guān)

；護(hù)理問(wèn)題與措施4.治療中的護(hù)理措施給患者講解疾病相關(guān)的知識(shí)，減輕患者的焦慮情緒囑患者不要用患牙咀嚼，上藥后半小時(shí)喝水，兩小時(shí)后吃東西，不用患牙咀嚼。轉(zhuǎn)移患者的注意力。護(hù)理問(wèn)題與措施5.療后的護(hù)理問(wèn)題有充填材料脫落的可能

與患者過(guò)早用患牙咀嚼有關(guān)。相關(guān)知識(shí)的缺乏，缺乏補(bǔ)牙后的相關(guān)知識(shí)。

有繼續(xù)齲壞的可能與患者口腔衛(wèi)生較差有關(guān)。

護(hù)理問(wèn)題與措施6.治療后護(hù)理措施囑患者半小時(shí)后喝水，兩小時(shí)后再吃東西，24小時(shí)不用該側(cè)牙咀嚼，避免吃太黏的食物如：口香糖、年糕、糯米等食物。向患者講解正確的刷牙方法，每半年常規(guī)口腔檢查。

護(hù)理問(wèn)題與措施4健康教育1.口腔衛(wèi)生堅(jiān)持早晚或進(jìn)食后刷牙，飯后漱口，及時(shí)清除留在口腔的食物殘?jiān)图?xì)菌，選用含氟牙膏對(duì)預(yù)防齲病有一定作用。2.食物嵌塞牙齒的治療對(duì)于位置不正的智齒和食物嵌塞的牙齒及時(shí)治療，不合適的義齒和牙套及時(shí)處理。3.口腔檢查定期口腔檢查。預(yù)防4.齲病的治療牙洞淺的要在去除破壞的牙質(zhì)后用適當(dāng)材料充填，防止進(jìn)一步齲壞；牙洞深的齲病，要根據(jù)具體情況進(jìn)行適當(dāng)?shù)闹委?。齲病引起的牙髓炎或根尖周炎，要清除牙髓腔內(nèi)或牙根周圍的細(xì)菌感染，經(jīng)過(guò)根管治療保住牙齒。對(duì)于已經(jīng)失去治療價(jià)值的殘冠、殘根及時(shí)拔除，及時(shí)鑲復(fù)。預(yù)防牙齒早晚正確刷含氟牙膏堅(jiān)持用

保健牙刷更護(hù)齒健康飲食少吃糖牙齒定期去檢查

防齲五步曲謝謝醫(yī)療護(hù)理PPT模板Eventplanningisaneffectivebehaviortoincreasemarketshare.Anactionplanwithexecutable,actionableandcreativeideascaneffectivelyenhancethecompany'sreputationandbrandreputation.適用于工作匯報(bào)/會(huì)議報(bào)告/個(gè)人競(jìng)聘/述職報(bào)告/比賽匯報(bào)人：xxx添加相關(guān)標(biāo)題Eventplanningisaneffectivebehaviortoincreasemarketshare.添加相關(guān)標(biāo)題Eventplanningisaneffectivebehaviortoincreasemarketshare.添加相關(guān)標(biāo)題Eventplanningisaneffectivebehaviortoincreasemarketshare.添加相關(guān)標(biāo)題Eventplanningisaneffectivebehaviortoincreasemarketshare.目錄CONTENTS此處添加相關(guān)標(biāo)題點(diǎn)擊此處添加相關(guān)主要內(nèi)容Eventplanningisaneffectivebehaviortoincreasemarketshare.Anactionplanwithexecutable,actionableandcreativeideascaneffectivelyenhancethecompany'sreputationandbrandreputation.PART

01此處添加相關(guān)標(biāo)題Eventplanningisaneffectivebehaviortoincreasemarketshare.Anactionplanwithexecutable,actionableandcreativeideascaneffectivelyenhancethecompany'sreputationandbrandreputation.添加標(biāo)題Eventplanningisaneffectivebehaviortoincreasemarketshare.Eventplanningisaneffectivebehaviortoincreasemarketshare.Anactionplanwithexecutable,actionableandcreativeideascaneffectivelyenhancethecompany'sreputationandbrandreputation.

添加標(biāo)題添加標(biāo)題關(guān)鍵詞添加副標(biāo)題Eventplanningisaneffectivebehaviortoincreasemarketshare.Anactionplanwithexecutable,actionableandcreativeideascaneffectivelyenhancethecompany'sreputationandbrandreputation.此處添加相關(guān)標(biāo)題Eventplanningisaneffectivebehaviortoincreasemarketshare.Anactionplanwithexecutable,actionableandcreativeideascaneffectivelyenhancethecompany'sreputationandbrandreputation.添加標(biāo)題Anactionplanwithexecutable,actionableandcreativeideascaneffectivelyenhancethecompany'sreputationandbrandreputation.添加標(biāo)題Anactionplanwithexecutable,actionableandcreativeideascaneffectivelyenhancethecompany'sreputationandbrandreputation.添加標(biāo)題Anactionplanwithexecutable,actionableandcreativeideascaneffectivelyenhancethecompany'sreputationandbrandreputation.添加標(biāo)題Anactionplanwithexecutable,actionableandcreativeideascaneffectivelyenhancethecompany'sreputationandbrandreputation.添加標(biāo)題關(guān)鍵詞Eventplanningisaneffectivebehaviortoincreasemarketshare.醫(yī)療健康此處添加相關(guān)標(biāo)題點(diǎn)擊此處添加相關(guān)主要內(nèi)容Eventplanningisaneffectivebehaviortoincreasemarketshare.Anactionplanwithexecutable,actionableandcreativeideascaneffectivelyenhancethecompany'sreputationandbrandreputation.PART

02Eventplanningisaneffectivebehaviortoincreasemarketshare.Anactionplanwithexecutable,actionableandcreativeideascaneffectivelyenhancethecompany'sreputationandbrandreputation.關(guān)鍵詞添加副標(biāo)題Audiencecrowd:Universitystudentswhoarerequiredbytheteachertodemonstratethecurriculum.Newcomerswhowanttostandoutfromthecompetitionjustaftergraduation.Needtousethedemonstrationtoenhancethepersuasiveworkman.85%KEYWORDS此處添加相關(guān)標(biāo)題010203Eventplanningisaneffectivebehaviortoincreasemarketshare.添加標(biāo)題Eventplanningisaneffectivebehaviortoincreasemarketshare.添加標(biāo)題Eventplanningisaneffectivebehaviortoincreasemarketshare.添加標(biāo)題此處添加相關(guān)標(biāo)題關(guān)鍵詞Eventplanningisaneffectivebehaviortoincreasemarketshare.關(guān)鍵詞Eventplanningisaneffectivebehaviortoincreasemarketshare.關(guān)鍵詞Eventplanningisaneffectivebehaviortoincreasemarketshare.關(guān)鍵詞添加副標(biāo)題關(guān)鍵詞添加副標(biāo)題Eventplanningisaneffectivebehaviortoincreasemarketshare.Anactionplanwithexecutable,actionableandcreativeideascaneffectivelyenhancethecompany'sreputationandbrandreputation.此處添加相關(guān)標(biāo)題01020304關(guān)鍵詞Eventplanningisaneffectivebehaviortoincreasemarketshare.關(guān)鍵詞Eventplanningisaneffectivebehaviortoincreasemarketshare.關(guān)鍵詞Eventplanningisaneffectivebehaviortoincreasemarketshare.關(guān)鍵詞Eventplanningisaneffectivebehaviortoincreasemarketshare.此處添加相關(guān)標(biāo)題點(diǎn)擊此處添加相關(guān)主要內(nèi)容Eventplanningisaneffectivebehaviortoincreasemarketshare.Anactionplanwithexecutable,actionableandcreativeideascaneffectivelyenhancethecompany'sreputationandbrandreputation.PART

03此處添加相關(guān)標(biāo)題關(guān)鍵詞Anactionplanwithexecutable,actionableandcreativeideascaneffectivelyenhancethecompany'sreputationandbrandreputation.關(guān)鍵詞Anactionplanwithexecutable,actionableandcreativeideascaneffectivelyenhancethecompany'sreputationandbrandreputation.關(guān)鍵詞Anactionplanwithexecutable,actionableandcreativeideascaneffectivelyenhancethecompany'sreputationandbrandreputation.關(guān)鍵詞Anactionplanwithexecutable,actionableandcreativeideascaneffectivelyenhancethecompany'sreputationandbrandreputation.此處添加相關(guān)標(biāo)題2020202220242026專業(yè)團(tuán)隊(duì)專屬定制Audiencecrowd:Universitystudentswhoarerequiredbytheteachertodemonstratethecurriculum.Newcomerswhowanttostandoutfromthecompetitionjustaftergraduation.Needtousethedemonstrationtoenhancethepersuasiveworkman.此處添加相關(guān)標(biāo)題添加標(biāo)題添加標(biāo)題關(guān)鍵詞專業(yè)團(tuán)隊(duì)專屬定制Eventplanningisaneffectivebehaviortoincreasemarketshare.關(guān)鍵詞專業(yè)團(tuán)隊(duì)專屬定制Eventplanningisaneffectivebehaviortoincreasemarketshare.此處添加相關(guān)標(biāo)題點(diǎn)擊此處添加相關(guān)主要內(nèi)容Eventplanningisaneffectivebehaviortoincreasemarketshare.Anactionplanwithexecutable,actionableandcreativeideascaneffectivelyenhancethecompany'sreputationandbrandreputation.PART

04此處添加相關(guān)標(biāo)題Eventplanningisaneffectivebehaviortoincreasemarketshare.關(guān)鍵詞Eventplanningisaneffectivebehaviortoincreasemarketshare.關(guān)鍵詞Eventplanningisaneffectivebehaviortoincreasemarketshare.關(guān)鍵詞Eventplanningisaneffectivebehaviortoincreasemarketshare.關(guān)鍵詞標(biāo)題Eventplanningisaneffectivebehaviortoincreasemarketshare.Anactionplanwithexecutable,actionableandcreativeideascaneffectivelyenhancethecompany'sreputationand