下颌第三磨牙拔除术后疼痛的临床分析及预防

Pain and prevention in extraction of the mandibular third molar

目的研究下颌阻生第三磨牙拔除术后疼痛的相关因素,探索其预防和控制方法。方法第一阶段选择450例下颌阻生第三磨牙拔除患者(第1组),分析术后疼痛的相关因素,建立预先判断牙齿拔除难度的评估模式,在此基础上制定术后疼痛的临床干预模式。第二阶段另外选择450例下颌阻生第三磨牙拔除患者(第2组),术前判断拔牙难度和引起疼痛的危险因素,并实施术后疼痛的临床干预模式(有选择性和针对性地给予术前用药或牙槽窝局部用药),观察治疗效果。结果2组患者的年龄、性别、拔牙难度、拔牙时间等相关因素的差异无统计学意义,具有可比性。拔牙难度和拔牙时间是与术后疼痛相关最为紧密的因素,手术后期疼痛还与局部感染因素(牙齿龋坏)以及女性月经周期相关。实施临床干预模式后,第2组患者的术后疼痛程度、重度疼痛发生率和止痛药服用量均明显低于第1组。结论拔除下颌阻生第三磨牙时,实施基于术前拔牙难度判断的围手术期药物的合理控制,可以实现术后疼痛的个体化预防,减轻或避免术后疼痛,有助于避免过量或不当使用药物。

Objective To study the post-operative pain-related factors in lower third molar extraction, and to find an effective prevention program. Methods The first phase of the study was a clinical follow-up of 450 cases of lower third molar extraction. Factors associated with post-operative pain were analyzed, and difficulty assessment protocol of the tooth extraction was build. On this basis, a pain-prevention clinical plan was constitute, and implemented in the second phase of 450 cases（selectively systemic or local medication）. Treatment effects were observed. Results There were no significant differences between the two phase groups on the distribution of ages, sex, difficulty of tooth extraction, operation time, and other related factors, means that they were statistically comparable. Tooth extraction difficulty and operation time were most important predictive factors for post-operative pain. Local infective factors（including caries） and women＇s menstrual cycle also account for late stage pain. Through targeted pre-operative medication or post-operative alveolar socket treatment, pain was significantly reduced or prevented. Conclusion Reasonable peri-operative drug control basing on the difficulty assessment can provide a comprehensive and individualized control of pain after tooth extraction. Also, excessive or inappropriate using of drugs is largely avoided.