牙源性牙痛误诊误治68例分析

An analysis of 68 cases of misdiagnosed and mistreated toothache patients

目的:分析引起牙源性牙痛误诊误治的相关影响因素,以期提高牙痛的正确诊断率。方法:选择2005—2009到广州市海珠区口腔医院就诊的牙痛病例中,对误诊误治并经再次诊治疼痛缓解的病人68例进行回顾性研究,记录病人临床资料信息,统计、分析其主要症状、体征。结果:牙痛误诊中牙髓炎占最大比例,牙髓炎又以深龋已充填未做牙髓治疗者占多数,其余依次为隐蔽龋、隐裂、楔形缺损、牙周牙髓联合病变、重度磨耗及畸形中央尖磨损等。此外龈乳头炎、牙根折也易出现误诊误治。结论:部分牙髓炎急性发作体征不典型,定位困难及医生询问病史、检查不仔细是牙痛误诊、误治主要原因。熟悉各种牙痛的临床表现及体征,抓住引发牙痛几个重要原因以及正确阅读X线片有助于提高牙痛病人的诊治成功率。

AIM： To analyze the factors influencing the diagnosis of odontogenic toothache. METHODS：Patients with toothache in Guangzhou Haizhu District Dental Hospital in 2005 - 2008 were included. Sixty-eight misdiagnozed and mistreated patients who recovered after a successful retreatment were studied retrospectively. Clinical data and descriptive statistics were recorded. The main symptoms and signs were analyzed. RESULTS： Pulpitis in which the majority was treated as deep caries without pulp treatment accounted for the largest proportion of misdiagnosis in toothache, followed by hidden caries, cracked, wedge-shaped defects, periodontal pulp joint disease, severe wear and abnormal wear of the central tip. In addition, gingival papillitis and root fracture were also prone to misdiagnosis and mistreatment. CONCLUSION： Generally, atypical symptoms of acute pulpitis, difficulty in locating of toothache source and carelessness of doctors were the main reasons of misdiaznosis and mistreatment.