下颌舌侧不同部位牙龈疼痛敏感度的初步研究

Primary Study on Pain Sensitivity of lingual Mucosal of mandibular

目的:研究不同部位口腔下颌舌侧牙龈黏膜疼痛敏感度,发现相对敏感区域并提出解决方案,以减轻患者注射麻药时的疼痛感及全身并发症的发生。方法:对需要拔除的下颌患牙进行局部浸润麻醉,使用阿替卡因肾上腺素注射液及相对应的0.3×21mm细针头,舌侧注射部位距离舌侧牙龈缘约5mm,然后记录注射部位的疼痛程度。疼痛分级采用国际通用方法,但加以改良,使之更详细。采用x2检验分析各牙位的中重度和重度疼痛患者构成比。结果:800例患者中,无痛到中度疼痛患者有653例,占总数的81.63%;中重度和重度疼痛患者147例,占18.37%。中重度和重度疼痛患者在中切牙组占43%,侧切牙组占37%,尖牙组占27%,第一前磨牙组占11%,第二前磨牙组占12%,第一磨牙和第二磨牙组分别占9%和6%,磨牙后垫区占2%。与前磨牙、磨牙和磨牙后垫区相比,中切牙、侧切牙和尖牙组的中重度和重度疼痛患者比例明显增加,且有显著差异(x2检验,P<0.01)。结论:中切牙、侧切牙和尖牙舌侧牙龈黏膜疼痛敏感度较高,最好先表面麻醉后再注射麻药,以减少患者的疼痛感,同时减少患者的恐惧感和全身并发症的发生。

Objective： To evaluate pain sensitivity of lingual side of mandibular alveolar mucosal and investigate the sensitive areas,so as to propose countermeasures to decrease pain of injection and prevent systemic complications at the injection of local anesthetic.Methods： 800 patients were recruited in this study.Injections for local infiltration anesthesia were performed on the lower teeth need to be extracted.Primacaine was injected with a fine needle with 0.3 mm diameter.Pain score at the moment of needling was recorded according to patients’description.Pain score was divided into six levels according to a modified international classification.Chi-square test was used to analyze the constituent ratio of the patients reported moderate-to-severe to severe pain at each tooth.Results： Among the 800 patients,653（81.63%） felt painless to moderate pain,147（18.37%） felt moderate-to-severe to severe pain.Various constituent ratios of moderate-to-severe to severe pain at each lower tooth were recorded： central incisor,43%;lateral incisor,37%;canine,27%;first premolar,11%;second premolar,12%;first molar,9%;second molar,6%;and retromolar pad,2%.Compared to the posterior lower teeth,more patients felt moderate-to-severe to severe pain,which was of statistical significance.Conclusion： The anterior region of lingual side of mandibular alveolar mucosal was proved to be more sensitive to needling pain.Hence,it is important to relieve needling pain by superficial anesthesia before injection,so as to lessen dental phobia and reduce the occurrence of systemic complications.