Pierce A
Department of Dentistry, University of Adelaide, South Australia 5000.
Aust Endod J. 1998 Aug;24(2):60-5. doi: 10.1111/j.1747-4477.1998.tb00009.x.
Diagnosis of pulpal disease can be difficult due to the lack of diagnostic signs and symptoms available to the practitioner. An understanding of the possible underlying pathological processes, combined with an exact assessment of the pain history, and appropriate clinical tests, should aid the practitioner in determining the nature of pulpal inflammation, and differentiating it from dentine sensitivity and cracked teeth. The responses of the pulp to traumatic injury to the periodontal membrane (PDM) require special consideration, particularly with respect to the assessment of pulp vitality, and the determination of cases requiring pulp extirpation in order to avoid inflammatory root resorption. Although the pulp is relatively isolated from the rest of the dentoalveolar complex by a dentine/cementum barrier, it is important to remember that it can communicate with the PDM through apical and lateral foramina, and areas of damaged cementum. Hence, it is a priority to both preserve the integrity of the cemental layer in cases of traumatic injury and periodontal disease, and to prevent the inflammation and resorption associated with periapical lesions by accurate diagnosis of irreversible pulpitis and pulp necrosis, followed by appropriate endodontic debridement procedures.
由于从业者可利用的诊断体征和症状不足，牙髓疾病的诊断可能会很困难。了解可能的潜在病理过程，结合对疼痛病史的准确评估以及适当的临床检查，应有助于从业者确定牙髓炎症的性质，并将其与牙本质敏感和牙隐裂相区分。牙髓对牙周膜（PDM）创伤性损伤的反应需要特别考虑，尤其是在评估牙髓活力以及确定需要进行牙髓摘除术以避免炎性牙根吸收的病例方面。尽管牙髓通过牙本质/牙骨质屏障与牙体牙槽复合体的其他部分相对隔离，但重要的是要记住，它可以通过根尖孔和侧支根管以及牙骨质受损区域与PDM相通。因此，在创伤性损伤和牙周疾病的情况下，保护牙骨质层的完整性，以及通过准确诊断不可逆性牙髓炎和牙髓坏死，随后进行适当的根管清创程序，来预防与根尖周病变相关的炎症和吸收，是当务之急。
