小结
定义
病史和体格检查
关键诊断因素
- 存在的危险因素
- 牙痛
- 牙热敏性
- 发热
- 口内和/或口外水肿
- 口内和/或口外红斑
- 口内和/或口外分泌物
- 张口困难
- 牙齿叩击敏感
- 牙松动
- 深牙周袋、出血、牙龈萎缩
- 牙周围骨质丢失
- 牙抬高/挤压
- 呼吸急促
- 吞咽困难/流涎
- 发声困难
- 呼吸困难/呼吸喘鸣
- 姿势性改变
- 悬雍垂偏移
- 口底升高
- 低血压
其他诊断因素
- 口臭/口腔异味
- 口干燥症
- 神经系统体征
危险因素
- 口腔卫生不佳
- 龋齿
- 牙周病
- 部分萌出或阻生牙
- 牙创伤
- 牙折
- 过度咬合磨损
- 酒精或药物滥用
- 低等社会经济状况
- 营养不良
- 年龄过大或过小
- 既往接受过放射治疗
- 特定药物
- 免疫抑制或共患病（并发症的风险较高）
- 大型牙修复体
- 夜磨牙症
- 既往根管治疗失败
诊断性检查
首要检查
- FBC 和分类计数
- 全景 X 光检查
需考虑的检查
- 根尖周 X 线
- 头部和颈部 CT（增强）
- 感染部位抽吸样本的革兰氏染色/培养及其敏感性
- C 反应蛋白 (CRP)
- 红细胞沉降率 (ESR)
- 血清电解质
- 血浆纤维蛋白原水平
- 头颈部磁共振成像
- 筋膜间隙超声检查
- 电活力测试
- 热敏测试
- 血液培养
新兴检查
- 血清C端交联肽 (C-terminal cross-linking telopeptide, CTX)
治疗流程
高风险
低风险
撰稿人
作者
Melanie S. Lang, DDS, MD
Associate Professor
Department of Oral and Maxillofacial Surgery
University of Washington School of Dentistry
Seattle
WA
利益声明
MSL has contributed to Oakstone Audio Reviews in Oral and Maxillofacial Surgery. MSL has published two manuscripts related to perioperative antibiotic use with materials from the AAOMS. She is an AAOMS representative to the ADA for a group studying the use of antibiotics in dentistry. MSL is a member of the working group involved in the development of ADA guidelines, and she is also an author of several references cited in this topic.
Thomas B. Dodson, DMD, MPH
Professor and Chair
Department of Oral and Maxillofacial Surgery
University of Washington School of Dentistry
Seattle
WA
利益声明
TBD is a paid Consultant-Associate Editor for the Journal of Oral and Maxillofacial Surgery and Consultant-Surgeon for ClearChoice Seattle and Federal Way. He is an unpaid committee member for the Research and Development Commission of the AOCMF and the Committee on Research for the Oral and Maxillofacial Surgery Foundation. TBD is an unpaid liaison to the Committee on Research and Technology Assessment, American Association of Oral and Maxillofacial Surgery. He is also an author of some references cited in this topic.
同行评议者
Samuel J. McKenna, DDS, MD
Professor and Chairman
Department of Oral and Maxillofacial Surgery
Vanderbilt University
Nashville
TN
利益声明
SJM declares that he has no competing interests.
Kamran Ali, FDSRCS (Eng)
Associate Professor
Lead in Oral Surgery
Plymouth University Peninsula Schools of Medicine & Dentistry
Plymouth
UK
利益声明
KA declares that he has no competing interests.
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