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《根管治疗学·牙髓之路(第8版)》内容简介：关于“牙髓治疗方法”的争论已经持续了1个多世纪。人们不断产生新想法，迎接新挑战，发展新材料，提出新技术；同时，一些错误也被一再重复，有些治疗还在完全依靠个人的经验。在这段时期，这个被认为“小而不重要的组织”，一直在重复着历史，这促使我们选择了一种不同的方法——一条前人很少走过的路。随着对根管解剖系统的深入了解，其中有些方法和路径被证明为不可行、无用、偏离方向或没有出路；有的方法是明显的进步，有的却是退步；有的方法具有创造性，有的仅仅是重复；有的基于生理学基础，而有的仅仅依靠经验。在新千年到来之际，我们不仅需要重温这些不同的方法和路径，同时还要吸取过去几个世纪的历史经验和教训——因为它使牙髓病学（endodontology）和牙髓学（endodontics）发展变得完全不同了。

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Chief[2] Complaint

On arrival for a dental consultation, the patient should complete a thorough registration that includes information pertaining to medical and dental history (Figs. 1-1 and 1-2). This should be signed and dated by the patient, as well as initialed by the clinician as verification that all of the submitted information has been reviewed (see Chapter 29 for more information).

The reasons patients give for consulting with a clinician are often as important as the diagnostic tests performed. Their remarks serve as initial important clues that will help the clinician to formulate a correct diagnosis. Without these direct and unbiased comments, objective findings may lead to an incorrect diagnosis. The clinician may find a dental pathosis, but it may not contribute to the pathol...

Baseline[5] blood pressure and pulse should be recorded for the patient at each treatment visit. Elevation in blood pressure or a rapid pulse rate may indicate an anxious patient who may require a stress reduction protocol, or it may indicate that the patient has hypertension or other cardiovascular health problems. Referral to a physician or medical facility may be indicated. It is imperative that vital signs be gathered at each treatment visit for any patient with a history of major medical problems. The temperature of patients presenting with subjective fever or any signs or symptoms of a dental infection should be taken.57,80,105

The[6] chronology of events that lead up to the chief complaint is recorded as the dental history. This information will help guide the clinician as to which diagnostic tests are to be performed. The history should include any past and present symptoms, as well as any procedures or trauma that might have evoked the chief complaint. Proper documentation is imperative. It may be helpful to use a premade form to record the pertinent information obtained during the dental history interview and diagnostic examination. Often a SOAP format is used, with the history and findings documented under the categories of Subjective, Objective, Appraisal, and Plan. There are also built-in features within some practice management software packages that allow digital entries into the patient’s electronic fil...

Sinus[10] tracts of odontogenic origin may also open through the skin of the face (Figs. 1-9 and 1-10).2,56,64 These openings in the skin will generally close once the offending tooth is treated and healing occurs. A scar is more likely to be visible on the skin surface in the area of the sinus tract stoma than on the oral mucosal tissues (Fig. 1-10, C and D). Many patients with extraoral sinus tracts give a history of being treated by general physicians, dermatologists, or plastic surgeons with systemic or topical antibiotics or surgical procedures in attempts[11] to heal the extraoral stoma. In these particular cases, after multiple treatment failures, the patients may finally be referred to a dental clinician to determine whether there is a dental cause. Raising the awareness of physici...

On[12] occasion, a chronic endodontic infection will drain through an intraoral communication to the gingival surface and is known as a sinus tract.12 This pathway, which is sometimes lined with epithelium, extends directly from the source of the infection to a surface opening, or stoma, on the attached gingival surface. As previously described, it can also extend extraorally. The term fistula is often inappropriately used to describe this type of drainage. The fistula, by definition, is actually an abnormal communication pathway between two internal organs or from one epithelium-lined surface to another epithelium-lined surface.6

Mobility[15]

Like percussion testing, an increase in tooth mobility is not an indication of pulp vitality. It is merely an indication of a compromised periodontal attachment apparatus. This compromise could be the result of acute or chronic physical trauma, occlusal trauma, parafunctional habits, periodontal disease, root fractures, rapid orthodontic movement, or the extension of pulpal disease, specifically an infection, into the periodontal ligament space. Tooth mobility is directly proportional to the integrity of the attachment apparatus or to the extent inflammation in the periodontal ligament. Often the mobility reverses to normal after the initiating factors are repaired or eliminated. Because determining mobility by simple finger pressure can be visually subjective, the back ends o...

书籍介绍

《根管治疗学·牙髓之路(第8版)》内容简介：关于“牙髓治疗方法”的争论已经持续了1个多世纪。人们不断产生新想法，迎接新挑战，发展新材料，提出新技术；同时，一些错误也被一再重复，有些治疗还在完全依靠个人的经验。在这段时期，这个被认为“小而不重要的组织”，一直在重复着历史，这促使我们选择了一种不同的方法——一条前人很少走过的路。随着对根管解剖系统的深入了解，其中有些方法和路径被证明为不可行、无用、偏离方向或没有出路；有的方法是明显的进步，有的却是退步；有的方法具有创造性，有的仅仅是重复；有的基于生理学基础，而有的仅仅依靠经验。在新千年到来之际，我们不仅需要重温这些不同的方法和路径，同时还要吸取过去几个世纪的历史经验和教训——因为它使牙髓病学（endodontology）和牙髓学（endodontics）发展变得完全不同了。

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