华西口腔医学杂志 ›› 2024, Vol. 42 ›› Issue (4): 426-434.doi: 10.7518/hxkq.2024.2023427

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拔牙后的感染与防治

曹钰彬(), 叶立, 潘剑()   

  1. 口腔疾病防治全国重点实验室 国家口腔医学中心 国家口腔疾病临床医学研究中心 四川大学华西口腔医院口腔颌面外科,成都 610041
  • 收稿日期:2023-12-05 修回日期:2024-04-24 出版日期:2024-08-01 发布日期:2024-07-17
  • 通讯作者: 潘剑 E-mail:yubin.cao@scu.edu.cn;jianpancn@163.com
  • 作者简介:曹钰彬,主治医师,博士,E-mail:yubin.cao@scu.edu.cn|潘剑,医学博士,主任医师,博士研究生导师。四川大学华西口腔医院口腔外科主任。中华口腔医学会牙及牙槽外科专业委员会副主任委员、口腔颌面外科专业委员会委员。四川省卫生健康委员会学术和技术带头人,临床技能名师。四川省口腔医学会理事、牙及牙槽外科专业委员会主任委员,四川省抗癌协会头颈肿瘤专业委员会委员。美国北卡罗来纳大学教堂山分校 (University of North Carolina-Chapel Hill) 博士后。从事口腔颌面外科临床、教学、科研与管理工作20余年。
  • 基金资助:
    四川省干部保健重点研发项目(川干研ZH2024-901);四川省科技厅中央引导地方-自由探索项目(2023ZYD0110);四川省卫生健康委员会普及应用项目(21PJ062);四川大学华西口腔医院探索与研发项目资助(RD-03-202405)

Postextraction infections, prevention, and treatment

Cao Yubin(), Ye Li, Pan Jian()   

  1. State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Dept. of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
  • Received:2023-12-05 Revised:2024-04-24 Online:2024-08-01 Published:2024-07-17
  • Contact: Pan Jian E-mail:yubin.cao@scu.edu.cn;jianpancn@163.com
  • Supported by:
    Cadre Healthcare Key R&D Program of Sichuan Province(ZH2024-901);Centrally Guided Local-Free Exploration Project of Sichuan Science and Technology Program(2023ZYD0110);Universal Application Project of Health Commission of Sichuan Province(21PJ062);Research and Develop Program of West China Hospital of Stomatology, Sichuan University(RD-03-202405)

摘要:

术后感染是牙拔除术最常见的并发症之一,拔牙术后感染可表现为局部感染,也可扩散为全身感染。临床上口腔外科医生可通过督促患者加强口腔卫生保健、合理应用抗生素和选择适当的拔牙手术方式来预防拔牙术后感染。对于感染的治疗策略,口腔外科医生应根据不同的临床表现和诊断来制定。对于干槽症、迟发性感染、间隙感染、边缘性颌骨骨髓炎等局部组织感染,可通过局部清创处理、治疗性运用抗生素、必要时切开引流等方法来控制感染;对于怀疑发生坏死性筋膜炎的患者,应广泛清创,以减少组织坏死面积;对于接受过放疗或者抗骨吸收类药物治疗的患者,拔牙应遵循相关临床指南或专家共识的建议,以减少颌骨坏死等风险;对于全身基础情况较差或免疫功能不全的患者,应注意鉴别感染性心内膜炎和颅内感染,以保障患者的生命安全。本文中笔者结合文献回顾和临床经验,总结了拔牙后感染的预防与治疗策略,以期为口腔外科同行提供参考。

关键词: 牙槽外科, 牙拔除术, 干槽症, 间隙感染, 预防

Abstract:

Postoperative infection is one of the most common complications of tooth extraction. It may manifest as localized infection or develop to systemic infection. Clinically, oral surgeons can prevent postoperative infections by urging patients to strengthen oral hygiene, applying antibiotics in a rational and compliant manner, and choosing appropriate surgical methods for tooth extraction. For the treatment of infection, the oral surgeon should formulate a response strategy on the basis of different diagnoses. For local infections such as dry socket, delayed alveolar osteitis, gap infection, and marginal osteomyelitis of the jaws, the infection can be controlled by local debridement, therapeutic use of antibiotics, and incise and drain if necessary. For patients suspected of necrotizing fasciitis, timely extensive debridement should be made to reduce the area of tissue necrosis. For those who have received radiotherapy or anti-resorptive drugs, tooth extraction should follow the recommendations of the relevant clinical guidelines or expert consensus to minimize the risk of osteonecrosis of the jaws. For patients with poor systemic health or dysfunction of the immune system, attention should be paid to identifying infective endocarditis and intracranial infection to ensure the life safety of patients. In this study, the author intends to combine literature review and clinical experience to tackle postextraction infection and its prevention to provide a reference for colleagues on oral and maxillofacial surgery.

Key words: alveolar surgery, tooth extraction, dry socket, interstitial infection, prevention

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