如何处理智齿感染

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共同创作者是 Tu Anh Vu, DMD

参考

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智齿（第三磨牙）之所以叫这个名字，是因为智齿长得最晚，常常要到青春期后期才长出来。 [1] （也有部分人根本就不长智齿。） [2] 智齿发炎是件令人十分痛苦的事情，通常需要立即采取措施。看牙医前，你也可以通过几个步骤来缓解痛苦。

部分 1
部分 1 的 3:

家中护理

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    冠周炎（智齿周围发炎）是指智齿周围组织感染，红肿发炎。可因牙齿部分萌出所致，也可因智齿周围过度拥挤，不易进行牙齿清洁所致。 [3] 为明确智齿是否发炎，需仔细查看以下征兆及症状： [4]
    • 牙龈鲜红或牙龈发红有白点。牙齿周围的牙龈会红肿发炎。
    • 下颌有中度至重度疼痛，并伴有咀嚼困难。可看到脸颊肿胀，鼓出一块。肿胀部位摸上去会感觉发烫。 [5]
    • 嘴里有令人难受的金属味。金属味是由感染部位的血和脓引起。还会感觉有口臭。 [6]
    • 张嘴或吞咽困难。可能感染已由牙龈转移到周围肌肉。 [7]
    • 发热。体温超过100华氏度（37.8摄氏度）表明你正在发热，身体正在抵御感染。如感染严重，可伴有肌肉无力。如有这种情况，应立即联系牙医或医生。
    • 某些情况下，牙根也会感染。如牙根感染，牙医很可能会把牙齿拔掉。 [8]
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    盐水有天然抗菌作用。用盐水漱口可杀灭口腔细菌。 [9] [10] 将半勺至一勺盐加入8盎司（约227毫升）温水中充分混匀。 [11]
    • 倒一口盐水在嘴里含漱30秒，含漱时要充分漱洗感染部位，杀灭细菌。
    • 30秒后吐出盐水——别喝下去。每天用盐水漱口三至四次。
    • 该方法可与牙医开的抗生素同时使用。
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    当地药店可能会有牙用抗菌凝胶出售，主要要看你居住何处。凝胶可以控制感染并缓解疼痛或炎症。 [12]
    • 使用凝胶前，先彻底漱口，然后用棉签取一两滴凝胶直接涂抹于发炎部位。
    • 不要直接用手指涂抹凝胶，这样可能会沾染到更多细菌。
    • 每天涂凝胶三到四次，以达到最佳效果。
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    如果因智齿感染感觉疼痛严重，可服用同时有缓解炎症作用的镇痛片。非类固醇类抗炎药（NSAIDs）通常在药店药房都可以买到。 [13]
    • 布洛芬（艾德维尔或摩特灵）、甲氧萘丙酸（萘普生）和阿司匹林是最常见的非类固醇类抗炎药。不得给18岁以下儿童服用阿司匹林，因为阿司匹林会引发雷氏综合症，造成肝脑损伤。 [14]
    • 对乙酰氨基酚（扑热息痛）不是非类固醇类抗炎药，没有消炎的作用，但可以缓解疼痛。 [15]
    • 按包装说明的剂量服用或遵照医嘱，不得超剂量服用。
    • 切记是药三分毒，服药前必须仔细阅读包装说明。如需要，可咨询药剂师或医生。
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    如果不想服药或不能服药，可在感染部位敷上冰袋。就医前，冰袋可以缓解疼痛和炎症。 [16] 如肿胀得厉害，要紧急治疗。
    • 将冰块倒入塑料袋或者裹在毛巾里，然后将冰袋敷在疼痛部位至少十分钟。
    • 也可用袋装冷冻蔬菜，如冻豌豆或冻玉米。（请勿食用解冻后再冷冻的袋装蔬菜。）
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    一定要尽快和牙医预约就诊时间。如果感染得不到适当的治疗，会扩散到口腔及身体其他部位。 [17]
    • 冠周炎还会导致牙龈病、龋齿、囊肿等并发症。更为严重的并发症还有淋巴结肿大、败血症、全身感染，甚至可以导致死亡。
    • 如果牙医太忙没有时间立即给你治疗，可以到急诊诊所或医院。很多急诊诊所或医院都有急诊牙医。
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部分 2
部分 2 的 3:

牙医诊治

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    牙医会检查感染部位并拍X射线查明感染情况是否严重，以确定最佳的治疗方案。 [18]
    • 牙医会检查牙齿位置，确定牙齿是否已从牙龈完整或部分地萌出。牙医也会注意周围牙龈的状况。
    • 如果智齿尚未萌出，牙医可能需要拍X射线来确定牙齿的部位及其位置。这些因素会影响到牙齿是否需要拔除。
    • 不要忘记告知既往病史。牙医需要了解你是否对药物过敏。
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    咨询牙医治疗需要多少开销。还要询问治疗的一切风险和好处，以及是否还有其他治疗方法可供选择。
    • 不要怕问问题。你有权了解自己的医疗情况。
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    如智齿即将从牙龈中顺利萌出，且感染情况也不算严重，牙医只需用抗菌溶液简单地清洁感染部位就可以了。
    • 牙医会除掉发炎部位受感染的组织、脓液、食物残渣或菌斑。如牙龈出现脓肿，有时需要切开小口排出脓液。
    • 清洁后，牙医会建议接下来几天如何在家中护理。可用口腔凝胶消炎，用抗生素全面清除感染，以及用止疼药缓解疼痛。 [19] 通常开的抗生素包括阿莫西林、克林霉素和青霉素。 [20]
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    智齿感染的主要原因之一是，包裹智齿的牙龈部位（即牙龈瓣）因细菌、菌斑和塞在牙缝下的食物残渣而感染。如智齿仍包裹在牙龈中（但萌出位置正常），去掉感染的牙龈瓣往往比拔除智齿本身要容易得多。 [21] [22]
    • 牙医可能会安排一次小型外科手术，称为“龈盖切除术”，术中会切除遮盖智齿的牙龈软组织。 [23]
    • 切除后，发炎部位就容易保持卫生，不会有菌斑和细菌，大大减少智齿再次感染的几率。
    • 术前，牙医会局部麻醉手术部位。然后使用手术刀、激光或采用电烙术将感染的组织瓣切除。 [24]
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    如出现多重感染，且智齿也没有主动萌出的迹象，就需要将智齿拔除。感染非常严重的情况下也需要将智齿拔除。 [25]
    • 根据智齿的位置，由牙医或口腔外科医生来拔除智齿。 [26]
    • 牙医会进行局部麻醉，然后拔除智齿。 [27]
    • 可能会开抗生素、止疼片来防止进一步感染并缓解疼痛。一定要按牙医的要求保持好口腔卫生。
    • 和牙医预约术后随访时间，让牙医检查牙龈，确保牙龈正常愈合。牙医会检查另一侧智齿的位置，以防另一侧智齿也需要拔除。
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部分 3
部分 3 的 3:

保持口腔卫生

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    为避免日后感染，一定要保持好口腔卫生。保持好口腔卫生的第一步就是用软毛牙刷每天刷牙两次。硬毛牙刷太粗糙，会磨损娇弱的牙齿釉质。 [28]
    • 将牙刷与牙龈线形成45度角。 [29]
    • 以打小圈的方式刷牙，而不是来回刷（会伤害牙釉质）。
    • 每天刷牙两次，每次至少刷两分钟。确保刷到牙龈线，也不要忘记刷牙齿的背面。
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    用牙线清洁牙齿和刷牙一样重要，因为牙线可以去除在齿缝间堆积的，牙刷无法刷到的菌斑和细菌。如果不清理菌斑，就会导致龋齿、感染和牙龈疾病。每天至少用牙线清洁一次牙齿。 [30] [31]
    • 两手将牙线抓好，在牙齿间轻柔地来回移动。不要用力弹在牙龈上，这样会刺激牙龈，导致出血。
    • 将牙线贴在牙齿上弯曲成C形。将牙线轻柔地在牙齿和牙龈上滑动。
    • 抓好牙线，轻柔地来回摩擦牙齿。
    • 要用牙线清洁好每个牙缝，以及后磨牙的背面。一定要在使用牙线后漱口，吐掉脱落的菌斑和细菌。
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    使用抗菌漱口水有助于控制口腔细菌，同时也能保持口气清新。选择有美国牙医协会认证的漱口水，美国牙医协会认证的产品效果好。 [32] [33]
    • 可在刷牙前后使用漱口水。将一小满盖漱口水倒入嘴里，漱齿约30秒后吐出。
    • 可用商业品牌抗菌漱口水，或用未经稀释的洗必泰，大部分药房均有售。 [34]
    • 如果感觉漱口水刺激性太强，可用无酒精漱口水。
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    和牙医预约定期检查牙齿的时间，这是预防智齿感染及其他牙齿问题的最佳措施。 [35]
    • 每六个月要看一次牙医，尤其在智齿尚未萌出时要看牙医。牙医会建议在出现某些健康问题时增加来访频率。
  5. {"smallUrl":"https:\/\/www.wikihow.com\/images_en\/thumb\/2\/22\/Deal-with-an-Infected-Wisdom-Tooth-Step-16.jpg\/v4-460px-Deal-with-an-Infected-Wisdom-Tooth-Step-16.jpg","bigUrl":"https:\/\/www.wikihow.com\/images\/thumb\/2\/22\/Deal-with-an-Infected-Wisdom-Tooth-Step-16.jpg\/v4-728px-Deal-with-an-Infected-Wisdom-Tooth-Step-16.jpg","smallWidth":460,"smallHeight":345,"bigWidth":728,"bigHeight":546,"licensing":"<div class=\"mw-parser-output\"><\/div>"}
    智齿感染时不要吸烟或使用烟草制品，会刺激牙龈并导致感染恶化。 [36]
    • 吸烟对健康有害，对口腔健康也一样有害。尽早向医生咨询戒烟方法。 [37]
    • 吸烟会污染牙齿和舌头，减缓身体的愈合能力，导致牙龈疾病和口腔癌。 [38]
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小提示

  • 如果智齿没有引发问题，也不一定都要拔除。牙医能帮你确定是否需要拔除。 [39] 出现智齿问题的人通常在15到25岁之间。

[40]

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警告

  • 家中自行治疗和护理大多无法治愈感染。如有感染，应尽快让牙医检查，并及早进行治疗。
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参考

  1. ↑ http://www.mouthhealthy.org/en/az-topics/w/wisdom-teeth
  2. ↑ http://www.livescience.com/27529-missing-wisdom-teeth.html
  3. ↑ http://www.colgateprofessional.com/patient-education/articles/periocoronitis-infection-near-wisdom-tooth
  4. ↑ http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Teeth_wisdom_teeth?open
  5. ↑ http://www.nlm.nih.gov/medlineplus/ency/article/001057.htm
  6. ↑ http://www.medicinenet.com/pericoronitis/article.htm
  7. ↑ http://www.mayoclinic.org/diseases-conditions/wisdom-teeth/basics/symptoms/con-20026676
  8. ↑ http://www.mayoclinic.org/diseases-conditions/wisdom-teeth/basics/treatment/con-20026676
  9. ↑ https://www.deltadentalins.com/oral_health/oral_surgery.html
  1. ↑ http://www.medicinenet.com/wisdom_teeth/page2.htm
  2. ↑ http://www.colgate.com/en/us/oc/oral-health/conditions/mouth-sores-and-infections/article/sw-281474979357039
  3. ↑ http://www.ncbi.nlm.nih.gov/pubmed/23485568
  4. ↑ http://familydoctor.org/familydoctor/en/drugs-procedures-devices/over-the-counter/pain-relievers-understanding-your-otc-options.printerview.all.html
  5. ↑ http://www.healthline.com/health/headache-reyes-syndrome
  6. ↑ http://familydoctor.org/familydoctor/en/drugs-procedures-devices/over-the-counter/pain-relievers-understanding-your-otc-options.printerview.all.html
  7. ↑ http://www.crestprohealth.com/dental-hygiene-topics/wisdom-teeth/Treating-an-Infected-Wisdom-Tooth.aspx
  8. ↑ http://www.nhs.uk/Conditions/Wisdom-tooth-removal/Pages/Introduction.aspx
  9. ↑ http://www.medicinenet.com/pericoronitis/page2.htm
  10. ↑ https://www.urmc.rochester.edu/news/story/1711/pre-op-antibiotics-prevent-infection-for-wisdom-teeth-surgery-study-finds.aspx
  11. ↑ http://www.medicinenet.com/pericoronitis/page2.htm
  12. ↑ http://www.colgateprofessional.com/patient-education/articles/periocoronitis-infection-near-wisdom-tooth
  13. ↑ http://www.mayoclinic.org/tests-procedures/wisdom-tooth-extraction/basics/what-you-can-expect/prc-20020652
  14. ↑ http://www.medicinenet.com/pericoronitis/page2.htm#what_is_the_treatment_for_pericoronitis
  15. ↑ http://www.nhs.uk/Conditions/Wisdom-tooth-removal/Pages/Introduction.aspx
  16. ↑ http://www.medicinenet.com/wisdom_teeth/page2.htm
  17. ↑ http://www.nhs.uk/Conditions/Wisdom-tooth-removal/Pages/Introduction.aspx
  18. ↑ http://www.yourdentistryguide.com/wisdom-teeth/
  19. ↑ http://www.nhs.uk/Livewell/dentalhealth/Pages/Teethcleaningguide.aspx
  20. ↑ http://www.mouthhealthy.org/en/az-topics/b/brushing-your-teeth
  21. ↑ http://www.nhs.uk/Livewell/dentalhealth/Pages/Teethcleaningguide.aspx
  22. ↑ http://www.mouthhealthy.org/en/az-topics/f/Flossing%20Steps
  23. ↑ http://www.mouthhealthy.org/en/ada-seal-products/category-display/?category=Plaque%2fGingivitis+Control+Mouthrinse
  24. ↑ http://www.nhs.uk/Livewell/dentalhealth/Pages/Teethcleaningguide.aspx
  25. ↑ http://www.medicinenet.com/chlorhexidine-topicalmucous_membrane/article.htm
  26. ↑ http://www.mouthhealthy.org/en/dental-care-concerns/questions-about-going-to-the-dentist/
  27. ↑ https://www.dentalhealth.org/tell-me-about/topic/sundry/smoking-and-oral-health
  28. ↑ http://www.surgeongeneral.gov/library/reports/50-years-of-progress/consumer-guide.pdf
  29. ↑ http://www.mouthhealthy.org/en/az-topics/s/smoking-and-tobacco
  30. ↑ http://www.medicinenet.com/wisdom_teeth/article.htm#do_all_wisdom_teeth_need_to_be_extracted
  31. ↑ http://www.emedicinehealth.com/wisdom_tooth_problems-health/article_em.htm

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