干槽症

概述

干槽症（牙槽骨发炎）是一种令人痛苦的牙齿问题，有时会发生在您拔掉恒牙后。干槽症是指拔牙部位无法形成血凝块，或者血凝块在伤口愈合之前就脱落或溶解。

通常情况下，拔牙部位会形成血凝块。血凝块会在空牙槽中的底层骨和神经末梢上形成保护层。血凝块还为新骨的生长和血块上软组织的发育提供了基础。

底层骨和神经暴露会导致剧烈疼痛，这种疼痛不仅在牙槽中，而且还会扩散至脸侧面的神经。牙槽会发炎，并可能充满食物残渣，从而加剧疼痛。如果您出现干槽症，通常在拔牙后一到三天会开始疼痛。

干槽症是拔牙后最常见的并发症，例如拔除第三臼齿（智齿）时。单靠非处方药不足以治疗干槽症疼痛。您的牙医或口腔外科医生会提供缓解疼痛的治疗方法。

症状

干槽症的体征和症状可能包括：

• 可能在拔牙后几天内出现剧烈疼痛
• 拔牙部位的血块部分或全部流失，您可能注意到它是空（干）槽
• 牙槽中能看见骨质
• 疼痛会从牙槽传到您拔牙侧的耳朵、眼睛、太阳穴或颈部
• 口腔有口臭或恶臭
• 口腔有难闻的气味

何时就诊

拔牙后，一定程度的疼痛和不适很正常。但是，您应该能够使用牙医或口腔外科医生开的止痛药来控制正常疼痛，并且随着时间的流逝，疼痛会减轻。

如果拔牙后几天内出现新疼痛或疼痛加剧，请立即咨询您的牙医或口腔外科医生。

When to see a doctor

A certain amount of pain and discomfort is typical after a tooth removal. But you should be able to manage the pain with the pain reliever your dentist or oral surgeon prescribed. The pain should lessen with time.

If you develop new pain or the pain gets worse in the days after your tooth removal, contact your dentist or oral surgeon right away.

病因

引起干槽症的确切原因仍在研究中。研究人员怀疑可能与某些问题有关，例如：

• 细菌污染牙槽
• 拔牙困难（如阻生智齿）导致的手术部位创伤

风险因素

增加患干槽症风险的因素包括：

• 吸烟和烟草使用。香烟或其他形式的烟草中的化学物质可能阻止或减缓愈合，而且会污染创伤点。吸烟这个行为可能会使血凝块过早地物理脱落。
• 口服避孕药。口服避孕药中的高水平雌激素可能干扰正常愈合过程，增加干槽症风险。
• 不当的家庭护理。不遵守家庭护理指南和不良的口腔卫生可能增加干槽症风险。
• 既往干槽症经历。如果您曾患过干槽症，您下次拔牙后更有可能患干槽症。
• 牙齿或牙龈感染。拔牙周围当前或之前受到感染会增加干槽症风险。

并发症

疼痛、干槽症很少导致感染或严重并发症。然而，潜在并发症可能包括牙槽愈合延迟或感染，或进展为慢性骨感染（骨髓炎）。

预防

手术前您可以做些什么

您可以采取以下步骤来预防干槽症：

• 寻求有拔牙经验的牙医或口腔外科医生。
• 如果可能，请尝试戒烟，因为抽烟和使用其他烟草产品会增加干槽症的风险。考虑与您的医生或牙医讨论可以帮助您永久戒烟的计划。
• 与您的牙医或口腔外科医生谈谈您正在服用的任何处方药或非处方药或补充剂，因为它们可能会干扰血液凝固。

您的牙医或口腔外科医生可能会做什么

您的牙医或口腔外科医生将采取许多步骤以确保牙槽窝正常愈合并防止干槽症。这些步骤可能包括推荐以下一种或多种药物，这可能有助于防止干槽症：

• 手术前后立即使用抗菌漱口水或凝胶
• 口服抗生素，尤其是在免疫系统受损的情况下
• 涂抹伤口的消毒液
• 手术后使用药物敷料

手术后您能做什么

您将得到医嘱，说明拔牙后愈合过程中可能出现的情况以及如何护理伤口。拔牙后在家中正确护理有助于促进愈合并防止伤口损伤。这些说明可能涉及以下问题，并有助于防止干槽症：

• 活动。拔牙手术后，请计划好在当天剩余时间内休息。请遵循您的牙医或口腔外科医生的建议，了解应何时恢复正常活动以及在多久时间内避免可能会导致牙槽中的血块脱落的剧烈锻炼和运动。
• 疼痛管理。拔牙后的第一天，冷敷面部外侧，然后热敷，以帮助减轻疼痛和肿胀。请按照牙医或口腔外科医生的指示对面部进行热敷或冷敷。按照处方服用止痛药。
• 饮料。拔牙手术后要多喝水。如果牙医或口腔外科医生建议，就应避免喝酒精饮料、咖啡因饮料、碳酸饮料或热饮。至少一个星期不用吸管喝水，因为吸吮动作可能会使牙槽中的血块脱落。
• 食物。拔牙手术当天只吃软食，例如酸奶或苹果酱。麻醉效果消失前，小心冷、热液体并留意不要咬伤脸颊。如果可以忍受，就可开始吃半软食品。避免用口腔的手术侧进行咀嚼。
• 清洁口腔。拔牙手术后，您可以轻轻地漱口并刷牙，但应在最初 24 小时内避开拔取部位。24 小时之后，请在手术后的一周内每天几次用温盐水轻轻漱口。请用 1/2 茶匙（2.5 毫升）食盐配 8 盎司（237 毫升）水的温盐水。遵循牙医或口腔外科医生的嘱托。
• 烟草使用。如果您吸烟或使用烟草制品，请在手术后至少 48 小时内不要吸烟，并且此后也尽量避免。口腔外科手术后使用任何烟草制品都会延误愈合并增加发生并发症的风险。

What your dentist or oral surgeon may do

Your dentist or oral surgeon can take steps to help with proper healing of the socket and prevent dry socket. These steps may include recommending one or more of these medicines, which may help prevent dry socket and infections:

• Dressing with medicine to put on the wound after surgery.
• Antibacterial mouthwashes or gels immediately before and after surgery.
• Antiseptic solutions to put on the wound.
• Oral antibiotics, usually only if you have a weakened immune system.

What you can do after surgery

Your dentist or oral surgeon can give you instructions about what to expect during the healing process after a tooth removal and how to care for the site. Proper at-home care after a tooth removal helps with healing and prevents damage to the wound. To help prevent dry socket, instructions will likely include:

• Activity. After your surgery, plan to rest for that day. Follow instructions from your dentist or oral surgeon about when you can return to your usual activities. Also follow instructions about how long to avoid vigorous exercise and sports that might cause the blood clot to come out of the socket.
• Pain management. Put cold packs on the outside of your face on the first day after tooth removal. After the first day, warm packs may help. Cold and warm packs can help decrease pain and swelling. Follow instructions from your dentist or oral surgeon about putting cold or heat on your face. Take pain medicines as prescribed.
• Beverages. Drink lots of water after the surgery. Avoid alcoholic, caffeinated, carbonated or hot beverages for as long as recommended. Do not drink with a straw for at least a week. The sucking action may cause the blood clot to come out of the socket.
• Food. Eat only soft foods, such as yogurt or applesauce, for the first day. Be careful with hot and cold liquids or biting your cheek until the numbness wears off. When you feel ready, start eating foods that do not need a lot of chewing. Avoid chewing on the surgery side of your mouth.
• Cleaning your mouth. After surgery, you may gently rinse your mouth and brush your teeth, but avoid the site where the tooth was removed for the first 24 hours. After the first 24 hours, gently rinse your mouth with warm salt water several times a day for a week after your surgery. Mix 1/2 teaspoon (2.5 milliliters) of table salt in 8 ounces (237 milliliters) of water. Follow the instructions from your dentist or oral surgeon.
• Tobacco use. If you smoke or use tobacco, do not do so for at least 48 hours after surgery and as long as you can after that. Using tobacco products after oral surgery can slow healing and increase the risk of complications.