1.牙間乳(ru)(ru)突炎 由(you)于(yu)食物(wu)嵌(qian)塞引(yin)起乳(ru)(ru)突炎。有(you)自(zi)發性痛，其特點為持(chi)續(xu)性脹(zhang)痛，冷(leng)熱刺激(ji)痛。檢查可(ke)見牙間乳(ru)(ru)突充(chong)血水腫(zhong)，局部牙齦明顯(xian)觸痛，常可(ke)見有(you)食物(wu)嵌(qian)塞于(yu)鄰間隙。

　　2.三叉神經痛 三叉(cha)神(shen)經(jing)痛(tong)(tong)(tong)性質為(wei)銳痛(tong)(tong)(tong)，突然(ran)發(fa)(fa)(fa)作，疼(teng)痛(tong)(tong)(tong)劇(ju)烈(lie)像撕裂樣，有(you)反射痛(tong)(tong)(tong)，并沿三叉(cha)神(shen)經(jing)分布。與急性區(qu)別(bie)點是(shi)三叉(cha)神(shen)經(jing)痛(tong)(tong)(tong)很少(shao)在夜間發(fa)(fa)(fa)作，多因在、說活誘發(fa)(fa)(fa)，每次發(fa)(fa)(fa)作時(shi)間短暫，持續數秒至1、2分鐘(zhong)，很少(shao)持續超過5分鐘(zhong)。冷熱刺(ci)激不引(yin)起疼(teng)痛(tong)(tong)(tong)，有(you)疼(teng)痛(tong)(tong)(tong)接點稱為(wei)“板機點”，觸(chu)及此(ci)處則引(yin)起疼(teng)痛(tong)(tong)(tong)發(fa)(fa)(fa)作。

　　3.急性(xing)(xing)上(shang)(shang)(shang)頜(he)(he)竇炎 急性(xing)(xing)上(shang)(shang)(shang)頜(he)(he)竇炎患者常(chang)以(yi)上(shang)(shang)(shang)頜(he)(he)就(jiu)診。因上(shang)(shang)(shang)頜(he)(he)后牙(ya)的牙(ya)根接(jie)的上(shang)(shang)(shang)頜(he)(he)竇底，分布上(shang)(shang)(shang)頜(he)(he)后牙(ya)牙(ya)髓(sui)神(shen)經在(zai)入根尖孔前(qian)經上(shang)(shang)(shang)頜(he)(he)竇側壁和竇底，故上(shang)(shang)(shang)頜(he)(he)竇內的感染常(chang)引起上(shang)(shang)(shang)頜(he)(he)后牙(ya)的神(shen)經痛(tong)(tong)，并反射(she)患側頭(tou)面部痛(tong)(tong)，很(hen)像急性(xing)(xing)牙(ya)髓(sui)炎，所以(yi)應加以(yi)區別。其(qi)特點是：急性(xing)(xing)上(shang)(shang)(shang)頜(he)(he)竇炎疼痛(tong)(tong)為持續性(xing)(xing)脹痛(tong)(tong)，可累及上(shang)(shang)(shang)頜(he)(he)尖牙(ya)、雙尖牙(ya)、磨牙(ya)區。檢查(cha)(cha)叩痛(tong)(tong)。患者常(chang)有、鼻阻及流膿鼻涕歷史。檢查(cha)(cha)上(shang)(shang)(shang)頜(he)(he)竇前(qian)壁壓(ya)痛(tong)(tong)，若化膿做(zuo)副鼻竇穿刺(ci)，可有膿液流出。

　　4.慢性(xing)(xing)增生(sheng)性(xing)(xing)牙(ya)(ya)髓炎（1）牙(ya)(ya)齦息(xi)(xi)(xi)肉(rou)(rou) 多(duo)系鄰(lin)面(mian)齲損牙(ya)(ya)齦長(chang)入(ru)(ru)洞內形成(cheng)息(xi)(xi)(xi)肉(rou)(rou)。檢查時探(tan)(tan)針撥動息(xi)(xi)(xi)肉(rou)(rou)蒂與牙(ya)(ya)齦相連(lian)。（2）牙(ya)(ya)周膜(mo)息(xi)(xi)(xi)肉(rou)(rou) 由于多(duo)根(gen)(gen)牙(ya)(ya)破壞(huai)大(da)，髓底穿通，根(gen)(gen)分叉穿通，長(chang)期慢性(xing)(xing)刺激，引起牙(ya)(ya)周膜(mo)增生(sheng)，穿入(ru)(ru)孔內形成(cheng)牙(ya)(ya)周膜(mo)息(xi)(xi)(xi)肉(rou)(rou)。息(xi)(xi)(xi)肉(rou)(rou)蒂是與牙(ya)(ya)周膜(mo)相連(lian)，探(tan)(tan)針檢查可(ke)插(cha)入(ru)(ru)髓底直達根(gen)(gen)分叉，但探(tan)(tan)痛(tong)不明顯。

　　5.慢性閉鎖性牙(ya)髓(sui)炎（1）深(shen)齲 患牙(ya)對冷(leng)熱酸甜(tian)均感(gan)疼痛(tong)(tong)，無(wu)(wu)自(zi)(zi)發痛(tong)(tong)。深(shen)齲洞探診敏感(gan)，無(wu)(wu)叩痛(tong)(tong)。溫度測試敏感(gan)，電(dian)活力測試正(zheng)常。2）牙(ya)髓(sui)充血 患牙(ya)對冷(leng)熱刺(ci)(ci)激敏感(gan)，尤其是冷(leng)刺(ci)(ci)激更(geng)為敏感(gan)，無(wu)(wu)自(zi)(zi)發痛(tong)(tong)，疼痛(tong)(tong)性質為銳(rui)痛(tong)(tong)。無(wu)(wu)叩痛(tong)(tong)，電(dian)活力測試讀數低于(yu)正(zheng)常。

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