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Oral Surgery And Oral Infections Oral Surgery And Oral Infections Dr shabeel

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Oral Surgery And Oral Infections Oral Surgery And Oral Infections Dr shabeel Powered By Docstoc
					Oral Surgery And Oral
      Infections



      Dr shabeel pn
Oral Surgery

• Includes: The diagnostic and surgical
 treatment of diseases, injuries, and
 defects involving both the junctional and
 the esthetic aspects of the hard and soft
 tissues of the oral and maxillofacial
 regions.
Types of Oral Surgery
•   Impacted tooth removal
•   Alveoplasty
•   Abscesses
•   Osteomyelitis
•   Fractures
•   Cysts, tumors
•   Dental implant placement
•   Maxillofacial prosthetics
•   Immediate denture
•   Facial esthetics
•   Cleft lip/ palate
•   TMJ disorders
•   Salivary Gland Obstruction
Patient Instructions

• Have the client use a soft tooth brush with a simple brushing
  technique.
• Give instructions of prosthesis care.
• Recommend what to include and not include in the diet.
       • Promotion of healing
                     Protein, vitamin A, C, and Riboflavin
        • Tissue resistance
                     Diet variation including all food groups
• Provide instruction sheets for clients to take home.
• When instructing about diet, explain in quantity or servings.
Pre-surgical Instructions
• Explain procedures for anasthesia and surgery
• Explain alcohol and medication restrictions
        • Some medications will interfere with the anasthetic and other drugs
          provided during or after the treatment
• Assess whether the client will need transportation to and
    from the appt. ie. when sedation is used…
•   Tell them to get a good nights rest the night before.
•   Wear loose and comfortable clothing.
•   Ask to remove contact lenses or any prosthesis.
•   Explain the number of hours before surgery the client
    should stop their intake of food and liquid.
Post-surgical Instructions
• If bleeding persists, place a gauze pad or cold wet tea bag over the area for
    ½ hr. Bite firmly!
•   Don’t rinse for 24 hours.
•   After 24 hours rinse with warm salt water after brushing and every 2 hours.
•   Brush more thoroughly but avoid area of surgery.
•   Get at least 8 – 10 hours of rest each night.
•   Avoid strenuous exercise for the first 24 hours.
•   Don’t smoke for 24 hours.
•   Use a pain relieving medication prescribed by the dentist.
•   Apply ice pack 15 min on and 15 min off.
•   Include phone number the client can call after hours in case of
    complications.
•   Do not suck from a straw for 24 hours
Diet

• Indications for a Liquid Diet
     • Jaws wired together
     • All clients who have a condition that makes it hard
       to open their mouth
• Indications for a Soft Diet
     • Client with no appliance or with a single appliance
     • Client who has been maintained on liquid diet
       throughout the treatment period.
Diet Planning Hints

• This is for the client who isn’t hospitalized
     • Provide instruction sheets
     • Explain nutritional needs in servings
     • Show ways to vary the diet
     • Suggest the limitation of cariogenic foods
Client Preparation
• Reduce the bacteria count
         • Makes post-surgical infection less likely
•   Reduce inflammation
         • Will lessen bleeding during surgery
         • Promotes healing
•   Remove calculus
         • Prevents interference with the placement of surgical instruments
         • Prevents the breaking off of calculus
•   Instruct the client in personal oral care
•   Interpret dentists directions
•   Motivate the client who will have remaining teeth
         • Prevents further tooth loss
•   A complete debridement should be scheduled for a few weeks after
    surgery to insure the prevention of infection and assess tiissues.
• The DH or DA may participate in suture
 removal, irrigation of the sockets, and
 other post surgical procedures when the
 client returns for his/her follow up.
DA’s Responsibilities

• Maintain a clear surgical field
• Observe vital signs
• Reassure the client and help them to relax
• Provide pre/post operative instructions
• Make follow up call
• DA MUST ASK IF THE CLIENT HAS TAKEN
 PRE MEDS IF REQUIRED!!!
Holistic Approaches to OS
• Apply annatto after tooth extraction or gum surgery.
• Drink catnip tea or take in capsules to help you relax
    before dental treatment
•   Use chamomile as a poultice for pain and swelling.
•   Soak a washcloth in warm comfrey tea and use as a
    compress to relieve the pain of jaw and tooth fractures.
•   St. John's wort is given to people for neuralgic pains
    after tooth extractions.
•   Use the fresh tops of shepherd's purse to help stop
    bleeding after tooth extraction
Holistic Cont.
Use of Magnets can:
• Acceleration of growth of new cells (speeding up
  wound healing processes)
• Suppression of pain (analgesic effect)
• Suppression of inflammation
• Widening of blood vessels
• Improving tissue flexibility
• Eliminating swelling
• Strengthening immunity
• Stimulating and stabilizing bone tissues
• Dramatic improvements in effectiveness of
  prescription medication and supplemental
  nutrients, vitamins and minerals
Infections related to Oral Surgery

• Osteomyelitis



• Pericoronitis
Osteomyelitis
• An inflammation of
  the bone marrow that
  produces pus and
  affects the calcified
  components of bone.
Causes

• 1. acute periapical infection
  2. pericoronitis
  3. acute periodontal lesions
  4. trauma-fractures and extraction of
  teeth
  5. acute infection of the maxillary sinus
How is it Diagnosed?
•   Complete blood count
•   Erythrocyte sedimentation rate
•   C-reactive protein
•   Needle aspiration or bone biopsy
•   X-rays
•   Radionuclide bone scans
•   CAT scans
•   MRI
•   Ultrasound
Signs and Symptoms
• severe pain
• regional lymphadenopathy
• soreness of the involved teeth
• if the infection involves the mandibular canal, a
  paresthesia of the lip is common
• On radiographs:
  decreased density of trabeculae
• multiple small radiolucent areas become
  apparent
• sequestra - irregular calcified areas separate from
  remaining bone
Tx of Osteomyelitis
• Teeth should be extracted only when necessary
    and antibiotics should be given prior to and
    following the surgical procedure.
•   Massive doses of antibiotics, usually one of the
    penicillin drugs, are given for at least six weeks.
•   A surgeon may perform a bone biopsy to see if
    an abscess has formed on the bone. If an
    abscess is found, antibiotics are given and
    surgery is performed to remove the abscess.
•   If pus has formed, it is sometimes necessary to
    drain the bone by drilling holes in it.
Tx Cont.

• Restrict the movement of the area as
  much as possible.
• Monitored blood tests and x-rays.
Holistic Tx of Osteomyelitis

• Hepar sulphuris – pain, swelling, infection
• Chamomile -pain and swelling
• Witch Hazel – helps fight infections and
 cleanses mouth
Pericoronitis
• Inflammation of the gingiva around a
  partially erupted tooth.
• Resulting from debris accumulating under
  the flap of tissue.
• Or from constant contact between the flap
  and the tooth in the opposing arch.
• Usually occurs in teenagers and young
  adults.
Pericoronitis Cont.
• Usually affects the
  mandibular third
  molars.
Signs & Symptoms
•   Pain when chewing
•   Bad taste
•   Trismus
•   Swelling in the neck and in the area of the tooth
•   Fever
•   Partially erupted tooth
•   Red inflammed tissue around the partially erupted tooth
•   Pus
•   Pain when touched
•   Enlarged lymph nodes
Treatment
• Irrigate under the flap of tissue with warm saline
    solution.
•   Gently clean with a scaler
•   Instruct the client to rinse with warm saline
    solution every 2 hours
•   Antibiotics
•   Surgical removal of the flap after antibiotic
    therapy
•   Third molar extraction
Homeopathic Tx
• Dandelion is useful for treating abscesses in the mouth
• Combined with myrrh and licorice root, echinacea is
    excellent for the treatment of abscesses in the mouth.
•   Rub eucalyptus oil or evening primrose on sore, inflamed
    gums for temporary relief
•   Use a horsetail mouthwash to relieve mouth and gum
    infections.
•   Red clover ointment can treat abscesses.
•   For pain and inflammation around wisdom teeth,
    Belladonna is often given for throbbing pains and Hepar
    sulph to promote expulsion of pus.
Other Oral Infections
• Herpes




• Thrush
What is Oral Thrush?
• It is an infection in the oral
   cavity of yeast fungus, Candida
   albicans. It affects the
   mucous membranes of the
   mouth. It causes white
   patched in the mouth that can
   be very painful and make
   swallowing and chewing
   difficult.
• Thrush effecting the
   mouth and throat is also
   known as oropharyngeal
   candidiasis
How do you get Thrush?
• Thrush also known as Candida, does not
    become a problem until the natural flora of the
    mouth is disturbed, favoring candida over the
    other microorganisms of the oral cavity.
•   This disturbance of the oral cavity can be caused
    by a number of factors such as, taking
    antibiotics, or chemotherapy. Systemic
    problems can also cause an imbalance; diabetes,
    malnutrition, drug abuse, or immune deficiencies
    such as AIDS or deficiencies related to old age.
Thrush Cont.
• Those who have dentures that do not fit
 well can suffer from breaks in the mucous
 membranes of the oral cavity. This can
 act as a gateway for candida. Those who
 have suffered from this problem show
 evidence of it when they have moist, pale
 pink spots on their lips. These spots are
 known as angular chelitis. This is a clear
 indication of candida infection.
Symptoms of Thrush

• White cream coloured or yellow slightly
  raised spots in the mouth.
• When the creamy substance is scraped
  away wounds will be present and will
  bleed slightly.
• A burning sensation may be felt in the
  mouth and throat area.
Treatment
• Get the main condition that caused the thrush
    under control.
•   Anti-fungal drugs will have to be either sucked
    on or a liquid that must be held in the mouth
    before swallowing to eliminate the fungus.
•   If it spreads or becomes complicated, systemic
    treatment in the form of tablet or injection may
    be needed.
Coping with the Symptoms of
Thrush
• Thrush can make the
    mouth very sensitive,
    this can make oral
    hygiene very difficult
    to maintain.
•   Use an extra soft
    toothbrush.
•   It is also helpful to
    rinse with a diluted
    solution of 3%
    hydrogen peroxide.
Foods to Avoid if you have Thrush
•   Yeast- breads, crackers, pastries
•   Fruit Juices- canned, bottled or frozen
•   Coffee and Tea- Regular, instant, decaffeinated. Herbal teas are tolerated
•   Caffeine- anything containing caffeine
•   Dairy or Dairy Containing Products
•   Black Pepper- hard to digest. Cayenne pepper is a recommended
    alternative as it promotes digestion.
•   Any type of mushroom
•   Pickled and smoked meats, including sausages, hot dogs, corned beef,
    pastrami, and ham.
•   Condiments, Sauces, and Vinegar-Containing Foods
•   Dried, candied fruits.
•   Leftovers, best to eat fresh foods due to mold growth.
Foods Recommended
•   Vegetables and Legumes
•   Fish/Shell fish, meat, poultry
•   Whole grains
•   Nuts
•   Fruits – avoid for 3 months then reintroduce 1 at a time on an
    empty stomach
•   Seeds such as pumpkin, sesame and sunflower
•   Non grain such as Amaranth, buckwheat and quinoa
•   Butters (almond, sesame and sunflower)
•   Fats (Butters or unrefined oils
Herpes
• Herpes simplex is a common and usually mild
    infection
•   A virus causes herpes
•   Causes cold sores or fever blisters on the mouth
    and face
•   Once introduced to the body it will live there for
    a lifetime
•   Often with periodic symptoms or no symptoms
    at all
Herpes Symptoms
• Can take 4-6 weeks
    to heal fully
•   May cause small
    pimples or blisters
    which will eventually
    crust over and scab
•   May cause flu like
    symptoms; fever,
    swollen glands in
    lymph nodes in the
    head and neck region
How often will it occur? Why?
• depends upon the HSV type and how long the
    infection has resided in the body
•   prolonged exposure to strong sunlight can
    trigger oral herpes
•   individuals will discover what triggers outbreaks
    in their own bodies
•   people who experience a strong initial outbreak
    can expect to have several recurrences a year
How is it Spread?

• Skin to skin contact
• if you have a “cold sore” and kiss
  someone, the virus will be transferred to
  that person
• if you have a “cold sore” and have oral
  sex, your partner will get genital herpes
Herpes Tx
• no treatment or medication that will cure herpes
    but there is some to control it
•   3 most common meds: Acyclovir (Zovirax),
    Valacyclovir (Valtrex) and Famciclovir (Famvir)
• Episodic therapy means taking the medication
    only during an outbreak to speed up the healing
    process
•   Suppressive therapy means taking antiviral
    medication daily
Holistic Tx
• Whole olive leaves can be boiled in water or treated with
    wine to make a remedy
•   carbohydrates from red marine algae is a low-cost, high
    potential, broad spectrum antiviral agent
•   As a mild antiseptic, Sage will help heal coldsores
•   Rub tea tree oil directly on cold sores to promote healing
•   Use a salve made of thyme, myrrh, and goldenseal to
    treat oral herpes
•   A mouthwash made from violet soothes coldsores
•   Capsicum, Dulcamara, Kali muriaticum, Kreosotum, and
    Upas tiente all assist tin the relief of oral herpes.
The End