Oral Surgery And Oral Infections

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Oral Surgery And Oral Infections

• Dr shabeel pn

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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.

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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

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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.

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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.

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Post-surgical Instructions

• If bleeding persists, place a gauze pad or cold
  wet tea bag over the area for ½ hr. Bite firmly!
• Dont 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.
• Dont 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

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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.

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Diet Planning Hints

• This is for the client who isnt hospitalized
• Provide instruction sheets
• Explain nutritional needs in servings
• Show ways to vary the diet
• Suggest the limitation of cariogenic foods

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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.

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• 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.

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DAs 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!!!

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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

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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

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Infections related to Oral Surgery

• Osteomyelitis
• Pericoronitis

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Osteomyelitis

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

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Causes

• 1. acute periapical infection2. pericoronitis3.
  acute periodontal lesions4. trauma-fractures and
  extraction of teeth5. acute infection of the
  maxillary sinus

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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

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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 radiographsdecreased density of trabeculae
• multiple small radiolucent areas become apparent
  
• sequestra - irregular calcified areas separate
  fromremaining bone

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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.

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Tx Cont.

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

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Holistic Tx of Osteomyelitis

• Hepar sulphuris pain, swelling, infection
• Chamomile -pain and swelling
• Witch Hazel helps fight infections and cleanses
  mouth

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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.

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Pericoronitis Cont.

• Usually affects the mandibular third molars.

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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

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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

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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.

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Other Oral Infections

• Herpes
• Thrush

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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

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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.

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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.

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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.

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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.

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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.

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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.

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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

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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

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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

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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

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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

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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

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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.

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• The End