Episodes & Posts
Episodes
Posts
27 APR 2022 · MEDICAL EMERGENCIES
SYNCOPE
- Most common in dental clinic
- Most common complication of LA injection – due to fear
- Cause is anxiety
- Most frequent cause of fainting in dental office - vasovagal syncope/ shock
- Rx is leg end elevation or lie in supine position
- Ammonia smell – hypoglycemia precipitates a syncope
ALLERGY
- C/F – urticarial – red rashes on skin with itchiness & irritability.
- Rx
o Antihistamine
o Steroid
o Patient has penicillin allergy only
DIABETES AND FEBRILE TEMPERATURE ABOVE 102° C
- Always under antibiotic coverage for dental procedure
- Must be below 120
- 100 is normal
- Morning aapointments
- Dry mouth, xerostomia, perio problems, sometimes caries
HYPERTENSION
- If BP shows 210/100 – refer to physician & postpond the treatment.
- Don’t try LA WITHOUT ADRENALINE
- OR DON’T SIMPLY THINK THAT ITS BECAUSE OF FEAR FROM DENTAL SHOW, esp if BP repeatedly shows high ok!
ANAPHYLAXIS
- C/F – broncho constriction
o Palpitation
- Rx – 1:1000 adrenaline IM/ SubCutaneous MOH**
ANGINA PECTORIS
- Rx –
o Glyceryl trinitrate
o Isosorbyl dinitrate } sublingual tabs
o Nitroglycerin
MYOCARDIAL INFARCTION
- All elective Rx to be done after 6 months
- Even RCT contra – indicated in recent MI
HEART FAILURE
- Rx
o Treat the patient in upright position or reclined position
ASTHMA
- Constriction & inflammation of bronchiolesAvoid NSAIDS
- Rx
o Always with inhaler (bronchodialator)
o In upright position.
o ACUTE CASES – administer Epinephrine, subcutaneous 1:1000************
CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD)
- 2 – 3 litres of O2 to be given prior to procedure
- O2 mask given to patient
- Never put mask directly on mouth
HYPERVENTILATION
- Low CO2 in body –
- Therefore treatment is CO2 administration
- How can you do that – ask patient to breathe into paper bag(not plastic)
- Caused due to anxiety
RENAL FAILURE
- Surgical procedure best done 24 hours after dialysis
27 APR 2022 · INFECTIVE ENDOCARDITIS
- Subacute infection / bacterial endocarditis — present in already diseased heart patient conditions like
o Ventricular septal defect
o Mitral regurgitation (MR)
o Valve replacement
o Down’s syndrome
o Congenital heart disease
- If surgery done - it will lead to mitral stenosis, bacteremia and septicimia
- Bacteria responsible – streptococcus viridans group: Sanguis , Mitis
- If such patients has to undergo dental procedure that involves gum bleeding – give prophylaxis
- I] Procedures requiring prophylaxis
o Extraction
o Banding on molars
o Intraligamentary injection
o Scaling (deep)
- II] No prophylaxis needed
o RCT
o Bonding
o Nerve block
o Supragingival scaling
- PROPHYLAXIS : [I AND II present in patients]
o Amoxycillin 2grams – most common I E prophylaxis
o For pedo – amox 50mg/kg body weight (either or or options)****
o 1⁄2 to 1 hour before the procedure
o Another choice – cephalosporin prophylaxis
o If allergic to penicillin and cephalosporin
- Azithromycin
o If asthmatic patient under theophylline is allergic to penicillin
- Ciprofloxacin
- Because azithromycin is contra indicated to theophylin
o PROSTHETIC VALVE PATIENT**
- Prophylaxis is must
- Than MI or even recent bypass surgery
o If patient is unconscious and allergic to penicillin
- Clindamycin , ciprofloxacin
PENICILLIN
- Mech Of Action – inhibit cell wall synthesis
- Complications – urticarial, angioedema, swelling in throat /mouth, wheezing, anaphylaxis
- Rx : 1:1000 adrenaline/epinephrine injection
ANTIPLATELET DRUG
- Bleeding time
- ASPIRIN THERAPY
27 APR 2022 · ANTICOAGULANT THERAPY
PT (prothrombin time) → tested for Anticoagulant, liver damage (from alcoholism), vit k deficiency patients
PTT (plasma thromboplastin time) → HEPARIN, Renal dialysis, haemophilia pts
INR- INTERNATIONAL NOMINALIZED RATIO (Patient PT/ Control PT) → WARFARIN/COUMIDAN- anticoagulant
- PROTHROMBIIN TIME
- NORMAL INR IS 1
- IF MORE THAN 1 – BLEEEDER
- IF LESS THAN 1 - CLOTTER
- INR SHOULD BE 2-3 FOR EXTRACTION IS OKAY
- IF UNDER WARFARIN, might have more inr, so need to check
27 APR 2022 · EXTRACTION
ABSOLUTE CONTRA–INDICATION
- Central hemangioma
- A V fistula
BONE SWAGGING – pushing bone into contact with root surface without # the
bone at its base.
SEQUENCE OF EXTRACTION
a) Maxilla followed by mandible
b) Posterior followed by anterior
c) 8.7.5.4.2.1.6.3
- Fibre injure – dentogingival fibre – 1st fibre torn while extracting****
- Pure rotation — maxillary CI, PM mandibular
- More palatal — maxillary primary molars
- Alveoloplasty — after multiple extraction
o To reduce severe labial undercuts
27 APR 2022 · COMPLICATIONS OF EXTRACTIONS
➣ Most common during extraction — haemorrhage / bleeding
- Rx – localized application of pressure
➣ Most common after extraction —
- Dry socket (alveolar Osteitis) (3-4 days after extraction)****
- Cause is dislodgement or disintegration of clot
- Patient comes with pain 3 – 4 days after extraction (because until thes time they are under medication for extraction)
- Common sites – mandibular 3rd Molar
- Rx
o Sedative dressing ZnO
o Eugenol for every 24 hours
- Precipitating factors
o Smoking
o Oral contraceptives
➣ Most common for maxillary posterior
- Oro – antral fistula
- Maxillary 1st Molar > maxillary 2nd p Molar
- Tooth closest to maxillary sinus is maxillary 1st followed by maxillary 2nd PM
- Which tooth has root that is mostly pushed into sinus when extraction ➝ PALATAL ROOT of Max first molar !!***
- Rx
o Below 2 mm – no Rx req
o 2 - 6 mm — tight suture
o More than 6 mm — flap placement (from buccal to palatal)
➣ Most common with Maxillary 3rd molar
- Tuberosity fracture
- Rx
o If teeth is not attached to #ed maxillary tuberosity **, remove teeth, replace the tuberosity bone and tight
o Suture in the soft tissue.
o If teeth attached to #ed tuberosity, place tooth back and splint with metal wire to adjacent tooth and remove after 6 months
➣ While removing maxillary tori, nasal cavity is exposed
27 APR 2022 · INCISION AND DRAINAGE (NO:11 BLADE)
- Need not require antibiotic prophylaxis unless the patient is diabetic or febrile 102°C
- Other cases — Do I&D — followed by antibiotics
- Site — most prominent fluctuant portion of swelling — BEST SITE
NOTE- IF THE SITE IS necrotic, by gravity principle the site of I and D is bottom of
the swelling
SPACE INFECTION
SUBLINGUAL SPACE INFECTION
- Shows change in colour in the floor of mouth
- Tongue will be elevated
- Incision to be done intraorally parallel to wharton’s duct***
SUBMANDIBULAR SPACE INFECTION
- Rx
o Extraorally at the angle of mandible
- I & Dto be done
o The drain to be saturated to muscle
27 APR 2022 · IMPACTION
W – winter WAR lines
H – height of mandible outline – easy for extraction
A – angulation of tooth – mesio angular – easiest
(most common) - disto – difficult ( least common)
R – root type – convergent root – easy
F – follicle – large follicle – easiest
Mesio - angular, converging roots, large follicle “EASY”
Disto - angular, divergent roots, small follicle, “DIFFICULT”
Horizontal – requires sectioning of tooth**********
QN Palatal root of upper 6 is the most pushed in max. sinus.
QN Factors that make surgery more difficult:- Distoangular, thin follicle, narrow PL, & divergent
curved.
OCCLUSAL XRAY ➝ BEST FOR IMPACTED LOWER CANINE
27 APR 2022 · SUTURE
- Needle – 3/8th curved, reverse cutting edge is commonly used in dentistry for perio, surgical extraction etc.
- Needle should be held at 2/3rd from the tip or 1/3rd from the eyelet
- In 3rd M surgery, most commonly used needle holder intra orally — curved hemostat or artery forceps
SUTUTRE MATERIALS:-
- Most commonly used material intra orally — 3.0 black braided silk
Resorbable
Eg: Catgut – 8 days
o Shouldn’t sterilize in autoclave because cattle protein will get denatured
o Sterilize using 70% isopropyl alcohol
◾ Best % /concentration of alcohol for sterilization purpose
o Normal catgut will completely resorb by 70 days
o Eg: chromium catgut (12-15 days)
◾ Catgut coated with chromium layer
◾ Advantages — increase tensile + increase life span
◾ Main use in oro antral fistula suture
Eg: Vicryl
◾ Made of polyglycolic acid
Non – resorbable
◾ Eg: nylon
◾ Silk (BBS)
◾ Prolene
Blood clot suture to return blood in its place = figure of 8
HEMOSTAT
a) Gelatin sponge
b) Bone wax
c) Oxidized cellulose – MOST EFFICIENT**
d) d-cotton soaked in epinephrine
27 APR 2022 · INSTRUMENTS
ELEVATORS
- Commonly used intra oral periosteal elevator — 9 molt
- Commonly used extraction elevator — straight elevator
- Commonly used to remove #ed root tip — apexo elevator
- Commonly used to remove mandibular # M root tip – crier
PRINCIPLE OF ELEVATORS
- Mechanical advantage — wheel and axle principle
- Wedge principle – adjacent tooth should be present
o done for bone dialation
- Lever principle — interdental bone breakage
o Wedging of socket wall not uses elevator
EXTRACTION FORCEPS
- For Mandibular 1st M — NO. 11 (a type of cowhorn)
- For Maxillary anterior – No. 150
- For Maxillary PMS- NO.1 UNIVERSAL *****
- For Mandibular anterior and PM — No. 151
TISSUE FORCEPS
- Most commonly used — Addison’s forceps
- Most for 3rd M region tissue holding flap — Stills forceps
- Epulis fissuratum — Allis forceps
- To hold a tooth that is luxated from socket — Russian forceps
- To raise flap from inner side of upper lip — Metzehaum forceps
- Suture forceps after mandibular 3rd M extraction — curved hemostat
- To retract cheek and buccal periosteum – Minnesota Retractor
- For dentoalveolar # in maxilla (Lefort I) — Roud disimpaction forceps
o (ENGAGE AT HARD PALATE ALONG NASAL FLOOR)
- Nasomaxillary # in maxilla — Arch forceps or walsham forceps
BONE FILE
- Used to remove sharp edges after extraction
- Used in ALVEOLOPLASY process for smoothening of bony edges!***
SURGICAL BLADES
1) BP No.15 blade – most common intra oral surgery**
2) No.12 blade – most common periodontal surgery
3) No.11 blade – stab incision (I& D)**
Most important sign of fracture of mandible is Malocclusion
1. QN- Walsham's Forceps: for nasal fracture treatment
2. QN Ach’s Forceps For nasal bone straightening
3. QN Allis Forceps: to hold tissues prior to excision
4. QN Addison Forceps: to hold tissue flap during suturing
5. QN Stillis Forceps: It used in the posterior region in mouth where
6. QN Addison Forcep cannot reach due to its long length (7 to 9 Inches)
7. QN Artery Forceps: to ligate ruptured arteries or arteries planned to be removed
8. QN Minnesota retractor: retract flap and cheek together.
9. QN Farabeuf Retractor the retractor which retract the flap and the cheek together when doing surgery.
27 APR 2022 · MUSCLE OF MASTICATION
- Derived from 1st branchial arch
- Nerve supplied — anterior division of mandible nerve
◾ — max trunk – medial pterygoid
- Artery supplied — maxillary artery
- Accessory muscles of mastication —
o A) geniohyoid
o B) anterior belly of digastric } mouth opening or depression of mandible
o C) mylohyoid (dislodgement of the denture)
- Major muscles – masseter , temporalis, medial and lateral pterygoid
A) MASSETER
a. Present on the lateral surface of mandible
b. Closing of mouth / elevates the mandible
c. Strongest muscle of mastication that helps in slight protrusion of mandible
d. Cause for trismus in tetanus (lock jaw) = masseter
B) TEMPORALIS
a. Fan shaped muscle
b. Muscle is originated from the posterior to anterior
c. Elevation of mandible
d. Retrusion of mandible
C) MEDIAL PTERYGOID
a. Muscle present on the medial surface of ramus of mandible
b. Muscle that has to be dissected during maxillary tuberosity surgery
c. Trismus during IANB – due to needle pricking their medial pterygoid muscle
d. Elevation of mandible
e. Protrusion of mandible } actions
D) LATERAL PTERYGOID
a. Muscle of TMJ
b. Depression of mandible
c. Protrusion of mandible } actions
ELEVATION – MASSETER, M.Pterygoid, Temporalis
DEPRESSION – L. Pterygoid, mylohyoid, geniohyoid, anterior digastric.
1. QN Muscles of Mandibular movement :
2. QN Muscles elevation of the mandible: Masseter, temporalis and medial pterygoid
3. QN Muscles depression of the mandible: geniohyoid, mylohyoid, digastric, lateral pterygoid and infrahyoid
4. QN Muscles protrusion of the mandible: Lateral pterygoid, medial pterygoid assists, masseter
5. QN Muscle retraction (retruded) of the mandible: Temporalis
6. QN Muscle do lateral movement of the mandible: Lateral pterygoid, medial pterygoid.
7. QN Glenoid fossa (mandibular) found in temporal bone.
NOTE 1 — muscle involved in protrusion
— bilaterally medial pterygoid
— lateral pterygoid
NOTE 2 — in condylar #, the condyle is displaced — anteromedialy**
NOTE 3 — in TMJ dislocation, condyle is displaced – anteriorly
NOTE 4 — mandible displaces to affected side / same side aka IPSILATERAL
A) Unilateral condylar #
B) Unilateral condylar hypoplasia
C) Unilateral condylar ankylo*****
NOTE 5 — in # of body mandible, the proximal segment is displaced in
UMA — UPWARD, MEDIAL, ANTERIORLY
INTERNAL DERANGEMENT
Problem associated with defect in any of the masticatory muscle, mainly L.Pterygoid
Information
| Author | The Gulfie Dentist |
| Organization | The Gulfie Dentist |
| Categories | Courses |
| Website | - |
| - |
Copyright 2026 - Spreaker Inc. an iHeartMedia Company
