Oral Surgery And Oral Oral Surgery And Oral InfectionsInfections

Dr shabeel pnDr shabeel pn

Oral SurgeryOral Surgery

• Includes: The diagnostic and surgical Includes: The diagnostic and surgical treatment of diseases, injuries, and treatment of diseases, injuries, and defects involving both the junctional defects involving both the junctional and the esthetic aspects of the hard and the esthetic aspects of the hard and soft tissues of the oral and and soft tissues of the oral and maxillofacial regions.maxillofacial regions.

Types of Oral SurgeryTypes of Oral Surgery

• Impacted tooth removalImpacted tooth removal• AlveoplastyAlveoplasty• AbscessesAbscesses• OsteomyelitisOsteomyelitis• FracturesFractures• Cysts, tumorsCysts, tumors• Dental implant placementDental implant placement• Maxillofacial prostheticsMaxillofacial prosthetics• Immediate dentureImmediate denture• Facial estheticsFacial esthetics• Cleft lip/ palateCleft lip/ palate• TMJ disordersTMJ disorders• Salivary Gland ObstructionSalivary Gland Obstruction

Patient InstructionsPatient Instructions

• Have the client use a soft tooth brush with a simple Have the client use a soft tooth brush with a simple brushing technique.brushing technique.

• Give instructions of prosthesis care.Give instructions of prosthesis care.

• Recommend what to include and not include in the diet.Recommend what to include and not include in the diet.• Promotion of healingPromotion of healing

Protein, vitamin A, C, and RiboflavinProtein, vitamin A, C, and Riboflavin

• Tissue resistanceTissue resistance Diet variation including all food groupsDiet variation including all food groups

• Provide instruction sheets for clients to take home.Provide instruction sheets for clients to take home.

• When instructing about diet, explain in quantity or servings.When instructing about diet, explain in quantity or servings.

Pre-surgical InstructionsPre-surgical Instructions

• Explain procedures for anasthesia and surgeryExplain procedures for anasthesia and surgery• Explain alcohol and medication restrictionsExplain alcohol and medication restrictions

• Some medications will interfere with the anasthetic and other Some medications will interfere with the anasthetic and other drugs provided during or after the treatmentdrugs provided during or after the treatment

• Assess whether the client will need transportation Assess whether the client will need transportation to and from the appt. ie. when sedation is used…to and from the appt. ie. when sedation is used…

• Tell them to get a good nights rest the night before.Tell them to get a good nights rest the night before.• Wear loose and comfortable clothing.Wear loose and comfortable clothing.• Ask to remove contact lenses or any prosthesis.Ask to remove contact lenses or any prosthesis.• Explain the number of hours before surgery the Explain the number of hours before surgery the

client should stop their intake of food and liquid.client should stop their intake of food and liquid.

Post-surgical InstructionsPost-surgical Instructions

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

• Don’t rinse for 24 hours. Don’t rinse for 24 hours. • After 24 hours rinse with warm salt water after brushing and every After 24 hours rinse with warm salt water after brushing and every

2 hours.2 hours.• Brush more thoroughly but avoid area of surgery.Brush more thoroughly but avoid area of surgery.• Get at least 8 – 10 hours of rest each night.Get at least 8 – 10 hours of rest each night.• Avoid strenuous exercise for the first 24 hours.Avoid strenuous exercise for the first 24 hours.• Don’t smoke for 24 hours.Don’t smoke for 24 hours.• Use a pain relieving medication prescribed by the dentist.Use a pain relieving medication prescribed by the dentist.• Apply ice pack 15 min on and 15 min off.Apply ice pack 15 min on and 15 min off.• Include phone number the client can call after hours in case of Include phone number the client can call after hours in case of

complications.complications.• Do not suck from a straw for 24 hoursDo not suck from a straw for 24 hours

DietDiet

• Indications for a Liquid DietIndications for a Liquid Diet• Jaws wired togetherJaws wired together

•All clients who have a condition that makes All clients who have a condition that makes it hard to open their mouthit hard to open their mouth

• Indications for a Soft DietIndications for a Soft Diet•Client with no appliance or with a single Client with no appliance or with a single

applianceappliance

•Client who has been maintained on liquid Client who has been maintained on liquid diet throughout the treatment period.diet throughout the treatment period.

Diet Planning HintsDiet Planning Hints

• This is for the client who isn’t This is for the client who isn’t hospitalizedhospitalized

•Provide instruction sheetsProvide instruction sheets

•Explain nutritional needs in servingsExplain nutritional needs in servings

•Show ways to vary the dietShow ways to vary the diet

•Suggest the limitation of cariogenic foodsSuggest the limitation of cariogenic foods

Client PreparationClient Preparation

• Reduce the bacteria count Reduce the bacteria count • Makes post-surgical infection less likelyMakes post-surgical infection less likely

• Reduce inflammationReduce inflammation• Will lessen bleeding during surgeryWill lessen bleeding during surgery• Promotes healingPromotes healing

• Remove calculusRemove calculus• Prevents interference with the placement of surgical instrumentsPrevents interference with the placement of surgical instruments• Prevents the breaking off of calculusPrevents the breaking off of calculus

• Instruct the client in personal oral care Instruct the client in personal oral care • Interpret dentists directionsInterpret dentists directions• Motivate the client who will have remaining teethMotivate the client who will have remaining teeth

• Prevents further tooth lossPrevents further tooth loss

• A complete debridement should be scheduled for a few A complete debridement should be scheduled for a few weeks after surgery to insure the prevention of infection weeks after surgery to insure the prevention of infection and assess tiissues.and assess tiissues.

• The DH or DA may participate in The DH or DA may participate in suture removal, irrigation of the suture removal, irrigation of the sockets, and other post surgical sockets, and other post surgical procedures when the client returns procedures when the client returns for his/her follow up.for his/her follow up.

DA’s ResponsibilitiesDA’s Responsibilities

• Maintain a clear surgical fieldMaintain a clear surgical field

• Observe vital signsObserve vital signs

• Reassure the client and help them to Reassure the client and help them to relaxrelax

• Provide pre/post operative instructionsProvide pre/post operative instructions

• Make follow up callMake follow up call

• DA MUST ASK IF THE CLIENT HAS TAKEN DA MUST ASK IF THE CLIENT HAS TAKEN PRE MEDS IF REQUIRED!!!PRE MEDS IF REQUIRED!!!

Holistic Approaches to OSHolistic Approaches to OS

• Apply annatto after tooth extraction or gum surgery. Apply annatto after tooth extraction or gum surgery.

• Drink catnip tea or take in capsules to help you relax Drink catnip tea or take in capsules to help you relax before dental treatment before dental treatment

• Use chamomile as a poultice for pain and swelling. Use chamomile as a poultice for pain and swelling.

• Soak a washcloth in warm comfrey tea and use as a Soak a washcloth in warm comfrey tea and use as a compress to relieve the pain of jaw and tooth compress to relieve the pain of jaw and tooth fractures.fractures.

• St. John's wort is given to people for neuralgic pains St. John's wort is given to people for neuralgic pains after tooth extractions. after tooth extractions.

• Use the fresh tops of shepherd's purse to help stop Use the fresh tops of shepherd's purse to help stop bleeding after tooth extraction bleeding after tooth extraction

Holistic Cont.Holistic Cont.Use of Magnets can:Use of Magnets can:• Acceleration of growth of new cells Acceleration of growth of new cells

(speeding up wound healing processes) (speeding up wound healing processes) • Suppression of pain (analgesic effect) Suppression of pain (analgesic effect) • Suppression of inflammation Suppression of inflammation • Widening of blood vessels Widening of blood vessels • Improving tissue flexibility Improving tissue flexibility • Eliminating swellingEliminating swelling• Strengthening immunity Strengthening immunity • Stimulating and stabilizing bone tissues Stimulating and stabilizing bone tissues • Dramatic improvements in effectiveness of Dramatic improvements in effectiveness of

prescription medication and supplemental prescription medication and supplemental nutrients, vitamins and mineralsnutrients, vitamins and minerals

Infections related to Oral Infections related to Oral SurgerySurgery

• OsteomyelitisOsteomyelitis

• PericoronitisPericoronitis

OsteomyelitisOsteomyelitis

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

CausesCauses

• 1. acute periapical infection1. acute periapical infection2. pericoronitis2. pericoronitis3. acute periodontal lesions3. acute periodontal lesions4. trauma-fractures and extraction of 4. trauma-fractures and extraction of teethteeth5. acute infection of the maxillary 5. acute infection of the maxillary sinussinus

How is it Diagnosed?How is it Diagnosed?

• Complete blood countComplete blood count• Erythrocyte sedimentation rate Erythrocyte sedimentation rate • C-reactive proteinC-reactive protein• Needle aspiration or bone biopsyNeedle aspiration or bone biopsy• X-raysX-rays• Radionuclide bone scansRadionuclide bone scans• CAT scansCAT scans• MRIMRI• UltrasoundUltrasound

Signs and SymptomsSigns and Symptoms• severe painsevere pain• regional lymphadenopathyregional lymphadenopathy• soreness of the involved teethsoreness of the involved teeth• if the infection involves the mandibular canal, a if the infection involves the mandibular canal, a

paresthesia of the lip is commonparesthesia of the lip is common• On radiographs:On radiographs:

decreased density of trabeculaedecreased density of trabeculae• multiple small radiolucent areas become multiple small radiolucent areas become

apparent apparent • sequestra - irregular calcified areas separate fromsequestra - irregular calcified areas separate from

remaining boneremaining bone

Tx of OsteomyelitisTx of Osteomyelitis

• Teeth should be extracted only when Teeth should be extracted only when necessary and antibiotics should be given necessary and antibiotics should be given prior to and following the surgical procedure.prior to and following the surgical procedure.

• Massive doses of antibiotics, usually one of Massive doses of antibiotics, usually one of the penicillin drugs, are given for at least six the penicillin drugs, are given for at least six weeks. weeks.

• A surgeon may perform a bone biopsy to see A surgeon may perform a bone biopsy to see if an abscess has formed on the bone. If an if an abscess has formed on the bone. If an abscess is found, antibiotics are given and abscess is found, antibiotics are given and surgery is performed to remove the abscess. surgery is performed to remove the abscess.

• If pus has formed, it is sometimes necessary If pus has formed, it is sometimes necessary to drain the bone by drilling holes in it. to drain the bone by drilling holes in it.

Tx Cont.Tx Cont.

• Restrict the movement of the area as Restrict the movement of the area as much as possible.much as possible.

• Monitored blood tests and x-rays.Monitored blood tests and x-rays.

Holistic Tx of OsteomyelitisHolistic Tx of Osteomyelitis

• Hepar sulphuris – pain, swelling, Hepar sulphuris – pain, swelling, infectioninfection

• Chamomile -pain and swelling Chamomile -pain and swelling

• Witch Hazel – helps fight infections Witch Hazel – helps fight infections and cleanses mouthand cleanses mouth

PericoronitisPericoronitis

• Inflammation of the gingiva around a Inflammation of the gingiva around a partially erupted tooth.partially erupted tooth.

• Resulting from debris accumulating Resulting from debris accumulating under the flap of tissue.under the flap of tissue.

• Or from constant contact between the Or from constant contact between the flap and the tooth in the opposing flap and the tooth in the opposing arch.arch.

• Usually occurs in teenagers and young Usually occurs in teenagers and young adults.adults.

Pericoronitis Cont.Pericoronitis Cont.

• Usually affects the Usually affects the mandibular third mandibular third molars.molars.

Signs & SymptomsSigns & Symptoms

• Pain when chewingPain when chewing• Bad tasteBad taste• TrismusTrismus• Swelling in the neck and in the area of the toothSwelling in the neck and in the area of the tooth• FeverFever• Partially erupted toothPartially erupted tooth• Red inflammed tissue around the partially erupted Red inflammed tissue around the partially erupted

toothtooth• PusPus• Pain when touchedPain when touched• Enlarged lymph nodesEnlarged lymph nodes

TreatmentTreatment

• Irrigate under the flap of tissue with warm Irrigate under the flap of tissue with warm saline solution.saline solution.

• Gently clean with a scalerGently clean with a scaler• Instruct the client to rinse with warm Instruct the client to rinse with warm

saline solution every 2 hourssaline solution every 2 hours• AntibioticsAntibiotics• Surgical removal of the flap after antibiotic Surgical removal of the flap after antibiotic

therapytherapy• Third molar extractionThird molar extraction

Homeopathic TxHomeopathic Tx

• Dandelion is useful for treating abscesses in the Dandelion is useful for treating abscesses in the mouthmouth

• Combined with myrrh and licorice root, echinacea is Combined with myrrh and licorice root, echinacea is excellent for the treatment of abscesses in the excellent for the treatment of abscesses in the mouth. mouth.

• Rub eucalyptus oil or evening primrose on sore, Rub eucalyptus oil or evening primrose on sore, inflamed gums for temporary relief inflamed gums for temporary relief

• Use a horsetail mouthwash to relieve mouth and Use a horsetail mouthwash to relieve mouth and gum infections. gum infections.

• Red clover ointment can treat abscesses.Red clover ointment can treat abscesses.• For pain and inflammation around wisdom teeth, For pain and inflammation around wisdom teeth,

BelladonnaBelladonna is often given for throbbing pains and is often given for throbbing pains and Hepar sulphHepar sulph to promote expulsion of pus. to promote expulsion of pus.

Other Oral InfectionsOther Oral Infections

• HerpesHerpes

• ThrushThrush

What is Oral Thrush?What is Oral Thrush?

• It is an infection in the oral It is an infection in the oral cavity of yeast funguscavity of yeast fungus, , Candida albicans.Candida albicans. It It affects the mucous affects the mucous membranes of the mouth. membranes of the mouth. It causes white patched in It causes white patched in the mouth that can be very the mouth that can be very painful and make painful and make swallowing and chewing swallowing and chewing difficult. difficult.

• Thrush effecting the Thrush effecting the mouth and throat is mouth and throat is also known asalso known as oropharyngeal oropharyngeal candidiasiscandidiasis

How do you get Thrush?How do you get Thrush?

• Thrush also known as Candida, does not Thrush also known as Candida, does not become a problem until the natural flora of become a problem until the natural flora of the mouth is disturbed, favoring candida over the mouth is disturbed, favoring candida over the other microorganisms of the oral cavity.the other microorganisms of the oral cavity.

• This disturbance of the oral cavity can be This disturbance of the oral cavity can be caused by a number of factors such as, taking caused by a number of factors such as, taking antibiotics, or chemotherapy. Systemic antibiotics, or chemotherapy. Systemic problems can also cause an imbalance; problems can also cause an imbalance; diabetes, malnutrition, drug abuse, or diabetes, malnutrition, drug abuse, or immune deficiencies such as AIDS or immune deficiencies such as AIDS or deficiencies related to old age.deficiencies related to old age.

Thrush Cont.Thrush Cont.

• Those who have dentures that do not fit Those who have dentures that do not fit well can suffer from breaks in the well can suffer from breaks in the mucous membranes of the oral cavity. mucous membranes of the oral cavity. This can act as a gateway for candida. This can act as a gateway for candida. Those who have suffered from this Those who have suffered from this problem show evidence of it when they problem show evidence of it when they have moist, pale pink spots on their have moist, pale pink spots on their lips. These spots are known as angular lips. These spots are known as angular chelitis. This is a clear indication of chelitis. This is a clear indication of candida infection. candida infection.

Symptoms of ThrushSymptoms of Thrush

• White cream coloured or yellow White cream coloured or yellow slightly raised spots in the mouth. slightly raised spots in the mouth.

• When the creamy substance is When the creamy substance is scraped away wounds will be present scraped away wounds will be present and will bleed slightly.and will bleed slightly.

• A burning sensation may be felt in A burning sensation may be felt in the mouth and throat area.the mouth and throat area.

TreatmentTreatment

• Get the main condition that caused the Get the main condition that caused the thrush under control.thrush under control.

• Anti-fungal drugs will have to be either Anti-fungal drugs will have to be either sucked on or a liquid that must be held in sucked on or a liquid that must be held in the mouth before swallowing to eliminate the mouth before swallowing to eliminate the fungus.the fungus.

• If it spreads or becomes complicated, If it spreads or becomes complicated, systemic treatment in the form of tablet or systemic treatment in the form of tablet or injection may be needed.injection may be needed.

Coping with the Symptoms of Coping with the Symptoms of ThrushThrush• Thrush can make the Thrush can make the

mouth very sensitive, mouth very sensitive, this can make oral this can make oral hygiene very difficult hygiene very difficult to maintain. to maintain.

• Use an extra soft Use an extra soft toothbrush. toothbrush.

• It is also helpful to It is also helpful to rinse with a diluted rinse with a diluted solution of 3% solution of 3% hydrogen peroxide. hydrogen peroxide.

Foods to Avoid if you have Foods to Avoid if you have ThrushThrush• Yeast- breads, crackers, pastriesYeast- breads, crackers, pastries• Fruit Juices- canned, bottled or frozen Fruit Juices- canned, bottled or frozen • Coffee and Tea- Regular, instant, decaffeinated. Herbal teas are Coffee and Tea- Regular, instant, decaffeinated. Herbal teas are

tolerated tolerated • Caffeine- anything containing caffeine Caffeine- anything containing caffeine • Dairy or Dairy Containing Products Dairy or Dairy Containing Products • Black Pepper- hard to digest. Cayenne pepper is a recommended Black Pepper- hard to digest. Cayenne pepper is a recommended

alternative as it promotes digestion.alternative as it promotes digestion.• Any type of mushroomAny type of mushroom• Pickled and smoked meats, including sausages, hot dogs, corned Pickled and smoked meats, including sausages, hot dogs, corned

beef, pastrami, and ham.beef, pastrami, and ham.• Condiments, Sauces, and Vinegar-Containing Foods Condiments, Sauces, and Vinegar-Containing Foods • Dried, candied fruits.Dried, candied fruits.• Leftovers, best to eat fresh foods due to mold growth.Leftovers, best to eat fresh foods due to mold growth.

Foods RecommendedFoods Recommended

• Vegetables and LegumesVegetables and Legumes• Fish/Shell fish, meat, poultryFish/Shell fish, meat, poultry• Whole grainsWhole grains• NutsNuts• Fruits – Fruits – avoid for 3 months then reintroduce 1 at a time on avoid for 3 months then reintroduce 1 at a time on

an empty stomachan empty stomach

• Seeds Seeds such as pumpkin, sesame and sunflowersuch as pumpkin, sesame and sunflower

• Non grain Non grain such as Amaranth, buckwheat and quinoasuch as Amaranth, buckwheat and quinoa

• Butters (Butters (almond, sesame and sunflower)almond, sesame and sunflower)

• Fats (Butters or unrefined oilsFats (Butters or unrefined oils

HerpesHerpes

• Herpes simplex is a common and usually Herpes simplex is a common and usually mild infection mild infection

• A virus causes herpes A virus causes herpes • Causes cold sores or fever blisters on the Causes cold sores or fever blisters on the

mouth and facemouth and face• Once introduced to the body it will live Once introduced to the body it will live

there for a lifetime there for a lifetime • Often with periodic symptoms or no Often with periodic symptoms or no

symptoms at all symptoms at all

Herpes SymptomsHerpes Symptoms• Can take 4-6 weeks Can take 4-6 weeks

to heal fully to heal fully • May cause small May cause small

pimples or blisters pimples or blisters which will which will eventually crust eventually crust over and scab over and scab

• May cause flu like May cause flu like symptoms; fever, symptoms; fever, swollen glands in swollen glands in lymph nodes in the lymph nodes in the head and neck head and neck region region

How often will it occur? How often will it occur? Why?Why?• depends upon the HSV type and how long depends upon the HSV type and how long

the infection has resided in the body the infection has resided in the body

• prolonged exposure to strong sunlight can prolonged exposure to strong sunlight can trigger oral herpes trigger oral herpes

• individuals will discover what triggers individuals will discover what triggers outbreaks in their own bodiesoutbreaks in their own bodies

• people who experience a strong initial people who experience a strong initial outbreak can expect to have several outbreak can expect to have several recurrences a year recurrences a year

How is it Spread?How is it Spread?

• Skin to skin contactSkin to skin contact

• if you have a “cold sore” and kiss if you have a “cold sore” and kiss someone, the virus will be someone, the virus will be transferred to that person transferred to that person

• if you have a “cold sore” and have if you have a “cold sore” and have oral sex, your partner will get genital oral sex, your partner will get genital herpesherpes

Herpes TxHerpes Tx

• no treatment or medication that will cure no treatment or medication that will cure herpes but there is some to control itherpes but there is some to control it

• 3 most common meds: 3 most common meds: Acyclovir (Zovirax), Acyclovir (Zovirax), Valacyclovir (ValtrexValacyclovir (Valtrex) and ) and Famciclovir Famciclovir (Famvir)(Famvir)

• Episodic therapy means taking the Episodic therapy means taking the medication only during an outbreak to medication only during an outbreak to speed up the healing process speed up the healing process

• Suppressive therapy means taking Suppressive therapy means taking antiviral medication daily antiviral medication daily

Holistic TxHolistic Tx

• Whole olive leaves can be boiled in water or Whole olive leaves can be boiled in water or treated with wine to make a remedy treated with wine to make a remedy

• carbohydrates from red marine algae is a low-cost, carbohydrates from red marine algae is a low-cost, high potential, broad spectrum antiviral agent high potential, broad spectrum antiviral agent

• As a mild antiseptic, Sage will help heal coldsoresAs a mild antiseptic, Sage will help heal coldsores• Rub tea tree oil directly on cold sores to promote Rub tea tree oil directly on cold sores to promote

healing healing • Use a salve made of thyme, myrrh, and goldenseal Use a salve made of thyme, myrrh, and goldenseal

to treat oral herpes to treat oral herpes • A mouthwash made from violet soothes coldsoresA mouthwash made from violet soothes coldsores• Capsicum, Dulcamara, Kali muriaticum, Capsicum, Dulcamara, Kali muriaticum,

Kreosotum, and Upas tiente all assist tin the relief Kreosotum, and Upas tiente all assist tin the relief of oral herpes.of oral herpes.

The EndThe End