oral surgery and oral infections 1

8/3/2019 Oral Surgery and Oral Infections 1

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Oral Surgery And Oral

Infections

By: Terri and Premlata


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Oral Surgery

Includes: The diagnostic and surgicaltreatment of diseases, injuries, and

defects involving both the junctional andthe esthetic aspects of the hard and softtissues 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 brushingtechnique.

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 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 ofcomplications.

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 hardto open their mouth

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

Client who has been maintained on liquid dietthroughout 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 sutureremoval, irrigation of the sockets, and

other post surgical procedures when theclient 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 painsafter tooth extractions.

Use the fresh tops of shepherd's purse to help stopbleeding 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 supplementalnutrients, vitamins and minerals


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Infections related to Oral Surgery

Osteomyelitis

Pericoronitis


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Osteomyelitis

An inflammation ofthe bone marrow thatproduces pus andaffects the calcifiedcomponents of bone.


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Causes

1. acute periapical infection2. pericoronitis

3. acute periodontal lesions4. trauma-fractures and extraction ofteeth

5. 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 radiographs:decreased density of trabeculae

multiple small radiolucent areas become

apparent sequestra - irregular calcified areas separate from

remaining bone


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Tx of Osteomyelitis

Teeth should be extracted only when necessaryand antibiotics should be given prior to andfollowing the surgical procedure.

Massive doses of antibiotics, usually one of thepenicillin 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 andsurgery 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 asmuch 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 andcleanses mouth


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Pericoronitis

Inflammation of the gingiva around apartially erupted tooth.

Resulting from debris accumulating underthe flap of tissue. Or from constant contact between the flap

and the tooth in the opposing arch.

Usually occurs in teenagers and youngadults.


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Pericoronitis Cont.

Usually affects themandibular thirdmolars.


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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 salinesolution.

Gently clean with a scaler Instruct the client to rinse with warm saline

solution every 2 hours

Antibiotics

Surgical removal of the flap after antibiotictherapy 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, inflamedgums 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 oralcavity of yeast fungus, Candidaalbicans. It affects themucous membranes of themouth. It causes whitepatched in the mouth that canbe very painful and makeswallowing and chewingdifficult.

Thrush effecting themouth and throat is alsoknown as oropharyngealcandidiasis


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How do you get Thrush?

Thrush also known as Candida, does notbecome a problem until the natural flora of themouth 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, takingantibiotics, or chemotherapy. Systemic

problems can also cause an imbalance; diabetes,malnutrition, drug abuse, or immune deficienciessuch as AIDS or deficiencies related to old age.


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Thrush Cont.

Those who have dentures that do not fitwell can suffer from breaks in the mucous

membranes of the oral cavity. This canact as a gateway for candida. Those whohave suffered from this problem showevidence of it when they have moist, pale

pink spots on their lips. These spots areknown as angular chelitis. This is a clearindication of candida infection.


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Symptoms of Thrush

White cream coloured or yellow slightlyraised spots in the mouth.

When the creamy substance is scrapedaway wounds will be present and willbleed slightly.

A burning sensation may be felt in themouth and throat area.


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Treatment

Get the main condition that caused the thrushunder control.

Anti-fungal drugs will have to be either suckedon or a liquid that must be held in the mouthbefore swallowing to eliminate the fungus.

If it spreads or becomes complicated, systemic

treatment in the form of tablet or injection maybe needed.


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Coping with the Symptoms ofThrush

Thrush can make themouth very sensitive,this can make oral

hygiene very difficultto maintain.

Use an extra soft

toothbrush. It is also helpful to

rinse with a dilutedsolution 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 Fruitsavoid 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 mildinfection

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 symptomsat all


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Herpes Symptoms

Can take 4-6 weeksto heal fully

May cause smallpimples or blisterswhich will eventuallycrust over and scab

May cause flu like

symptoms; fever,swollen glands inlymph nodes in thehead and neck region


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How often will it occur? Why?

depends upon the HSV type and how long theinfection has resided in the body

prolonged exposure to strong sunlight cantrigger oral herpes individuals will discover what triggers outbreaks

in their own bodies

people who experience a strong initial outbreakcan 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 tothat 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 herpesbut there is some to control it

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

Episodic therapy means taking the medicationonly during an outbreak to speed up the healingprocess

Suppressive therapy means taking antiviralmedication daily


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Holistic Tx

Whole olive leaves can be boiled in water or treated withwine to make a remedy

carbohydrates from red marine algae is a low-cost, highpotential, 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, andUpas tiente all assist tin the relief of oral herpes.


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The End

oral surgery and oral infections 1

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