Oral Surgery And Oral Infections

1. Oral Surgery And Oral Infections By: Terri and Premlata

2. 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.

3. 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

4. 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.

5. 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.

6. 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

7. 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.

8. 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

9. 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.

10. 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.

11. 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!!!

12. 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

13. 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

14. Infections related to Oral Surgery • Osteomyelitis • Pericoronitis

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

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

17. 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

18. 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 fromremaining bone

19. 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.

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

21. Holistic Tx of Osteomyelitis • Hepar sulphuris – pain, swelling, infection • Chamomile -pain and swelling • Witch Hazel – helps fight infections and cleanses mouth

22. 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.

23. Pericoronitis Cont. • Usually affects the mandibular third molars.

24. 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

25. 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

26. 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.

27. Other Oral Infections • Herpes • Thrush

28. 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

29. 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.

30. 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.

31. 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.

32. 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.

33. 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.

34. 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.

35. 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

36. 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

37. 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

38. 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

39. 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

40. 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

41. 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.

42. The End