The document discusses various complications that can occur during tooth extraction such as fracture of the tooth or surrounding bone, nerve damage, hemorrhage, displacement of tooth fragments or roots into nearby anatomical spaces, and failure of local anesthesia. It provides classifications of complications and describes techniques for prevention and management of each complication. Post-operative complications like pain, swelling and dry socket are also covered.
EXODONTIA CAN BE DEFINED AS THE PAINLESS REMOVAL OF THE WHOLE TOOTH OR A TOOTH ROOT WITHOUT TRAUMA TO THE INVESTING TISSUES, SO THAT THE WOUND HEALS UNEVENTFULLY AND NO POST OPERATIVE PROSTHETIC PROBLEM IS CREATED.
One of the most painful but easy-to-treat dental emergencies is a dry socket.
• Dry socket symptoms are experienced after a tooth extraction.
• This condition requires follow-up care by the doctor who performed the surgery, an oral surgeon or a dentist who is familiar with how to treat it.
For more information, contact :-
Dr Sachdeva's Dental Aesthetic And Implant Institute,
I 101, Ashok Vihar Phase 1, Delhi- 110052
Contact us at
• Phone : +919818894041,01142464041
• Our Websites:
• www.sachdevadentalcare.com
• www.dentalclinicindelhi.com
• www.dentalimplantindia.co.in
• www.dentalcoursesdelhi.com
• www.facialaestheticsdelhi.com
#drysocket #management #thirdmolarextraction #extractioncomplications
Exodontia or Extraction is the painless removal of whole tooth or tooth root with minimal trauma to the investing tissues, so that the wound heals uneventfully and no post-operative prosthetic problem is created.
EXODONTIA CAN BE DEFINED AS THE PAINLESS REMOVAL OF THE WHOLE TOOTH OR A TOOTH ROOT WITHOUT TRAUMA TO THE INVESTING TISSUES, SO THAT THE WOUND HEALS UNEVENTFULLY AND NO POST OPERATIVE PROSTHETIC PROBLEM IS CREATED.
One of the most painful but easy-to-treat dental emergencies is a dry socket.
• Dry socket symptoms are experienced after a tooth extraction.
• This condition requires follow-up care by the doctor who performed the surgery, an oral surgeon or a dentist who is familiar with how to treat it.
For more information, contact :-
Dr Sachdeva's Dental Aesthetic And Implant Institute,
I 101, Ashok Vihar Phase 1, Delhi- 110052
Contact us at
• Phone : +919818894041,01142464041
• Our Websites:
• www.sachdevadentalcare.com
• www.dentalclinicindelhi.com
• www.dentalimplantindia.co.in
• www.dentalcoursesdelhi.com
• www.facialaestheticsdelhi.com
#drysocket #management #thirdmolarextraction #extractioncomplications
Exodontia or Extraction is the painless removal of whole tooth or tooth root with minimal trauma to the investing tissues, so that the wound heals uneventfully and no post-operative prosthetic problem is created.
This lecture talk about the disturbance of adrenal gland hormones and how it affect health. it also discuss in brief how to manage such condition in your dental clinic
In this brief lecture I will discuss most common endodontic emergencies that occur while practicing endodontics. The lecture is directed to the mind of undergraduate level.
I hope you enjoy it.
It include proximal stripping, Diagnostic aids, advantages, disadvantages, periodontal consideration, procedure for proximal stripping. Expansion, extraction, Distalization in detail as method of gaining space, Extra-oral, Intra-oral method for gaining space. uprighting, derotation of posterior teeth. proclination of anterior teeth.
All the mistakes are rectified.Complete and precise knowledge about EXODONTIA .I would like to again focus on compatibility of this ppt;some pictures differ from original one.Animations and Transitions added are not visible .Good for beginners to understand and remember.Images give you better way to grasp.Enjoy and have fun watching this ppt.
Definition
Types
Indications
Local Contraindications
Systemic Contraindications
Pre Operative Assessment
Dental Surgeon Chair Positions
Post Operative Assessment
Mechanical principles involved in tooth extraction
Lever
Wedge
Elevators
Role of Forceps
Principles of elevator and forceps use
Motions of Forcep's
Procedure for closed extraction
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
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Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
3. Complication :
Any adverse , unplanned events that tend to increase the
morbidity above what would be expected from a particular
operative procedure under normal circumstances.
3
4. Classification
• Operative complications
• Failure of Anesthesia
• Problems with tooth being extracted
• Injury to adjacent teeth
• Extraction of wrong tooth
• Fracture of alveolar bone
• Fracture of maxillary tuberosity
• Maxillary sinus perforation
• Gingival and mucosal laceration
• Injury to inferior alveolar nerve
• Hemorrhage
• TMJ trauma
• Post-operative complications
• Hemorrhage
• Ecchymosis and hematoma
• Post-operative pain
• Post-operative swelling
• Dry socket
4
5. Failure Of Local Anesthesia
Failure of local anesthesia is usually the result of either:
• inaccurate placement of the anesthetic solution
• too small a dosage
• not waiting long enough for the anesthesia to act before commencing
surgery
Check for subjective signs and objective signs to confirm LA has worked.
If anesthesia cannot be secured by using conventional techniques of
infiltration or regional block
intraligamental, intraraosseous or intrapulpal injections may be indicated,
provided that the cause of the failure is not local infection around the tooth 5
6. Problems with tooth being extracted
• Root Fracture and Displacement
• Tooth lost in pharynx
6
7. Root Fracture and Displacement
Prevention of Root Fracture and Displacement
1. Always consider the possibility of root fracture.
2. Use surgical (i.e., open) extraction if high probability of fracture
exists.
3. Do not use strong apical force on a broken root.
Management:
open extraction
root fragment(5 mm in greatest dimension) is left , lf tooth was
healthy
7
8. Question????
You are posted at remote place . What would you do if tooth fracture
during extraction and you don’t have time and or facilities required to
complete extraction???
Remove any exposed pulpal tissue
Cover the fragment with zinc oxide eugenol dressing
in which cotton wool fibers are incorporated
Arrangement is made for removal of fragments by
own / referred to maxillofacial surgeon
8
9. Root displaced in the sinus
• Mostly in case of 1st PM and buccal roots of 1st molars (maxillary)
9
10. 10
Management
1. Nose blow test to visualize the root
2. Placement of suction tip in the socket may aspirate small root fragment
3. A long piece of iodoform gauze, ½ inch wide is placed in the antrum through
socket and pulled out in 1 stroke ( sometime removes the root by friction or
because it sticks to gauze).
Should be performed only if opening is large, opening should never be enlarged
4. If previous methods are ineffective
Radiograph is taken
Mucoperiosteal flap should be raised above the socket/ Caldwell-Luc approach
Removal of root
Socket is closed to avoid creation of oro-antral fistula
12. Root displaced in submandibular space
Cause:
Root of the 2nd and 3rd molar may be pushed through a perforation in the lingual
surface of the mandible into the region of the submandibular fossa
Periapical infection may facilitate root displacement during instrumentation
Management:
The index finger of the left hand is inserted onto the lingual aspect of the floor of
the mouth
To place pressure against lingual aspect of the mandible and force the root back
into the socket
Then be grasp it with the root tip elevator or small hemostat
If this fails, reflect a soft tissue flap on the lingual aspect of the mandible and
gently dissect the overlying mucoperiosteum and remove the root tip
Antibiotic prophylaxis 12
13. Tooth Lost into the Pharynx
Management:
• Patient should be turned toward the surgeon
• Placed into a position with the mouth facing the floor as much as
possible.
• The patient should be encouraged to cough and spit the tooth out
onto the floor.
• The suction device can sometimes be used to help remove the tooth.
13
14. If swallowed or aspirated:
• Transport to emergency room
• chest and abdominal radiographs taken
If the tooth has been aspirated,
oconsultation with regard to the possibility of removing the tooth with
a bronchoscope should be requested.
oThe urgent management is to maintain the patient’s airway and
breathing.
oSupplemental oxygen may be appropriate if signs of respiratory
distress are observed.
14
15. If the tooth has been swallowed,
o It is highly probable that it will pass through the gastrointestinal tract within 2 to
4 days (Because teeth are not usually jagged or sharp, unimpeded passage occurs
in almost all situations)
o A radiograph of the abdomen taken to confirm location of the tooth
o Follow-up radiographs are probably not necessary because swallowed teeth are
ultimately passed out along with feaces.
15
16. Injuries to adjacent tooth
• Fracture or dislodgement of adjacent restoration
• Luxation of adjacent tooth
16
17. Fracture or dislodgement of adjacent restoration
If a large restoration exists:
Patient should be warned about possibility of
fracturing or displacing during extraction.
• Straight elevator should be inserted entirely into
the periodontal ligament space, or not used at all
to luxate the tooth before extraction
• During elevation a finger should be placed upon
the adjacent tooth to support it and enable any
force transmitted to it to be detected.
17
18. Management
• The surgeon should make sure the restoration is removed from the
mouth and does not fall into the empty tooth socket
• Once the surgical procedure has been completed, the injured tooth
should be treated by replacement of the displaced crown or
placement of a temporary restoration
18
19. Luxation Of An Adjacent Tooth
• Caused due to Inappropriate use of the extraction instruments
Prevention
• Judicious use of force with elevators and forceps
• Other teeth should not be used as fulcrum for an elevator.
• Narrow forceps may be useful for the extraction of tooth that is crowded and
has overlapping adjacent teeth (eg. Mandibular anterior crowding)
19
20. Management
If an adjacent tooth is significantly luxated or partially avulsed
• Reposition in the tooth socket and left alone
• Occlusion should be checked to ensure that the tooth has not been
displaced into a hyperocclusion and traumatic occlusion
If the luxated tooth is mobile
• The tooth should be stabilized with semirigid fixation to maintain it in its
position
• For this a simple silk suture that crosses the occlusal table and is sutured to
the adjacent gingiva is usually sufficient
(NOTE: Rigid fixation with circumdental wires and arch bars should be avoided because it
results in increased chances for external root resorption and ankylosis of the tooth.)
20
21. • Occur as a result of uncontrolled forces.
• Usually occurs when buccolingual forces inadequately mobilize a tooth, excessive tractional
forces are used or both
• Tooth is suddenly released from the socket and the forceps strikes the teeth of the opposite
arch, chipping or fracturing a cusp
• Mostly occur with extraction of lower teeth because these teeth may require more vertical
tractional forces for their delivery, especially when using cowhorn forceps.
Injury of Teeth in the opposite arch
21
22. Prevention
• Avoid using excessive tractional forces
• The surgeon or assistant should hold a finger or suction tip against
them to absorb the blow of the forceps released in that direction.
Management
• The tooth should be smoothed or restored ,as necessary, to keep the
patient comfortable until a permanent restoration can be
constructed.
22
23. Extraction of the Wrong Tooth
Causes
• A dentist removes a tooth for another dentist
• Use of differing tooth numbering systems
• Differences in the mounting of radiographs
Prevention
• Focus attention on the procedure.
• Check with the patient and the assistant to ensure that the correct tooth is
being removed.
• Check, then recheck, images and records to confirm the correct tooth
23
24. Management
Immediately
• The tooth should be replaced quickly into the tooth socket
• Splinting is done
• Endodontic treatment after successful reattachment
24
25. Fracture of alveolar bone
Prevention
• Conduct thorough preoperative clinical and radiographic
examinations.
• Do not use excessive force.
• Use surgical ( i.e. open) extraction technique to reduce the force
required.
25
26. Management
1. If bone has been completely removed from the tooth socket along
with the tooth :- tooth is not replaced
- sharp margin should be smoothed
- soft tissue should be positioned and sutured
2. If bone remain attached to the periosteum:-
- bone is separated from tooth and left attached to overlying soft
tissue
-tooth is removed
-bone and soft tissue flap are re approximated and sutured
26
27. • What would be the sequence of extracting 1st PM , Canine and lateral incisor ?
1. 1st PM , Canine and lateral incisor
2. Lateral incisor , canine and 1st PM
3. Canine , 1st PM and lateral incisor
27
28. Fracture of the maxillary tuberosity
• Most commonly occur due to extraction of
maxillary 3rd molar/ 2nd molar , if it is the last tooth in the arch.
Management
• If the bone remains attached to the periosteum:
-should take measures to ensure the survival of the fractured bone.
28
29. • If the tuberosity is excessively mobile and cannot be dissected from the
tooth:
Option 1:
• Splint the tooth being extracted to adjacent teeth
• Defer the extraction by 6 to 8 weeks (allowing time for bone to heal)
• The tooth is then extracted with an open surgical technique
Option 2 :
• Section the crown of the tooth from the roots
• Defer the extraction of the roots by 6 to 8 weeks( allowing time for the
tuberosity and root section to heal )
• Remove the tooth roots
29
30. If the maxillary tuberosity is completely separated from soft tissue
oSmooth the sharp edges of the remaining bone
oReposition and suture the remaining soft tissue
oCheck for an oro-antral communication (if present provide the necessary
treatment)
Advice:
• If this occur patient should be warned this could occur in next similar
extraction
• If preoperative radiograph reveals such possibility extract tooth by careful
dissection
30
31. Maxillary sinus Perforation
• Predisposing factor:
Presence of large antrum
Reduced bone height
Roots of maxillary molars(divergent) and premolars approaching antrum
But how
• Preoperative radiographs
• Decision is made to extract tooth either by closed/open technique
• In closed technique:
never apply excessive apical force
Leave apical one third of the palatal root of molars if it is retained unless there is
positive indication of extraction
• If indicated undergo open extraction
31
32. Management :
Diagnosis
Presence of bone on apex of root
Nose-blowing test
what to do After the diagnosis of oroantral communication has been established or a
strong suspicion exists???????
If the communication is small (2 mm in diameter or less)
No additional surgical treatment is necessary
Measures to ensure the formation of a high-quality blood clot in the socket
advise the patient to take sinus precautions to prevent dislodgment of the blood clot.
32
33. Sinus precaution
• Avoid blowing the nose, sneezing violently, sucking on straws, and
smoking
Patients who smoke and who are unable to stop (even temporarily)
should be advised to take only small puffs, not deep drags
• Surgeon must not probe through the socket into the sinus with a
dental curette or a root-tip pick
33
34. • If the opening between the mouth and sinus is of moderate size (2 to 6 mm)
place some clot-promoting substances e.g. gelatin sponge
A figure of “8” suture should be placed over the tooth socket
Advise to follow sinus precautions
Prescribed medications to reduce the risk of maxillary sinusitis
• Antibiotics—usually amoxicillin, cephalexin, or clindamycin— for 5 days
• In addition, a decongestant nasal spray should be prescribed to shrink the nasal
mucosa to maintain ostium patency
34
35. • If the sinus opening is large (7 mm or larger):
Repair with buccal and with a flap
Advise to follow sinus precautions
Prescribed medications to reduce the risk of maxillary sinusitis
• Antibiotics—usually amoxicillin, cephalexin, or clindamycin— for 5 days
• In addition, a decongestant nasal spray should be prescribed to shrink the
nasal mucosa to maintain ostium patency
Follow up after 2 weeks
35
36. Mandible fracture
Rare
Causes
Removal of deeply impacted mandibular 3rd molar
Removal of teeth from a severely atrophic mandible
Application of excess force that needed to remove a tooth
Management
Treated by methods applied for treating jaw fractures
36
37. Gingival and mucosal lacerations
Causes
• Mostly in difficult and complicated extractions.
• Usually an indication of faulty technique or selection of the wrong
method of extraction.
Management
• Most injuries heal without complication – because of remarkable
resistance of the tissues.
• Wound cleansed for any foreign matter.
37
38. Injury of the inferior alveolar nerve
Causes
• Uncommon occurrence in the
extraction of erupted mandibular
teeth.
• Injudicious curettage or improper use
of elevators to remove root apices.
• Result in paresthesia and sometimes
anesthesia of half the lower lip
and chin.
38
39. Management
• Most cases - the nerve regenerates within 6 weeks to 6
months.
• If the nerve does not regenerate, the bony walls of the
mandibular canal may have been displaced, impinging on it.
• This condition sometimes can be remedied by a
decompression operation.
• Traumatic neuroma – excised and the nerve reanastomosed
or grafted.
39
40. Hemorrhage
Cause
• Due to the accidental tearing or cutting of a large artery or vein.
• More often, it is encountered in regions of inflammation where tissues are
excessively hyperemic.
Management
• Arrested generally by manual pressure on gauze pack placed over the area.
• If large vessel involved – clamped with a hemostat and tied with 3-0 catgut
suture.
40
41. Subcutaneous emphysema
Causes
• Air forced into the connective tissue of intramuscular or facial spaces.
• Most often after air-driven dental hand piece or a compressed air
spray bottle for irrigation.
• Swelling – rapid onset, elastic consistency.
• Such air is absorbed very slowly, in 1 to 2 weeks, and no treatment is
needed.
41
42. TMJ trauma
• If the jaw is inadequately supported during the extraction of mandibular
molars, patient may experience :
- Pain in TMJ
- dislocation
Prevention
• Controlled force and adequate support to the jaw
• Use of a bite block on contralateral side aid in mandible stabilization.
Management
• Moist heat, resting the jaw, a soft diet, and 600 to 800 mg of Ibuprofen
every 4 hours for several days
• 500 to 1000mg of Acetaminophen
42
44. Postoperative Care
• Satisfactory recovery – surgeon’s responsibility.
• Main purpose – expedite healing and prevent or relieve pain and
swelling.
44
45. Rest
• For prompt healing of wounds.
• No strenuous exercise should be performed for the first 12 to 24
hours after extraction because the increased blood pressure may
result in greater bleeding.
• A malpositioned gauze pack is not effective in controlling bleeding
because the pressure of biting is not precisely directed
onto the socket.
45
46. Diet
When should one start eating???
• Only liquids and soft solids – 1st day.
• Warm or cold food.
• Chewing form the unoperated side.
• Increased fluid intake to prevent dehydration from limited food
intake.
46
Why to give specific diet instructions???
47. Oral hygiene
• Advice to keep their teeth and the whole mouth clean - for rapid
wound healing.
• On the day of surgery – gently brush the teeth that are away from the
area of surgery
-Prevent a new bleeding episode
-Avoid disturbing sutures and
-Avoid inducing pain
• After a day – rinsing should begin.
• Half tea spoon of salt in a glass of warm water.
• Commercial mouthwash??
47
48. Pain
• Begins after the effects of anesthetic have left.
• Intermittent application of cold to surgical site during 1st 24 hours
helps to reduce pain in two ways:
-Diminishes nerve conduction and thereby has an anesthetic effect
-Helps to reduce swelling and thus decreases pain associated with
tissue distention.
• Small doses of an analgesic drug at
short intervals rather than large doses
infrequently.
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49. Swelling
• Direct proportion to the degree of surgical trauma.
• 1st step to reduce swelling – Careful handling of the tissues.
• Application of cold to the operated site – Produce vasoconstriction
and thereby reduces the exudation of fluid and blood into the tissue
spaces.
• Prolonged use – Compensatory vasodilation.
• Pressure dressing are also beneficial.
• After 24 to 48 hours – heat in the form of moist compresses.
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50. Smoking
• Increase the incidence of alveolar osteitis.
• Tobacco smoke and nicotine interfere with wound healing.
• Discontinued for 5 days.
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53. LOCAL CAUSES
• Trauma
• Mechanical dislodgement of the clot
• Damage to blood vessel or soft tissue
• Fracture of alveolar bone
• Damage to nutrient blood vessel
• Infection
• Presence of granulation tissue
• Chronic inflammation of gingiva
• Acute infection of bone and soft tissue
54. • Local abnormality
• Unusually large bone marrow space
• Presence of Hemangioma
SYSTEMIC CAUSES
• Disorder related to systemic disease
• Leukemia, Aplastic anaemias
• Platelet disorders: Thrombocytopenia
• Coagulation defects : Hemophilia
• Structural malformation : Hereditary Hemorrhagic Telengectesia
• Drug therapy: Aspirin, Anti coagulant therapy
55. Management
• Pressure packs
• Use of LA solution with vasoconstrictors
• Socket suturing
• Hemostatic forceps
• Splints
• Thermal measures- cautery , hot saline packs
56. Firm gauze roll should be placed upon the socket & patient asked to
bite upon it .
Horizontal mattress suture
57. ECCHYMOSIS AND HEMATOMA
• Mild ecchymosis especially in elderly patient with increased capillary
fragility and poor tissue elasticity
• Extensive ecchymosis and hematoma formation result from improper
hemostasis during surgery
58. Management
• Intermittent ice pack(30 min per hour )for the 1st 24 hour after
surgery
• Following which intermittent hot moist packs are used to resolve the
condition
• Patient should be advised that discoloration is from bleeding into the
tissues and is not a bruise or a gangrenous process.
59. Postoperative pain
Due to traumatized hard tissues -
Bruising of bone during instrumentation or overheating of bur during
bone removal.
Soft tissues :-
Ragged flap – heals slowly (incision not proper)
Soft tissue become entangled with bur
Proper Retraction
60. Postoperative swelling
• EDEMA :
1. If the soft tissues are not handled carefully during an extraction
traumatic edema may be formed.
2. The use of blunt instrument, the excessive retraction of badly designed
flap, or a bur becoming entangled in the soft tissues predispose to this
condition.
3. IF sutures are tied too tightly post operative swelling due to edema or
haematoma formation may cause sloughing of the soft tissues and
breakdown of the suture line.
4. Usually both conditions regress if the patient uses hot saline mouth
baths frequently for 2-3 days.
61. b. INFECTION :-
• Pain and swelling
Mild - hot saline mouth baths
Severe – antibiotic & analgesics
62. Management
• External hot moist packs for 20 min/hour
• Warm isotonic saline mouth rinse every 3-4 hours and the use of antibiotics.
63. Dry socket / alveolar osteitis / alveolitis sicca dolorosa
• Condition in which there is loss of the blood clot from the socket
• Initially the clot has a dirty grey appearance and then it disintegrates
• Ultimately leaving a grey or greyish yellow bony socket bare of granulation tissue
• Diagnosis :
• Gently pass a small probe into the extraction wound
• Bare bone, extremely sensitive
• Suppuration generally absent
64. • Foul odor is present
• Severe radiating pain usually described as throbbing ache
• The symptoms generally start on the 3-5 day after extraction of tooth
• If untreated will last for about 7-14 days
65. Nitzan’s hypothesis of dry socket
• Suggested that fibrinolytic activity was due to organisms like Treponema
denticola , Bacteroid Melaninogenicus and Bacteroid oralis
66. Birn’s Hypothesis of Dry Socket
• Most accepted explanation of dry socket till date
Trauma and inflammation causes release of stable tissue activator from the
adjacent bony socket and soft-tissues
Tissue activator converts plasminogen (present in the blood clot) to
the plasmin
Plasmin causes lysis of blood clot and pain by conversion of kininogen to
kinin
67. Predisposing factors :-
1. Infection of socket : release of plasminogen activators
2. Trauma - use of excessive force
3. Vasoconstrictors (contributory factor)
4. Mandibular extractions (dense & less vascular, contaminated
with food debris)
5. Bacteriological origin – Treponema denticolum .
6. Pt. on oral contraceptives, smokers
69. Clinical features
• Pt. usually presents within 2-4 days : granulation tissue appears in 2-4 days,
it is absent in cases of dry socket.
• Dull, boring pain to severe throbbing pain, may radiate Gingival margin of
socket – swollen & red
• Socket may be filled with food debris or a brown friable clot on removal of
which exposes the bare bone which is severely tender to touch
• Regional lymph nodes may be tender
71. Prevention :-
1. Scaling & any gingival inflammation – (1 week prior to extraction).
2. Antiseptic mouth wash before extraction
3. Minimum amount of local anesthetic
4. Atraumatic tooth removal
5. Prophylactic use of antibiotics especially metronidazole
6. Nerve blocks preferred to LA infiltrations
7. Irrigation of extraction socket
8. Warm saline rinse
72. Management
1. Aim – relief of pain & speeding of resolution
2. Socket irrigation with warm saline & all degenerating blood clot removed.
3. Sharp bony spurs - excised with rongeur forceps or removed with a wheel stone
4. Loose dressing – zinc oxide & oil of cloves on cotton wool is tucked into the
socket.
5. Analgesic tab & hot saline mouth baths
6. Recall after 3 days
73. CONCLUSION
• Prevention of complications should be a major goal of the surgeon.
• Complications should be diagnosed as soon as they occur & dealt
promptly and effectively.
• The surgeon who anticipates a reasonable probability of an unusual
specific complication should inform the patient.
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74. REFERENCES
• Howe Geoffrey L. The Extraction of Teeth. 2nd edition
• Oral And Maxillofacial Surgery , vol.2, Daniel M. Laskin
• CONTEMPORARY ORAL AND MAXILLOFACIAL SURGERY, 6th edition
• Exodontia Practice, Abhay N. Datarkar
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