CDT 0506.

ORAL SURGERY
SUMMARY 2020-2021-2022.
SESSION 02
SOURCES OF CONTAMINATION IN
THE SURGERY.
 SOURCES OF CONTAMINATION IN THE
SURGERY.
 Floors.

 Lamps.

 Walls.

 The operator and

 The patient.
 CLEANING THE SURGERY.
 Prior to operation.
 Clean thoroughly the units,lamp, patient’s chair, spittoon
e.t.c with disinfectants e.g. Savlon,septol,hypochlorite.
 Between patients.
 Take dirty instruments away ,soak them in hypochlorite
solution for few minutes,clean them in running water and
sterilize.
 After operating Hours.
 Sterilize all instrument used in the day, and store them in
clean covered containers, then, clean the
units,lamps,chair,sucker and spittoon.
Personnel should know how to maintain
sterility in clinic.
• Maintainance of sterility in dental surgery.
 Proper hand washing before and after procedure
by use of soap and water.
 Proper use of gloves and masks for self protection
and cross infection.
 Use of protective eye glasses.
 Avoid putting clean and dirty things together.
 Do not expose sterile instruments for too long and
 Minimize talking over sterile field.
 SESSION 03
HEMOSTASIS.
Excessive blood loss should be
prevented during and after surgery.
 TYPES OF HAEMORRHAGE.
 Primary haemorrage.
 This occurs immediately after tooth extraction.
Reactionary haemorrhage.
 The bleeding may start some hours after tooth
extraction.
 Secondary haemorrhage.
 This occurs to two OR Three days after the
extraction and is due to infection breaking down
the vascular granulation tissue.
 METHODS BLEEDING CONTROL
Pressure packs.
 The surgical site is cleaned then a post
operative sterile gauze pack is placed over
the bleeding socket.
Vaso constrictors.
 These are manipulations and agents that are
directed at narrowing the diameter of blood
vessels which supply the bleeding point.
 METHODS OF BLEEDING CONTROL.
 Thermal.
 The method is rarely used in dental clinics,almost used
in surgical operations.sterile piece of cloth has been
soaked in hot water is laid on bleeding area and blood
vessels contract resulting in decreased bleeding.
 Suturing.
 These are recommended for soft tissue tears.
 Ligation.
 This involves tying off vessel with suture.
 Bee wax
 Session 04
CONTROL OF PAIN.
 PAIN;-This reffers to a distressing sensation
or as a disturbing sensation causing
suffering or distress.
TYPES OF PAIN.
Pain Reaction.
Pain Threshold.
Pain Perception.
 FACTORS WHICH DETERMINE THE LEVEL
OF TOLERANCE.
 Psychological make up.

 Fear and apprehension of dental treatment.

 Fatigue.

 Age.
METHODS OF CONTROLLING PAIN.
Removing the course.
Blocking the pathway of painful impulses.
Raising the pain threshold, drugs possessing
analgesic properties are used.
Preventing pain reaction by cortical
depression.
Using psychosomatic methods.
Be honest and inform the patient about the
procedure.
 Analgesia.
 Is a loss of pain sensation unaccompained by
loss of other forms of sensibility.
 Anaesthesia.
 Is a loss of all forms of sensation, including
pain, touch, temperature and pressure
perception and may be accompanied by
impairment of motor function.
HOW LOCAL ANAESTHESIA WORK.
 Local anaesthesia, by an unknown action on the minute
openings in the nerve membrane prevent the passage of
sodium ions (Na+) through the membrane into the nerve
cells, and the passage of potassium ions (K+) through the
membrane out of the nerve.

 Thus the depolarized nerve is unable to depolarize and

conduct an impulse. The prevention of depolarization must
take place over an area of two or three nodes of ranvier in
a myelinated fibre because the local anaesthesia reache
the membrane of a myelinated nerve at these nodes.
THE PRESENCE OF THE FOLLOWING
FACTORS FAULT OR NO ANAESTHESIA MAY
RESULT;
Too high or low pH of tissues.
Excessive dilution with blood or tissue fluids.
Too rapid absorption of the anaesthetic into
the systemic circulation.
Potency of a drug.
 ADVANTAGES OF VASOCONSTRICTORS IN
LOCAL ANAESTHETIC AGENTS ARE;-
 Minimize bleeding thus providing a bloodless operation field.

 Retard absorption of local anaesthetic thus increasing their

duration.

 Decrease absorption thereby reducing their toxicity.

 Decrease absorption of local anaesthetics permitting smaller

volumes to be used.

 They increase the efficiency of the local anaesthesia solutions.

 ADRENALINE
Is a vasoconstrictors commonly added
to most local anaesthetics.
 ADVANTAGES OF ADRENALINE
Causes deepening of anaesthesia.

Less solution is needed.

Reduces bleeding.

Reduces toxicity by delaying absorption.

DISADVANTAGES OF ADRENALINE.
It is the main cause of fainting .
Not good in hypothyroidism.
May cause delayed healing and dry socket.
Idiosyncrasy.
pH unstable so alters pH or anaesthesia.
Not used in patients taking trycyclic
antidepressants.
 LOCAL ANAESTHETIC AGENTS.
 This is a solution which when injected
into tissues of living body produces
anaesthesia.
THE REQUIREMENTS OF THE IDEAL AGENT
(Local anaesthetic) ARE ;-
It should be potent and reliable.
Its action should be reversible.
It should be safe – not poisonous.
It should not cause irritation to tissues.
Rapidity of onset.
Duration of effect should be reasonably long.
Sterility – they should be sterile.
Low toxicity.
To be able to penetrate mucous membrane.
 CONSTITUENTS (Components) OF LOCAL
ANAESTHETIC (Ideal agents);-
 A reducing agent.
 i.e Sodium meta – bisulphate which competes for the
availability of oxygen.
 Preservative.
 This aims at prolonging shelf – life (Capry-
hydrocuprienotoxin).
 Fungicide.
 Thymol is added to serve as a fungicide.
 The vehicle.
 The above mentioned substances are dissolved in modified
Ringer solution.
ADVANTAGES OF LOCAL ANAESTHESIA
They have less side effects.
There is no need of an anaesthetist.
No need of premedication.
Easily manipulated.
Bleeding is minimal in surgical operations.
The patient does not need post operative
care.
 DISADVANTAGES OF LOCAL ANAESTHESIA.

 Difficult to inject nervous patients, children

and mental cases.
 Causes mental trauma in case of major
surgery.
INDICATIONS OF LOCAL ANAESTHESIA
 Extraction.
 Used in the extraction of teeth.
 Conservation.
 Used in root canal treatment.
 Oral surgery.
 Including ;-
Gingivectomy,Alveolectomy,Cystectomy,Apicoectomy,Tumo
ur excision e.t.c
 Prosthetics.
 Periodontal surgery.
 Scaling and polishing
Special Precautions Of Local Anaesthesia.

• Patient with cardiac disorders –

Hypertension, Angina etc.
• Patients with allergic to local anaesthetics.
PRE- ANAESTHETIC ASSESSMENT.
• Know the name of the patient and his/ her
occupation.
• Physical status of the patient.
• Medical and Oral history.
• Previous experience of LA and GA.
• Any need for consulting physician.
• Is there need for premedication.
• Patients on corticosteroids.
 METHODS OF ACHIEVING LOCAL
ANAESTHESIA.
• Topical Anaesthesia.
 Is applied directly to the surface especially MUCOSA.
INDICATION OF TOPICAL ANAESTHESIA
 Incision and drainage of abscesses.
 Scaling of teeth.
 Extraction of very mobile deciduous teeth.
 To stop vomiting reflex when taking impression.
 The portion to be anaesthetized should be free
from saliva.
 METHODS OF ACHIEVING LOCAL
ANAESTHESIA.
• Local Infiltration.
 This used especially in the maxilla.
• Field Block.
 This used in the cystectomy (cyst removal).
• Nerve block.
• Spinal Anaesthesia.
 The drug is introduced into the subarachnoid
space to anaesthetize a spinal segment.
 TOPICAL ANAESTHETIC AGENTS
• This includes the following;-
 Ethyl chloride- refrigerant.
 Amethocaine.
 Lignocaine 5% ointment.
 Prilocaine
 Benzyl alcohol 4-10%.
 Procaine.
 Lignocaine spray 10%.
 Xylocaine 2%.
 Ethyl Chloride.
• PROPERTIES.
 It is a gas at room temperture.
 Boiling point 50 F.
 It is inflammable.
 It condenses into a colourless liquid under
pressure.
 XYLOCAINE 2%.
• PROPERTIES .
• Very stable.
• Low toxicity.
• Non – irritant.
• Very potent.
• Compatible with vasoconstrictors.
COMPLICATIONS OF LOCAL ANAESTHESIA.

EARLY COMPLICATIONS.
Palpitation and loss of
consciousness (Fainting).
Breaking the Needle.
Injection of the wrong solution.
 COMPLICATIONS OF LOCAL
ANAESTHESIA.

LATE COMPLICATIONS.
 Pain.
 Injection at the site of infection.
 Haematoma formation.
 Ulceration of the lip.
OTHER COMPLICATION .
Generalized infection.
Homologous Serum Jaundice
 INJECTION TECHNIQUE.
Infiltration Anaesthesia.
Regional Block.
Palatal Injection.
The lingual Injection.
The Buccal injection.
Interdental Injection (Interseptal)
The mental Block.
 TESTING OF ANAESTHESIA.
 Infiltration anaesthesia may be tested by
pricking the gingivae with a blunt
instrument. Watch the patient’s eyes for
any indication of response.
 Alternatively , this may be tested by
Taping the tooth under observation. In
regional block there will be numbness of
the lower lip on the affected side including
tingling of the tongue in the same side.
 FACTORS FOR FAILURE OF
ANAESTHESIA.
 Anatomical Variations in the position of the
nerves.
 Injection into a blood vessel.
 Injection into an infected Area e.g. abscess
or cyst.
 Empty cartridge.
 Poor localization of the anaesthetic drug
around the inferior dental nerve.
STAGES OF EFFECTIVENESS OF GENERAL
ANAESTHESIA.
 Stage of Induction.
 In this stage the patient is conscious but experiences warmth,
giddiness and suffocation.
 Stage of Delirium.
 This begins when consciousness is lost and primitive emotions
appear.
 Stage of Surgical Anaesthesia.
 Breathing is regular and slow and is marked around the
abdomen.
 Stage of Bulbar Paralysis.
 Paralysis by the anaesthetic becomes dangerous because the
vital centres of the medulla are seriously affected.
 INHALATION ANAESTHESIA .
• There are two types:-
Volatile liquids (liquids at room
temperature) – Either, vinylether, chloroform,
methoxyflurance, halothane
trichloroethylene and ethyl chloride.
Anaesthetic gases (gases at room
temperature) – nitrous oxide, cyclopropane
and ethylene.
 SESSION 05
EXODONTIA. (TOOTH EXTRACTION)
 The ideal tooth extraction.
 This is the painless removal of the 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.
 CONSERVATIVE TREATMENT HAS FAILED
OR IS NOT INDICATED.
I. Periodontal diseases, - gross cariesn with complete
crown damage or with periapical infection, attrition,
hypoplasia, or pulpal lesions e.g. (pulpitis, pulpal
hyperplasia).
II. Trauma to the teeth or jaws leading to dislocation of a
tooth from its socket.
III. Tooth lying in the fractured line.
IV. A healthly sound tooth must be extracted;-
• As part of orthodontic treatment, prosthetic treatment
plan, therapeutic irradiation, retained deciduous teerh
root fragements to be removed and Impacted tooth.
 SYSTEMIC LIMITATIONS.
 Cardiac diseases.
 Rheumatic fever.
 Blood disorders.
 Anaemia.
 Sickle Cell Diseases
 Leukaemia.
 Thrombocytopenic Purpura.
 Haemophilia.
 Diabetes mellitus.
 Artificial heart valves.
 Pregnancy.
 LOCAL CONTRAINDICATIONS.
Acute inflammatory process in the oral
cavity;-
 E.g. ulcerative necrotic gingivitis, periconitis.
Acute dental alveolar abscess.
Local malignances.
 COMPLICATIONS OF TOOTH
EXTRACTION.
 Fracture of the Crown of a Tooth.
 Fracture of tooth being extracted.
 Fracture of the alveolar bone.
 Fracture of maxillary tuberosity.
 Fracture of an adjacent or opposing tooth.
 Fracture of the mandible.
 Dislocation of Temporomandibular Joint (TMJ).
 Displacement of a Tooth.
 Excessive Haemorrhage.
 Damage to the ; -Gum, Lower lip, inferior Dental Nerve,
Mental Nerve.
POST COMPLICATIONS OF EXODONTIA.

 Infective socket (Dry socket).

 Haemorrhage.
 Pain.
 Swelling.
 Numbness.
 TMJ Dislocation.
 Trismus.
 INFECTIVE/ DRY SOCKET.
FACTORS WHICH INCREASES THE INCIDENCES OF
DRY SOCKET.
 Trauma.
 Smoking.
 Infection.
 Poor blood supply.
 Radiotherapy.
 Poor oral hygiene.
 General Systemic Condition.
 CLINICAL FEATURES.
• Severe continuous pain.
• Necrotic odour.
• Raw edge of the socket.
• Gum margins rounded, oedematous,
Reddish/ blue.
• Exposed Socket (No clot).
• Septic alveolus.
 CAUSES OF DRY SOCKET.
 Presence of Acute Periapical infection.
 Use of unsterile instruments.
 Poor blood clot.
 Lack of clot Formation, due to the
vasoconstrictor Action of the adrenaline.
 Vigorous post operative washing of the mouth.
 A low resistance of the patient to infection.
 The presence of sepsis in the mouth. E.g.
Vincent’s infection.
 TREATMENT OF DRY SOCKET.
 The socket is gently irrigated with warm
normal saline to remove all debries.
 The socket is dried.
 Dressing the socket with cotton wool or zinc
oxide eugenol.
 Give analgesic and anti- biotics
 PREVENTION OF DRY SOCKET.
• This is achieved by ;-
Atraumatic surgery.
Avoiding contamination.
Maintainance of a good level of general
health.
 CLASSIFICATION OF MANDIBULAR
IMPACTION.
Mesioangular.
Horizontal.
Vertical.
Distoangular.
Buccal or Lingual displacement.
 PRINCIPLE OF REMOVAL OF
MANDIBULAR IMPACTION.
 There types can be applied:-
Sectioning Technique.
Bur technique.
Combination of the two.
 A PREPARED TRAY OF STERILE
INSTRUMENTS .
 Should include the following;-
 A catridge syringe and anaesthetic solution, scaplel and handle.
 Artery forceps.
 Tweezers and scissors.
 Needle and sutures.
 Elevators.
 Periosteal elevator.
 Handpiece and surgical bur.
 Forceps.
 Gauze.
 Chiesel and mallet.
 PRINCIPLES OF REMOVAL MANDIBULAR
TOOTH IMPACTED.
 Sectioning Technique.
 Bone is removed using chiesel and mallet to
expose the crown.
 Bur Technique
 .Bone is removed from the mesial, buccal
and distal surface of the alveolus.
 Chiesel and bur technique.
 The technique is the same as for their
removal by chiesel and bur combined.
POINTS TO REMEMBER IN EXTRACTION.

Never say “ This tooth is simple to

extract”.
In any extraction you must expect a
breakage of a tooth.
Tell the patient in case of any root
fracture , don’t hide.
Many fractured roots or crowns can
be managed through surgical removal.
 FACTORS CAUSING DIFFICULT
EXTRACTION.
I. Abnormal number of roots and shape.
II. An unfavourable pattern of roots.
III. Caries extending to the root or root mass.
IV. Fracture or resorption of the root.
V. Hypercementosis of roots.
VI. Impacted teeth.
VII.ANKYLOSIS.
VIII.Fracture of maxillar tuberosity.
 SESSION 06
ORAL AND MAXILLOFACIAL INJURIES.

• Soft Tissue Injuries.

 This reffers to the wounds involving the
soft tissue of the facial area.
CLASSIFICATION (TYPES) OF SOFT TISSUE
INJURY.
 Contusion.
 This is an injury which affects the skin and
subcutaneous tissure without breaking the skin.
 Abrasion.
 This is a wound produced by scraping of the
covering skin.
 Laceration.
 This is usually produced by some sharp objects
such as Metal or glass resulting in a tear wound.
CLASSIFICATION (TYPES) OF SOFT TISSUE
INJURY.
 Penetrating wounds.
 These are punctured type wounds produced by
sharp objects such as knife,nail, etc.
 Gunshot Wounds.
 These are produced by gunshot, shrapnel or other
projectiles.
 Burns.
 Caused by contact with flames, hot liquids, hot
metals, steam, acids electricity, irradiation and
irritant gases.
 WOUND HEALING.
 Wound.
 As any forcible disruption of the continuity of tissues.
 WOUND HEALING.
 Is a process of repairing damaged body tissues by natural body
mechanism.

 SYSTEMIC AND LOCAL FACTORS AFFECTING WOUND HEALING.

 Infection. ->Nutritional factors.
 Presence of foreign bodies. ->Medications e.g steroid.
 Immune status. ->Cigarette smoking.
 Diseases like diabetes mellitus. ->blood supply.
 General health. ->Vascular insufficient.
 TREATMENT STEPS OF WOUND.
Arrest The haemorrhage.
Debridement.
Prevention of the wound.
Closure of the wound.
Skin grafts and skin flaps.
Dressing the wound.
COMPLICATIONS OF TRAUMATIC DENTAL
INJURIES.
Infection e.g. Absscess and Osteomyletis.
Pulp necrosis.
Loss of function.
Loss of esthetic.
Root resorption.
Malalignment of teeth.
 CLASSIFICATION TOOTH INJURIES
(DENTO ALVEOLAR INJURIES)
Crown fractures.
Crown- root fractures.
Root fracture.
Luxation.
Exarticulation.
Intrusion.
Lateral displacement.
 CLINICAL SIGNS AND SYMPTOMS OF
JAW FRACTURE.
Pain.
Deformity.
Malocclusion.
Abnormal mobility of the jaw.
Swelling.
Salivation.
 COMPLICATIONS OF SEVERE MAXILLAR
INJURIES.
Blockage of air way.
Loss of Consciousness.
Displacement of the eyes.
Damage To nerves.
Opening of the Cranial Cavity.
-Resulting in the escape of cerebro- spinal
fluid into the nose.
Opening of the sinus followed by infection.
 FACTORS FOR REMPLANTATION THAT
SHOULD NOT BE CONSIDERED /DONE.
Extensive Caries.
Advanced periodontal disease.
Root fracture or fracture of the alveolar
socket.
When extra-oral period exceed 2 hours.
PROCEDURES FOR REMPLANTATION.
 Rinse the tooth in normal saline or clean the
tooth gently with gauze soaked in normal saline.
 Examine the socket for debries or fracture.
 Replace the tooth in the socket using gentle
pressure.
 Apply splint for 1-2 weeks.
 Check position of the tooth with radiographs.
 Administer tetanus prophylaxis and antibiotics
therapy for 4-5 days.
 THINGS TO BE NOTED IN INTRA- ORAL
EXAMINATION .
 The following should be noted;-
Laceration, haemorrhage and swelling of the oral
mucosa and the gingival.
Abnormalities of Occlusion.
Displacement of teeth.
Fracture of crowns or cracks in the enamel.
Mobility of the teeth.
Colour of the teeth.
Reaction to percussion.
Reaction to sensitivity test.
RADIOGRAPHIC EXAMINATION IS REQURED
TO PROVIDE THE FOLLOWING INFORMATION.
Extent of root development.
Size of pulp cavity.
Presence of root fracture or alveolar
fracture.
Displacement in an extrusive or intrusive
direction.
Position of intruded apex and the
permanent successor.
 FRACTURE OF THE JAWS.
• Fracture;-
 Is a break in a bone.
• A fracture may be ;-
• INCOMPLETE,- The bone breaks along one
border but remains intact on the opposite
side.
• COMPLETE,- In which case the bone is
completely broken.
CLASSIFICATION OF JAWS FRACTURE.
A simple fracture.
 Is one in which the overlying tissues are
intact.
Greenstick fractures: are incomplete fracture;
 One side of the bone is broken and the other
is bent like a bow.
 A compound fracture.
 Is a disruption of overlying skin.
CLASSIFICATIONS OF JAWS FRACTURE.
 Comminuted fracture.
 Is one in which many fragments are produced at the
fracture site as a result of the crush to the bone.
 Impacted fractures.
 Are very rare in case of mandible.
SPECIAL FRACTURES
 Access to infection.
 Exposure to saliva.
 Involvement of airway.
 Teeth in the fracture line.
 JAW FRACTURE SHOULD BE EXAMINED
WITH RADIOGRAPHS.
Radiographs examined is essential for the
following to;-
Confirm the presence of a fracture line.
Determine severity of bone damage.
Determine relationship of teeth to the
fracture line.
Detect fractures in other parts of the bone.
 PRINCIPLES OF MANAGEMENT OF JAW
FRACTURES:
Through clinical and radiographic
examination.
This should be done immediately the patient
has passed the danger stage.
Reduction of the fracture ends.
Immobilization of the fragments.
The control of infection.
 PHASES OF THE HEALING FRACTURE OF
BONE.
Haematoma Formation.
Organization of clot into granulation.
Formation provisional callus.
Formation of definitive callus.
 COMPLICATION OF THE HEALING OF
FRACTURES.
 Infection.
 Delayed healing in the presence of an
infection or inadequate fixation.
 Non union.
-This follows delayed healing if the cause is not
corrected.
 Mal-union.
-Is healing in poor position.
 FRACTURE OF MANDIBLE.
The Degree of displacement depends on the;-
 -Site of the fracture
 -Intensity of the blow and its direction.
 -Direction in which the fracture follows.
 -Muscular pull excreted by the relevant
muscle.
 COMMON SITES OF THE FRACTURES OF
MANDIBLE IN THE ORDER OF IMPORTANCE.
• Are as follows;-
Angle of the mandible.
Neck of condyles.
Body of the mandible.
The symphysis.
The Ramus.
SIGNS AND SYMPTOMS OF MANDIBULAR
FRACTURE.
• -Pain during mastication, palpation or
movement of the mandible.
• -Abnormal mobility.
• -Malocclusion.
• -Deformity.
• -Disability to masticate.
• -Ecchymosis of the gingival and mucosa.
• -Salivation and foetid breath.
 TREATMENT METHOD OF MANDIBULAR
FRACTURE.
Intedental eyelet wiring.
Arch bar.
Cast metal cap splints.
Gunning- type splints.
Transosseous wiring.
Bone plating.
Pin fixation.
COMPLICATION OF THE FRACTURE OF THE
MANDIBLE.
Infection.
Delayed union due to infection.
Mal-union and deformity.
Disorders of occlusion.
Impaire function of the temporomandibular
joint.
Anaesthesia of the lower lip.
 COMPLICATIONS OF OTHER MAXILLA
FRACTURE.
 Horizontal Fracture of the maxilla (LeFort I).
 The body of the maxilla is separeted from the
base of the skull above the level of the palate and
below the attachment of zygomatic process.
Clinical features.
-Mobility of maxilla.
-Mild bleedng of nose.
-Malocclusion.
-Open bite of the anterior teeth.
 COMPLICATION OF OTHER MAXILLA
FRACTURE.
 Pyramid Fracture (LeFort II).
 This separates the whole maxilla from its
attachment above the nasal aperture, lateral
walls of the antrum, sutures with zygoma
and the inferior – medial margin of the orbit.
 Clinical features of pyramid fracture
(LeFort II).
• Mobility of the upper jaw.
• Premature contact of the last teeth.
• Clear fluid has seen in the nose.
• Bleeding from the nose.
• Red eyes associated with subconjuctival
haemorrhage.
 COMPLICATION OF OTHER MAXILLA
FRACTURE.
 Transiverse Fracture (LeFort III).
 This is the high level of fracture which
extends downwards and backwards from the
fronto- maxillary suture through the
ethmoid, the interior – orbital fissure, fronto-
zygomatic suture and temporo-zygomatic
suture or thinnest part of zygomatic arch.
 Clinical features of Transiverse fracture
(LeFort III).
Oedema of the face round the eyelids i.e.
bulging of eyelids.
Loss of consciousness.
Damage to the floor of the Orbit.
Bleeding from the nose and ears.
Premature contact of the last teeth.
Sub- conjuctival ecchymosis.
Cerebrospinal rhinorrhea.
 PRIMARY CARE SHOULD BE DONE AS IN
PYRAMIDAL FRACTURE.
• Immediate management of the patient should
follow a pattern such as follows;-
 P-Posture.
 A-Aspiration.
 T-Tongue traction.
 T-Tubes.
 E-Examination in detail.
 R-Reassurance.
 N-Notification of specialist service.
 SESSION 07.
EMERGENCIES IN THE DENTAL SURGERY.
• The following are emergencies will be
discussed;-
Fainting (syncope).
Airway obstruction.
Cardiorespiratory arrest.
Shock.
Epileptic attack.
Haemorrhage.
 FAINTING (SYNCOPE)
• This is emotional result which
occur due to a transient fall in
blood pressure.
 SIGNS AND SYMPTOMS OF FAINTING
(SYNCOPE).
Pallor.
Dizziness.
Light headaches.
Clammy skin.
Nausea and
Loss of consciousness.
 MANAGEMENTS OF SYNCOPE.
Place the patient in a supine position with the
head lower than the rest of the body.
Maintain clear airway and oxygen may be
given.
Consciousness usually returns fairly quickly. i.e
in the early stages, hot,sweet tea or coffee.
Give mild- respiratory stimulants such as a salt
of ammonia (Ammonium Chloride).
 EPILEPTIC ATTACK.
 Major Seizure (Grandmal Seizure) and
 Minor Seizure (Petit Mal).
 HAEMORRHAGE.
 LOCAL CAUSES OF HAEMORRHAGE.
Gross tissue damage.
Infection of the extraction wound.
Injury to large blood vessels such as inferior
alveolar artery.
Lack of adequate pressure pack and failure
by the patient to bite on the gauze packed.
 HAEMORRHAGIC.
Systemic Causes.
Clotting disorder.
Purpura.
Malignant condition e.g. leukaemia.
Liver disease e.g. liver cirrhosis.
Vitamin K deficiency.
Anticoagulant treatment.
 CARDIAC ARREST.
 The most common cause of Cardiac Arrest
are;-
Allergic reactions to a drug.
Anaesthesia.
Idiosyncrasy.
Drowning.
Electric shock and
Asphyxia.
 SHOCK.
 Is a clinical syndrome characterized by
inadequate perfusion of the tissues with
blood due to cardiovascular defect.
 TYPES OF SHOCK.
 Hypovolaemic shock.
 Cardiogenic shock.
 Septic shock.
 Anaphylactic shock and
 Neurogenic shock.
 HYPOVOLAEMIC SHOCK
• Result from decrease of volume of circulator
blood caused by;-
-Bleeding.
-Plasma exudation.
-Diarrhoea and vomiting and other fluid loss.
-Plasma exudation into cavities E.g. in bowel
obstruction or peritonitis.
 SEPTIC SHOCK .
• Clinical features.
 Pallor.
 Sweating.
 Warm skin.
 Develops insidiously without fever.
 MANAGEMENTS OF SHOCK.
 Maintain air way.
 Apply oral way.
 Check breathing.
 Mouth-mouth (Kiss of life).
 Cardiovascular system.
 This is done by resustation and Application of I.V
fluid.
 Drugs.
 Adrenaline, steroid and Nikethamide.
 MANAGEMENTS OF SHOCK.
Electrolyte correction.
 Intra- Venous fluid.
 SESSION 08.
ORAL DISEASES.
• INFLAMMATORY PROCESS.
 Inflammation.
-Is one of the fundamental reactions of the
body to injury.
 CAUSES OF INFLAMMATION.
I. Physical Agents. Includes;- Trauma,heat,
cold and Ionizing radiation.
II. Chemical Agents. Includes;-Corrosive
acids,Alkalis, Phenol and Mercuric chloride.
III. Living organisms.
IV. Antigen- Antibody reaction.
V. Hyperaemia.
VI. Exudation.
 SIGNS AND SYMPTOMS (FEATURES) OF
ACUTE INFLAMMATION.
Pain (DOLOR).
Swelling (TUMOR).
Redness (RUBOR).
Hotness (WARMER).
Loss of function (FUNCTION LAESA).
 SEQUENCE OF EVENTS FOLLOWING
TISSUE DAMAGE.
 Demolition Phase.
-Macrophages engulf fibrin, red cells, bacteria
and degenerate polymorphs etc.
 Resolution.
-This means complete returns to normal
following acute inflammation.
 Organization.
-Is a reversed flow of exudates back into the
blood vessels.
 SEQUENCE OF EVENTS FOLLOWING
TISSUE DAMAGE.
Suppuration.
 This is typical of pyogenic infection e.g.
turpentine.
 The agent kills many leukocytes which are
often called ‘puss cells’.
Pus.
 Is made up of ;-leucocyte,organisms,tissue
debris.
 SPREAD OF INFECTION IN THE ORAL
CAVITY.
 Pulp infection.
 Pulp hyperaemia.
 Pulpitis.
 Pulp Necrosis.
 Gangrene.
 Abscess.
CLINICAL FEATURES OF PULPITIS.
Inflammation of the pulp.
Attacks of severe pain.
Frequent pain when his / her goes to sleep.
Pain persists for a few minutes to several
hours.
Not tender on percussion.
Tooth not mobile.
Patient cannot localize the which has pain.
Reacts weakly to electric stimuli.
 SYMPTOMS AND SIGNS OF PULP
NECROSIS.
Patient no longer experiences pain.
Tooth is not sensitive to any stimuli.
The acffected tooth turns to darker.
Blood supply is limited.
Necrotic odour.
 CLINICAL FEATURES OF ACUTE
PERIAPICAL PERIODONTITIS.
 Patient complains of severe pain.
 Patient will feel that the tooth is too high
than others.
 The pain increases when he / she drinks hot
liquids.
 The pain decreases when he / she drinks
cold drinks.
 Tooth is mobile.
 Little external swelling.
 CLINICAL FEATURES OF PERIAPICAL
ABSCESS.
Lymphadenitis.
Fever.
The tooth slightly extruded from the
socket.
Extremely painful tooth.
 COMPLICATIONS PERIAPICAL ABSCESS.

o Osteomylitis.
o Cellulitis.
o Bacteremia.
o Fistula formation.
 Lateral Periodontal Abscess.
• This is related to a pre- existint periodontal
pocket.
• Clinical features.
Pocket depth 5-8mm.
Pain.
Swelling destroying the costical palate of
bone.
The tooth tender in percussion.
Ballooning the overlying tissue.
 TREATMENT.
Extraction of tooth after acute symptoms
have subsided.
Insertion of a dull probe into pocket to
produce drainage.
 LUDWING’s ANGINA.
 Angina ludovic ;-
-> is a serious generalized septic cellulites of the
mandibular region.
->An extension of infection from mandibular molar
teeth into the floor of the mouth.
-> Involves the molars of the lower jaw – generally
the second and third molars.
->CAUSED by haemolytic streptococcus and
anaerobic infection for the presence of gas in the
tissue.
 CLINICAL FEATURES OF LUDWING’S
ANGINA.
 Respiratory distress.
 Brawny induration.
 Dyspagia , difficult in eating and breathing.
 No fluctuance.
 Tissues may become gangrenous.
 Tissue are boardlike and do not pit.
 Fever.
 Stiffness in tongue movement.
 Salivation.
TREATMENTS OF LUDWING’s ANGINA.

->High dose antibiotic therapy e.g. Benzyl

penicillin injection 6 hourly.
->Incision ;- to release tissue tension.
->Tracheoctomy.
->Extraction of tooth which are infected.
 PERICORONITIS.
 This is an inflammation of the soft tissues
covering around the crown of a partially
erupted or unerupted tooth.
 CAUSES OF PERICORONITIS.
• Impaction of food under the gum flap.
• Diminished resistance due to systemic
disease.
• Biting on the gum flap by opposing tooth,
causes laceration of the flap.
• In ulcero- membraneuos gingivitis.
Clinical features of Acute Pericoronitis.
Pus discharge beneath the flap.
Foetor Oris.
Trismus.
Enlargement of regional lymphnode.
 Severe ,sharp pain. (throbbing pain)
Discomfort in swallowing .
Signs of partial tooth eruption.
High temperature and
Severe malaise.
TREATMENT OF PERICORONITIS.
->Analgesics.
->Extraction.
->Incision and drainage if an abscess has
formed.
->Prescribe antibiotics orally or intramusculary.
->Grind down the cusps of the opposing
tooth.
 STOMATITIS (ACUTE) HERPETIC
GINGIVOSTOMATITIS.
 This is an acute infectious disease usually
ocurring in young children.
 It is caused by a virus – called Herpes virus
Hominis.
CLINICA FEATURES OF STOMATITIS (acute)
HERPETIC GINGIVOSTOMATITIS.
Fever.
General body Malaise.
Lymphadenitis.
Raised body temperature.
Ulcers are painful, small and shallow.
Ulcers may appear on lips, cheeks,
tongue,sublingual mucosa and palate.
ACUTE ULCEROMEMBRANOUS GINGIVITIS.

 Clinical features .
 Necrosis and ulceration of interdental papillae.
 Soreness and bleeding of the gingivae following
minor trauma.
 Increased salivation.
 Characteristic Foetid odour.
 Lymphadenopathy.
 Fever.
 Malaise.
 TREATMENTS OF ACUTE
ULCEROMEMBRANOUS GINGIVITIS.
->Oral hygiene instructions.
->Scaling and polishing.
->Drug therapy including ;- Oxygen releasing
agents, Hydrogen peroxide and antibiotic.
->Topical application of penicillin or
tetracycline.
->Penicillin lozenges or chewing gums.
->Systematically administered antibiotic.
 CANDIDIASIS.
• Candidiasis.(Thrush, Candida Stomatitis).
 Is an infective disease by the candida
albicans, a yeast, which in the mouth may
invade a superficial layer of the epidermis
and give rise to various symptoms.
 TREATMENTS.
Nystatin is the drug of choice.
Amphotericine B tabs – is an alternative.
Fruconazole tabs.
Children in a suspension of 1ml (100,000 iu).
Nystatin drops in adult, tabs 500,000 iu .
 PRE-DISPOSING FACTORS OF FUNGAL
INFECTION (CANDIDIASIS).
Immunodeficiency.
Acquired immunosuppression.
Diabetes mellitus.
Pregnancy.
Hypoparathyroidism.
Corticosteroid therapy.
Systemic antibiotic therapy.
Xerostomia.
Poor oral hygiene.
 OSTEOMYLETIS.
-> This reffers to an inflammatory disease of
the jaw bone causing bone destruction and
accumulation of pus in the bone marrow.

 The disease affects the bone marrow,

cancellous and cortical plate.
 AETIOLOGY.
Causative organisms is commonly
Staphylococcus Aures, OTHER
microorganisms such as pneumococcus or
salmonella may be involved in the infection.
CLINICAL FEATURES OF OSTEOMYLETIS.

Enlargement of regional lymphnode.

Body malaise.
Elevation of body temperature.
The affected area become painful and loose.
Fever.
Fistulas.
Trismus.
Adenopathy.
 MODE OF ENTRY
Blood Stream.
Periapical infection.
Sequelae.
Sequestrum.
 TREATMENT OF OSTEOMYLETIS.
-Incision and adequate drainage.
-Antibiotic treatment with metronidazole
500mg and ampicillin 0.5 gram.
-Surgical intervention.
 PRE-DISPOSING FACTORS OF
OSTEOMYLETIS.
 Odontogenic infection.
 Fracture of the mandible.
 Medication like steroids.
 Bacteriology.
 Oral bacteria- staphylococcus , streptococci
and anaerobic bacteria.
 Diminished host defense like systemic
conditions e.g. Diabetes ,malnutrion and AIDS.
LOCAL AND SYSTEMIC FACTORS THAT
AFFECT WOUND HEALING.
 Infection.
 Vascular insufficient.
 Diseases like diabetes mellitus.
 Presence of foreign bodies.
 Nutritional status , malnutrition.e.g. protein deficiency,
vitamin deficiency etc.
 Immune status .
 Cigarette smoking.
 Medication e.g. steroids.
 Presence of foreign bodies.