Dental Surgery Educational Dvds
SOME TYPES OF HEART CONDItions put people at a higher risk to develop infectious endocarditis, or an infection of the heart that can damage heart valves. To protect these patients, cardiologists often recommend antibiotic protection before undergoing surgery, including dental surgery. Your dentist or dental surgeon, in addition to any other doctors, should be made aware if you have one of these conditions before you undergo surgery.
Fluoride supplements in the form of tablets to drops have long been considered an alternative to water fluoridation. Although the effectiveness of fluoride supplements was endorsed by many small clinical studies, closer examination of the experimental conditions of these, their methods and the analysis of their results undermined confidence in their findings. More modern, well-conducted clinical trials of supplements suggest that today, in children also exposed to fluoride from other sources such as toothpaste, the marginal effect of fluoride supplements is very small and there is substantial risk of fluorosis if supplements are used by young children.71 This has resulted in changes to recommended fluoride dosage schedules and deferment of the age commencing the use of supplements, implemented in many countries. Overall, poor compliance and potential risks of fluorosis make fluoride supplements a poor public health measure and they are infrequently prescribed in dental practice.72...
In the light of the multiple routes of transmission noted above, the key principles that underpin modern infection control procedures are shown in Table 7.2. These apply in all healthcare settings, including dental surgery. The cleaning of used surgical instruments to remove visible deposits is an essential step prior to their sterilisation. In hospitals, both the cleaning and the subsequent sterilisation procedures are usually performed in a Central Sterile Supply Unit (CSSU). However, increasing amounts of minor surgery are performed in primary care and, under these circumstances, the decontamination of used instruments might be performed in a medical or dental practice. In such cases, instrument cleaning may be achieved by hand scrubbing in soap or detergent, but ultrasonic baths and washer disinfectors are very useful and more effective for many items. Heavy-duty protective gloves should be worn during instrument cleaning, and care taken to avoid sharps injuries.
Figure 24-16 The technique for the extraoral block of the mandibular nerve is essentially the same as that for the maxillary block, except that the needle is directed upward and posteriorly, so that the mandibular nerve is contacted as it exits the foramen ovale. (Redrawn from Bononi SR The trigeminal nerve. In Bennett CR ed Monheim's Local Anesthesia and Pain Control in Dental Practice, 7th ed. St. Louis, CVMosby, 1984.)
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Figure 20-11 The nerve of the right lateral nasal wall. Note the site and distribution of the sphenopalatine ganglion.(Redrawn from Bononi SR The trigeminal nerve. In Bennett CR Manheim's Local Anesthesia and Pain Control in Dental Practice, 7th ed. St. Louis, CVMosby, 1984. From Raj PP Clinical Practice of Regional Anesthesia. New York, Churchill Livingstone, 1991, p 207.) Figure 20-11 The nerve of the right lateral nasal wall. Note the site and distribution of the sphenopalatine ganglion.(Redrawn from Bononi SR The trigeminal nerve. In Bennett CR Manheim's Local Anesthesia and Pain Control in Dental Practice, 7th ed. St. Louis, CVMosby, 1984. From Raj PP Clinical Practice of Regional Anesthesia. New York, Churchill Livingstone, 1991, p 207.)
Figure 24-15 Extraoral posterior approach for nerve block of the maxillary division of the trigeminal nerve. (Redrawn from Bononi SR The trigeminal nerve. In Bennett CR ed Monheim's Local Anesthesia and Pain Control in Dental Practice, 7th ed. St. Louis, CV Mosby, 1984.) Figure 24-15 Extraoral posterior approach for nerve block of the maxillary division of the trigeminal nerve. (Redrawn from Bononi SR The trigeminal nerve. In Bennett CR ed Monheim's Local Anesthesia and Pain Control in Dental Practice, 7th ed. St. Louis, CV Mosby, 1984.)
'Sedo-analgesiaThis term describes the use of a combination of a sedative drug with local anaesthesia, e.g. in dental surgery or surgical procedures performed under regional blockade. The recent expansion in the development of minimally invasive sur gery makes this technique more widely applicable.
Elderly patients may have an associated decrease in cardiovascular and respiratory reserve. Procedures that make use of local anesthetics such as ophthalmic surgery and concomitant use of sedative drugs can increase the risk of respiratory depression. The frequent irrigation of the mouth during oral and dental surgery can cause hypoventilation and hypoxemia even without sedation.
Not all can be seen by observing the surface is a statement that is sometimes equated to icebergs, but is likewise applicable to teeth, since only their surface features are evident to clinical inspection. A large segment of dental practice, namely endodontia. is directly concerned with the hidden portion of a tooth. The name, endodontia, implies inside a tooth , thereby involving the treatment of the pulp cavity and its tissues.
The selection of patients presenting for dental chair anaesthesia should be the same as for patients undergoing any outpatient procedure, i.e. only healthy ASA grade I and II patients are appropriate. The preoperative screening of patients may be particularly difficult in a dental practice, but this is the situation in which careful selection of patients is of greatest importance. It is essential that the dental practitioners involved have some understanding of the anaesthetic implications of common medical conditions and are able to exclude patients with significant cardiac or respiratory disease, renal or hepatic impairment, bleeding disorders or a potentially difficult airway at the time of referral. Patients who do not meet these criteria should be referred to a specialist centre which has back-up facilities and should not be treated in a dental surgery.
The minimum standards for monitoring during anaesthesia should be met (Table 38.17). Although most of the procedures in dental practice are short, it is very important that monitoring is used in each case. There is a high potential for airway obstruction resulting in hypoxaemia and also a relatively high incidence of cardiac arrhythmias especially when halothane is used. In practices where tracheal intubation is used, a capnograph is required. Table 54.1 List of emergency drugs to be available in dental practices
Anaesthesia and dentistry have a long historical association. Some of the first anaesthetics given were for dental extractions and the use of anaesthesia was quickly taken into dental practice in the late 19th century. Dental anaesthetic techniques have evolved in parallel with the changes in practice in other aspects of anaesthesia. The days of single operator anaesthetists and the 'black gas' induction (100 nitrous oxide) are now long gone. For many years, dental anaesthesia had been practised in a variety of sites varying from within dental schools to remote dental practices, with anaesthesia provided by anaesthetists, medical practitioners or indeed dentists. tistry by the Royal College of Anaesthetists (1999) have effectively concentrated the provision of anaesthesia for dental surgery to centralized facilities. Both reports stated that sedation should be used in preference to general anaesthesia wherever possible and made further recommendations on training in sedation...