Oral Surgery and Infections

Oral Surgery

And

Oral Infections

Premlata Kshatriya and Terri Morris

Oral Surgery and Infections

Oral surgery and oral infections are a major part of the dental profession. Everyone needs to be aware of the precautions, signs, symptoms and treatments of infections and procedures for oral surgery. This paper will include information on oral surgery, oral thrush, osteomyelitis, pericoronitis, and oral herpes as well as homeopathic remedies for these infections and other oral conditions.

Oral Surgery

Oral surgery includes: the diagnostic and surgical treatment of diseases, injuries, and defects involving both the functional and the esthetic aspects of the hard and soft tissues of the oral and maxillofacial regions.

Surgery for treatment of diseases and correction of defects of perio tissues is considered perio surgery. In the scope of perio surgery is: procedures for the elimination of pockets, gingivoplasty, treatment of furcation involvement, correction of mucogingival defects, and treatment for bony defects around the teeth.

Categories of Treatment

Exodontics

Impacted tooth removal

Alveolar bone surgery (alveoplasty)

Abscesses

Osteomyelitis

Fractures of jaws (bone)

Fractures of teeth or alveolar bone

Cysts

Tumors

Dental implant placement

Maxillofacial prosthetics

Immediate dentures

Prognathism correction

Facial esthetics

Cleft lip/palate

TMJ disorders

Salivary gland obstruction

There are specific instructions that should be given to patients before they have surgical treatment. These instructions will give them a better understanding of what they are about to experience and how to prepare for it.

Patient Instructions

Pre-surgical Instructions

  • Explain any general procedures used for anesthetic and for the surgery itself.
  • Provide printed instructions which include the food and liquid intake and number of hours before surgery that the client should stop eating and drinking.
  • Certain medications aren’t compatible wit anesthetic and drugs to be used during and following the procedure.
  • When any type of sedation is used the client shouldn’t drive.
  • The night before they should get a good rest.
  • Their clothing should be loose and comfortable (the sleeves should be able to be drawn up over the elbows
  • They should also be asked to remove contact lenses and prosthesis and should bring containers to put them in.

Post-surgical instructions are instructions that are given to the patient once the procedure is complete. These instructions will allow the patient to promote proper post-surgical healing and oral care. It will also prepare them for any unusual occurrences that may occur.

Post-Surgical Instructions

  • To control the bleeding (in office) the client should keep a piece of gauze over the area for 30 min. then throw out.
  • If the bleeding persists they should place gauze or a cold wet tea bag over the area for another 30 minutes. Make sure that you inform them that they should bite firmly.
  • Do not rinse for 24 hours.
  • After 24 hours you can rinse with warm salt water after brushing and every 2hrs there after.
  • Brush your teeth more thoroughly but avoid the surgical area.
  • Get plenty of rest and avoid strenuous exercise during the first 24 hours.
  • Use a liquid or soft diet high in protein (to promote healing) and drink water and fruit juices freely.
  • Use a pain medication prescribed by the dentists and follow the dentist’s instructions regarding the medication.
  • If there is swelling and ice pack can be applied 15 minutes on and 15 minutes off as directed by the dentist.
  • The instructions should include the telephone number to call after hours if complications arise.

Diet Considerations

The nutritional state can influence the resistance to infection and wound healing. Specific recommendations of what to include and not in diet should be given.

Nutritional and dietary needs:

  • Essential for promotion of healing
  • Protein and vitamins A, C and riboflavin
  • Essential for building gingival tissue resistance
  • Varied diet with all essential food groups
  • Essential for dental caries prevention
  • Non Cariogenic foods

Adequate diet before surgery is needed to support an adequate post surgical response. The surgery itself can result in anorexia, inability to chew and increased metabolic requirements (due to healing requirements). After surgery a client may need a liquid diet for one or two days but should be graduated as soon as possible to a soft diet of high nutritional quality until normal eating ability is restored. In some cases, supplements may be appropriate and should be prescribed after a consultation with the client’s dietitian and physician has taken place. In many cases however, clients prefer purees of normal foods to commercial supplements.

Indications for a Liquid Diet

The jaws are required together, or any condition that makes them have a difficulty in opening the mouth.

Examples of liquid diet foods are:

  • Fruit juices
  • Milk
  • Eggnog
  • Canned baby foods
  • Purred foods

Indications for a Soft Diet

The client has no appliance or has a single appliance but does not have complications in opening the mouth. The patient who has been kept on a liquid diet throughout the treatment period also is considered.

A soft diet aids in protecting the tissues from rough textures until the tissues heal and can respond positively to a plaque removal routine.

Examples of soft diet foods are:

  • Eggs
  • Cooked cereals
  • Soft cooked veggies
  • Canned fruits
  • Finely divided meats
  • Ice cream

Suggestions for Instruction

Make sure you provide instruction sheets that show specific pre and post surgical meal plans. Also express nutritional needs in quantity or serving, show ways to vary the diet and suggest the limitation of Cariogenic foods. For patients who are receiving dentures, instruction must be provided over a period of time.

Roles We Play in the Office

Dental Hygienists Responsibilities

  • Participate in suture removal
  • Irrigation or sockets
  • Other post-surgical procedures when the client returns for their post-operative check-up.
  • Prior to the surgery the DH should have an appointment scheduled for a debridement.
  • Reducing the oral bacteria count will aid in upkeep of an aseptic field. It will also make post-surgical infection less likely or less severe.
  • Reducing the inflammation and improving the tissue tone will lessen local bleeding at the time of the surgery and will promote healing.
  • The removal of calculus will remove the source of plaque retention, prevent interference with instrument placement, and will prevent the breaking off and lodging in a socket or inhalation of it (which will inhibit healing)
  • Instruct the clients in pre-surgical and personal oral care procedures.
  • Make sure you instruct about foods that provide the elements essential to tissue building and repair.
  • Interpret the dentist’s directions so the client fully understands.
  • Motivate the client who will have remaining teeth so they aren’t compromised.
  • After the surgery or removal of appliance there should be another cleaning especially if the client hasn’t been able to open their mouth.
  • OHI on different aids that can be used after surgery to help them with their oral hygiene regimen.

Dental Assistants Responsibilities

  • Prepare all armentarium and medications
  • Maintain a clear surgical field for the surgeon
  • Observe vital signs and keep monitoring them
  • Reassure the client and try to help them to relax
  • Provide them with the pre-operative and post-operative instructions.
  • Inform them of what to expect
  • Make a follow up call
  • Ask if client has taken their premeds if required
  • Make sure the allergies are noted

Homeopathic Healers

Phosphorus for persistent bleeding.

Apis mellifica for post injection soreness.

Chamomilla because it increases tolerance of pain. This herb is taken before the dental visit.

Staphysagria heals the gum tissue.

Symphytum helps heal bone tissue.

Cuprum metallicum helps control jaw muscle spasms.

Some dentists use burdock root, olive leaf extract, and oil of oregano as natural antimicrobial agents in cleaned cavitations to induce healing and filling with new bone.

Calendula contains many immune system stimulators. Mouthrinses made from the tictures of calendula, myrrh, and goldenseal soothes and helps heal tissues.

Echinaacea used in mouthrinses as an antibacterial agent and because it increases the number of T-cells and plasma cells, it enhances antibody production, stimulates the immune system, and neutralizes toxins.

Gotukda tea heals tissues and promotes tissue growth.

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.

How Do You Get Oral Thrush?

This type of infection is present in almost half the population. Those who wear dentures will have thrush without necessarily suffering from any ill effects of the infection.

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.

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.

What Are The Symptoms Of Oral Thrush?

White cream coloured or yellow spots in the mouth. The effected areas will be slightly raised. When the creamy substance is scraped away, small wounds will appear underneath and may bleed slightly.

Those adults who suffer from thrush may also feel an uncomfortable burning sensation in the mouth and throat.

Who Is At Higher Risk?

HIV infected individuals and those who suffer from AIDS

Newborn babies

Denture users

Adults with diabetes or other metabolic disturbances

Those undergoing antibiotic treatment or chemotherapy

People with poor nutrition

People with immune deficiencies

How Does Oral Get Diagnosed?

In newborn babies it is usually diagnosed by clinical picture. Sometimes the babies tongue can be scraped and a sample sent to a laboratory for further testing. In adults, other diseases and systemic illnesses can cause Thrush. A sudden and intense outbreak of Thrush can be caused by aggravation of the main illness. The appearance of the condition is unmistakable in the oral cavity. It is recognized by visual detection in most cases.

How Does Oral Thrush Get Treated?

The first thing that has to be done is to get the main condition that caused the Thrush under control. For example, a better fitting denture may have to be fabricated or the treatment for a diabetic may have to be adjusted. The exception to this is for AIDS patients. A course of anti-fungal drugs may have to be taken orally.

Once the condition that is causing the Thrush is taken care of the Thrush itself can be dealt with. Anti-fungal medications are used such as, nystatin, amphotericin, or miconazole in the form of pastilles that are sucked or an oral suspension that is held in the mouth before swallowing. If the infection spreads or becomes complicated, systemic treatment may be necessary. This form of medication comes in a tablet form or in the form of an injection.

Coping With The Symptoms Of Oral 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.

Holistic Approach to Oral Thrush

Diet

There are certain foods that have been thought to make Candida albicans worse and certain foods have been thought to be therapeutic and promote healing. The following is a list of food to avoid and foods to eat if you are suffering from oral Thrush.

Food you must avoid

Yeast- breads, crackers, pastries

Fruit Juices- canned, bottled or frozen. Fresh squeezed may be tolerated.

Coffee and Tea- Regular, instant, decaffeinated. Herbal teas are tolerated (caffeine-free)

Caffeine- anything containing caffeine (including chocolate)

Dairy or Dairy Containing Products- Milk (contains lactose, a simple carbohydrate which feeds the yeast)

Black Pepper- hard to digest. Cayenne pepper is a recommended alternative as is promotes digestion.

Edible Fungi- mushrooms

Smoked meats- smoked fish, pickled and smoked meats, including sausages, hot dogs, corned beef, pastrami, and ham.

Condiments, Sauces, and Vinegar-Containing Foods- Mustard, Ketchup, steak sauce, pickles, green olives, mayonnaise.

Dried and Candied Fruits- Raisins, apricots, prunes, figs and pineapples.

Leftovers- mold grows on food that has not been properly refrigerated. It is best to eat fresh foods.

Food you can eat

Vegetables and Legumes

ArtichokeEggplant Peppers, all types

AsparagusGarlicPotatoes, red skinned

BeansGreen beanPumpkin

BeetLeeksRadish

BroccoliLettuceRutabaga

Brussel SproutsMustardSoybean

CabbageOkraSpinach

CarrotsOnionTomato

CauliflowerParsleyTurnips

CeleryParsnipTofu

ChardPeas, all typesYams

Cucumber

Fish/Shell FishWhole GrainNuts

CodBarleyAlmond

CrabKamutBrazil nut

HalibutMilletFilbert

Orange RoughyOatsMacadamia nut

SalmonRice-brownPecan

ShrimpRyePine nut

TroutSpeltWalnut

TunaTeff

Wild Rice

FruitsMeatPoultry

Avoid fruit for 3 months and AntelopeChicken

then reintroduce fruit 1 at a timeBeefBrazil nut

and eat all fruit alone on an BuffaloFilbert

empty stomach.LambMacadamia nut

PorkPecan

Apple RabbitPine nut

ApricotSquirrelWalnut

AvocadoVeal

BananaVenison

GrapefruitRed meat

Mango

Nectarine

Orange

Papaya

Peach

Pear

SeedsNon GrainButtersFats

PumpkinAmaranthAlmondButter

SesameBuckwheatSesame (tahini)Oils, unrefined

SunflowerQuinoaSunflower

Osteomyelitis

A latent stage of the progression of a periapical infection, which results in the infection spreading into the bone.

Acute or chronic inflammation of the bone marrow or of the bone and marrow.

Can involve any portion of the jaw bone: the alveolar bone proper, supporting cortical bone, or trabecular bone.

Develops from the invasion of the bone tissue by pathogens from a periapical abscess, an extension of cellulites or contamination of surgical sites.

Frequently occurs in the mandible.

Continuation of osteomyelitis leads to bone resorption and sequestra formation.

Paresthesia, an abnormal sensation from the area, such as burning or prickling, may develop in the mandible if the infection involves the mandibular canal carrying the inferior alveolar nerve.

Localized parasthesia of the lower lip may occur if the infection is distal to the mental foramen where the mental nerve exits.

Osteomyelitis of the jaws is uncommon since dental care and antibiotics are readily available.

Pericoronitis

Inflammation of the tissue flap over a partially erupted tooth, commonly a third molar.

When the gingival tissue lays over the partially erupted crown, it creates an environment in which food and plaque can become impacted.

Characterizedby: edema, redness, exudates, foul odor, and pain that may radiate from the point of origin to the ear, throat or floor of the mouth. A tenderness of the lymph nodes, facial edema, difficulty in closing the mouth and a possible increase in body temperature.

Treatmentinvolves the removal of the bacteria and local irritants. Accomplished with antibacterial or antiseptic oral rinses and may require a drug therapy regimen.

Surgical removal of the gingival tissue or the involved tooth, especially in the case of third molars.

Pericoronitis is a special type of acute periodontal abscess that occurs when gingival tissue (operculum) overlies an erupting tooth (usually a third molar, also known as a wisdom tooth). Recurring acute symptoms are usually initiated by trauma from the opposing tooth or by impaction of food or debris under the flap of tissue that partially covers the erupting tooth.

When dental referral is not readily available, one procedure for relieving the pain is surgical removal of the operculum. inject local anesthetic directly into the overlying tissue and then cut it away using the outline of the tooth as a guide for the incision. Sutures are not required

Do not undertake any major blunt dissection while draining pus. This could spread a superficial infection into the deep spaces of the head and neck or follow a deep abscess posteriorly into the carotid sheath.

Herpes

What Is Herpes And What Causes It?

Herpes simplex is a common and usually mild infection. It can cause “sold sores” or “fever blisters” on the mouth and face. A virus causes herpes. It is different from other common viral infections. Once introduced to the body it will live there for a lifetime. Often with periodic symptoms or no symptoms at all. This is known as “latency”. This virus can travel the nerve pathway and hide in a latent state in the nerve root for long periods of time. Even though the symptoms caused by the virus being present are not apparent all the time the symptoms may occur later.

Symptoms

When a person is first infected with HSV – 1 or HSV – 2 the immune system is not as strong and the virus develops much quicker and spreads to more places then it might later. First symptoms are uncomfortable and appear about two weeks after the virus is contracted. In some cases the first episode may be so minor that it goes undetected. Some people have no symptoms at all. For these people, when the symptoms do occur it may “reactivation” be in a later episode. This could be weeks or months or years later.

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