Chapter 5: Oral Surgery Introduction



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Using the Aseptic Technique

Introduction


Oral surgical procedures provide an opportunity for the transmission of infection or disease from patient to patient, from surgeon or assistant to patient or from the patient to members of the operating team. The preparation of the instruments and performance of the procedure should be done in such a way as to minimize transmission of disease.

Standardization


Standardization of instruments used in dental clinics throughout the IHS should be encouraged. This is especially helpful to dental officers and assistants who may be assigned from one clinic to another. It also helps when dental specialty consultants communicate with dental officers to offer suggestions and advice pertaining to oral surgery.

Instruments


Proper use of the following instruments will help you avoid the introduction of contaminants into the operating field which may result in disease transmission:

Procedures for Setting Up for Oral Surgery

The following are procedures for setting up for an oral surgery procedure (impaction). The principles outlined are important; however, the procedure will need to be adapted to each clinic.



Step

Action

1

Clean the unit for the procedure.

2

Place the radiographs on the view box.

3

Wash hands!

Note: Nonsterile gloves may be worn at this point, but remember that they are clean, not sterile.

4

Gather all items needed for the procedure. This includes:

Warning: Do not open any of these items at this time.

5

Place the above listed items at the unit.

6

Open the sterile basic pack carefully in such a way that neither the basin nor the inside of the towel wrap are touched with the nonsterile gloves.

7

Fill the sterile basin with the sterile saline, being careful not to touch either the basin or towel with the saline container.

8

Add expendable items to the sterile area near the saline basin by carefully opening each package and letting each item drop onto the sterile towel.

Warning: Do not touch the sterile area at this time with the nonsterile gloves. You must have sterile gloves on before any item can be handled on the sterile towel.

9

Open the sterile pack carefully--touching the outside surface and corners only.

Warning: Do not touch the inside with either bare hands or nonsterile gloves.

10

Set up anesthetic syringe, needle, and anesthetic carpules on an adjacent nonsterile area.

Note: The doctor will anesthetize the patient while wearing the non-sterile gloves. The assistant can complete the set-up after changing to sterile gloves.

11

(Doctor) Put on sterile gloves carefully.

Warning: Do not touch any surface outside the sterile packs after gloving.

12

Complete the opening of the sterile packs by arranging the instruments on the sterile towel.

13

Drape the patient with a sterile towel, connect and secure the suction tubing to the evacuator, and begin the procedure.

14

Do not touch any object or surface outside the sterile area.

Warning: If you inadvertently touch a nonsterile object, you must reglove.

Note: The patient’s chest can be used as a transfer point since a sterile towel is present.

15

(Assistant) Irrigate using a hand syringe in one hand and suction in the other.

Warning: Never use internal spray from a high speed hand piece or water from a standard water-air syringe.

Treating Alveolar Fractures

Introduction


Injuries to the teeth and alveolar process are common and should be considered emergency conditions, since a successful outcome is dependent upon prompt management. Lacerations and abrasions of the skin or mucosa are noted frequently. All missing teeth must be accounted for and ensure that they are not imbedded in soft tissue injuries. Segments of the alveolar process that have fractured are usually readily detected by visual examination and palpation. These segments often contain more than one tooth.

Initial Treatment


The initial treatment is to attempt to place the segment into its proper position and then stabilize it until osseous healing occurs. This may require no more than digital pressure and a local anesthetic.

Procedures for Treating an Alveolar Process with Splintering

Frequently splintering of the alveolar process occurs making repositioning very difficult. You must then perform the following steps:



Step

Action

1

Develop a buccal flap to gain access to the fracture.

Note: The flap must not jeopardize the blood supply to the alveolar segment and usually can be made through the buccal vestibule.

2

Gently reposition the segment with a blunt instrument

3

Ensure that the lingual soft tissue is intact before incising the facial tissue.

4

Examine the bony fractures and place the bone and the roots of the teeth in their proper position.

Note: Often the ends of the roots will be luxated from the bony sockets and will need to be replaced into the sockets.

5

Perform endodontic treatment after 1 to 2 weeks if obvious interruption of the apical blood supply has taken place.

Warning: Root canal treatment should not be performed at this initial stage since the extra time and trauma involved may do more damage than good. Those teeth having wide open apical foramen may not require endodontic treatment and should be carefully observed for healing.

6

Carefully inspect the occlusion once the alveolar segment appears to be in its proper position.

Note: Slight misalignment along the base of the alveolar fracture is acceptable if the occlusion is accurate.

7

Stabilize the segment for four to six weeks.

Note: Various methods of stabilization can be used. (See Stabilization Methods on following pages.)

Stabilization Methods


The following methods may be used to stabilize the segment:

  • An arch bar placed across the segment and extended a few teeth on either side of the fractures is probably the simplest method.

  • An acid-etched arch wire is also simple and acceptable.

  • A cold cure acrylic splint can be made either in situ or on casts made following the reduction of the fracture and alignment of the occlusion.

Reflecting Flaps

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