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Management of Infected 3 rd Molars PowerPoint PPT Presentation


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Management of Infected 3 rd Molars. 1. Pericoronitis. Microorganisms and their toxins are sheltered from host defenses by obstructive soft tissue. The response is a local one. If there is any pus, it is minimal. Hallmarks of Pericoronitis. Localized pain Localized erythema

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Management of Infected 3 rd Molars

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Management of infected 3 rd molars l.jpg

Management of Infected 3rd Molars


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1. Pericoronitis

  • Microorganisms and their toxins are sheltered from host defenses by obstructive soft tissue.

  • The response is a local one.

  • If there is any pus, it is

    minimal


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Hallmarks of Pericoronitis

  • Localized pain

  • Localized erythema

  • Partially impacted 3rd molar

  • May have localized intraoral edema

  • May have limited trismus

  • May have limited amount of pus

  • May have history of similar signs and symptoms


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Treatment of Choice

  • Preoperative loading dose of antibiotics

  • Remove offending 3rd molar – sedation if needed

  • Debride and irrigate socket

  • Do not close wound

  • Continue postoperative antibiotics for 7-10 days

  • Postoperative analgesics PRN

  • Monitor closely in the week following extraction


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Rationale

  • The tooth is the cause of the initiation and perpetuation of the problem.

  • Tooth removal and socket debridement immediately decreases bacterial colonization at the site of infection.

  • There is no evidence that surgical procedures promote the spread of infection.


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Rationale

  • Delaying removal delays resolution.

  • Delaying removal increases the risk of worsening – what if the antibiotics are not effective?

  • Removal immediately decreases microbial counts, antibiotics do so and assist the host to do so more slowly.


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Second Choice of Treatment

  • Prescribe antibiotics to be started immediately

  • Give patient clear instructions on monitoring progress of infection

  • Schedule removal after resolution of acute episode


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