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Joseph L. McQuirter, DDS

Oral and Maxillofacial Surgery Consulting Specialist. Joseph L. McQuirter, DDS. Perils of Treatment - Diseases of the Teeth /Mouth. Complications of Dental Extractions Compromises of the Airway Oral Bleeding Orofacial Injuries Odontogenic Infections Osteonecrosis

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Joseph L. McQuirter, DDS

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  1. Oral and Maxillofacial Surgery Consulting Specialist Joseph L. McQuirter, DDS

  2. Perils of Treatment - Diseases of the Teeth /Mouth • Complications of Dental Extractions • Compromises of the Airway • Oral Bleeding • Orofacial Injuries • Odontogenic Infections • Osteonecrosis • Orafacial Pain

  3. Complications of Dental Extractions • Bleeding • Swelling • Jaw Stiffness (Trismus) • Pain / Dry Socket (Alveolar Osteitis) • Infection • SensoryNerve Disturbance • Oral antral communication (fistula) • Temporomandibular Joint (TMJ) dysfunction • Jaw fracture

  4. ~ Dental Caries ~ Periodontal Disease Dental infections are the most common infections known to man

  5. Dental treatment is frequently performed on an urgent / emergency basis as a result of an active dental infection or injury producing pain and/or swelling

  6. Gums Jaw Tooth

  7. Bleeding following tooth extraction • Rate of post operative bleeding ( 7% to 10% 3rd molars) • Usually associate with • difficult extraction • long surgical procedures • Usual bleeding sources • 7 % arterial • 72 % soft tissue

  8. Bleeding – Complication of tooth extraction

  9. Bleeding – Complication of tooth extraction Pressure placed directly over the bleeding site typically stops bleeding

  10. Swelling after tooth extraction is not uncommon

  11. Jaw Stiffness (Trismus) Complication of tooth extraction

  12. Jaw pain • following tooth extraction 1st 24 hours usually associated with surgery 24 to 36 hours post op Constant dull throbbing spontaneous pain may be associated with DRY SOCKET

  13. Dry Socket TREATMENT: Gently irrigate (saline) Place sedative dressing (1 – 30% for 3rd molars)

  14. Post Op Infections (0.06 – 4.3% for 3rd molars) Many extractions are performed on and urgent basis due to pain from an infected tooth

  15. Infections may spread to • adjacent tissue spaces • Sinus and orbital cavities • Inter muscular spaces • of the jaw • Floor of the mouth • Parapharyngeal spaces

  16. Altered Nerve Function (0.02 – 7.1% for 3rd molars) The most frequent nerve injury Lingual and Inferior Alveolar / Mental Nerves Lingual nerve Lingual nerve Inferior Alveolar nerve Mental nerve

  17. Oral Antral Communication • following tooth extraction • (0.06% for 3rd molars)

  18. Temporomandibular Joint Pain / Dysfunction Myofascial Pain

  19. Fracture of the jaw associated with dental extractions (< 0.01% for 3rd Molars) Subject to Spontaneous Fracture

  20. Perils of Treatment - Diseases of the Teeth /Mouth • Complications of Dental Extractions • Compromises of the Airway • Oral Bleeding • Orofacial Injuries • Odontogenic Infections • Osteonecrosis • Orafacial Pain

  21. Compromises of the Airway • Aspiration • Bleeding • Infection • Injuries

  22. Barriers (rubber dam) frequently used to prevent swallowing / aspiration • Aspiration • Teeth & fragments • Dental appliances • Dental instruments Ingested Tooth Aspirated Tooth

  23. Airway compromise Due to bleeding Post op chin / floor of mouth surgery Post extraction in patient with Bleeding Diatheses

  24. Airway compromise • due to • dental infection

  25. Airway • compromise • due to Injury Unopposed pull of supra hyoid muscles in an inferior & posterior direction Flail Mandible Fracture

  26. Airway compromise Injury with bleeding (Mandibular Fractures)

  27. Perils of Treatment - Diseases of the Teeth /Mouth • Complications of Dental Extractions • Compromises of the Airway • Oral Bleeding • Orofacial Injuries • Odontogenic Infections • Osteonecrosis • Orafacial Pain

  28. Bleeding Gums • Periodontal Disesae • Hormonal Changes (pregnancy gingivitis) • Anticoagulant Therapy • Bleeding Diatheses

  29. Midline tongue piercing relatively blood-free especially when good compression hemostasis is used (tongs)

  30. Significant bleeding may be encountered with with piercing more laterally

  31. Direct pressure whether applied manually or with sutures generally arrests bleeding

  32. Perils of Treatment - Diseases of the Teeth /Mouth • Complications of Dental Extractions • Compromises of the Airway • Oral Bleeding • Orofacial Injuries • Odontogenic Infections • Osteonecrosis • Orafacial Pain

  33. Orofacial Injuries Soft Tissue Dentoalveolar Fractures Jaw Fractures (Maxilla / Mandible)

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