2023 ECD IV Exam III Study Guide Pt. 2 PDF

Armamentarium for Suturing & Ext ● ● Mandibular Forceps: No 151 Lower molar forceps: No. 87 or No. 23 (cowhorn forceps) ○ 23: two pointed heavy beaks that enter into bifurcation of lower molars and can squeeze handles of forceps to elevate tooth, use B and L cortical plates as fulcrum Armamentar...

Armamentarium for Suturing & Ext ● ● Mandibular Forceps: No 151 Lower molar forceps: No. 87 or No. 23 (cowhorn forceps) ○ 23: two pointed heavy beaks that enter into bifurcation of lower molars and can squeeze handles of forceps to elevate tooth, use B and L cortical plates as fulcrum Armamentarium for Suturing & Ext ● Root tip forceps: No 65 forceps to remove broken down maxillary molar roots and narrow premolars and lower incisors ● Periotomes: preserve B plate by severing PDL 360 degrees, important for implants From Dr. Elo’s Presentation (Info that was red) From Dr. Elo’s presentation -- BP <160/100 , HBAIC <10 EXTRACT: Acronym to Prevent Wrong Tooth Extractions • Examination: independent exam from the referral doctor; preferably at a separate consultation appointment • X-ray check: current and diagnostic; correct patient and spatial orientation • Treatment plan: does the treatment plan correspond with the referring doctor’s? • Review chart: chart review preoperatively in advance of the procedure • Announce: current plan with the “Time Out” procedure • Count: the teeth; (this is the 1st tooth count during the “Time Out”) • Treat: beginning the surgery with a 2nd tooth count 0 Analgesics (multimodal approach should be used) • Recommended pain management regimen strategy that is highly effective for most patients undergoing dental surgery is to use alternating doses of NSAIDs and acetaminophen, with the possible addition of no more than 5-7 opioid tablets if absolutely needed for acute pain control. Recommendations for MILD Pain Control Ibuprofen 200 mg: 2 tabs PO q 4-6h prn pain; maximum 3.2 g/day [Ibuprofen is the GOLD STANDARD for managing post-op dental pain] Acetaminophen 325 mg: 325-650 mg PO q 4-6h prn pain; maximum 4.0 g/day Naproxen sodium 220 mg: 220-440 mg PO q 8-12h prn pain; maximum 1.5 g/day Aspirin 325 mg: 325-650 mg PO q 4-6h prn pain; maximum 4.0 g/day Recommendations for MODERATE Pain Control Ibuprofen 600 mg: 1 tab PO q 6h prn moderate pain; maximum 3.2 g/day [Ibuprofen is the GOLD STANDARD for managing post-op dental pain] Tylenol with codeine #3® (300 mg acetaminophen and 30 mg codeine): 1 tab PO q 4-6h prn moderate pain; maximum 4.0 g/day acetaminophen Norco® 5/325 (5 mg hydrocodone and 325 mg acetaminophen): 1 tab PO q 4-6h prn moderate pain; maximum 4.0 g/day acetaminophen Ultram® (tramadol 50 mg): 1 tab PO q 4-6h prn moderate pain; maximum 400 mg/day Toradol® (ketorolac 10 mg): 1 tab PO q 6h prn moderate pain; maximum 40 mg/day [this is an NSAID] Examples of Prescriptions for MODERATE Pain Relief Rx: Ibuprofen 600 mg Rx: Tylenol with codeine #3® Rx: Norco® 5/325 Rx: Ultram® 50mg Disp: 16 (sixteen) tabs Disp: 7 (seven) tabs Disp: 7 (seven) tabs Disp: 7 (seven) tabs Sig: 1 tab PO q 46h prn pain Sig: 1 tab PO q 6h prn pain Sig: 1 tab PO q 6h Sig: 1 tab PO q 4prn pain 6h prn pain Recommendations for SEVERE Pain Control Norco® 7.5/325 (7.5 mg hydrocodone and 325 mg acetaminophen): 1 tab PO q 4-6h prn severe pain; maximum 4.0 g/day acetaminophen Percocet® 5/325 (5 mg oxycodone and 325 mg acetaminophen): 1 tab PO q 4-6h prn severe pain; maximum 4.0 g/day acetaminophen Examples of Prescriptions for SEVERE Pain Relief Rx: Norco® 7.5/325 Rx: Percocet® 5/325 Disp: 7 (seven) tabs Disp: 7 (seven) tabs Sig: 1 tab PO q 4-6h prn pain Sig: 1 tab PO q 4-6h prn pain Examples of ANTIBIOTIC Prescriptions Rx: Penicillin VK 500 mg Rx: Amoxicillin 500 mg Rx: Azithromycin Rx: 250 mg Metronidazole 500 mg Disp: #24 tabs Disp: #18 tabs Disp: #6 tabs Sig: 1 tab PO qid til gone Sig: 1 tab PO tid til gone Sig: 2 tabs PO on Sig: 1 tab PO tid Day 1; then 1 tab til gone PO daily til gone Disp: #18 tabs Example of Prescription for ANTIBACTERIAL mouthwash Rx: Chlorhexidine gluconate 0.12% Disp: 473 mL (one bottle) Sig: 15 mL PO swish 30 seconds/spit tid until gone Necrotizing Perio Diseases ● ● Prevalence: rare (especially in general practice setting in US) Originally names “Trench Mouth” or “Vincent’s Infection” after WWI soldiers ○ ○ ● Now called necrotizing stomatitis,cancrum oris, orofacial gangrene, Noma Least severe: necrotizing gingivitis, then necrotizing periodontitis (gingiva and crestal bone), necrotizing stomatitis (oral soft tissue and extraoral facial tissue), them noma/oro-facial gangrene (any oral tissue and extraoral facial tissue) 2 varieties currently ○ ○ Necrotizing periodontal disease in chronically, severely compromised: AIDS patients, severely malnourished kids Necrotizing periodontal disease in temporarily or moderately compromised: with gingivitis or periodontitis and other predisposing factors (smoking, stress, poor nutrition, local anatomical factor, previous hx) Necrotizing Perio Diseases ● Signs and Symptoms ○ ○ ○ ○ ○ ○ Abrupt onset with severe pain (radiating gnawing pain) making eating or sleeping difficult Extreme pain with spicy and hot food Poss fever (100-102) high pulse, confusion Foul mouth odor (rotten meat), metallic taste YA for necrotizing perio; necrotizing ulcerative gingivitis see triggered with stressful events (finals week, military training…), necrotizing ulcerative periodontitis in AIDs, chemo pt, starvation Punched out, crate-like depression at crest of interdental papilla where gingival tissue missing ■ Can be lined by gray, pseudomembranous tissue film (slough) or expose white, dry alveolar bone ■ Tissue adjacent deeply inflamed with severe swelling, loss of stippling and redness Necrotizing Perio Diseases ● Microbio ○ ○ ○ ○ ● Fusobacterium nucleatum, Prevotella intermedia (orange and red complex bacteria) Large diverse population of Treponema spirochetes that infiltrate surrounding tissue Selemonas responsible for foul odor In AIDS pt see more Candida albicans, Aggregatibacter species Histo ○ Damage to gingival capillaries leads to coronal tissue infarction and necrosis and lesion ordered as follow from lesion toward healthy tissue ■ Necrotic tissue (dead epi and soft tissue with bacteria) ■ Exposed ulcerated soft tissue at various stages disintegration ■ Fibrin deposits and leukocytes along with infiltrating spirochetes Necrotizing Perio Diseases ● ● Diagnosis: made by evaluating extent Differentials ○ ○ ○ ○ Herpetic gingivostomatitis: causes severe mouth pain and ulcerations but will have multiple shallow ulcers across gingiva and no focus of interdental tissue or plaque accumulation SSC: ulcers but often painless with one ulcer surrounded by dense tissue mass Severe periodontitis: beefy red gingiva, mouth odor, inflammation, maybe tissue sloughing or purulent discharge, calculus deposit can look like bone, but different texture and can be removed, painless usually Linear gingival erythema and linear IgA disease: bright red gingival erythema, sometimes thought as precursor disease in AIDS pt, no bone exposure Necrotizing Perio Diseases ● Etiology ○ Normal perio disease progression with disease causing microbes, plus depressed immune response allowing high bacterial growth ■ See immunosuppression with stress (high corticosteroids suppress immunity), viral infections (HIV), malnutrition, chemo ■ Once existing perio starts getting more progressed, tissue damage and pain -> more stress-> more destruction Necrotizing Perio Diseases ● Prog ○ ○ ○ ○ ○ ○ ○ ● Amount of disease control poss depends on tissue destruction amount and how well can control etiology Necrotizing ulcerative gingivitis: excellent/good Necrotizing ulcerative periodontitis: fair/poor (some residual damage) Necrotizing stomatitis/ noma: hopeless (life threatening, severe damage will remain) Due to stress: excellent good (once resolve stress) Poor nutrition: good (if nutritional supplements can be given and long term food access possible) AIDS: poor/hopeless: may not resolve if terminal Tx ○ ○ Urgent dental tx: ultrasonic debridement (remove necrotic tissue, calculus, bact mass), OHI (soft brush, mild dentifrice like baking soda, warm salt water rinse), antibiotics (amoxicillin 250mg with metronidazole 250 mg every 6 hr 7-10 days), multivitamin/protein food supplement, 1-2 week check Follow up care: rest, PCP referral for med cont and malnutrition, poss social services/aid/counselling referral