Advanced functions chapter 56: Oral and Maxillofacial surgery

What is oral and maxillofacial surgery?

- Is the specialty of dentistry involving the diagnosis and surgical treatment of diseases, injuries, and defects

Indications for maxillofacial surgery:

- extractions of decayed teeth that cannot be restored

- surgical removal of impacted teeth

- periprosthetic surgery to smooth and contour the alveolar ridge

- removal of teeth for orthodontic treatment

- removal of root fragmens

- removal of cysts and tumors

- biopsy

The surgical assistant must have advanced knowledge and skills in:

- patient assessment and monitoring

- specialized instruments

- surgical asepsis

- surgical asepsis

- surgical; procedures

- pain control techniques

The surgical team completes procedures in what two types of settings?

- the private dental office

- the hospital or outpatient surgical suite

Specialized instruments and accessories:

- it is critical for the surgical assistant to have a working knowledge and understanding of the surgical instruments

Surgical asepsis:

- because surgical procedures invade open tissue, the surgical team must follow sterile techniques

What is a sterile field?

- site where surgical instruments and accessory items are placed during the surgery

What is a surgical scrub?

- type of hand wash used to lessen the chance of infection

- must be a minimum of 5 minutes

What is proper gloving?

- required for assistance in an invasive procedure

Advanced surgical preparation:

- have all patient records and radiographs in order

- have consent forms signed and available

- information requested from the patient's physician must have been received

- check for laboratory cases

- ensure that surgical setups have been prepared and sterilized

- provide preoperative instructions for any premedication

Treatment room preparation:

- place protective barriers

- keep surgical instruments in their wraps until they are to be used

- have the appropriate pain-control medications set out and ready for administration

- have the postoperative instructions ready to provide to the patient

patient preparations includes:

- update the medical history and laboratory reports

- confirm with the patient that any prescribed premedication was taken as directed

- place the radiographs on monitor

- take vital signs for a baseline

- seat and drape the patient

- position the chair

What to do during surgery:

- maintain the chain of asepsis

- transfer and receive instruments

- provide aspiration and retraction as needed

- maintain a clear operating field with light

- monitor the patient's vital signs

- steady the patient's head and mandible if necessary

- observe the patient's condition and anticipate the surgeon's needs

What should happen after surgery:

- stay with the patient

- give verbal and written postoperative instructions

- schedule a postoperative visit

- update the patient's treatment records

- break down and disinfect the treatment area

What is a multiple extraction and alveoplasty procedure?

- multiple extraction procedure involving the contouring and smoothing of the alveolar crest of the surgical site

Removal of impacted teeth:

- a complex extraction of a tooth that has not erupted

What is soft-tissue impaction?

indicates that the tooth is located under the gingival tissue

What is hard-tissue impaction?

- indicates that the tooth is partially or totally covered by tissue and bone

What is a biopsy?

- the surgical removal and examination of lesions in the oral cavity

What is an incisional biopsy?

- only a sample of the suspicious tissue is cut from a mass (incised) and removed for purposes of diagnosis

What is an excisional biopsy?

- the entire lesion is removed

What is an exfoliative cytology?

- A brush biopsy

- only cells are removed and biopsied

What are sutures?

- Sutures are the stitches placed to control bleeding and promote healing

What are absorbable sutures?

- plain catgut provides the fastest healing for mucous membranes and subcutaneous tissues

- chromic catgut provides a much slower healing, allowing the internal tissues to heal first

- Vicryl is a synthetic absorbable material

What are nonabsorbable sutures?

- Silk is used for its strength and ease of use

- Polyester fiber is one of the strongest sutures

- Nylon is used for its strength and elasticity

- These sutures need to be removed

When nonabsorbable sutures are placed, when does the patient need to come back to get them removed?

- In approximately 5 to 7 days

Control of bleeding:

- a 2 x 2 inch piece of gauze is folded and placed to control bleeding and encourage clot formation and healing

- keep gauze in place for 30 minutes

- if bleeding does not stop, call the dental office

- do not disturb the clot with your tongue or by rinsing your mouth vigorously

- strenuous work or physical activity is restricted that day

Control of swelling:

- ibuprofen is used before and after surgery

- during the first 24 hours, a cold pack is placed in a cycle of 20 minutes on and 20 minutes off

- after the first 24 hours, external heat is applied to the area of the face in question to increase circulation in the tissues and to promote healing

- after the first 24 hours, the patient may begin gently rinsing the oral cavity with warm saline solution

Postoperative care diet:

- the day of surgery, the patient can drink liquids and et soft nutrious foods, making sure not to eat anything too hot or too cold

- the patient can begin eating solid foods the next day or as soon as he or she can chew comfortably

- try to chew on the opposite side of the surgical site

- if troubled by nausea and vomiting call the office

- it is important to advise the patient to avoid alcoholic beverages

What is alveolitis?

- Dry socket

- usually occurs 3-5 days after extractions

How does alveolitis occur?

- by not caring for the extraction site as instructed

- not following home care instructions

- a patient that has either smoked, sneezed, coughed, spit or drank with a straw, within the first 24 hours

- women taking oral contraceptives are more susceptible

What is the treatment for dry socket?

- irrigate tissue with warm saline solution

- pack extraction site with iodoform gauze

- prescribe analgesic and antibotics

- procedure repeated every one to two days

- the patient will be instructed to return to the office daily for a dressing change until the socket starts to heal and the pain lessens