Category Archives: Preoperative Health Status Evaluation

Soft Tissue Incision

Soft Tissue Incision

Several types of incisions can be used to gain access to the residual ridge for implant placement. The incision should be designed to allow convenient retraction of the soft tissue for unimpeded implant placement. It should preserve or increase the quantity of attached tissue and preserve local soft tissue esthetics. When the quantity of attached tissue is adequate and the underlying bone is expected to he of adequate width,

FIG. 14-44 Self-retaining photographic cheek retractors provide excellent access and soft tissue retraction.

FIG. 14-44 Self-retaining photographic cheek retractors provide
excellent access and soft tissue retraction.

FIG. 14-45 Crestal incision is the moststraightforward method of access to residual ridge for implant placement.

FIG. 14-45 Crestal incision is the moststraightforward method of
access to residual ridge for implant placement.

a simple crestal incision is the incision of choice (fig. 14-45). Closure of the incision must be done carefully,  hecause the implants lie directly beneath the incision.This approach works well in the mandible and posterior maxilla. An incision placed, slightly palatal Illay be a bet- (
ter .choic  in the anterior maxilla, especially when esthetics is of concern, because it preserves facial contour and soft tissue bulk. When there has been loss of vestibular depth and Of  attached tissue in the edentuious mandible, periirnplant soft tissue health is more likely if the tissue adjacent
to the implant is nonmobile. A modification of the Kazanjian vestibuloplasty can be used to gain access to the ridge for implant placement and to increase vestibular depth and quantity of attached issue on the residual ridgeJfig. 14-46).

 

 

 

PREPARATION

PREPARATION

Preparedness is the second most impoi tant factor (after prevention) in the management of medical emergencies. Preparation to handle emergencies includes four specific actions: (l) ensuring that the dentist’s own education
about emergency management is adequate and up-to date, (2) having the au xiliarv staff trained to assist in medical emergencies, (3) establishing a system to gain

Preoperative Health Status Evaluation

Preoperative Health Status Evaluation

TABLE 1-2 r

Effect of Dental Medications in Lactating Mothers

Effect of Dental Medications in Lactating Mothers

Effect of Dental Medications in Lactating Mothers

 

BIBLIOGRAPHY

BIBLIOGRAPHY

Bickley LS, Hoekelman RA: Bates guide to physical examination and history taking, ed 7, Philadelphia, 1999, Lippincott.

Gage TW, Pickett FA: musby’s dental drug reference, ed 6, St Louis, 2003, Mosby.

Hupp JR, Williams’TP, Vallerand WP: The 5 minute clinical (011-
~I/It [or dental professioncts I’J)A, Baltimore, 2002, Williams & Wilkins.
Little JW, Falace DA, i\;i1I(,!.CS, ct al: Dental managnncnt orthe
lIledically compromised patient ed 6, St LOllis, 2002, Mosby.

Preoperative Health Status Evaluation

Preoperative Health Status Evaluation

BOX 1-27

Classification of Medications with Respect to Potential Fetal Risk

Classification of Medications with Respect to Potential Fetal Risk

Classification of Medications with Respect to Potential Fetal Risk

 

Preoperative Health Status Evaluation

Preoperative Health Status Evaluation,

BOX 1-26

Dental Medications to Avoid in Pregnant Patients

Aspirin and other nonsteroidal antiinflammatory drugs
• Carbamazepine
• Chloral hydrate (if chronically used)
• Chlordiazepoxide
• Corticosteroids
• Diazepam and other benzodiazepines
• Diphenhydramine hydrochloride (if chronically used)
• Morphine .
• Nitrous oxide (if exposure is greater than'”9 hr/week
or 02 is less than 50%)
• Pentazocine hydrochloride
• Phenobarbital
• I’romethazine hydrochloride
• Propoxyphene
• Tetracyclines

Postpartum

Postpartum

BOX 1-25

Management of Patient Who Is Pregnant

1. Defer surgery until after delivery if possible.
2. Consult the patient’s obstetrician if surgelY cannot be
delayed.
3. Avoid dental.radiographs unless information about
tooth roots or bone is necessary for proper dental care.
If radiographs must be taken, use proper shielding ..
:4. Avoid the use of drugs with teratogenic potential.
Use local anesthetics when anesthesia is necessary.
5. Use at least 50% oxygen if nitrous oxide sedation is
used. ‘
6. Avoid keeping the patient in the supine position for
long periods, to prevent vena caval compression.
1. Allow the patient to take frequent trips to the rest room.

breast-feeding a child. Avoiding drugs that are known to enter breast milk and to be .potentially harmful to infants . is prudent (the child’s pediatrician can provide guidance). Information about some drugs is provided in Table 1-2. However, in general, all the drugs common in oral surgical care are safe to use in moderate doses, with the exception of cortlcosteroids, aminoglycosides, and tetracyclines, which should not be used.

Postpartum

Postpartum

Special considerations should be taken when providing oral surgical care for the postpartum patient who is

FIG. 1-5 Proper lead apron shield is used during dental radiogra- . phy. Use of thyroid protection is demonstrated.

FIG. 1-5 Proper lead apron shield is used during dental radiogra-
. phy. Use of thyroid protection is demonstrated.

 

 

MANAGEMENT OF PREGNANT . AND POSTPARTUM PATIENTS

MANAGEMENT OF PREGNANT . AND POSTPARTUM PATIENTS

Pregnancy

Although riot a disease state, pregnancy is still a situation in which. special considerations are necessary when oral surgery is required. The primary concern when providing care for a pregnant” patient is the ptevention of genetic damage to the fetus. Two areas of oral surgrcal management.
with potential for creating fetal damage are (1) dimtal radiography and (2) drug administration. It is virtually impossible to perform an oral surgical procedure properly with neither radiographs nor’ the administration’ of medications; therefore one option is to defer any elective oral surgery until after delivery to avoid fetal risk. Frequently, temporary measures can be used to delay surgery.

However, if surgery during pregnancy cannot be postponed efforts should be made to lessen fetal exposure to teratogenic-factors. In the case o’f irradiation, using protective aprons and taking periapical films of only the
areas ‘requiring surgery can accomplish. this (Fig. 1-5). The.list of drugs’ thought to pose little risk to the fetus is relatively short. For purposes of oral surgery, the following drugs are believed least likely to harm a fetus when used in moderate amounts:.Iidocaine, buplvacaine, acetaminophen,
codeine, penicillin cephalosporins, and erythromycin ..Although aspirin is otherwise safeto use, it shouldnot be given late ill the third trimester because of its anticoagulant property. All sedative drugs are best
avoided in pregnant patients. Nitrous oxide should not be used during the. first trimester butifnecessary can be used in the second and third trimesters as long as it is’ delivered with at least’ 50% Oxygen ‘(Boxes 1-25 and 1-26). The Food and Drug Administration (FDA) created . a system of drug categorization based on the known degree of risk to the human fetus posed by particular drugs. When required to give a medication to a pregnant patient, the clinician should check that the drug falls into an acceptable risk cate~ory before administering it to the patient (Box 1-27)

Pregnancy can be emotionally and physiologically stressful; therefore an anxiety reduction’ protocol is recommended. Patient vital signs should be obtained, with particular attention paid to any elevation in blood pressure
(a possible sign of preeclampsia). A patient nearing delivery may ·need special positioning of the chair during care, because if the patient is placed .in a nearly supine position, the uterine ‘contents may cause bothpression
of the inferior vena cava, compromising nI10US return to the heart and thereby cardiac output. The patient may need to be in a more upright position or with her torso turned slightly to one side during surgery. Frequent breaks to allow the patient -to void are commonly necessary late ill pregnancy because of fetal pressure on the urinary bladder. Before performing any oral surgery on a pregnant patient, her obstetrician
should be consulted.

Preoperative health status

Preoperative health status

BOX 1-24

Management of Patient with a Seizure Disorder

1. Defer surgery until the seizures are well control-ed.
2. Consider having serum levels of antiseizure medications
measured if patient compliance is questionable.
3. Use anxiety reduction protocol.
4. Avoid hypog._ly_ce.m_i.a and fa_tigue.

tremens with hallucinosis, marked agitation and circulatory collapse.
Patients requiring oral surgery who exhibit signs of severe alcoholic liver disease or signs of ethanol withdrawal should be treated in the hospital setting. Liver function tests, a coagulation profile, and medical consultation
before surgery are desirable. In patients able to be treated Oil an ambulatory basis, the dose of drugs metabolized in the liver should be altered and the patient should be monitored closely for signs of oversedation.