Oral Surgery

Oral Surgery
chapter one

congestive heart failure
brief about/ the myocardium is unable to pump the blood to the body
signs & symptoms/ dyspnea, hyperventilation, cough, hemoptysis, cyanosis,
murmurs.
treatment/ 5-10mg diazepam(valium), 1.5-3mg bromazepam(lexotanil), small
amount of vasoconstrictors with LA
*all drugs given at least 1 hour before procedure.
*********
angina pectoris
brief about/ temporary ischemia of myocardium
sign & symptom/ pain proximal to sternum, chest discomfort, burning
sensation, tightness.
*(fatigue, stress, rich meal) can be inducing factors.
treatment/ like congestive heart failure
*********
myocardial infarction
brief about/ ischemic necrosis of heart parts
sign & symptom/ pain posterior to sternum, burning sensation, pressure
tightness.
*all are more severe than angina
*if the accident occur in 6 months delay surgery.
treatment/ sublingual nitrates
**********
rheumatic heart disease
brief about/ mitral and aortic valve damage due to rheumatic fever
sign symptom/ ---
treatment/ antibiotic prophylaxis
*********
heart murmur
brief about/ pathologic sound of valves defect, syphilis, septic endocarditis
sign and symptom/ systolic and diastolic and continuous
treatment/ antibiotic prophylaxis
**********
congenital heart disease
brief about/ *types of congenital heart diseases:
1. patent ductus arteriosus
2. atrial septal defect
3. ventricular septal defect
4. tetralogy of fallo

treatment/ premedication, antibiotic prophylaxis, small amount of
vasoconstrictors with LA
*********



cardiac arrhythmia
brief about/ periodic variation of normal heart rhythm
treatment/ premedication, no use of vasoconstrictors
*********

prosthetic heart valve
treatment/ antibiotic prophylaxis
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surgical corrected heart disease
*********
heart pacemaker
brief about/ used to maintain cardiac rhythm
treatment/ vasoconstrictors with LA, avoid certain electric dental instruments
***********
hypertension
brief about/ abnormal elevation of arterial pressure above 90 mmHg diastolic
and 140 mmHg systolic
*safe cases is 140-160/90-95, while unsafe cases 160-190/95-110
sign and symptom/ acute pulmonary edema, hypertension, encephalopathy can
be sign of malignancy >140mmHg (with papilloedema, retinal hemorrhage),
severe headache, nausea, vomiting, and coma.
treatment/ premedication, avoid noradrenalin, use aspiration, use
furosemide(Lasix)
************
orthostatic hypotension
brief about/ sudden drop in blood pressure
factors/ diabetic neuropathy, antihypertensive agents, pregnancy, sedatives,
fatigue, sympathectomy
treatment/clinical evaluation, monitor blood pressure, premedication of
psychological stress, avoid sudden position change
************


cerebrovascular accident
brief about/ acute neurologic disability due to focal necrosis of
brain(hemorrhage, embolism, thrombosis)
sign and symptom/ dizziness, vertigo, headache, perspiration, pallor, slow
breathe, rapid pulse rate, difficulty swallowing, loss of facial expression and pupil
dilation
treatment/ avoid surgical care in 6 months of stroke and monitor Bp and use
premeditations.
*************
anemia and blood disease
brief about/ types: Aplastic anemia, biermers megaloblastic anemia,
hypochromic anemia, sickle cell anemia, methemoglobinemia
treatment/ control hematocrit and hemoglobin levels, premedication, careful
with bone due to osteoporosis, don't use articaine and prilocaine in case of
methemoglobinemia
**************
Leukemia
brief about/ neoplastic pathology of WBC
treatment/ avoid nerve block ( hematoma) , only use infiltration, antibiotic
prophylaxis
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hemorrhagic diatheses
brief about/ bleeding disorders:
1. vascular diseases // alteration of vascular wall, telangiectasia, rendu-oster,
ehler-danlos, von willebrand
2. thrombocytic disorders // thrombocytopenia, glanzmann, thrombocytosis,
thrombocythemia
3. hemorrhagic diatheses of coagulation // deficiency of coagulant factor,
anticoagulant presence, vitamin K deficiency, severe liver disease

treatment/ premedication, morning visits, limit appointments, avoid nerve block,
smoothen bony edges and pack alveolus socket with absorbable gelatin sponge or
oxidized cellulose and suture, put gauze for 1 hour after extraction, avoid aspirin
and NSAIDs indomethacin due to bleeding tender, instead use acetaminophen
and paracetamol, ibuprofen, eat cold food and drinks for few days and don't eat
hard food for a week
*************
patient recieving anticoagulant drugs
coumarin drugs // increase prothrombin
* for surgical procedure the level of prothrombin should be at maximum 1.5
INR(international normalized ratio)
2-3 = prophylaxis of venous thrombosis, atrial fibrillation
2.5-3.5= prosthetic heart valves
2-3.5= minor dental extraction and minor osteotomies
1.6-1.9= extensive surgery
heparin drugs // parental and don't need adjustments if it's low mw ( clexane,
fraxiparine)
* discontinue use 4 hours before procedure
Aspirin // discontinue 2-5 days before procedure and start 24 hours after.

** all these drugs need morning test before procedure for : prothrombin,
thromboblastin and bleeding, do few sessions
*** for minor procedures no need to quit medication if you use fibrinolysis
inhibitor ( tranexamicacid) for 2 days postoperatively
*************
hyperthyroidism
brief about/ excess of thyroid hormones due to gland hyperfunction
sign and symptom/ anxiety, irritability, hyperactivity, sweating, tremor of
hands, insomnia, loss weight, tachycardia, arrythmia, weakness.

*factors lead to crisis//stress, surgery, trauma, LA, iodine drugs, pregnancy,
diabetic ketoacidosis
treatment/ sedative administration, normalize thyroid function, use (felypressin)
the safest vasoconstrictor with aspiration.
***********


brief about // an abnormality in secretion metabolism and insulin effect that disrupt
the carbs, prots, and lipids metabolism
preparation//
1. screening test // checking the glucose level of blood by glucometer.
2. doing morning visits to prevent hypoglycemia (insulin shock)
3. diabetic diet shouldnt be changed
4. no need for post or preoperative antibiotic prophylaxis
5. any fever or suppuration related infection (increase catechlamine,
glucagon) is treated with antibiotic prophylaxis and drainage for
dentoalveolar abscess
6. using noradrenaline for vasoconstrictor at max 1:50,000 in LA due to less
effect on glycogenolysis than adrenaline
7. acetaminophen(tylenol) is used as minor analgesic
8. avoid using corticosteroids and salicylate aspirin (hypoglycemic)
9. using anxiolytics afternoon and morning before procedure
10. wound healing is improved by smoothening bone edges, suturing, gentle
manipulation

hypoglycemia // glucose level in blood below 55mg/100ml, characteristics:
 hunger
 pallor
 trembling
 distress
 vertigo
 sweating
 fatigue
 anxiety
 headache
 confusion
 paresthesia
 diplopia
 decreased blurred vision
in severe cases coma and death occur.



hyperglycemia // less danger and slower and rare, characterized by :
weakness, headache, vomiting, nausea, xerostomia, diarrhea, dyspnea,
dehydration, finally coma.

**************

acute glomerulonephritis, chronic glomerulonephritis, renal failure


brief about// acute diffused inflammation of glumeroli
*occur after upper respiratory infection (tonsillitis, otitis, pharyngitis)
treatment// not allowed to perform procedure
*************

brief about// slow progress disease, lead to parenchyma destruction and renal
retraction
sign and symptom // proteinuria, polyuria, hemorrhagic casts in blood,
hypertension, headache, anemia.
treatment// no antibiotic prophylaxis , only blood pressure control
**************

brief about// permanent kidney damage result impaired glomerular and tubular
function, develop anemia, hemorrhagic
diatheses and metabolic disturbances.
causes// glomerulonephritis, hypertensive nephrosclerosis, diabetes mellitus,
nephrotoxins.
treatment// hematocrit level in anemia, avoid hemorrhage in hemorrhagic
diatheses, minimal use of
vasoconstrictor in hypertension, local
bleeding control by gelatin sponge in the
socket and sutures, minimal amount of
LA avoid toxicity, avoid procedure on the
day of hemodialysis.

****************

brief about// can cause acute adrenocortical insufficiency
recommendations//
1. if patient recieve glucocorticosteroids during last 30 days, then he's
immunocompromised and supplementation administered.
2. if patient recieve glucocorticosteroids in past not the last 30 days, he's
okey and no supplementation.
3. if patient recieve glucocorticosteroids daily with doses >10mg
prednisone(10mg prezolon & 8mg medrol), are considered
immunocompromised and need supplementations.
4. if patient recieve glucocorticosteroids on long term alternate-day
regimen, do surgery on day not having the medication.

supplementations// 100 mg hydrocortisone ( solu-cortef ) IM or IV before
surgery
*if surgery is painful and prolonged give 50-100 mg hydrocortisone 6 hours
after surgery.
**dont exceed 250 mg.

sign and symptom // nausea, vomiting, headache, weakness, hypotension,
confusion, sleepiness, dehydration, hyperpyrexia...if not treated coma then
death.


brief about// hyperadrenalism, hypersecretion hormones from adrenal cortex
precautions// operate in hospital with consultation,sedation, perform carefully*
*high risk of fracture due to severe osteoporosis of jaw.
*************

brief about// paroxymal dyspnea, coughing, edema of mucosa and viscous
mucous production.
factors induce it// stress, allergy, temperature change.
sign and symptom// epiratory dyspnea, nonproductive cough, wheezing, anxiety,
cold limbs, cyanotic pale face.
**can develop status asthmaticus which is severe condition.
prevention// knowing frequency and duration of attach, sedatives, painless
procedure, short appointments.
******************

brief about// infectious disease of mycobacterium tuberculosis(esp.lungs)
sign and symptom// persistent coughing, productive sputum nonpurulent.
treatment// examine presende of ffcm