ORAL SURGERY
Lecture : 1 د.دمحم رحيل
Oral and maxillofacial surgery : Is part of dental specialities that dealing with management of
diseases , injuries and defect of human jaws and associated structures .
Oral surgery forms the connecting link between medical and dental specialties.
Terminology
Pain ; unpleasant physical sensation experienced followed the application of noxious stimuli .
Anesthesia ; loss of all modalities of sensation which include pain and touch
Analgesia ; loss of pain sensation only
Parasthesia ; altered sensation ( tingling sensation ) and this may occur when a damaged nerve
is regeneration or when a local anesthesia is either starting to work or its effect is wearing off
Depolarization; when a stimulus excites a nerve this will lead to an increase in permeability of
the membrane to Na ions , the rapid influx of Na ions to the interior of the nerve will cause
depolarization of the nerve membrane from the resing level to its firing threshold
Repolarization; reestablishment of polarity, especially the return of a cell's membrane
potential to resting potential after depolarization. This occur by
the movement of positively
charged K
+
ions out of the cell.
local anesthesia
loss of sensation in a circumscribed area of the body caused by depression of excitation in nerve
endings or inhibition of the conduction process in peripheral nerves it differ from general
anesthesia by which the loss of sensation occur without loss of consciousness.
Requirement of local anesthesia
1. it should not be irritating to the tissue to which it is applied
2. it should not cause any permenant alteration to the nerve structure
3. its systemic toxicity should be low
4. the time of onset of anesthesia should be as short as possible
5. the duration of action must be long enough to permit completion of the procedure
6. it should be free from producing allergic reactions
7. it should be either sterile or be capable of being sterilized by the heat without
deterioration
8. it should have potency sufficient to give anesthesia without using harmful concentration
9. it must be effective regardless of whwther it is injected into the tissue or applied locally
to mucous membranes.
10. It should be stble in solution and readily under go transformation in the body
Uses of local anesthesia
a. Diagnostic uses ;
Can used to determine the source of pain , for example pain of pulpitis which may be
difficult for the patient and dentist to isolated because of its tendency to reffered to other
parts of mouth or face , so LA can distinguish between maxillary and mandibular sources by
giving LA to the suscepected tooth in one jaw ,if pain relieved so it’s the causative tooth
but if not relieved this mean that the causative tooth in the opposing jaw .
b. Therapeutic uses ;
As in treatment of painful conditions as dry socket and trigeminal neuralgia
c. Preoperative uses
LA can be used alone or with sedation in different surgical procedures and avoid the
complications of general anesthesia especially in patients with cardio-vascular or airway
diseases . or can be used before general anesthesia to decrease bleeding and reduce the depth
of general anesthesia.
d. postoperative uses
LA can uses post operatively to decrease patient discomfort or pain , and reduce the need for
strong postoperative analgesia
Indications of local anesthesia
LA indicated in almost all the dental procedures , in oral surgery for extraction of teeth
,apicoectomy ,incisions and drainage of abscesss ,removal of cysts ,ranula and all other
surgical procedures.
In conservative treatment as for cavity preparation ,crown preparation ,pulp treatment …
In periodontal diseases as for deep scaling and mucogingival surgical procedures
Also LA used in some cases of prosthodontics and orthodontic treatments
Contraindications for local anesthesia
a. Absolute contraindication as in patients with history of allergy to local anesthesia
b.
Relative contraindications as in presence of acute inflammation at the site of injection , in
patients with significant medical diseases as cardiovascular diseases,clinical
hyperthyroidism , small child, mentally retarded patients , major surgical procedures
Advantages of local anesthesia
1. No special preparation of the patient is needed
2. No complicated apparatus are needed
3. No risk of respiratory obstraction
4. Anesthesia last for at least an hour
5. Patient remains awake and cooperative and no need for care posoperatively
6. Seriously ill patient as with heart diseases can usually tolerate local anesthesia without
any risk.
Disadvantages of local anesthesia
No true disadvantages to the use of local anesthesia when the patient is normal and there is
no contraindications to its use .