haghighi - oral repairs - oregon pa presentation… · rapid onset of facial cellulitis of...
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Oral Health
Considerations for
the Medical Professional
Or how can I discuss the oral cavity and still look like I
know what I’m talking about?
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snow board mt rainier.JPG
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Factoid
� If the pt is experiencing temperature sensitivity with lingering pain to hot and cold abx therapy is not indicated
� If the pt is experiencing constant pain, no real temperature sensitivity antibiotics are indicated
Oral Bacteria
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Two main danger zones
� Floor of Mouth/Deep Neck Space infections
�Cavernous Sinus Thrombosis
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Urgent care required
�Dysphagia
� Pooling saliva
�Dyspnea
� Trismus
� Floor of mouth raised
Delayed care o.k.
�No dyspahgia
�No trismus
� Floor of mouth supple
Cavernous Sinus Thrombosis
� Headache associated with cn III, !V, V deficit
� Eye swelling/ fullness/ pain
� Bilat. Eye swelling, confusion, coma, death
�MRI with contrast
� 50% cultures positive for s.a.
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“A unique aspect o
f
the ve i ns in the head and neck is their valveless n
at ur e”
Maxillofacial Infections
Selected Readings
OMFS Vol 2 No 1
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Urgent care
�Consider aggressive i.v. abx. therapy
� Steroid therapy in appropriate patients
�Monitor vitals and pulse oximetry
�Arrange for:
� transfer
� refer to appropriate specialist
� consult anesthesia
Rapid Onset of Facial Cellulitis
of Odontogenic Origin� Assess pt ability to fight infection
� Clindamycin x 300mg tid x 7- 10 days
� Amoxicillin x 500mg tid x 7-10 days plus Flagyl x 500mg tid x 7-10 days
� Unasyn (1.5gm -3.0gm) q6 + Flagyl 500 mg tid x 7-10 days
� MRSA? � Use Bactrim with caution in the elderly and poor GFR
Dx Labs & Exams
�CBC and basic chem panel
�Ct jaws and neck with contrast
�MRI with contrast (CST)
� Panorex or 2d rendering
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“the most important therapeutic
action in the management of orofacial infections is the drainage of
pus, and antibiotics are merely an
adjunct…”
Pogrel, A; OMFS Clinics of North America: Feb, 1993
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Bells Palsy vs. Ischemic Stroke
Bells Palsy vs Ischemic Stroke
Bells Palsy
� Peripheral VII
� Slow onset with progressive worsening (hrs-days)
� Able to wrinkle forehead one side
� No tongue deviation
� Absence of central symptoms
Ischemic Stroke� Central
� Acute onset(minutes)� Able to wrinkle forehead bilaterally
� Tongue deviation to opposite side of lesion
� Dysarthria, diplopia, dysphagia c.n. V dys/anesthesia
� Weakness in limbs
Anticoagualted Dental
Patients – routine oral surgery
� Best controlled via surgical approach
� Antifybrinolytics
� Amicar (aminocaproic acid)?
� Tranexamic Acid?
� Plavix shmavix
� Coumadin who cares? ☺
� Same for Eliquis, Rivaroxaban, Pradaxa CrCl<30
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Xerostomia
(drug induced or pathologic)
� Biotene
� Sugarless chess
� Pilocarpine
� Saliva substitutes
� Smoking cessation
�Other non alcoholic mouth rinses
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