joseph l. mcquirter, dds
DESCRIPTION
Oral and Maxillofacial Surgery Consulting Specialist. Joseph L. McQuirter, DDS. Perils of Treatment - Diseases of the Teeth /Mouth. Complications of Dental Extractions Compromises of the Airway Oral Bleeding Orofacial Injuries Odontogenic Infections Osteonecrosis - PowerPoint PPT PresentationTRANSCRIPT
![Page 1: Joseph L. McQuirter, DDS](https://reader035.vdocuments.mx/reader035/viewer/2022062305/568164e2550346895dd74535/html5/thumbnails/1.jpg)
Joseph L. McQuirter, DDSOral and Maxillofacial
Surgery
Consulting Specialist
![Page 2: Joseph L. McQuirter, DDS](https://reader035.vdocuments.mx/reader035/viewer/2022062305/568164e2550346895dd74535/html5/thumbnails/2.jpg)
• Complications of Dental Extractions
• Compromises of the Airway• Oral Bleeding• Orofacial Injuries• Odontogenic Infections• Osteonecrosis• Orafacial Pain
Perils of Treatment - Diseases of the Teeth /Mouth
![Page 3: Joseph L. McQuirter, DDS](https://reader035.vdocuments.mx/reader035/viewer/2022062305/568164e2550346895dd74535/html5/thumbnails/3.jpg)
Complications of Dental Extractions
• Bleeding• Swelling • Jaw Stiffness (Trismus)• Pain / Dry Socket (Alveolar Osteitis)• Infection• Sensory Nerve Disturbance • Oral antral communication (fistula)• Temporomandibular Joint (TMJ)
dysfunction• Jaw fracture
![Page 4: Joseph L. McQuirter, DDS](https://reader035.vdocuments.mx/reader035/viewer/2022062305/568164e2550346895dd74535/html5/thumbnails/4.jpg)
~ Dental
Caries
~ Periodontal Disease
Dental infections are the most
common infections
known to man
![Page 5: Joseph L. McQuirter, DDS](https://reader035.vdocuments.mx/reader035/viewer/2022062305/568164e2550346895dd74535/html5/thumbnails/5.jpg)
Dental treatment is frequently performed on an urgent / emergency
basis as a result of an active dental infection or injury producing pain and/or swelling
![Page 6: Joseph L. McQuirter, DDS](https://reader035.vdocuments.mx/reader035/viewer/2022062305/568164e2550346895dd74535/html5/thumbnails/6.jpg)
![Page 7: Joseph L. McQuirter, DDS](https://reader035.vdocuments.mx/reader035/viewer/2022062305/568164e2550346895dd74535/html5/thumbnails/7.jpg)
Bleeding following tooth extraction Rate of post operative bleeding ( 7% to
10% 3rd molars) Usually associate with
difficult extraction long surgical procedures
Usual bleeding sources 7 % arterial 72 % soft tissue
![Page 8: Joseph L. McQuirter, DDS](https://reader035.vdocuments.mx/reader035/viewer/2022062305/568164e2550346895dd74535/html5/thumbnails/8.jpg)
Bleeding – Complication of tooth extraction
![Page 9: Joseph L. McQuirter, DDS](https://reader035.vdocuments.mx/reader035/viewer/2022062305/568164e2550346895dd74535/html5/thumbnails/9.jpg)
Bleeding – Complication of tooth extraction
Pressure placed directly over the bleeding site
typically stops bleeding
![Page 10: Joseph L. McQuirter, DDS](https://reader035.vdocuments.mx/reader035/viewer/2022062305/568164e2550346895dd74535/html5/thumbnails/10.jpg)
Swelling after tooth extraction is not
uncommon
![Page 11: Joseph L. McQuirter, DDS](https://reader035.vdocuments.mx/reader035/viewer/2022062305/568164e2550346895dd74535/html5/thumbnails/11.jpg)
Jaw Stiffness (Trismus) Complication of tooth
extraction
![Page 12: Joseph L. McQuirter, DDS](https://reader035.vdocuments.mx/reader035/viewer/2022062305/568164e2550346895dd74535/html5/thumbnails/12.jpg)
Jaw pain following tooth
extraction1st 24 hours
usually associated with surgery
24 to 36 hours post op
Constant dull throbbing spontaneous pain may be
associated with
DRY SOCKET
![Page 13: Joseph L. McQuirter, DDS](https://reader035.vdocuments.mx/reader035/viewer/2022062305/568164e2550346895dd74535/html5/thumbnails/13.jpg)
TREATMENT:
1. Gently irrigate (saline)
2. Place sedative dressing
Dry Socket
(1 – 30% for 3rd molars)
![Page 14: Joseph L. McQuirter, DDS](https://reader035.vdocuments.mx/reader035/viewer/2022062305/568164e2550346895dd74535/html5/thumbnails/14.jpg)
Post Op Infections(0.06 – 4.3% for 3rd molars)
Many extractions are performed on and
urgent basis due to pain from an infected
tooth
![Page 15: Joseph L. McQuirter, DDS](https://reader035.vdocuments.mx/reader035/viewer/2022062305/568164e2550346895dd74535/html5/thumbnails/15.jpg)
Infections may spread to adjacent tissue spaces • Sinus and orbital cavities• Inter muscular spaces of the jaw• Floor of the mouth• Parapharyngeal spaces
![Page 16: Joseph L. McQuirter, DDS](https://reader035.vdocuments.mx/reader035/viewer/2022062305/568164e2550346895dd74535/html5/thumbnails/16.jpg)
Altered Nerve Function (0.02 – 7.1% for 3rd molars)
The most frequent nerve injury Lingual and Inferior Alveolar /
Mental Nerves
Mental nerve
Lingual nerve
Inferior Alveolar nerve
Lingual nerve
![Page 17: Joseph L. McQuirter, DDS](https://reader035.vdocuments.mx/reader035/viewer/2022062305/568164e2550346895dd74535/html5/thumbnails/17.jpg)
Oral Antral Communicationfollowing tooth
extraction(0.06% for 3rd molars)
![Page 18: Joseph L. McQuirter, DDS](https://reader035.vdocuments.mx/reader035/viewer/2022062305/568164e2550346895dd74535/html5/thumbnails/18.jpg)
Temporomandibular Joint Pain / Dysfunction
Myofascial Pain
![Page 19: Joseph L. McQuirter, DDS](https://reader035.vdocuments.mx/reader035/viewer/2022062305/568164e2550346895dd74535/html5/thumbnails/19.jpg)
Fracture of the jaw associated with dental extractions (< 0.01% for 3rd Molars)
Subject to Spontaneous Fracture
![Page 20: Joseph L. McQuirter, DDS](https://reader035.vdocuments.mx/reader035/viewer/2022062305/568164e2550346895dd74535/html5/thumbnails/20.jpg)
• Complications of Dental Extractions
• Compromises of the Airway• Oral Bleeding• Orofacial Injuries• Odontogenic Infections• Osteonecrosis• Orafacial Pain
Perils of Treatment - Diseases of the Teeth /Mouth
![Page 21: Joseph L. McQuirter, DDS](https://reader035.vdocuments.mx/reader035/viewer/2022062305/568164e2550346895dd74535/html5/thumbnails/21.jpg)
Compromises of the Airway• Aspiration
• Bleeding
• Infection• • Injuries
![Page 22: Joseph L. McQuirter, DDS](https://reader035.vdocuments.mx/reader035/viewer/2022062305/568164e2550346895dd74535/html5/thumbnails/22.jpg)
Aspiration• Teeth & fragments
• Dental appliances
• Dental instruments
Aspirated
Tooth
Ingested
Tooth
Barriers (rubber dam) frequently used to prevent swallowing / aspiration
![Page 23: Joseph L. McQuirter, DDS](https://reader035.vdocuments.mx/reader035/viewer/2022062305/568164e2550346895dd74535/html5/thumbnails/23.jpg)
Airway compromiseDue to bleeding
Post op chin / floor of mouth surgery
Post extraction in patient with Bleeding Diatheses
![Page 24: Joseph L. McQuirter, DDS](https://reader035.vdocuments.mx/reader035/viewer/2022062305/568164e2550346895dd74535/html5/thumbnails/24.jpg)
Airway compromise
due to dental infection
![Page 25: Joseph L. McQuirter, DDS](https://reader035.vdocuments.mx/reader035/viewer/2022062305/568164e2550346895dd74535/html5/thumbnails/25.jpg)
Airway comprom
isedue to
Injury Flail Mandible Fracture
Unopposed pull ofsupra hyoid muscles in an inferior & posterior
direction
![Page 27: Joseph L. McQuirter, DDS](https://reader035.vdocuments.mx/reader035/viewer/2022062305/568164e2550346895dd74535/html5/thumbnails/27.jpg)
• Complications of Dental Extractions• Compromises of the Airway
• Oral Bleeding• Orofacial Injuries• Odontogenic Infections• Osteonecrosis• Orafacial Pain
Perils of Treatment - Diseases of the Teeth /Mouth
![Page 28: Joseph L. McQuirter, DDS](https://reader035.vdocuments.mx/reader035/viewer/2022062305/568164e2550346895dd74535/html5/thumbnails/28.jpg)
Bleeding Gums• Periodontal Disesae• Hormonal Changes (pregnancy gingivitis)• Anticoagulant Therapy• Bleeding Diatheses
![Page 29: Joseph L. McQuirter, DDS](https://reader035.vdocuments.mx/reader035/viewer/2022062305/568164e2550346895dd74535/html5/thumbnails/29.jpg)
Midline tongue piercing relatively blood-free especially when good compression
hemostasis is used (tongs)
![Page 30: Joseph L. McQuirter, DDS](https://reader035.vdocuments.mx/reader035/viewer/2022062305/568164e2550346895dd74535/html5/thumbnails/30.jpg)
Significant bleeding may
be encountered with with piercing more
laterally
![Page 31: Joseph L. McQuirter, DDS](https://reader035.vdocuments.mx/reader035/viewer/2022062305/568164e2550346895dd74535/html5/thumbnails/31.jpg)
Direct pressure whether applied manually or with sutures generally arrests bleeding
![Page 32: Joseph L. McQuirter, DDS](https://reader035.vdocuments.mx/reader035/viewer/2022062305/568164e2550346895dd74535/html5/thumbnails/32.jpg)
• Complications of Dental Extractions• Compromises of the Airway• Oral Bleeding
• Orofacial Injuries• Odontogenic Infections• Osteonecrosis• Orafacial Pain
Perils of Treatment - Diseases of the Teeth /Mouth
![Page 33: Joseph L. McQuirter, DDS](https://reader035.vdocuments.mx/reader035/viewer/2022062305/568164e2550346895dd74535/html5/thumbnails/33.jpg)
DentoalveolarFractures
Jaw Fractures(Maxilla / Mandible)
Soft Tissue
Orofacial
Injuries