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Diagnosis (SPECIAL TEST (Radiography - add necessary data to charting and…

- - - - Low Risk
        
        No new lesions
        
        good OHCP
        
        no poor diet habits
        
        optimal F- exposure
        
        no family hx of caries
      - Moderate Risk
        
        1 new carious lesion per year
        
        irregular OHCP
        
        occasional snacking
        
        sealants done
        
        moderate F- exposure
      - High Risk
        
        2+ new lesions per year
        
        poor OHCP
        
        no sealants
        
        no F- exposure/use
        
        family hx caries
        
        dry mouth
- - - - Unilocular
      - Multilocular
    - - Unilocular
      - Multilocular
  - - - FBC/CBC
        Iron Studies
        Folate/Vit B12
        CRP
        Clotting profile (INR, platelet, APTT, fibrinogen)
        Immunoglobiln
        ANA
        Zn and Cu
  - - - Periapical
        Gingival
        Periodontal
        Pericoronal
    - - Epithelilisation of an OAC that has been present for 48/72hrs that has reorganised the communication and caused osteitis to surround bone margins
        Tx: Refer for Flap Advancement/Closure
    - - Diffuse inflammation of soft tissue spaces
        • Extensive, firm swelling (diffuse oedema)
        • Pain, Tenderness, Erythema (redness)
        • Dysphagia & ptosis may occur (depends on site)
    - - Spread through the facial planes. Common signs and symptoms include dysphagia, swelling, trismus, pain, fever
- - - - Past Hx w/ Trauma
        Mechanism of Action
        Signs of a head injury?
    - - Colour changes ((Translumination??))
        
        Pulp canal obliteration
        
        Hemorrhage
        
        Internal Resorption "pink spot"
      - Sound Changes ((Percussion??))
        
        Dull-sound? High metallic sound?
      - Cold & EPT Testing
    - - Adjacent teeth and opposing arch
      - Developing Successors
      - Soft Tissues
      - Inhalation?? - Take Chest x-ray
    - - Classification of Trauma (ANDREASEN)
        
        A: Injuries to the hard dental tissues and pulp
        
        Uncomplicated Crown Fracture
        A fracture contained to the enamel or involving enamel and dentin, but not exposing the pulp
        
        Enamel Infarction
        An incomplete fracture (crack) of the enamel without loss of the tooth substance
        
        Complicated Crown-Root Fracture
        A fracture involving enamel, dentin and cementum and exposing pulp.
        
        Root Fracture
        A fracture involving dentin, cementum and the pulp.
        
        Complicated Crown Fracture
        A fracture involving enamel and dentin and exposing the pulp
        
        Uncomplicated Crown-Root Fracture
        A fracture involving enamel, dentin and cementum but not involving the pulp.
        
        B: Injuries to the periodontal tissues
        
        Concussion
        An injury to the tooth supporting structures without abnormal loosening or displacement of the tooth, but with marked reaction to percussion.
        
        Subluxation
        An injury to the tooth supporting structures with abnormal loosening but without displacement of the teeth.
        
        Intrusive Luxation
        Displacement of the tooth into the alveolar bone. This injury is accompanied by comminution or fracture of the alveolar socket.
        
        Extrusive Luxation
        Partial displacement of the tooth out of its socket.
        
        Lateral Luxation
        Displacement of the tooth in a direction other than axially. This is accompanied by comminution or fracture of the alveolar socket.
        
        Avulsion
        Complete displacement of the tooth out of the socket
        
        C: Injuries to Supporting Bone
        
        D: Injuries to gingiva or oral mucosa
      - Symptoms
        
        Subluxation = Mobile, TTP, Bleeding?
        
        Extrusion = Negative to tests, appears longer
        
        Consussion = tooth will be TTP
        
        Intrusion = appears shorter, high metallic sound
        
        Root Fractures = Rx horizontal line or halo-effect
  - - - Throbbing pain initiated by hot/ or cold
        Minutes or hours
        Spontaneous or intermittent pain
        – Worse if bend over or lie down (increase intra-pulpal pressure)
        – Woken up at night
        – Confirm diagnosis try by reproducing symptoms
    - - Sharp pain 5-10 seconds (gone when stimulus removed) Caused by: coronal leakage (cracks, ill margins, defective restorations), Caries
        Usually non-detectable on PA
    - - ACUTE = Tooth TTP/biting, Widening of PDL space, Negative to testings
        CHRONIC = Asymptomatic, non-responsive to tests, widening of PDL space
        
        either from perio or endo origins
    - - Intense throbbing pain, very TTP Tooth may be mobile
        (will not responds to tests)
        Probably PA lesion on radiographs
        Draining through root canal or perhaps incision required
- - - - Bisphosphonates – don’t want to do an extraction if it can be avoided because of BRONJ (bisphosphonate related osteonecrosis of the jaw)
      - Steroids – they need steroid cover (double their normal dose) before their extraction to avoid HPA crisis
      - Warfarin/NOAC – Reduce healing capabilities in pts with high INR ie bleeding risk. Manage bleeds not IHD!
      - Immunosuppresants – Increases risk of infection and compromises healing capabilities
    - - Surgical considerations
        
        Diabetes
        Impaired healing and more bleeding and also may go into shock. Make sure you have sugar around you in case. Use haemostatic measures to stop bleeding like putting surgical, spongistan or gelfoam into the socket
        
        Cardiac Issues:
        Prosthetic heart valves, rheumatic heart diesease, repair or placement of ex. pacemakers w/n 6mnths, hx infective endocarditis, congenital issues (ie palliative shunts)
        – need antibiotic cover before the extraction (AB cover doses
        – Amoxicillin 2g 1 hour before or Clarithromycin 500mg PO 1hr, Clindamycin 600mg 1 hour before)
        
        Pregnancy – don’t want to give most drugs (paracetamol is ok), try to avoid extractions until after birth if possible
        
        Hypertension/ arrhythmias/angina/ other heart conditions
        – don’t want to give too much adrenaline, try to give adrenaline free local or if not don’t go more than 2 cartridges.
        
        Smoking – Nicotine impairs the reparative phase of periodontal disease and promotes futher destruction causing incraesed damage,
        – Huge risk of dry socket after extraction
  - - - Coffee(tannins)
        
        Smoking
        
        Other Dietary stains
    - - Discolored Root filing
        
        Tetracycline
        
        Hemorrhage