Present by, Bushara Ping, the student in dentistry year 6th. Phnom Penh Cambodia.

1. Perioperative and post operative complication and anti-inflammatory Present by: Bushara PING 6th DDS Faculty of Dentistry Phnom Penh

2. Perioperative Complications Fracture of the crown of the adjacent tooth or luxation of the adjacent tooth Soft tissue injuries Fracture of the alveolar process Fracture of the maxillary tuberosity Fracture of the mandible Broken instrument in tissues Dislocation of the temporomandibular joint Subcutaneous or submucosal emphysema Hemorrhage Displacement of the root or root tip into soft tissues Displacement of an impacted tooth, root or root tip into the maxillary sinus Oroantralcommunication Nerve injury

3. Postoperative Complications Trismus Hematoma Ecchymosis Edema Postextractiongranuloma Painful postextraction socket Fibrinolyticalveolitis (dry socket) Infection of wound Disturbances in postoperative wound healing

5. Menagerment Compression Ligation Suturing electro coagulation use of haemostatic agents.

6. Compression > Iodoform gauze: antiseptic may arrest bone bleeing as well ( place in the cavity 10 min to 3-4 days which it is removed. Aim of compression is to decrease the permeability of cacillaries: biting on a gauze 10-30 min. > Bone wax is consideration if compression can’t stop bleeding, to arrest bone bleeding

8. The gauze is paked over the wound for 2-3 day.Suturing of wound margins with a figure-eight suture Gauze pack, sutured over a postextraction wound

9. Ligature To stop the soft tissue bleeding involve a large vessel, if during operation bleeding due to large vessel an hemostat is used to clamp and ligature the vessel.

10. Electrocoagulation A technical to coagulate the Blood through the application of heat, resulting in the retraction of tissues in a necrotic mass.

11. Hemostat materiel vasoconstrictors (adrenaline), alginic acid, desiccated alum, etc., Other materials are also used, such as: fibrin sponge, gelatin sponge, oxidized cellulose, etc., These materials are suitable only for local application and are used to arrest generalized capillary bleeding, especially to control bleeding of the postextraction alveolus.

12. Hemostat meteriels Oxidized cellulose in pellet form, ( topical) Absorbable hemostaticnatural collagen sponges.( topical)

13. Hemostat materiel Packing of the alveolus with hemostatic materials: gelatin sponge, collagen, etc. Gelatin sponges.( topical)

15. Nerve injury is one of the most serious complications during oral surgical procedures. Most common: inferior alveolar, mental, and lingual nerves. > (anesthesia or hypesthesia, paresthesia, dysesthesia. resulting in various undesirable situations, such as a burning sensation, tingling, needles and pins, biting of the tongue and lips, abnormal chewing, burns through consumption of hot foods, etc.

16. Nerve Injury Seddon’s classification (Seddon 1943): neurapraxia, axonotmesis, neurotmesis. Risk of injury of the mental nerve

17. Question is…… neurapraxia, axonotmesis, neurotmesis. ????

18. Nerve injury Etiology: nerve block IDB, and Mental nerve(rarely) incision extension to metal foramen,.., incision at the alveolar ridge of an edentulous patient flap retraction: region of the mental nerve or at the lingual region of the third molar. not irrigated: bone near a nerve is excessively heated case of removal of impacted teeth: the teeth is close to mental or inferior alveolar nerves. perforation of the lingual cortical plate,

19. FibrinolyticAlveolitis (Dry Socket) Definition Dry socket (alveolar osteitis) is a painful dental condition that can occur after extraction of a permanent adult tooth. occurs when the blood clot at the site of the tooth extraction has been dislodged or has dissolved before the wound has healed. Exposure of the underlying bone and nerves results in severe pain. Dry socket delays the healing process.

20. FibrinolyticAlveolitis (Dry Socket) Symptoms Severe pain total loss of the blood clot Visible bone in the socket Bad breath Unpleasant taste in your mouth Swollen lymph nodes around your jaw or neck

21. FibrinolyticAlveolitis (Dry Socket) Causes Bacterial contamination of the socket ( infection) during exo and after exo. Severe bone and tissue trauma at the surgical site due to a difficult extraction Very small fragments of roots or bone remaining in the wound after surgery Infiltration of anesthesia. Dens and sclerotic bone around the tooth.

22. FibrinolyticAlveolitis (Dry Socket) Risk factors Smoking and tobacco use: contaminate the wound site, Sucking action from smoking, sneezing, coughing, spitting or sucking, within the first 24 hours. Oral contraceptives: estrogen levels from oral contraceptives may disrupt normal healing Improper at-home care: . Failure to follow guidelines Having dry socket in the past: Tooth or gum infection: Current or previous infections around the tooth to be extracted.

23. Treatment Irrigation gently Place gauze with eugenol ( replace every 24h till the pain subside) Or: Zinc-Oxide/eugenol 5 day Or : Alvogyl by Septodont

24. Anti-Inflammatory NSAID: pain medicationsand to reduce swelling. Commonly used in orthopedic problems such as arthritis, bursitis, and tendonitis. Steroid: derivative of a natural hormone of the body. commonly used in orthopedics.

25. Mediator inflammtary Complement system histamine serotonin bradykinin - major contributors to symptoms of inflammation leukotrienes - increase vascular permeability - increase mobilization of endogenous mediators of inflammation prostaglandins PGE2 ‑ promote edema and leukocyte infiltration PGI2‑ increase vascular permeability, enhance pain producing properties of bradykinin

27. NSAIDs the NSAIDs are thought to act by inhibiting prostaglandin(a group of naturally occurring fatty acids that act within the body to regulate acid secretion of the stomach, regulate body temperature platelet aggregation, and control inflammation,) 1. cycloo1xygenase-1 (COX-1),the enzyme that helps to maintain the stomach lining; and 2. cyclooxygenase-2 (COX-2), the enzyme that triggers pain and inflammation. Introductory Clinical Pharmacology (7th Ed) and Lww 2007 Drug Guide Package

28. Sign of inflammatory Redness - due to local vessel dilatation Heat - due to local vessel dilatation Swelling – due to influx of plasma proteins and phagocytic cells into the tissue spaces Pain – due to local release of enzymes and increased tissue pressure

29. NSAIDs NSAIDs work to block the effect of an enzyme called cyclooxygenase. This enzyme is critical in your body's production of prostaglandins ( mediator inflammatory) Prostaglandins also have other important functions in the body as a: gastric lining. Renal ( renal blood flow, > Hyper kaliémie..) Platelet aggregation Body temparature…

30. NSAIDs Traditional NSAIDs work against both COX-1 and COX-2, both types of this enzymes that function in your body , But The new medications (e.g. Celebrex) work primarily against COX-2, and allow COX-1 to function normally. Because COX-1 is more important in producing the protective lining ( gastric mucosa) . Due to Less Risk to gastric ulcer.

31. What is this Technique???

32. NSAIDs NSAIDs should NOT be used if: pregnant : breastfeeding : ? history of stomach ulcers taking blood thinning medication ( anticoagulant drug) Hypertension: B-blocker ??? Asthma: bronchospasme. Kidney problem Other medication is taking ( should know clearly)

33. NSAIDs pregnant : Lead to: - Reduce fetal weight - Prolongs the duration of gastation - Dystocia

34. NSAIDs history of stomach ulcers: Lead to: gastric ulcer, In server case > Hemorrhage gastric. Prostaglandine: important for gastric mucosa

35. NSAIDs Kidney problem: Lead to: Fluid sanguid Retention Na+ Hyper-Kaliémie Néphrite Insufficient Renal chronic

36. Referance Oral Surgery: Springer 2007 http://orthopedics.about.com/cs/paindrugs/a/nsaids.htm Berger, RG "Nonsteroidal Anti-inflammatory Drugs: Making the Right Choices" J. Am. Acad. Ortho. Surg., Oct 1994; 2: 255 - 260. van Tulder MW, et al. "Non-steroidal anti-inflammatory drugs for low-back pain The Cochrane Database of Systematic Reviews 2006 Issue 1 http://drugsafetysite.com/sulindac/ http://www.dentalgentlecare.com/dry_socket.htm Mayo clinic: http://www.mayoclinic.com/health/dry-socket/DS00778 http://www.webmd.com/oral-health/dry-socket-symptoms-and-treatment Introductory Clinical Pharmacology (7th Ed) and Lww 2007 Drug Guide Package

37. Thank you..! Thank you…!