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Dentistry 2023.pptx
1. D E P T ; P U B LI C H E A L T H 4 T H Y R
C O U R SE T I T LE ; D E N TI ST R Y
C R E D I T H O U R S ; T H R E E ( 0 1 )
B Y ; D R . N H I A L W A N L O L ( M D)
BARO Gambella College
2. Module I
īļIntroduction to Dentistry
ī Definition of dentistry
ī Anatomy and physiology oral cavity
ī Pathology of oral cavity
ī Dental Caries
3. Introduction to Dentistry
ī Definition;
Dentistry is a study of oral cavity
e.g bones, teeth and soft tissues
ī§ Dentistry is the science and art of preventing,
diagnosing, and treating, diseases, injuries and
malformations of the teeth, jaws and mouth and of
replacing lost or absent teeth and associated
structures.
6. Parts of the Teeth
6
A tooth has a crown, neck, and root
īThe crown: the visible part of teeth that projects
from the gingiva
īThe neck is between the crown and the root
īThe root is the part fixed in the tooth socket, which
is variant in number
8. Layers of Teeth
8
īEnamel: the outer most layer of teeth in the crown
īCementum: the outer most layer of teeth in the root
īDentin: the middle layer of teeth, forms the main
density of teeth
īThe pulp cavity: the central part of teeth, contains
connective tissue, blood vessels, and nerve
9. Sensory innervation and Blood Supply of the jaw
9
ī Superior and inferior alveolar arteries/ veins ; branch of maxillary
artery supply tooth
ī Upper jaw= superior alveolar nerves
ī Lower jaw= inferior alveolar nerves; both make dental plexus
īĄ Inferior alveolar nerve: all mandibular teeth, buccal soft tissues
of premolar, canine and incisors
īĄ Lingual nerve: all lingual soft tissues of all teeth
īĄ Long buccal nerve: buccal soft tissue of all molars
īĄ Anterior superior alveolar nerve: maxillary incisors and
canine, buccal soft tissues of incisors and canines
īĄ Middle superior alveolar nerve: maxillary premolar and
maxillary bone roots first molar, buccal soft tissue of premolar
10. Cont.âĻ
10
ī Post. Sup. alveolar nerve: maxillary molars except
a portion of first molar, buccal soft tissue of molars
ī Greater palatine nerve: lingual soft tissues of
molars and premolars
ī Nasopalatine nerve: lingual soft tissue of incisors &
canines
ī Mandibular premolar region, buccal soft tissue
innervated primarily by mental branch of IAN and
also by terminal branchâs of long buccal nerve
13. Salivary Glands
13
ī Major and Minor Salivary Glands
īĄ Three pairs of major Salivary Glands
ī Parotid â below and anterior to the ear
ī Submandibular â below the mandible
ī Sublingual â anterior floor of the mouth
ī Orifices / ducts:
īļ Stensenâs duct â parotid
īļ Whartonâs duct â submandibular
īļ Numerous small ducts of Sublingual
glands
ī Over 1000 minor glands
īˇ Buccal, palatal, lingual
14. The Role of Saliva
14
ī Physical protection provides a cleansing effect.
ī Chemical protection contains calcium, phosphate, and fluoride. It
keeps calcium there ready to be used during remineralization.
ī It includes buffers, bicarbonate, phosphate, and small proteins that
neutralize the acids after we ingest fermentable carbohydrates.
ī Antibacterial substances in saliva work against the bacteria; like
lactoferrin, lysozyme, lactoperoxidase, beta-lysin, and
immunoglobulins
ī Maintenance of homeostasis on dental surfaces:
īĄ Dissolves and dilutes metabolites
īĄ Maintains proper pH balance
īĄ Reduces plaque
15. Physiology
īļFunction of oral cavity
ī Digestion...mastication/chewing
ī Alternate airway....breathing
ī Articulation of speech...speaking
ī Anatomical support
ī Psychology...cosmetic
16. Pathology
ī Pathology of oral cavity is defined as disease
affecting bones, and connective tissues of oral cavity
ī Dental caries is a bacterial infection of the teeth
and soft tissues.
ī Oral hygiene; caring for teeth, gum and other soft
tissues
ī Connective tissue include; gum, and vocal mucosa
17. Dental Caries
ī Bacterial infection of the teeth and connective
tissues.
ī Pathophysiology of dental carier
ī Food particle + bacteria= form plaque--- plaque
form dental carrier
ī Dental plaque is colourless, soft, sticky material
disposed on the enamel.
18. Transmission of Caries Causing Bacteria
18
ī Mutans streptococci are transmitted through saliva, most
frequently the motherâs, to the infant.
ī When mothers have high counts of mutans streptococci in their
mouths, the babies also have high counts of the same bacteria
in their mouth.
Dental Plaque
ī Dental plaque is a colorless, soft, sticky coating that adheres
to the teeth.
ī Plaque remains attached to the tooth despite movements of the
tongue, water rinsing, water spray, or less than thorough
brushing.
ī Formation of plaque on a tooth concentrates millions of
microorganisms on that tooth
19. Dental Caries: A Bacterial Infection
19
ī There are two specific groups of bacteria found in the mouth that
are responsible for dental caries:
īŧ Mutans streptococci (Streptococcus mutans)
īŧ Lactobacilli
ī They are found in relatively large numbers
in the dental plaque.
ī The presence of lactobacilli in the mouth indicates a high sugar
intake.
20. The following mechanisms contribute to tooth decay
20
ī Plaque bacteria that ferment dietary sucrose produce acids that
lower the pH on the tooth surface, promoting demineralization and
eventually, tooth decay.
ī Plaque bacteria, such as S. mutans can also utilize sucrose to produce
extracellular polysaccharides, known as glucans, which are adhesive
polymers that enable mutans streptococci to avidly stick to the tooth
surface, thereby causing decay in the underlying structures.
22. The Caries Process
22
īFor caries to develop, three factors must occur at the
same time:
īĄA susceptible tooth
īĄDiet rich in fermentable carbohydrates
īĄSpecific bacteria (regardless of other factors,
caries cannot occur without bacteria)
25. Root Caries
25
ī Root caries is becoming more prevalent and is a concern
for the elderly population who often have gingival
recession exposing the root surfaces.
ī Carious lesions form more quickly on root surfaces than
coronal caries because the cementum on the root
surface is softer than enamel and dentin.
ī Like coronal caries, root caries has periods of
demineralization and remineralization.
27. Erosion
27
Cause: Bruxism (Involuntary clenching
teeth; esp. during sleep)
Loss by wear of surface of tooth or
restoration caused by tooth to tooth
contact during mastication or
parafunction
Loss by wear of dental tissue caused by
abrasion by foreign substance (e.g.,
toothbrush, dentifrice)
Progressive loss of hard dental tissue by
chemical processes not involving bacterial
action Cause: GERD
Cause: Over vigorous brushing
Abrasion
Attrition
28. Diagnosis of Dental Caries and Non Dental Caries
28
īRadiographs
īVisual
īLaser caries detector
Laser Caries Detector
īThe laser caries detector is used to
diagnose caries and reveal bacterial
activity under the enamel surface.
īCarious tooth structure is less dense and
gives off a higher reading than non- carious
tooth structure.
31. Treatments
31
ī Elimination of risk factors
ī Scaling, root planning & curettage
ī Antibiotic therapy (metronidazole or tetracycline)
ī Anti-pain (NSAIDs)
Filling
ī Amalgam (a mixture of mercury and other metals (solid/liquid)
used for filling holes in teeth)
ī Composite a solid material which is composed of 2/more
substances having d/t physical ch/tcs and in which each substance
retains its identity while contributing desirable properties to the
whole.
32. Methods of Caries Intervention
32
ī Fluoride: A variety of types are available to strengthen the tooth against
solubility to acid.
ī Antibacterial therapy: Products such as Chlorhexidine rinses are
effective.
ī Salivary flow can be increased by chewing sugarless gum, for example,
those with a non-sugar sweetener such as xylitol.
Preventive measures against
caries
A. Fluoride rinse
B. Chlorhexidine rinse
C. Xylitol gum.
D. Sealants- thin, plastic material
used to cover tooth surfaces. It
protects enamel from attack by
bacterial acids.
33. Complications of dental carrier
I. Local
ī Abscess..pus collection
ī Tooth loss
ī Pericorinitis
ī Chronic tooth pain
ī Bacterial infection of the floor of the mouth
ī e.g Ludwigâs angina
38. 1. Prosthodontics
The branch of dentistry that deals with the
replacement of missing teeth and related mouth
or jaw structures by bridges, dentures, or other
artificial devices.
38
39. 2. Endodontic
It deals with the tooth pulp & tissues
surrounding the root of tooth.
39
39
40. 3. Operative Dentistry (Restorative dentistry)
Concerned with restoration of parts of the teeth
that are defective as a result of disease, trauma,
or abnormal development to a state of normal
function, health, and aesthetics.
40
41. 4.Periodontic
The specialty of dentistry that studies
supporting structures of teeth, diseases, and
conditions that affect them.
41
42. 5. Oral and maxillofacial surgery
The dental specialty concerned with the
diagnosis and treatment of diseases affecting
the mouth, jaws and orofacial structures.
42
42
43. 6. Orthodontics
The specialty of dentistry that is concerned with
the study and treatment of malocclusions, which
may be a result of tooth irregularity,
disproportionate jaw relationships, or both.
43
44. A N A T O M Y A N D N O M E N C L A T U R E O F T E E T H
Module II
45. Outline
ī Classification
ī Anatomy of tooth
ī Parts of the tooth
ī Layers of the tooth
ī Innervation and blood supply of the teeth
ī Nomenclatures system of the teeth
46. Objective
īļBy the this session, students will be able to;
īClassify teeth
īDescribes normal anatomy of teeth
īExplain parts of the tooth
īDescribes layers of the teeth
īList nerves and blood vessels of the teeth
īLearn different nomenclature systems of the teeth
47. Teeth
ī The teeth are set in the tooth sockets and used in mastication
and speech
īļ Two class of teeth:
a) Primary/deciduous
b) Permanent
âĸ Children have 20 deciduous teeth; adults have 32 permanent
teeth
ī The 20 deciduous teeth consist of
âĸ 2 incisor, 1 canine, and 2 molar teeth on each side of the
upper and lower jaws
âĸ These teeth are replaced by the incisor, canine, and premolar
teeth of the permanent teeth 47
49. Parts of the Teeth
A tooth has a crown, neck, and root
īThe crown: the visible part of teeth that
projects from the gingiva
īThe neck is between the crown and the root
īThe root is the part fixed in the tooth socket,
which is variant in number
49
51. Layers of Teeth
ī Enamel: the outer most layer of teeth in the crown
ī Cementum: the outer most layer of teeth in the root
ī Dentin: the middle layer of teeth, forms the main
density of teeth
ī The pulp cavity: the central part of teeth, contains
connective tissue, blood vessels, and nerve
51
52. Sensory innervation and Blood Supply of the jaw
ī Superior and inferior alveolar arteries/ veins ; branch of maxillary
artery supply tooth
ī Upper jaw= superior alveolar nerves
ī Lower jaw= inferior alveolar nerves; both make dental plexus
â Inferior alveolar nerve: all mandibular teeth, buccal soft
tissues of premolar, canine and incisors
â Lingual nerve: all lingual soft tissues of all teeth
â Long buccal nerve: buccal soft tissue of all molars
â Anterior superior alveolar nerve: maxillary incisors and
canine, buccal soft tissues of incisors and canines
â Middle superior alveolar nerve: maxillary premolar and
maxillary bone roots first molar, buccal soft tissue of premolar
52
53. Cont.âĻ
âĸ Post. Sup. alveolar nerve: maxillary molars except
a portion of first molar, buccal soft tissue of molars
âĸ Greater palatine nerve: lingual soft tissues of
molars and premolars
âĸ Nasopalatine nerve: lingual soft tissue of incisors &
canines
âĸ Mandibular premolar region, buccal soft tissue
innervated primarily by mental branch of inferior
alveolar nerves and also by terminal branch of
long buccal nerve
53
55. Nomenclature of tooth
ī Nomenclature is the first step in understanding dental
anatomy.
ī Tooth numbering or âshorthandâ system of tooth
notation is necessary in clinical practice for
recording data and communication.
ī The various tooth notation systems are as follows:
A. Palmer notation system
B. Universal notation system
C. FDI system (Federation Dentaire Internationale)
55
56. A. Palmer notation system
ī In 1861 Adolph Zsigmondy of Vienna introduced the
symbolic system for permanent dentition. He then
modified it for the primary dentition in 1874.
ī The symbolic system is now commonly referred to as
the Palmer notation system or Zsigmondy system.
īļPrimary teeth
E D C B A â A B C D E
E D C B A â A B C D E
īļPermanent teeth
8 7 6 5 4 3 2 1 â 1 2 3 4 5 6 7 8
8 7 6 5 4 3 2 1 â 1 2 3 4 5 6 7 8
56
57. B. Universal notation system
ī In this system for the permanent dentition the maxillary
teeth are numbered through 1 to 16 beginning with
upper right third molar.
ī The mandibular teeth are numbered through 17 to 32
beginning with lower left third molar.
ī The universal system notation for primary dentition
utilizes upper case alphabets.
īļ Primary teeth- A B C D EâF G H I J
T S R Q PâO N M L K
īļ Permanent teeth
1 2 3 4 5 6 7 8â 9 10 11 12 13 14 15 16
32 31 30 29 28 27 26 25 â 24 23 22 21 20 19 18 17
57
58. C. FDI system
īThe FDI system is a two digit system that has
been adopted by WHO.
īIn this system the first digit indicates the
quadrant and the second digit indicates the
tooth within the quadrant.
ī1 to 4 and 5 to 8 as the first digit indicates
permanent and primary dentition respectively.
ī1 to 8 and 1 to 5 as the second digit indicates
permanent and primary teeth respectively.
58
62. PULP AND PERIRADICULAR DISEASES
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Dr Nhial
62
The Dental Pulp
ī Consists of richly vascularized and highly innervated
connective tissue
ī It is surrounded by dentin
ī The pulp tissue is in communication with the periodontium
and the rest of the body through the apical foramen and
accessory canals near the apex of the root
63. PULPITIS
ī Is inflammation of the dental pulp resulting from untreated caries,
trauma, or multiple restorations.
ī Pulpitis can occur when caries progresses deeply into the dentin
ī Trauma disrupts the lymphatic and blood supply to the pulp
ī Its principal symptom is pain
Main Cause
1.Infection: spread of dental caries to the pulp
2. Trauma
3. Physical irritation: excessive heat during cavity preparation.
4. Chemical irritation i.e. filling materials or cavity cleansers such as
alcohol, chloroform, hydrogen peroxide
5. Mixed microorganisms which are found in the oral cavity
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Dr Nhial 63
64. 11/19/2021
Dr Nhial 64
ī This image shows how the progression of decay, if not treated,
will lead to destruction of the tooth's hard tissue and pulp.
ī If treated at the beginning of the decay process (first image), a
small filling would resolve the problem.
ī If allowed to continue as in the last image, root canal therapy
would be necessary.
PROGRESSION OF DECAY (CARIES)
65. 11/19/2021
Dr Nhial 65
ī When Dental decay reaches a depth in the dentin that
is near the pulp tissue inside of the tooth, the pulp tissue can
become inflamed (pulpitis)
66. Classification of dental pulp disease
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Dr Nhial
66
Reversible pulpitis
ī Tissue is capable of
returning to normal state
of health if noxious stimuli is
removed
ī Sudden mild to moderate
pain or short duration
ī Sweat, sour foods or
beverages can cause pain
Irreversible pulpitis
ī Higher level of inflammation
ī Pulp is damaged beyond the
point of recovery
ī Sharp severe pain upon
thermal stimulation
ī Pain continues after the
stimulus is removed
ī Heat & sweat & sour foods
elicit pain
ī Pain may be spontaneous or
continuous
67. Diagnosis and Treatment of Pulpitis
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Dr Nhial
67
īDiagnosis is based on clinical findings and is
confirmed by x-ray.
īTreatment involves
īŧ Removing decay,
īŧ Restoring the damaged tooth, and
īŧ Sometimes doing root canal therapy (RCT) or extracting the
tooth.
69. Peri-radicular tissue
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Dr Nhial
69
ī The tissues surrounding and investing the cervical, middle, and apical
regions of the root are the cementum, periodontal ligament, and
alveolar bone.
Classification of Peri-radicular lesions
Classified into four main groups:
1. Acute apical Periodontitis (AAP)
2. Chronic apical Periodontitis (CAP)
3. Acute apical abscess (AAA)
4. Chronic apical abscess (CAA)
70. 1) Acute apical Periodontitis
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Dr Nhial
70
ī Etiology
īļ Extension of pulpal inflammation into the peri-radicular tissues
īļ Irritants: bacteria toxins from necrotic pulps, chemicals
(irritants or disinfecting agents) over instrumentation &
restorations in hyper occlusion.
ī S/symptoms
īļ moderate to severe spontaneous discomfort as well as pain on
mastication or occlusal contact.
īļ Application of pressure by fingertip can cause marked pain
71. 11/19/2021
Dr Nhial 71
ī Diagnosis
īļ Radiography: "Thickeningâ
of periodontal ligament (PDL) space
(May be not always)
ī Treatments
īŧ Adjustment of occlusion (when
there is evidence of hyper
occlusion)
īŧ Removal of irritants or a
pathologic pulp, or
īŧ Release of peri radicular exudates
72. 2) Chronic apical Periodontitis
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Dr Nhial
72
ī Etiology: results from pulp necrosis and usually is a sequel to
AAP.
ī S/symptoms:
īŧ Asymptomatic or slight discomfort
īŧ Do not respond to electrical or thermal stimuli
īŧ Percussion produces little or no pain there may be slight
sensitivity to palpation, indicating an alteration of the cortical
plate of bone and extension of CAP into the soft tissues
73. Radiography image: Well-circumscribed lesions and pear-shaped
configuration of periradicular to the canine are typical of CAP.
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Dr Nhial
73
74. 3) Acute apical abscess
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Dr Nhial
74
īļ Etiology: microbial and nonbacterial irritants from necrotic
pulp.
īļ S/symptoms:
īŧ Have moderate to severe discomfort or swelling.
īŧ Systemic manifestations of an infective process such as a
high temperature, malaise and leukocytosis
īŧ Because AAA occurs only with pulp necrosis, electrical or
thermal stimulation produces no response
īŧ However, teeth are painful to percussion and palpation
75. 11/19/2021
Dr Nhial 75
ī Radiography: range from thickening of the PDL
space (infrequent) to a frank resorptive lesion (usual)
ī Treatment: Removal of the underlying cause
(necrotic pulp), release of pressure (drainage here
possible) and root canal treatment
ī Clinical significance
īŧ If untreated, a Periapical/apical abscess can develop
into osteomyelitis , septicemia, Ludwigs angina, or
cavernous sinus thrombosis.
76. 4) Chronic apical abscess (Suppurative Apical
periodontitis)
11/19/2021
Dr Nhial
76
ī Result of a long-standing lesion that has resulted in an
abscess that is draining to a surface
ī Etiology
īŧ Pathogenesis similar to that of AAA results from pulp
necrosis and is usually associated with chronic apical
periodontitis that has formed an abscess
īŧ The abscess has "burrowed" through bone & soft tissue to
form a sinus on the oral mucosa or sometimes onto the skin
of the face
77. ContâĻ
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Dr Nhial
77
īļ Signs and symptoms
īŧ Because drainage exists, CAA is usually asymptomatic
except when there is occasional closure of the sinus
pathway, which can cause pain
īŧ Clinical, radiographic, and histopathologic features of CAA
are similar to described for CAP.
īŧ An additional features is the sinus tract
78. A. Apical abscesses occasionally drain
extra-orally (blue arrows)
B. The tooth was retreated nonsurgical
and the chin lesion healed within a few
weeks with some scarring.
11/19/2021
Dr Nhial
78
80. 11/19/2021
Dr Nhial 80
Peri-coronitis
ī Inflammatory process involving soft tissues covering
crown of partially erupted or un-erupted teeth.
ī Develops when food debris & bacteria are present
beneath the gingival flap
ī Usually seen associated with impacted mandibular 3rd
molars
81. 11/19/2021
Dr Nhial 81
Clinical features
īSevere pain
īSwollen, red, tender gingiva
īDiscomfort in swallowing
īRestriction of oral opening
īFoul taste
īPain may radiate to ear, floor of mouth or
throat
īLymphadenopathy
īMalaise & fever
83. 11/19/2021
Dr Nhial 83
Treatment
ī Antiseptic lavage under the gingival flap to remove gross
food debris & bacteria
ī Gingival flap is removed surgically if the tooth to be
retained
ī Extraction of tooth if needed
ī Antibiotics
ī Warm saline mouth rinse
84. Gingivitis
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Dr Nhial
84
ī It is an inflammatory lesion confined to the tissue of the
marginal gingiva.
Cause:
ī Accumulation of bacterial plaque at or near the gingival
margin.
ī The bacterial component of plaque produces and releases
variety of enzymes and toxins (e.g. lipopolysacchardies )
which diffuse through the junctional epithelium and initiate
inflammatory changes in the gingival connective tissues.
85. ContâĻ
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Dr Nhial
85
Clinical features
âĸ Redness of the gum
âĸ Gum bleeding
âĸ edema of the gum
âĸ Tenderness of the gum
Treatment:
âĸ Oral hygiene
âĸ Plaque control
âĸ Oraldine mouth wash
âĸ Administration of antibiotics
86. Acute Necrotizing Ulcerative
Gingivitis (ANUG)
11/19/2021
Dr Nhial
86
īDefinition: is an inflammatory destructive gingival
condition which exhibits characteristics clinical signs
and symptoms.
īThe other names for ANUG are "Vincent's gingivitis" or
"Vincents gingivostomatitis", 'Trench mouth'' and"
Ulcero-membraneous gingivitisâ
87. ContâĻ
11/19/2021
Dr Nhial
87
Causes
īFusiform bacteria
īTreponema vincenti
īTreponema deticola
īFusobacterium nucleatum
īPrevotella intermedia
īPorphymonas gingivalis
NB: These bacteria are found in large numbers in the
slough and necrotic tissues at the surface of the ulcer.
88. ContâĻ..
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Dr Nhial
88
Clinical features
ī Inter proximal ulcers covered with a yellowish-white or grayish
debris
ī Easily bleed
ī Necrosis develops rapidly
ī Linear erythema
ī Pain
ī Halitosis
ī Lymphadenitis
ī Fever and malaise
89. ContâĻ.
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Dr Nhial
89
Control of the acute phase
īAntibacterial cleaning
īIrrigation of the wound with 3% hydrogen peroxide
solution
īScaling of the affected teeth
īAntibiotics, Metronidazole
ī2% Chloxeidine mouth wash
91. Module IV ConâtâĻ..
Exodontia
īPainless removal of the tooth or root with
minimal injury to the surrounding soft tissue and
bone
īRemoval of the tooth does not require large
amount of force.
īPain and anxiety control is by:
īŧLocal anesthesia results in loss of pain,
temperature and touch but not pressure
91
92. Cont.âĻ
Duration of anesthesia
ī local anesthesia without vasoconstrictors
īŧMaxillary teeth: 10 - 20 minutes
īŧMandibular teeth: 40 - 60 minutes
īŧSoft tissue: 2 â 3 hours
īLasts longer in mandible due to the density
of the cortical bone of the mandible.
92
94. Indications for removal of teeth
īSevere dental caries
īPulpal necrosis
īSevere periodontal disease
īMal opposed teeth
īOrthodontic reasons
īCracked teeth or fractured root
94
95. Indications for removal of teeth
īPre prosthetic extraction
īImpacted teeth
īSupernumerary teeth
īTeeth associated with pathologic lesion
īPre radiation therapy
īSevere attrition ,abrasion or erosion
īTeeth involved in jaw fracture
95
96. Contraindications for the removal of teeth
ī Systemic contraindications
oUn controlled diabetes
oEnd stage renal disease with severe
uremia
oUncontrolled leukemia
oUncontrolled cardiac disease
oUnstable angina pectoris
96
97. Contraindications for the removal of teeth
o Recent MI
o Severely uncontrolled hypertension
o Pregnancy first and last trimester
o Bleeding disorders like hemophilia
o Platelet disorders
o Pt. on anticoagulants
NB: Absolute contraindication (arterioveinous
fistula and end stage renal disease)
97
99. Instrument used for extraction
1. Forceps
īUses of forceps
ī§To expand bony sockets
ī§To remove tooth
2. Elevator : for loosening
īStraight elevator
īPeriosteal elevator
īCryer elevator
99
100. Techniques of extraction
1. Closed extraction
īAdequate access and visibility needed
īSteps for closed extraction
1. Loosening of soft tissue attachment from
tooth
2. Luxation of tooth with dental elevator
3. Adaptation of forceps to tooth
4. Luxation of tooth with forceps
5. Removal of tooth from socket 100
101. Post extraction care
ī Curettage if any peri-apical pathology
ī Curette if any debris, calculus, amalgam, tooth & bone
fragment in the socket
ī Finger pressure is applied to buccal and lingual cortical
plates to compress the socket
ī Moistened 2x2 inch gauze is placed
101
103. Complications of exodontia
īŧ Fracture of crown or roots of the tooth being
extracted
īŧ Fracture of alveolar bone
īŧ Fracture of maxillary tuberosity
īŧ Fracture of adjacent or opposing tooth
īŧ Fracture of mandible
īŧ Dislocation of TMJ
īŧ Displacement of root into soft tissues ,maxillary
antrum
īŧ Bleeding
103
104. ContâĻ.
īŧInjury to gums, lips, IAN & its branch, lingual
nerve, tongue, floor of mouth, greater palatine
artery
īŧ Osteomyelitis
īŧ Infection
īŧ Trismus
īŧ Hematoma
104
105. Local anesthesia
ī Is the loss of sensation in circumscribed area of body
caused by depression of excitation in nerve endings
or inhibition of conduction process in peripheral
nerves.
ī Produces loss of sensation with out loss of
consciousness.
105
106. ContâĻ
Advantages of LA:
âĸ It can be easily mastered and can be given by
operator
âĸ Equipment required is limited in amount
âĸ Economical and transportable
âĸ The patency of air way is not impaired
âĸ Enables the patient to cooperate
Contraindications to LA:
ī§ Acute infection in the injection sites
ī§ Patients with hemorrhagic disease
106
107. Types of LA
1. Topical.
ī When applied to intact mucus membrane pass through the
epidermis and anaesthetize the nerve endings e.g.. Cocaine,
lidocaine.
ī It can be in the form of sprays, ointmentâĻ
2. Infiltration:- Deposition of LA near the terminal fibers to
produce anesthesia to localized areas served by the nerve
fibers.
- Sub mucous injection
- Supra periosteal
- Sub periosteal
* Mostly used in maxilla
107
108. ContâĻ
3. Regional anesthesia: Anesthetic solution
deposited near the nerve trunk & blocks all
impulses. It is also known as block
anesthesia.
** It is widely used in the mandible since
infiltration is unreliable due to the density of
the cortical bone of the mandible.
108
109. Summary of maxillary block
Posterior Superior Alveolar Nerve Block
Maxillary molars (with exception of
mesiobuccal root of maxillary 1st molar
in some cases), hard and soft tissue on
buccal aspect
Middle Superior Alveolar Nerve Block
Mesiobuccal root of maxillary 1st molar ,
premolars and
surrounding hard and soft tissue on buccal
aspect
Anterior Superior Alveolar Nerve
Block/Infraorbital Nerve Block
Maxillary central and lateral incisors and
canine, surrounding hard and soft tissue on
109
110. Local anesthesia in Mandible
ī The regional or block anesthesia in the mandible is achieved
by deposition of LA around the inferior alveolar nerve at
pterygo mandibular space / Retro molar area
For mandibular block:
ī Mandibular occlusal plane should be horizontal when
patient open his mouth
ī Operator should stand in front of the patient for giving
anesthesia to the right side and behind for the left.
ī The thumb of left hand is passed along the buccal surface of
the lower molar teeth until the internal oblique ridge is felt.
Then the tip is rolled in ward to lie in retro-molar fossa.
The mid point of the nail concedes the land mark for
insertion of the needle after preparation
110
111. ContâĻ
ī The syringe is held parallel to the mandibular
occlusal plane over 2nd premolar of the opposite side.
ī Needle is inserted about 0.5cm to anaesthetize the
lingual nerve and advance more 1.5- 2cm to
anaesthetize the inferior alveolar nerve and long
buccal nerve
111
112. Difficulties and complication of LA
1. Failure to obtain Anesthesia
a) Inadequate amount LA
b) Poor operater technique
c) Missing land marks
d) PH of tissue
e) Expiration of LA
112
113. ContâĻ
2. Pain during and after injection
Reduced by - Sharpe needle
- Tensing the tissue
- Slow injection
3. Hematoma formation: Occurs most frequently when posterior
superior alveolar block given.
4. Intra vascular injection: Frequently the patients feels faint.
Has a pale clammy skin, rapid pulse.
5. Trismus:
īŧ Difficulty of opening jaw due to muscle spasm
īŧ Injection to medial pterygoid muscle
6. Infection
113
114. ContâĻ
7. Facial paralysis: Injection to the parotid gland
8. Prolonged impairment of sensation due to damage of the
nerves.
9. Broken Needles
-When needle broken, the tissue must be kept under continuous
pressure until the protruding end is grasped by pliers or artery
forceps.
- If the edge is embedded completely, the patient should be
informed and X-ray should be taken to confirm the position and
presence.
114
115. ContâĻ
10. Lip trauma:
ī§ Children chews anaesthetized part.
ī§ Adults burn from hot drinks
11. Fainting
In this instance
âĸ Head should be lowered
âĸ Legs elevated
âĸ Tight clothes & belt loosened
âĸ Wet swab applied on brow
âĸ Stimulate respiration
115
117. 117
Module V
Management of Maxillofacial injuries
Introduction
âĸ The facial skeleton is divided into 3 parts
âĸ The upper 1/3: formed by frontal bone
âĸ The middle 1/3: from frontal bone to the level of
upper teeth.
âĸ The lower 1/3: the mandible
118. 118
The causes of maxillofacial trauma
īFights
īFalls
īRTAs
īOccupational hazards- athletic injury,
industrial mishaps
īIatrogenic causes- # of tooth, alveolus,
maxillary tuberosity, #of mandible during
dental treatment.
119. 119
âĸ Radiographic examination
For middle 1/3
- PA view of the skull
- Lateral view of the skull
For the mandibular fracture
- PA view of the mandible
- Right and left lateral view of the
mandible
120. 120
Basic principle life preservation in
traumatic patient
The ABC methods
īŧ Maintenance of patency of Air way
īŧ Bleeding control
īŧ Maintenance of Circulation
122. 122
Basic principles of management of fracture
1) Reduction: the restoration of fracture
fragments to their original position.
âĸ It can be closed or open reduction
īļ Closed reduction:
âĸ Can be carried out by manipulation or
traction
âĸ No surgical intervention is needed
âĸ Occlusion of the teeth is used as a guide line
123. 123
ī By manipulation: by digital or hand
manipulation
- when fragments are adequately mobile
- in patients come soon after trauma
ī By traction: fractured fragments are
subjected to gradual elastic traction
īļOpen reduction
- surgical reduction that allows visual
identification of fractured fragments
124. 124
2) Fixation
fractured fragments are fixed to prevent
displacement and for achieving proper
approximation
īŧ Direct skeletal fixation: by plates or
intraosseous wiring
īŧ Indirect skeletal fixation: by arch bar or
intermaxillary fixation
125. 125
3) Immobilization
- The fixation device is retained to stabilize
the reduced fragments until a bony union
takes place.
- For maxillary # 3 to 4 weeks
- For mandibular # 4 to 6 weeks
immobilization.
- In case of condylar # 2 to 3 weeks to
prevent Ankylosis.
126. 126
Fracture of the middle 1/3 of the face
Boundaries of middle 1/3 of the face
īŧSuperiorly: line from zygomaticofrontal
suture, across frontonasal suture,
frontomaxillary suture.
īŧ Inferiorly: occlusal plane upper teeth
īŧPosteriorly: sphenoethmoidal junction
127. 127
1) Le fort I
(horizontal fracture of the maxilla or Guerin's
fracture or floating fracture) separation of
dentoalveolar part of the maxilla
- Horizontal # line above the apices of the teeth at
the level of floor of the nose
- Usually bilateral
- Floating of the palate
- Hematoma within the maxillary antrum
- Bilateral hematoma of the cheek
Classification
129. 129
2) Le Fort II Fractures (Low Pyramidal
Subzygomatic fracture )
- line crosses pyramidally from nasal bone
then frontal process of maxilla then lacrimal
bone and infraorbital marigin crosses the
zygomatic buttress then move backwards and
fracture above maxillary tuberosity
- Facial swelling with massive edema
- Subconjuctival ecchymosis and diplopia
- Dish faced deformity
130. 130
- Infraorbital anesthesia both side
- Bilateral hematoma
- Retroposed upper dental arch with anterior open
bite
- Cracked pot sound on percussion of teeth
131. 131
3) Le fort III: (High level #)
ī Force is in lateral direction
ī Line runs from nasofrontal region then lacrimal bone then
ethemiod bone around the optical canal involving infraorbital
fissure then greater wing of the sphenoid then
zygomaticofrontal suture, and fracture of both side of the
zygomatic arches.
Clinical features:
ī Tenderness and separation at fronto zygomatic suture
ī Tenderness and deformity of zygomatic arches
ī Lengthening of face
- Depression of ocular levels
- Enophtalmos
- CSF leak via nose (csf rhinorrhea)
- Entire middle 1/3 separated from the cranial base.
- Bilateral circumorbital ecchymosis
132. 132
Treatment of middle face fracture:
1. Manual reduction
2. Reduction by traction
3. Open reduction
133. 133
Fracture of the mandible
Largest, strongest and heaviest bone of the face
Classification:
1)Condylar neck 35%
2)Angle 20%
3)Body 20%
4)Parasymphysis 13%
5)Symphysis 11%
6)Coronoid 1%
135. 135
Management
1) Closed reduction
- dental wiring or arch bar is used to get
the occlusion
- for 6 weeks
Indication
- Non displaced #
- Lack of soft tissue over the fracture
- # of children with developing tooth bud
- Coronoid process fracture
136. 136
2) Open reduction
Indications
- Displaced fracture
- Multiple fracture
- Associated mid face fracture
- Associated condylar fracture
Contraindicated if GA is not advisable,
sever comminuted or loss of soft tissue
and severe infection.
137. 137
Condylar fracture
Classified as:
- Non displaced: a crack is seen on
radiograph
- Deviation: simple angulation b/n
condylar neck and ramus
- Displacement: overlap b/n condyle and
ramus
- Dislocation: condylar fragments are
pushed anteriorly and medially
138. 138
Clinical feature:
- Pain and swelling in the region of
TMJ
- Limitation of oral opening
- Deviation towards the involved side
- Blood in external auditory canal
- Lack of condylar movement on
palpation
139. 139
Complication of maxillofacial fracture
īAnesthesia
īMalunion and deformity
īInfection
īDerangement of occlusion
īAnkylosis of TMJ
īEtcâĻ.
140. 140
The Temporomandibular Joint (TMJ)
īŧ The Temporomandibular joint (TMJ) is a small
joint located in front of the ear where the skull
and lower jaw meet.
īŧ It permits the lower jaw (mandible) to move and
function.
īŧ Between the condyle and the fossa is a disk made
of cartilage that acts as a cushion to absorb stress
and allows the condyle to move easily when the
mouth opens and closes.
141. 141
īTMJ disorders are not uncommon and have a
variety of symptoms.
īļPatients may complain of :
īŧEaraches
īŧHeadaches
īŧLimited ability to open their mouth.
īŧClicking or cracking sounds in the joint
īŧFeel pain when opening and closing their
mouth.
142. 142
Dislocation of TMJ
īExcursion of condylar head beyond the
anterior limit of articular eminence
It can be of:-
- Unilateral or bilateral
- Chronic or acute
143. 143
Causes
īBlow on the chin while the mouth is
open
īExcessive pressure on mandible while
extraction
īVomiting
īInjudicious use of mouth gag during
GA
144. 144
Clinical features
- Deviation of the chin
- Open bite
- Depression in front of the tragus
- Inability to close the mouth
- Drooling of the saliva
- Difficulty in speech and swallowing
Superior and inferior alveolar arteries/ veins ; branch of maxillary artery supply tooth
Upper jaw= superior alveolar nn
Lower jaw= inferior alveolar nn ; both make dental plexus
Fluoride is safe for dental health at low concentration. NaF salt is dietary recommended; lethal dose is 5-10 g; found in tablet form for cavity prevention.
Fluoride inhibits the activity of phosphatases. Used for prevention of tooth decay.
Fluoride is an inorganic monatomic anion; F-, bitter taste and odorless
Amalgam- is a mixture of mercury and other metals (solid/liquid) used for filling holes in teeth & for making tooth cements
- From medieval Latin amalgama
Composite- a solid material which is composed of 2/more substances having d/t physical ch/tcs and in which each substance retains its identity while
contributing desirable properties to the whole.
Most of the tooth mass composed of DENTIN
Superior and inferior alveolar arteries/ veins ; branch of maxillary artery supply tooth
Upper jaw= superior alveolar nn
Lower jaw= inferior alveolar nn ; both make dental plexus