PRINCIPLES OF THERAPY OF ODONTOGENIC INFECTIONS - Oral and Maxillofacial Surgery

According to Contemporary Oral and Maxillofacial Surgery, 6th Edition, the PRINCIPLES OF THERAPY OF ODONTOGENIC INFECTIONS are:

Principle 1: Determine Severity of Infection
Principle 2: Evaluate State of Patient’s Host Defense Mechanisms

Compromised Host Defense States:

Uncontrolled Metabolic Diseases
• Poorly controlled diabetes
• Alcoholism
• Malnutrition
• End-stage renal disease

Immune System–Suppressing Diseases
• Human immunodeficiency virus/acquired immunodeficiency
syndrome
• Lymphomas and leukemias
• Other malignancies
• Congenital and acquired immunologic diseases

Immunosuppressive Therapies
• Cancer chemotherapy
• Corticosteroids
• Organ transplantation

Principle 3: Determine Whether Patient Should Be Treated by General Dentist or Oral-Maxillofacial Surgeon

Criteria for Referral to an Oral-Maxillofacial Surgeon

• Difficulty breathing
• Difficulty swallowing
• Dehydration
• Moderate to severe trismus (interincisal opening less than 20 mm)
• Swelling extending beyond the alveolar process
• Elevated temperature (greater than 101°F)
• Severe malaise and toxic appearance
• Compromised host defenses
• Need for general anesthesia
• Failed prior treatment

Principle 4: Treat Infection Surgically

Principle 5: Support Patient Medically

Principle 6: Choose and Prescribe Appropriate Antibiotic

Guidelines for consideration when choosing a specific antibiotic:

- Determine the need for antibiotic administration.

- Use empirical therapy routinely.

- Use the narrowest-spectrum antibiotic.

- Use the antibiotic with the lowest incidence of toxicity and

side effects.

- Use a bactericidal antibiotic, if possible. 

- Be aware of the cost of antibiotics.

Principle 7: Administer Antibiotic Properly

Principle 8: Evaluate Patient Frequently

Most Common Causes of Some Conditions : Contemporary Oral and Maxillofacial Surgery, 6th Edition, Mosby

Most Common Causes of Some Conditions:

1. The most common cause of adrenal insufficiency is chronic therapeutic corticosteroid administration (secondary adrenal insufficiency).

2. The most common cause of a transient loss of consciousness in the dental office is vasovagal syncope.

3. During normal development, the lower third molar begins in a horizontal angulation, and as the tooth develops and the jaw grows, the angulation changes from horizontal to mesioangular to vertical. Failure of rotation from the mesioangular to the vertical direction is the most common cause of lower third molars becoming impacted.

4. A complication that every dentist believes can never happen—but happens surprisingly often—is extraction of the wrong tooth. This is usually the most common cause of malpractice lawsuits against dentists.

5. The most common cause of delayed wound healing is infection. Infections are a rare complication after routine dental extraction and are primarily seen after oral surgery that involves the reflection of soft tissue flaps and bone removal.

6. The most common cause of treatment failure of odontogenic infections is inadequate surgery. Atooth  may have to be re-evaluated for extraction, or an extension of the infection into an area not detected during the first treatment may have to be incised and drained.

7. The most common cause of Ludwig’s angina is an odontogenic infection.

8. Oral Candidiasis: Candida rarely causes disease unless the patient’s health becomes compromised. The two most common causes of compromise are:
- administration of antibiotics, especially penicillin, for prolonged periods,  and
-  immune system compromise, as occurs with acquired immunodeficiency syndrome (AIDS) or chemotherapy for leukemias and other forms of cancer.

9. One of the most common causes of true mucoceles is surgery on the sinus that results in separation of a portion of the sinus lining from the main portion of the sinus. This area can then become filled with mucus and walled off, forming a separate cystic lesion. These lesions are termed surgical ciliated cysts or postoperative maxillary cysts.

10. The most common causes of temporomandibular disorders (TMDs) are muscular disorders, which are commonly referred to as myofascial pain and dysfunction. These muscular disorders are generally managed with a variety of reversible nonsurgical treatment methods.

11. The most common cause of TMJ ankylosis involves macro-trauma, most frequently associated with condylar fractures. Other causes of ankylosis include previous surgical treatment that resulted in scarring and, in rare cases, infections.

# MCQ 4: Which of the following materials cannot be used as a base under composite restorations?

# Which of the following materials cannot be used as a base under composite restorations?
A. Zinc Phosphate
B. Zinc Polycarboxylate
C. Zinc Oxide Eugenol
D. Glass Ionomer Cement


Answer: C. Zinc Oxide Eugenol.
Reason: Residual free eugenol interferes with the proper setting of resin-based composites or resin cements. Therefore, various types of carboxylic acids have been used to replace eugenol and produce a ZOE-like material. These products are called zinc oxide-non eugenol cements.

Reference: Phillip's Science of Dental Materials, 12th Edition, Page No. 331

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#MCQ 3 # Which of the following materials could be used for cementing a bridge as well as restoring a cervical lesion?

# Which of the following materials could be used for cementing a bridge as well as restoring a cervical lesion?
A. Glass Ionomer cement
B. Zinc Polycarboxylate
C. Zinc Phosphate
D. Zinc Oxide Eugenol

Answer:
Correct Answer is: A. Glass Ionomer Cement

Only glass ionomer is used as a cement (luting agent) and a permanent restorative material.
Glass ionomer cement is often used for root surface carious lesions because of the potential advantage of fluoride release in helping to control the spread of caries.

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# MCQ 2 : Gutta Percha is Plasticized/Softened by:

# Gutta Percha is plasticized / softened by:

A. Alcohol

B. Chloroform

C. Eugenol

D. EDTA

Ans:

Reference: Grossman's Endodontic Practice, 13th Edition Page no. 366

Correct answer is B. Chloroform

Gutta Percha can be plasticized by chemical solvents such as Chloroform, Eucalyptol, or xylol  which enables the gutta percha to flow into small and curved wavy canals. 

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MCQ 1: The Largest Component of Gutta Percha Cones is:

# The Largest Component of Gutta Percha Cones is:
A. Gutta Percha
B. Zinc Oxide
C. Resins and Waxes
D. Coloring Agents

Why dentists should charge higher?

Most Dentists and Dental Students assume that dental extraction is a relatively easy procedure which takes less time to perform and they need not charge much for extractions because all you need is few milliliters of Local anesthetic, a pair of gloves and some reusable instruments which need to be autoclaved. So, in the fear that their competitor could charge less for the dental extraction and acquire more customers because we all have realized that Nepal, India, and Asia in general, is a price-sensitive economy, dentists prefer to charge less than they actually should have charged for dental extractions. Non - Asian dental patients are price sensitive too because dental treatment is something the general public has envisioned as a costly treatment. But, it is to be noted that Dentists in Asia are actually charging very less for dental extractions as well as other dental treatments and they should charge many times higher for the treatment than they are currently charging. Here are some reasons to justify it.

1. Dental Treatment is a One-to-One Patient Care
You cannot treat three patients at once however easy the procedure is or however flooded with patients your dental clinic is. Each patient has to be given sufficient time and instruments and chair should be set up and customized as per the necessity for every patient. This will take time. So, you can do only a limited number of patients on any given day, you cannot work 18 hours a day!! But does that mean we should charge an outrageous amount to a patient if very few patients come to our clinic? Not actually. They just need to be charged sufficiently so that you would not have to worry a bit about how many patients you can do today.

2. The cost of saving a Tooth
As Miguel de Cervantes said, "Every tooth in a man's head is more valuable than a diamond." The value of the tooth is reflected by the cost needed to remove it from the socket. People don't have to pay for keeping the teeth in their mouth. They know its importance only when they are lost. And when you charge just Rs. 500 (5 USD) to extract a tooth because it's easy and takes no time, you're telling them by your actions that they are not valuable, and more importantly, they are given a choice of sacrificing the tooth for a petty sum of money, instead of preserving it (if restoration or root canal treatment were possible) by paying a bit more money. People insist to have their restorable teeth removed just because they think you are trying to extort their hard earned money. So, the cost of dental extraction should be invariably higher than any restorative treatment efforts.