Dental Surgery Complications and Management

This assignment delves into various complications that can arise during dental surgery procedures. It covers a range of issues, including nerve damage, hemorrhage, oral antral fistula, equipment failure, and patient collapse. For each complication, the document provides detailed information on potential causes, symptoms, and effective management strategies. The aim is to equip readers with a comprehensive understanding of how to address these complications and ensure optimal patient care.

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Table of Contents
Question1: Purpose and functions of following equipments used during surgery......................1
a) Topical anaesthetic..................................................................................................................1
b) Local anaesthetic.....................................................................................................................1
c) Local anaesthetic syringe and needles....................................................................................1
d) Luxators/elevators...................................................................................................................1
e) Extraction Forceps..................................................................................................................1
f) Scalpel.....................................................................................................................................1
g) Periosteal elevator...................................................................................................................1
h) Cheek retractor........................................................................................................................2
i) Spencer wells...........................................................................................................................2
j) Suture and suture holder..........................................................................................................2
j) Dissecting forceps:...................................................................................................................2
k) Scissors...................................................................................................................................2
l) Surgical suction tip..................................................................................................................2
m) Surgical hand piece and burs.................................................................................................2
n) Irrigation syringe, needle and solution...................................................................................2
o) Haemostatic medicaments......................................................................................................2
Question2: Minor oral surgery procedures with equipment and their instruments.....................3
a) Implants...................................................................................................................................3
b) Apicectomy – Include raising the mucoperiosteal flap..........................................................3
c) Frenectomy..............................................................................................................................3
d) Biopsy.....................................................................................................................................3
e) Removal of impacted teeth – Include the occasional need for sectioning..............................3
f) Removal of buried roots..........................................................................................................4
g) Removal of erupted teeth........................................................................................................4

h) Removal of unerupted teeth and roots....................................................................................4
i) Removal of deciduous teeth.....................................................................................................4
j) Bone removal...........................................................................................................................4
Question3: Process of giving POI for following groups.............................................................4
a) Adults .....................................................................................................................................5
b) Children and young people.....................................................................................................5
c) Older people............................................................................................................................5
d) Patients having special needs..................................................................................................5
Question4: Way to respond for different-different complications..............................................5
a) Nerve damage.........................................................................................................................5
b) Haemorrhage...........................................................................................................................6
c) Oral antral fistula....................................................................................................................7
d) Equipment failure...................................................................................................................7
e) Collapse...................................................................................................................................7

Question1: Purpose and functions of following equipments used during surgery
a) Topical anaesthetic
It reduced the slightly discomfort which is associated with insertion of needle and
affective to a depth of 2mm. It is beneficial for decreasing the patient discomfort during initial
phase of surgery.
b) Local anaesthetic
It is an anaesthetic drug which can be given either by spray, shot or ointment on a small
patch area on body. It sedates an areas a person for a short period of time during surgery and
control post-surgery discomfort as well.
c) Local anaesthetic syringe and needles
A safety syringe helps in minimizing the risk which may occur during surgery due to
accidental needle-stick injury. These syringes and needles includes a sheath which locks over the
needle, after removing from the tissues of patients for preventing accidental needle stick.
d) Luxators/elevators
Luxators or elevators are sharper and thinner devices which are designed in extraction of
teeth i.e. separate the tooth from its surrounding bones.
e) Extraction Forceps
It includes two blades having sharp edges for cutting the periodontal fibres. It is
considered as an elevator to move the tooth 1-3mm by constant steady pressure with wrist.
f) Scalpel
It is an extremely sharp and small bladed instrument which is specially designed for
endodontic use. For example: Kerr Endodontics is a disposable scalpels and helps in improving
visibility within a microscope that allows for a more precise incision.
g) Periosteal elevator
This device is used for lifting a muco-periosteal flap off the bone during extraction of
tooth.
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h) Cheek retractor
Cheek retractors in dental surgery is used to hold the mouth of patients and open it
throughout surgery process. It can be disposable or autoclavable, where disposable retractors are
made up from clear materials, in order to provide improved visibility.
i) Spencer wells
These are considered as hemostatic forceps which are used to control blood flow within
vessels and left to sutured later.
j) Suture and suture holder
Suture and its holder is an artificial fibre used to keep wound to hold until sufficiently by
themselves. It is a series of stitches to secure from apposition in a surgery.
j) Dissecting forceps:
Dissecting forceps is an small instrument that should be handled in careful manner and
helps in grasp tiny tissues for treatment purpose at time of surgery.
k) Scissors
Scissors use in dental to cutting gauze and bind bandages to an suitable length and size.
l) Surgical suction tip
It is an plastic suction tip use for effective suction for damaging tissues surround mouth
and protect from blood loss at time of surgery.
m) Surgical hand piece and burs
Ceramic burs use for dental treatment procedures and carries for removal. Its head
contains blades that gives the cutting actions.
n) Irrigation syringe, needle and solution
It use for remove debris, lubricate by root canal walls and helps in dissolve tissues and
eradicate bacteria.
o) Haemostatic medicaments
It is useful in oral surgical cases and also useful in surgical procedures to affix
haemostasis when traditional procedures not effective.
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Question2: Minor oral surgery procedures with equipment and their instruments
a) Implants
It is a surgical component which interface with the jaw's bone or skull in order to support
a dental prosthesis. It is biological process which also known as osseointegration where each
materials like titanium helps in forming bond to bone. Under this surgery, as a I have prepared a
proper plan that includes- comprehensive dental exam, review of medical history then tailored to
treatment plan.
b) Apicectomy – Include raising the mucoperiosteal flap
It refers to a minor procedure for removal of tip of tooth's root during treatment.
Apicectomy is mostly done for front teeth treatment but can be used for back teeth also. Here,
my role start with a small incision then make preparation for root-end cavity with ultrasonic
driven microtips.
c) Frenectomy
It is performed generally by an oral surgeon who are specialised in improving proper
speech, swallowing and movement by free the tongue. Under this surgery, main role of mine is
to convince patient to take treatment by providing them better understanding about the procedure
of frenectomy and how it give them relief from pain.
d) Biopsy
It refers to a procedure of treatment where a small piece of tissue removes from an area
completely, to confirm a diagnosis. In biopsy treatment, after removal of a portion of suspicious
tissue by dentist, I have examined the same under a microscope to determine if there is a
cancerous cell in the removed gum tissue.
e) Removal of impacted teeth – Include the occasional need for sectioning
Impacted teeth can be defined as a tooth which is failed to erupt within expected
developmental window, into dental arch. Generally, it is essential to remove impacted teeth to
avoid future oral problems. It can be removed by tooth sectioning process i.e. impacted tooth cut
into sectioned and removed easily. Here, in this surgery main role of mine is to detect the
diagnoses of impacted wisdom teeth by taking dental X-rays.
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f) Removal of buried roots
After tooth decay or any trauma, the least part i.e. root remain in jawbone and buried
under gum. To remove this part, a soft tissue diode laser is used which cut gums and thereby
reduce pain. Here, my role is to give a local anaesthetic to patients that numbs the area around
decay tooth. This would help in reliving pain during procedure and patient feel only pressure.
g) Removal of erupted teeth
A tooth which is not fully emerged through gums and partially erupted are especially
hard to clean. They are also susceptible towards gingivities therefore, surgical extraction is used
for removal of suspected teeth. Here, at initial stage of treatment procedure, I have tailored
doctors with few sedation options that match with requirement of extraction. It includes oral
medications, nitrous oxide or IV sedation etc.
h) Removal of unerupted teeth and roots.
When teeth fail to grow in correct position and held below the normal gum line then such
teeth are called unerupted teeth. These tooth and unerupted roots are removed by extraction,
autotransplantation or by exposure with usage of direct mechanical force to tooth. Under this
procedure, I have numbed the area of operation of patient with anaesthetic injection.
i) Removal of deciduous teeth
When tooth is damaged due to decay, cavities or infection then they can be extracted by
orthodontic treatment (a brace). Here, my role is to obtain a postoperative dental radiograph in
order to confirm the complete removal of deciduous tooth. Along with this, I have also prepared
the document related to continued presence and take care of permanent tooth in proper manner.
j) Bone removal
Surgical tooth removal includes an incision process which is being made in the gum. This
could involve the process of bone removal around tooth for providing better access. Here, I used
to make plans about how to keep amount of bone that professionals will remove as limited as
possible.
Question3: Process of giving POI for following groups
After the dental surgery, it is essential for dentist and other service providers to give proper
post-operative instruction (POI). Here, they have to confirm with doctor that whether patient is
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fit to leave the surgery or not. These instructions are given to patients as per their age factor as
shown below:-
a) Adults
Adults may feel throat swelling after dental surgeries to few days which may be resolved
without any treatment. So, there is no need to take asprin for pain relief. Eat soft food for few
days including low fibres eatables, to reduce tooth problems.
b) Children and young people
For children, POI states to drink plenty of water within every half an hour to reduce
discomfort. Problems like stuff nose, bad breathe and more, can occur till few days after surgery.
They should play some games like swimming, football, travelling and more, for recovery of teeth
and gums after surgery as well as reduce the chance of failure of surgery.
c) Older people
Special precautions are taken while giving treatment to old age people because after dental
surgery, it will take time to recovery. Therefore, complete dietary chart and medicines which can
be used to reduce pain is given to older people after surgery.
d) Patients having special needs
For patients having special needs like any health issues, dentist must know the same before
surgery. This would help in giving proper instruction related to post-operative for better care of
teeth.
Question4: Way to respond for different-different complications
a) Nerve damage
This situation can occur during oral surgery, particularly in implantation process. Here, a
nerve injury reflects a complex situation after dental surgery for both patient and doctors. Under
this situation, it is better to do some surgical treatment like neurorraphy, decompression, nerve
stump intubation and more, for resolving the same. When nerve fibers like inferior alveolar are
damaged during implant fixtures then in such condition within few minutes I retrograde degeneration
towards Wallerian and CNS degeneration by concerning about periphery start from around site of
nerve injury.
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b) Haemorrhage
Intervention taken for managing post-extraction bleeding after dental surgery are suturing,
fibrin glue having collagen fleece and sutures, recombinant (non-surgical haemostatic measure),
tranexamic acid mouthwash including gelatin sponge and sutures etc. For managing excessive
bleeding during tooth surgery, as a professional firstly I have detected whether it is normal
bleeding or post-extraction bleeding, then take actions accordingly as shown in below figure:-
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Illustration 1: Degeneration following nerve injury by implant
fixature

c) Oral antral fistula
For treating oral antral and fistula, several interventions can be used as surgical and non-
surgical interventions. It includes soft tissue flaps, grafts, xenografts and more. For closing
oroantral fistulas, I use a palatal full thickness flap dates back first then take further procedure
for wounding heal.
d) Equipment failure
Under this case, practice owners should be acknowledged with actions required to handle
the case, like to follow some specific protocols. I have first contacted the Biomedical
Engineering Department for a failure that involves medical equipment providing life support
functions.
e) Collapse
For managing any emergency in dental surgery, rendering basic life support (BLS)
measures as well as cardiopulmonary resuscitation (CPR) therapy are considered as best option.
It can be done only by following some basic principles like Position (P), Airway (A), Breathing
(B), Circulation (C), and Definitive therapy. Here, I use to functioning airways and maintaining a
patent as first priority for managing emergency conditions like collapse.
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