sedation or general surgery, and certain oral or periodontal surgery procedures. Most routine informed consent can be easily accomplished during the verbal verification of diagnosis and treatment presentation.
When dental surgery is indicated, whether oral or periodontal, there are several pain and anxiety control methods available to make the surgery as smooth as possible and put the patient at ease. The three basic levels of anesthesia are local, conscious sedation, and general. You should review Dental Technician, Volume 1, Chapter 7, "Oral Pharmacology," to help you better understand the following information
The primary effect of local anesthetic agents is to penetrate the nerve cell membrane and block the conduction of nerve impulses from the point where the local anesthetic is active. This produces anesthesia in the local area. Local anesthesia, using infiltration, nerve block, or a combination of both techniques, is used in surgery cases to numb the surgery area.
Most dental surgery procedures require two or more injections of a local anesthetic. For this reason, it is a good practice to include two aspirating syringes with each instrument setup. This will let you supply the dentist with a loaded anesthetic syringe for as long as needed with minimum loss of time. Since anesthetic solutions are bitter and there is leakage from the injection sites, you will need to irrigate and aspirate the fluids from the patient's mouth after injection.
Conscious sedation is a minimally depressed level of consciousness that retains the patient's ability to independently and continuously maintain an airway, and respond appropriately to verbal commands. Conscious sedation involves using various drugs or a combination of drugs to achieve pain and anxiety control while maintaining the patient in a conscious state at all times. The common routes of administration of conscious sedation are oral premeditation, inhalation, and intravenous. Local anesthesia is administrated with all types of conscious sedation.
General anesthesia is a controlled state of unconsciousness accompanied by a partial or complete loss of protective reflexes, including the ability to maintain an airway independently and respond to verbal commands. General anesthesia renders the patient unconscious through depression of the central nervous system, thus eliminating patient cooperation as a factor. The administration of general anesthesia is performed by an anesthesiologist in the hospital operating room. Local anesthesia is also administered at the treatment site.
While there are many oral surgery procedures, some are more commonly performed than others. You should be knowledgeable of those that are commonly performed. In the following paragraphs, we discuss surgical procedures you will need to know.
Tooth extraction is an oral surgery procedure classified into three types: simple, complicated, and impacted extractions. These are explained briefly in the following paragraphs.
Simple extractions involve removal of a tooth or root that does not require bone removal or sectioning. The deciduous (nonpermanent) or permanent tooth extracted is erupted and usually diseased or malposed. Retained roots may be buried in the tissue and not visible in the oral cavity. Retained root tips may be present because of fractured teeth, advanced decay, or any incomplete post-surgical procedure. They can be identified on radiographs.
Complicated extractions involve removal of a tooth or root that requires surgical sectioning and/or bone removal.
Impacted extractions involve removal of a tooth that is partially or completely covered by bone and or soft tissue. This extraction may involve tissue incision, excision, or bone removal. Two types of impactions are associated with oral surgery: soft tissue and bony impaction.
Soft tissue - occurs when the tooth is blocked from eruption due to the gingival tissue. It may be partially erupted with a portion of the tooth visible in the mouth.Continue Reading