Manual of Minor Oral Surgery for the General Dentist

Pushkar Mehra, Richard D'Innocenzo

• Publisher: Wiley-Blackwell
• Year: 2015
• ISBN:
  9781118938430
• Edition: 2
• Topic: Medicine
• Subtopic: Dentistry

The Manual of Minor Oral Surgery for the General Dentist, Second Edition continues the aim of providing clear and practical guidance to common surgical procedures encountered in general practice. Fully revised and updated with three additional chapters, the book approaches each procedure through detailed, step-by-step description and illustration. Ideal for general dental practitioners and students, the book is an indispensible tool for planning, performing, and evaluating a range of surgical procedures in day-to-day practice.

The Manual of Minor Oral Surgery for the General Dentist begins with an expanded chapter on patient evaluation and history taking and a new chapter on managing the patient with medical comorbidities. It also address infections and sedation besides procedural chapters on such topics as third molar extractions, preprosthetic surgery, surgical implantology, crown-lengthening, and biopsy of oral lesions.

CHAPTER 1
Patient Evaluation and History Taking

Dale A. Baur, Andrew Bushey, and Diana Jee-Hyun Lyu

Department of Oral and Maxillofacial Surgery, Case Western Reserve University School of Dental Medicine and University Hospitals/Case Medical Center, Cleveland, OH, USA

Introduction

The initial physical examination and evaluation of a patient is a critical component in the provision of care prior to any surgical procedure. A thorough patient assessment, including a physical exam and medical history, is necessary prior to even simple surgical events. The information gathered during this encounter can provide the clinician with information necessary to make treatment modifications and assess and stratify risks and potential complications associated with the treatment. Disregarding the importance of this exam can result in serious morbidity and even death. Prior to initiating any surgical procedure, an accurate dental diagnosis must be formulated based on the patient’s chief complaint, history of present illness, a clinical dental examination, and appropriate and recent diagnostic imaging, such as a panoramic radiograph.

Medical history

The medical history of a patient is the most important information that a clinician can acquire and should be emphasized during the initial exam. With a thorough medical history, a skilled clinician can decide whether the patient is capable of undergoing a procedure and if any modifications should be made prior to the treatment. The dentist should be able to reliably predict how preexisting medical conditions might interfere with the patient’s ability to respond successfully to a surgical insult and subsequently heal. A careful and systematic approach must be used to evaluate all surgical patients. Only in this way can potential complications be managed or avoided. The medical history should be updated annually, but it should also be reviewed at each appointment to be assured there are no significant changes and/or additions.

A detailed questionnaire that covers all common medical problems aids in the collection of information to formulate the patient’s medical history (Figure 1.1). However, the dentist should review this questionnaire and ask focused questions as needed to clarify and expound on the past medical history. Any inconsistencies or discrepancies in the written or verbal history must be investigated. The dentist must formulate a thorough timeline of the patient’s medical history, surgical history, social history (smoking, drinking, and illicit drug habits), family history, current and previous medications, and allergies. If lingering questions remain after reviewing the history with the patient, consultation with the patient’s primary care physician should be considered. If the patient is unable to accurately review their medical history due to cognitive issues, then the caregiver and/or family must be prepared to provide the medical history. The use of any anticoagulants, corticosteroids, hypertension medication, and other medications should be thoroughly reviewed.¹ Female patients should be asked whether there is any possibility that they are pregnant; if there is uncertainty, urine beta-HCG is easy to obtain to provide a definitive answer. Allergies that should be addressed are those to medications and other items used in a dental office, such as latex. The medical history should emphasize the major organ systems, specifically the cardiovascular system, central nervous system, pulmonary system, endocrine system, along with the hepatic and renal systems.

Figure 1.1 Medical history questionnaire.

Source: Reprinted with permission from OMS National Insurance Company.

Cardiovascular system

As our population ages, the dentist is likely to see more patients with some aspects of cardiovascular disease. Hypertension is very common, and many patients are undiagnosed. Current studies note that nearly one-third of the US population has hypertension—defined as a systolic blood pressure higher than 139 mmHg or a diastolic blood pressure higher than 89 mmHg. Another one-quarter of the U.S. population has prehypertension—defined by a systolic blood pressure between 120 and 139 mmHg and a diastolic blood pressure between 80 and 89 mmHg.² For patients with a history of cardiovascular disease, vital signs should be monitored regularly during surgery (Table 1.1).

Table 1.1 Blood pressure classification

BP Classification	Systolic BP (mmHg)	Diastolic BP (mmHg)
Normal	<120	<80
Prehypertensive	120–139	80–89
Stage 1 hypertension	140–159	90–99
Stage 2 hypertension	≥160	≥1...

Table of contents

• Cover
• Title page
• Table of Contents
• Contributors
• Preface
• CHAPTER 1: Patient Evaluation and History Taking
• CHAPTER 2: Management of the Patient with Medical Comorbidities
• CHAPTER 3: Minimal Sedation for Oral Surgery and Other Dental Procedures
• CHAPTER 4: Surgical Extractions
• CHAPTER 5: Third Molar Extractions
• CHAPTER 6: Pre-prosthetic Oral Surgery
• CHAPTER 7: Evaluation and Biopsy Technique for Oral Lesions
• CHAPTER 8: Surgical Implantology
• CHAPTER 9: Hard-Tissue Augmentation for Dental Implants
• CHAPTER 10: Soft Tissue Surgery for Dental Implants
• CHAPTER 11: Surgical Crown Lengthening
• CHAPTER 12: Endodontic Periradicular Microsurgery
• CHAPTER 13: Dentoalveolar Trauma
• CHAPTER 14: Orofacial Infections
• CHAPTER 15: Complications of Dentoalveolar Surgery
• Index
• End User License Agreement