Evidence-Based Oral Surgery. A Clinical Guide for the General Dental Practitioner

Description

Foreword Contents Contributors Part I: Patient Assessment 1: Evidence Based Dentistry: What, Why, How 1.1 Introduction: What Is EBD 1.2 The Patient 1.3 Scientific Evidence 1.4 The Dental Provider 1.5 Why Do EBD? 1.6 How Can EBD Be Accomplished? 1.7 Paul-Elder Approach to Critical Thinking 1.8 Reasoning Through the Logic of This Chapter 1.9 Analyzing and Assessing Clinical Research Using the Tools of Critical Thinking 1.10 The Importance of Universal Intellectual Standards in Evidence-Based Dentistry 1.11 Conclusion References 2: Office Environment 2.1 Office Environment/Office Design 2.2 Blood-Borne Pathogens 2.3 Spatter and Aerosols 2.4 Infection Control Measures 2.5 Eyewear Safety Considerations 2.6 Extracted Teeth 2.7 Handling and Shipping of Biopsy Specimens 2.8 Musculoskeletal Disorders and the Dental Surgeon 2.9 Selecting Equipment to Fit Clinicians’ Ergonomic Needs 2.10 Magnification Aids 2.11 Illumination Considerations 2.12 Prevention Before Intervention 2.13 Conclusions References 3: Medical Assessment of the Oral and Maxillofacial Surgery Patient 3.1 Introduction 3.2 Medical History 3.3 Review of Systems 3.4 Physical Examination 3.5 Common Medical Problems 3.5.1 Cardiac Issues 3.5.1.1 Hypertension 3.5.1.2 Ischemic Heart Disease and Acute Myocardial Infarction 3.5.1.3 Congestive Heart Failure (CHF) 3.5.1.4 Arrhythmias 3.5.2 Bleeding Disorders 3.5.2.1 Anticoagulants 3.5.2.2 Decreased Production of Platelets 3.5.2.3 Medication-Induced Platelet Destruction/Inhibition 3.5.2.4 Increased Destruction of Platelets 3.5.3 Patients on Bisphosphonates 3.5.4 HIV Status 3.5.5 Pregnancy 3.5.6 Seizure Disorders 3.5.7 Adrenal Insufficiency 3.5.8 Diabetes 3.6 Antibiotic Prophylaxis 3.7 When to Postpone Surgery? 3.8 Conclusion References 4: Dental Radiography 4.1 Dentoalveolar Structures 4.1.1 Routine Radiographic Evaluation of Teeth 4.1.2 FDA-ADA Recommendation (Table 4.1) 4.1.3 Imaging with Portable X-Ray Units 4.1.4 Imaging of the Third Molars 4.1.5 Imaging Dental Infections 4.1.6 Imaging of Inflammation Associated with the Jaws 4.1.6.1 Osteomyelitis, Osteoradionecrosis, and Medication-Related Osteonecrosis of the Jaw (MRONJ) 4.1.7 Imaging of Cysts 4.1.8 Imaging of Benign Tumors and Malignant Tumors 4.1.9 Imaging of the Paranasal Sinuses 4.1.10 Imaging of the TMJ 4.1.11 Imaging of the Salivary Glands 4.1.12 Imaging Involving Dental Implants 4.2 Summary/Conclusion References 5: Complementary and Alternative Medicine 5.1 Introduction 5.2 Common CAM Systems 5.3 Herbal Therapy 5.3.1 Common Herbals 5.4 Supplements 5.5 Adjunctive Therapies 5.6 Conclusion References 6: Medicolegal and Ethical Considerations in Oral Surgery by the General Dentist 6.1 Special Implications of Traditional Medicolegal and Ethical Issues 6.1.1 Informed Consent 6.1.1.1 Fundamental Elements of Informed Consent 6.1.1.2 Additional Aspects of Informed Consent 6.1.1.3 Informed Consent and Oral Surgical Procedures 6.1.2 Standard of Care and Scope of Practice 6.1.2.1 Standard of Care 6.1.2.2 Scope of Practice 6.1.2.3 Risk Management 6.2 The Regulatory Environment, Compliance, and Technology 6.2.1 Opioid Analgesic Prescribing 6.2.2 HIPAA Compliance and Technology 6.2.2.1 Electronic Health Records 6.2.2.2 Electronic and Mobile Communication, the “Cloud,” and Compliance 6.2.2.3 Technology Security and Embedded PHI 6.3 Closing Remarks References Part II: Principles of Exodontia 7: Local Anesthetics in Dentistry 7.1 Introduction 7.2 Pharmacology of Local Anesthesia 7.2.1 Neurophysiology 7.2.2 Pharmacology of Clinical Agents 7.2.2.1 Local Anesthetics 7.2.2.2 Vasoconstrictor 7.2.2.3 Other Dental Cartridge Components 7.3 Topical Anesthetics 7.3.1 Benzocaine 7.3.2 Lidocaine 7.3.3 Tetracaine Hydrochloride 7.3.4 EMLA 7.4 Injected Local Anesthetics 7.4.1 Effectiveness and Proper Administration 7.4.2 Procaine 7.4.3 Lidocaine 7.4.4 Mepivacaine 7.4.5 Bupivacaine 7.4.6 Articaine 7.4.7 Prilocaine 7.5 Complications 7.5.1 Local Complications 7.5.1.1 Paresthesia 7.5.1.2 Prolonged Anesthesia and Soft Tissue Injury 7.5.1.3 Hematoma 7.5.1.4 Trismus 7.5.1.5 Ocular Complications 7.5.1.6 Palsy of CN VII 7.5.2 Systemic Complications 7.5.2.1 Overdose 7.5.2.2 Methemoglobinemia 7.5.2.3 Allergy 7.6 Summary References 8: Uncomplicated Exodontia 8.1 Introduction 8.2 Preoperative Issues 8.3 Operative Considerations 8.3.1 Adequate Visualization 8.3.2 Protect Patient 8.3.2.1 Tray Setups 8.3.2.2 Types of Forceps 8.3.2.3 Types of Elevators 8.3.2.4 Miscellaneous Instruments 8.3.3 Proper Use of Elevator and Forceps 8.3.4 Postextraction Toilette 8.4 Post-Op 8.5 Summary References 9: Complicated Exodontia 9.1 Assessment 9.2 Anatomical Issues 9.3 Maxillary Issues 9.4 Mandibular Extraction 9.5 Conclusion References 10: Unerupted and Impacted Teeth: A Guide for Assessment and Treatment 10.1 Introduction 10.2 Assessment of Unerupted and Impacted Teeth 10.2.1 Is the Tooth Simply Unerupted, or Is It Impacted? 10.2.2 Is the Tooth Ankylosed During Growth, or Are There Other Etiopathologic Reasons for Failure of Eruption? 10.2.3 Does the Tooth Demonstrate a Threat to Periodontal Health of Adjacent Teeth? 10.2.4 Is the Tooth Carious, Is the Distal of the Second Molar Carious, or Has It Undergone Internal/External Resorption? 10.2.5 Is an Abnormal Pericoronal or Periradicular Radiolucency Present? 10.2.6 Are There Signs of Acute or Chronic Infection? 10.2.7 Does the Patient Exhibit Pain Associated with the Impacted Tooth? 10.2.8 Is the Tooth Contributing to a Malocclusion or Skeletal Facial Deformity? 10.2.9 Does the Tooth Impinge on Vital Structures? 10.2.10 Does the Presence of an Impacted Toot Have an Effect on Systemic Health? 10.2.11 Does the Patient Have a Syndromic or Developmental Problem Associated with Unerupted Teeth? 10.2.12 Does the Unerupted Tooth Represent a Potential Important Functional Component of the Masticatory System? 10.3 Risk Assessment in Third Molar Removal 10.3.1 Indications for Third Molar Removal 10.3.1.1 Findings and Indications for Care 10.3.2 Evidence-Based Assessment of Surgical Technique and Perioperative Care 10.4 Adjunctive Medical Management: Steroids, Analgesics, and Antibiotics 10.5 Access Incisions 10.6 Ostectomy and Osteotomy 10.7 Sectioning of the Tooth 10.8 Preservation of Vital Structures 10.9 Management of the Osseous Defect 10.10 Closure 10.11 Postoperative Instructions 10.12 Complications of Care 10.12.1 Methods to Mitigate and Treat the Risks of Third Molar Removal 10.12.2 Dry Socket 10.12.3 Postoperative Cellulitis and Abscess 10.12.4 Osseous Defect, Fracture, and Osteomyelitis 10.12.5 Oral Antral Fistula 10.12.6 Inferior Alveolar Nerve Injury, Buccal Nerve Injury, and Lingual Nerve Injury 10.13 Summary References 11: Surgical Complications 11.1 Introduction 11.2 Preoperative Issues 11.3 Intraoperative Issues 11.4 Postoperative Issues 11.5 Documentation References 12: Acute Pain Management 12.1 Introduction 12.2 Postoperative Pain and Analgesic Medications 12.2.1 Acetaminophen 12.2.2 Nonsteroidal Anti-Inflammatory Agents (NSAIDS) 12.2.3 Opioids 12.3 Special Considerations in Prescribing 12.3.1 Pregnancy 12.3.2 The Nursing Mother 12.4 The American Opioid Epidemic 12.4.1 Role of Dentists in the Opioid Epidemic 12.4.2 Alternatives to Opioids for Postoperative Pain 12.5 Preemptive Analgesia References Part III: Management of Oral Pathology 13: Odontogenic Infections 13.1 Introduction 13.2 Microbiology 13.3 Fascial Planes and Spaces 13.3.1 Infections Arising from Maxillary Teeth 13.3.2 Infections Arising from Mandibular Teeth 13.3.3 Infections Spreading to the Deep Cervical Spaces 13.4 Management and Treatment 13.4.1 Determine Severity of Infection 13.4.2 Evaluate Host Defenses 13.4.3 Determine the Care Setting 13.4.4 Treat Surgically 13.4.5 Support Medically 13.4.6 Choose and Administer Appropriate Antibiotics 13.4.7 Reevaluate Frequently 13.5 Conclusion References 14: Osteonecrosis 14.1 Introduction 14.2 Osteomyelitis 14.2.1 Acute Suppurative Osteomyelitis 14.2.2 Chronic Osteomyelitis 14.3 Medication-Related Osteonecrosis of the Jaws 14.3.1 Staging and Appearance 14.3.2 Management 14.4 Osteoradionecrosis 14.4.1 Staging and Classification 14.4.2 Treatment 14.5 Conclusion References 15: Evidence-Based Principles of Antibiotic Therapy 15.1 The Principles of Modern Antibiotic Therapy 15.1.1 Principle 1: Surgery to Remove the Cause and Establish Drainage Is Primary; Antibiotics Are Adjunctive Treatment 15.1.2 Principle 2: Use Therapeutic Antibiotics Only When Clinically Indicated 15.1.3 Principle 3: Use Specific Antibiotic Therapy as Soon as Possible, Based on Culture and Sensitivity Testing 15.1.4 Principle 4: Use the Narrowest-Spectrum Empiric Antibiotic Effective Against the Most Likely Pathogens 15.1.5 Principle 5: Avoid the Use of Combination Antibiotics, Except in Specific Situations Where They Are Shown to Be Necessary 15.1.6 Principle 6: Use the Least Toxic Indicated Antibiotic, Considering Interaction with Concurrent Medications 15.1.7 Minimize the Duration of Antibiotic Therapy, as Appropriate to the Presenting Type of Infection 15.1.8 Use the Most Cost-Effective Appropriate Antibiotic 15.1.9 Use Prophylactic Antibiotics Only When Proved Effective or According to Professional Guidelines 15.1.10 Follow the Guidance of Evidence-Based Recommendations and Professional Guidelines When They Are Available 15.2 Empiric Antibiotics of Choice for Odontogenic Infections 15.3 Conclusion References 16: Preprosthetic Surgery 16.1 Introduction 16.2 Factors to Consider When Performing Preprosthetic Surgery 16.2.1 Local Anesthesia 16.2.2 Surgical Technique 16.3 Hard Tissue Removal 16.3.1 Alveoloplasty 16.3.2 Technique 16.3.3 Palatal Torus 16.3.4 Technique 16.3.5 Complications 16.3.6 Mandibular Tori and Maxillary/Mandibular Exostoses 16.3.7 Principles of Torus and Exostosis Removal 16.3.8 Technique 16.4 Soft Tissue Removal 16.4.1 Frenectomy 16.4.2 Technique 16.4.3 Soft Tissue Tuberosity of the Maxilla 16.4.4 Complications 16.5 Conclusion References 17: Soft Tissue Oral Pathology 17.1 Introduction 17.2 Focused History 17.3 Focused Examination 17.4 Differential Diagnosis 17.5 White Lesions 17.5.1 Diagnosis of White Lesions: History of the Presenting Lesion 17.5.2 Examination: Wipeable and Non-wipeable White Plaques 17.5.3 Wipeable White Plaques 17.5.4 Non-wipeable White Plaques: Findings Suggestive of a Benign Process 17.5.5 Non-wipeable White Plaques: Findings That Warrant Biopsy/Biopsies 17.6 Oral Ulcers 17.6.1 Oral Ulcerative Lesions: The Diagnostic Process 17.6.2 Acute Ulcerative Conditions 17.6.3 Chronic Ulcerative Conditions 17.6.3.1 Solitary Chronic Ulcers 17.6.3.2 Multifocal Chronic Ulcers 17.6.4 Diagnostic Work-Up for Oral Ulcerative Conditions 17.6.4.1 Acute Ulcerative Conditions 17.6.4.2 Chronic Ulcerative Conditions 17.7 Oral Mucosal Masses/Tumors 17.7.1 Oral Soft Tissue Masses/Nodules: The Diagnostic Process 17.7.2 Exuberant Reactive Hyperplasias 17.7.3 Benign Neoplasms 17.7.4 Malignant Neoplasms 17.8 Biopsy Considerations 17.8.1 Excisional Biopsy Technique 17.8.2 Incisional Biopsy Technique 17.9 Conclusion References 18: Dentoalveolar Trauma 18.1 Introduction 18.2 Causes 18.3 Patient Evaluation 18.3.1 History 18.3.2 Physical Exam and Radiographic Correlates 18.4 Classification of Dentoalveolar Fractures 18.5 Treatment of Dentoalveolar Injuries 18.5.1 Soft Tissue Injuries 18.5.2 Injuries to the Teeth 18.5.3 Injuries to Alveolus 18.6 Conclusion References Part IV: Advanced Oral Surgery 19: Disturbances of the Temporomandibular Joint Apparatus 19.1 Introduction 19.2 Clinical Evaluation 19.2.1 History from Patient 19.2.2 Physical Examination 19.2.3 Diagnostic Imaging 19.2.4 Panorex 19.2.5 Magnetic Resonance Imaging (MRI) 19.2.6 Computerized Tomography (CT) 19.2.7 Nuclear Medicine Bone Scan 19.3 Developing a Differential Diagnosis 19.3.1 Myofascial Pain and Dysfunction 19.3.2 Internal Derangements and Osteoarthritis 19.3.3 Low Inflammatory Disorders (Degenerative Joint Disease and Osteoarthritis) and High Inflammatory Disorders (Systemic Arthritic Conditions) 19.3.4 Hyper- and Hypomobility Disorders 19.4 Noninvasive Treatment 19.4.1 Physical Therapy (Professional and Home Directed) 19.4.2 Thermal and Massage Therapy 19.4.3 Occlusal Splints 19.4.4 Life Modifications 19.4.5 Pharmacotherapy 19.5 Surgical Procedures 19.6 Invasive Procedures 19.6.1 Arthrocentesis 19.6.2 Arthroscopy 19.6.3 Arthroplasty (Open Joint Surgery) 19.6.4 Total Joint Replacement 19.7 Conclusion References 20: Congenital Facial Deformities 20.1 Introduction 20.2 Normal Growth/Development 20.3 Timing of Interventions 20.4 Conclusion References 21: Dental Implants 21.1 Introduction 21.2 Discussion 21.2.1 Planning Treatment 21.2.2 Prosthetic Implant Placement Considerations 21.2.2.1 Implant Restorations 21.2.2.2 Implant Selection and Placement 21.2.2.3 Prosthetic Space 21.2.3 The Implant/Bone Interface Post-Implant Placement 21.2.4 Surgical Considerations 21.2.5 Timing of Dental Implant Placement and Loading 21.2.6 Socket Preservation 21.2.7 Bone Grafting 21.2.8 Sinus Elevation 21.2.9 Overdentures 21.2.10 Anticoagulants 21.2.11 Smoking 21.2.12 Bisphosphonates 21.2.13 Antibiotics and Rinses 21.2.14 Postoperative 21.3 Conclusion References 22: Forensic Odontology 22.1 Introduction 22.2 Forensics in the Dental Office 22.2.1 The Dental Record 22.3 Identification of the Deceased Patient 22.3.1 General Concepts 22.3.2 Circumstantial Identification 22.3.3 Scientific Identification 22.3.4 Dental Identification 22.3.4.1 General Information 22.3.4.2 Antemortem Evaluation 22.3.4.3 Postmortem Evaluation 22.3.4.4 Comparison Assessment 22.3.5 Role in a Mass Disaster 22.4 Bite Mark (Pattern Injury) Analysis 22.5 Conclusion References Part V: Illustrative Case Reports 23: Case 1: Diagnostic Dilemma - White and Red lesion 23.1 Case 1: Parts I and II 24: Case 2: Diagnostic Dilemma - Crusty Lips 24.1 Case 2: Parts I and II 25: Case 3: Diagnostic Dilemma - White Patch 25.1 Case 3: Parts I and II 26: Case Studies Evidence-Based Treatment Planning 26.1 Introduction 26.2 Case Study #4 26.3 Domain Problem List 26.3.1 Medical Issues 26.3.2 Dental Issues 26.3.3 Socioeconomic Issues 26.3.4 Legal/Ethical Issues 26.4 Case Study #5 26.4.1 Medical Issues 26.4.2 Dental Issues 26.4.3 Socioeconomic Issues 26.4.4 Legal/Ethical Issues