Maranan, Aira Angeli G.

41-C

SURGERY: Odontectomy September 2, 2015

CASE HISTORY

I. Identifying Data

Name: Guerrero, Ma. Veronica Mae

Gender: Female

Address: Mandaluyong City

Contact Number: 09279486272

Age: 22 years old

Date of birth: May 25, 1993

Civil Status: Single

Nationality: Filipino

Occupation: HR assistant

Primary care physician: None

II. Chief complaint

“Ang sakit ng bagang ko, di ko maikagat.”

III. History of present illness

A year ago, patient felt pain on the most posterior area of the ridge so she went to her dentist for

consultation. The dentist suggested to her to take a panoramic xray to check if her wisdom teeth are

already erupting. Her dentist recommended to her to have it extracted to prevent complications and further

pain. However, patient cannot afford the treatment. Recently, two weeks ago, her right cheek was swollen

and radiating pain triggered. Her dentist prescribed him Amoxicillin 500mg 3 times a day for a week and

mefenamic acid 500 mg if necessary. After a week, the swollen cheek subsided, but it is still painful

whenever she occludes her teeth.

IV.Medical History

a. Family/Social History

Mother - Diabetes

Father - No systemic disease

Siblings - no systemic disease

(-) drinking alcohol

(-) smoking

b. Allergies

(-) food allergies

(-) drug allergies

c. Systemic Diseases

(-) Cardiovascular Disorders

(-) Respiratory Disorders

(-) Renal Disorders

(-) Hepatic Disorders

(-) Coagulation Disorders

(-) Endocrine Disorders

e. Medications

None

V. Dental History

The patient does not have any unpleasant experience with a dentist. She has restorations on teeth 17, 16,15,14, 24,26,27,37, 36, 46 and 47.

VI. Clinical Examination

a. Extra-oral examination

1. Symmetrical face

2. (-) TMJ clicking sound

3. (-) Swellings

4. (-) Cracks/ fissures/ ulcers at lips

5. (-) Palpable lymph nodes

b.Intraoral examination

1. Good oral hygiene

2. Coral pink gingival color

3. Firm consistency of gingiva

4. Normal tongue position

5. (-) elevations, depressions or color changes

6. Straight facial profile

- There is absence of oral manifestations of any systemic disease.

VII. Radiographic Evaluation

Tooth 48 is in Class I Position B Mesioangular

VIII. Treatment Plan

a. Oral Prophylaxis

b. Extraction of 48

c. Restoration on tooth 25 and 36

d. Recall

IX. Pre-operative procedures

1. Sterilize instruments

2. Proper protective apparel

3. Good patient draping

4. Let patient gargle with 1% Povidone Iodine solution

X.Armamentarium

- Surgical Gloves

- Overgloves

- Towel, Soap, and Alcohol

- Waste Receiver with plastic

- Drape

- Disposable headcap

- Mask

- Eye protector

- Mouth Mirror

- Explorer

- Cotton Plier

- Spoon Shaped Excavator

- 1% Povidone Iodine

- 10% Povidone Iodine

- Sterile Gauze

- Cotton swab

- Topical Anesthesia

- Breech-Loading Aspirating metallic Syringe

- Carpule with anesthetics

- Long Dental needle

- Scalpel Handle No.3 and No. 15 Blade

- Molt Periosteal Elevator

- Minessota Retractor

- Handpiece

- Surgical Burs

- Hypodermic syringe

- 301, 304 Straight Elevators

- Cross Bar

- Surgical Curette

- Bone file

- Suture Materials

- Swaged Needle

- Needle Holder

- Adson Tissue Forceps

- Iris Scissors

XI. Surgical Procedure

1. Patient Preparation

a. Make sure the patient is wearing all protective attire for infection control. All instruments have

undergone infection control.

b. Ask patient to gargle 1% Povidone Iodine

2. Anesthesia

Dry area well, then apply topical anesthesia on the area of puncture of local anesthesia.

● Nerves anesthetized: Inferior alveolar nerve, lingual nerve and long buccal nerve

● Anesthetic solution: 2% Lidocaine 1:100,000 epinephrine

INFERIOR ALVEOLAR NERVE BLOCK

The 4TH quadrant would be the area of operation specifically tooth 48 and is anesthetized using

Inferior alveolar nerve and its subdivisions, mental nerve, incisive nerve and occasionally, lingual and

long buccal nerve. If the inferior alveolar nerve block would not include lingual and long buccal nerve,

supplementary injection is done for the lingual nerve to anesthetize 2/3 of the tongue, floor of oral

cavity and mucosa and periosteum on the lingual side of the mandible and for the long buccal nerve,

buccal mucous membrane and periosteum of the mandibular area. This is administered using

aspirating syringe, cartridge and a long needle.

3. Once anesthesia has taken effect or to test effectivity of anesthesia, periosteal elevator is used

4. Make an Incision with vertical releasing insicion in mesiobuccal groove of the 47

5. Reflect the mucosa using a Molt #9 Periosteal Elevator and expose the overlying bone

6. Using a #8 Round Carbide Bur remove the bone with mesiodistal direction on buccal surface of 48

7. Using a Straight Bur for ditching and Sectioning of the Crown

8. Luxate crown with the use of 301, 304 elevator

9. Split the root area and elevate using 301 and 304 elevator

10. After removing teeth, examine the alveolar socket. If there is a pathologic condition, curette the

socket. Irrigate the socket with Normal Saline Solution(NSS). If there are irregular margins use the

bone file to smoothen it.

11. Suture using a interrupted type and approximate the tissue properly.

12. Give postoperative care and instructions to the patient, recall the patient 5 to 7 days for suture

removal

XII. Possible complications and tissue management

a. Swelling

- Apply ice packs for first 12 hours to help control swelling

b. Bruising

-Should not cause any alarm, it will disappear in 7 to 14 days

c. Stiffness

-Patient might experience jaw musculature stiffness and limited opening of the mouth. It

will improve in 5 to 10 days

d. Inadvertent incisions

- Proper finger rest and guard

XIII. Post operative management and medication

1. There will be little discomfort when anesthesia wears off, take one capsule Mefenamic Acid 500mg

every four to six hours for pain. If pain disappears, stop medication. Take Amoxicillin 500mg every

8 hrs for 7 days

2. Avoid Smoking for first 12 to 24 hours

3. Do not drink alcoholic beverages

4. Do not use straw in drinking liquids

5. Eat high-caloric, high volume liquid diet best for first 12 to 24 hours

6. Avoid hot food or liquids for first 24 hours after operation

7. Chew on the non-operated site

8. Avoid vigorous spitting and gargling

9. Avoid playing with extraction site

10. During the 1st day, apply ice / cold compress on the operated site every 30 minutes for first 24 hrs.

11. Oral Hygiene: Do not rinse mouth or brush teeth for at least 8 hours after surgery.

12. No strenuous activities for 12 hours after surgery

13. On the third day after surgery, apply warm compress on the area of surgery for20 minutes every hour.

14. Mild bruising on the area of surgery may be expected. This will disappear in 7-14days.

15. Stitches will be removed after 5 to 7 days.