CHAPTER 7: PRINCIPLES OF ROUTINE EXODONTIA
PRESURGICAL MEDICAL ASSESSMENT
Patients caan chaave ca cvarieet cof chaealttha crriolltess cthaat criequerie ctrieatsent csoieiaation cori cseieaalt c
sanagesent cleforie cthae csurigeri caan cle csafelt creriforisei.
Sreaealt cseasuries csa cle cneeiei cto c
- aontriolt cllteeieng
- ltessen cthae cahaanae cof cenfeation c
- rrievent ca cseieaalt ceserigena
PAIN AND ANXIETY CONTROL
Resovalt cof ca ctootha, ceven cef cet ces cltoose caauses craen. c
Dense cltoaalt canesthaesea ces criequeriei cto crrievent craen ciurieng cextriaations. c
Loaalt canesthaesea csust cle calsoltutelt crriofouni cto celtesenate csensation cfrios cthae crultr, crerieoiontalt c
ltegasent, cani caijaaent csof ctissues. c
Even cwetha crriofouni cltoaalt canesthaesea, cratients cweltlt cstiltlt cexrerieenae ciesaosforit cfrios crriessurie c
rltaaei con cthae ctootha, cthae csuririounieng ctissues cani cthae cjaw cjoents ciurieng csost cextriaations.
Local Anesthesia
Priofouni cltoaalt canesthaesea ces cneeiei cef cthae ctootha ces cto cle criesovei cwethaout cshaarir craen cfori cthae c
ratient
SENSORY INNERVATION OF JAWS
NERVE TEETH SOFT TISSUE
Inferieori cAltveolteri cNerive Altlt csanielultaris Buaaalt csof ctissue cof
rriesoltaris, caanenes,
ani cenaesoris
Lengualt cNerive None Lengualt csof ctissue cof caltlt
Teetha
Long cBuaaalt cNerive None Buaaalt csof ctissue cof
soltaris cani cthae
seaoni crriesoltari
Anteriosurerieori cAltveoltari Maxe cInaesoris c& cCanenes Buaaalt csof ctissue cof
Nerive enaesoris cani caanenes
Meiiltesurerieori cAltveoltari Maxe crriesoltaris ca crorition cof Buaaalt csof ctissue cof
Nerive thae rriesoltaris
irist csoltari ctootha
It ces cessentialt cthaat cthae csurigeon criesesleri cthae crrieaese cennerivations cof caltlt cteetha cani csuririounieng c
sof ctissue cas cweltlt cas cthae cnenis cof cenjeation cneaessari cto canesthaetizee cthaose cnerives caosrltetelt
In carieas cof cnerive ctriansetion, carioss-ennerivation cexests. cFori cexasrlte:
- In cthae criegeon cof cthae csanielultari cseaoni crriesoltari, cthae cluaaalt csof ctissues carie cennerivatei c
rriesarielt cl cthae csentalt clrianaha cof cthae cenferieori caltveoltari cnerive clut caltso cl cthae cterisenalt c
lrianahaes cof cthae cltong cluaaalt cnerive
Whaen canesthaetizeeng ca csaxeltltari ctootha cfori cextriaation, cthae csurigeon cshaoulti canesthaetizee caijaaent c
teetha cas cweltlt
, Dense cltoaalt canesthaesea criesultts cen cthae cltoss cof caltlt craen, ctesreriaturie cani ctouaha csensations clut cet c
ioes cnot canesthaetizee cthae crriorrieoaertive cileris cof cthae cenvoltvei cnerives c
To crrioveie canesthaesea cfori csulttirlte ctootha cextriaations, cet csa cle cneaessari cto cenjeat csulttirlte c
aaritrieiges cof cthae cltoaalt canesthaetia
It ces cesroritant cto cnnow chaow csan caaritrieiges cof ca cgeven cltoaalt canesthaetia csoltution caan cle c
aisenesteriei csafelt . cThaerie carie c2 cieferient cwa s:
1. Eaaha cltoaalt canesthaetia chaas ca crieaosseniei csaxesus ciose clasei con cseltltegriass creri cneltogrias c
(sg/ng). c
2. Reaosseniei cMaxesus cLoaalt cAnesthaetia cDoses
Drug/Solution Maximum Number of Number of
Amount Cartridges Cartridges
(mg/kg) for 70-kg for 20-kg
(154-lb) Adult (44-lb) Child
Leioaaene c2% 5.0 10 3.0
wetha c1 c: c100,000
erenerhariene
Merevaaaene c2% 5.0 10 3.0
wetha c1 c: c20,000
ltevonoriiefrien
Merevaaaene 5.0 6 2.0
3% c(no
vasoaonstrieatori)
Prieltoaaene c4% 5.0 6 2.0
wetha c1 c: c200,000
erenerhariene
Aritiaaene c4% cwetha 7.0 6 1.5
1 c: c100,000
Erenerhariene
Burevaaaene c0.5% 1.5 10 3.0
wetha c1 c: c200,000
erenerhariene
Etiioaaene c1.5% 8.0 15 5.0
wetha c1 c: c200,000
erenerhariene
Sedation
Managesent cof cratient canxeet csust cle ca csajori caonseieriation cen corialt csurigeaalt crrioaeiuries
As cratient canxeet cenarieases, cet cofen cleaoses cneaessari cto cuse crhaarisaaoltogea cassestanae
Prieoreriativelt , corialt cseieaation csuaha cas:
1. cDeazeeras c
- sa chaeltr ca cratient criest cweltlt cthae cneghat cleforie cthae csurigeri cani crrioveie csose crielteef cof canxeet c
en cthae csorinen c
2. cLoriazeeras c
- sa cle cusefult cwhaen caisenesteriei con cthae csorineng cof csurigeri c
cNetrious coxeie c c
- friequentlt cthae cteahaneque cof cahaoeae cfori canxeous cratients cani csa cle cthae conlt cteahaneque c
riequeriei cfori csan cratients cwhao chaave cselti cto csoieriate canxeet
cDeereri cSeiation cvea centriavenous c(IV) crioute c
PRESURGICAL MEDICAL ASSESSMENT
Patients caan chaave ca cvarieet cof chaealttha crriolltess cthaat criequerie ctrieatsent csoieiaation cori cseieaalt c
sanagesent cleforie cthae csurigeri caan cle csafelt creriforisei.
Sreaealt cseasuries csa cle cneeiei cto c
- aontriolt cllteeieng
- ltessen cthae cahaanae cof cenfeation c
- rrievent ca cseieaalt ceserigena
PAIN AND ANXIETY CONTROL
Resovalt cof ca ctootha, ceven cef cet ces cltoose caauses craen. c
Dense cltoaalt canesthaesea ces criequeriei cto crrievent craen ciurieng cextriaations. c
Loaalt canesthaesea csust cle calsoltutelt crriofouni cto celtesenate csensation cfrios cthae crultr, crerieoiontalt c
ltegasent, cani caijaaent csof ctissues. c
Even cwetha crriofouni cltoaalt canesthaesea, cratients cweltlt cstiltlt cexrerieenae ciesaosforit cfrios crriessurie c
rltaaei con cthae ctootha, cthae csuririounieng ctissues cani cthae cjaw cjoents ciurieng csost cextriaations.
Local Anesthesia
Priofouni cltoaalt canesthaesea ces cneeiei cef cthae ctootha ces cto cle criesovei cwethaout cshaarir craen cfori cthae c
ratient
SENSORY INNERVATION OF JAWS
NERVE TEETH SOFT TISSUE
Inferieori cAltveolteri cNerive Altlt csanielultaris Buaaalt csof ctissue cof
rriesoltaris, caanenes,
ani cenaesoris
Lengualt cNerive None Lengualt csof ctissue cof caltlt
Teetha
Long cBuaaalt cNerive None Buaaalt csof ctissue cof
soltaris cani cthae
seaoni crriesoltari
Anteriosurerieori cAltveoltari Maxe cInaesoris c& cCanenes Buaaalt csof ctissue cof
Nerive enaesoris cani caanenes
Meiiltesurerieori cAltveoltari Maxe crriesoltaris ca crorition cof Buaaalt csof ctissue cof
Nerive thae rriesoltaris
irist csoltari ctootha
It ces cessentialt cthaat cthae csurigeon criesesleri cthae crrieaese cennerivations cof caltlt cteetha cani csuririounieng c
sof ctissue cas cweltlt cas cthae cnenis cof cenjeation cneaessari cto canesthaetizee cthaose cnerives caosrltetelt
In carieas cof cnerive ctriansetion, carioss-ennerivation cexests. cFori cexasrlte:
- In cthae criegeon cof cthae csanielultari cseaoni crriesoltari, cthae cluaaalt csof ctissues carie cennerivatei c
rriesarielt cl cthae csentalt clrianaha cof cthae cenferieori caltveoltari cnerive clut caltso cl cthae cterisenalt c
lrianahaes cof cthae cltong cluaaalt cnerive
Whaen canesthaetizeeng ca csaxeltltari ctootha cfori cextriaation, cthae csurigeon cshaoulti canesthaetizee caijaaent c
teetha cas cweltlt
, Dense cltoaalt canesthaesea criesultts cen cthae cltoss cof caltlt craen, ctesreriaturie cani ctouaha csensations clut cet c
ioes cnot canesthaetizee cthae crriorrieoaertive cileris cof cthae cenvoltvei cnerives c
To crrioveie canesthaesea cfori csulttirlte ctootha cextriaations, cet csa cle cneaessari cto cenjeat csulttirlte c
aaritrieiges cof cthae cltoaalt canesthaetia
It ces cesroritant cto cnnow chaow csan caaritrieiges cof ca cgeven cltoaalt canesthaetia csoltution caan cle c
aisenesteriei csafelt . cThaerie carie c2 cieferient cwa s:
1. Eaaha cltoaalt canesthaetia chaas ca crieaosseniei csaxesus ciose clasei con cseltltegriass creri cneltogrias c
(sg/ng). c
2. Reaosseniei cMaxesus cLoaalt cAnesthaetia cDoses
Drug/Solution Maximum Number of Number of
Amount Cartridges Cartridges
(mg/kg) for 70-kg for 20-kg
(154-lb) Adult (44-lb) Child
Leioaaene c2% 5.0 10 3.0
wetha c1 c: c100,000
erenerhariene
Merevaaaene c2% 5.0 10 3.0
wetha c1 c: c20,000
ltevonoriiefrien
Merevaaaene 5.0 6 2.0
3% c(no
vasoaonstrieatori)
Prieltoaaene c4% 5.0 6 2.0
wetha c1 c: c200,000
erenerhariene
Aritiaaene c4% cwetha 7.0 6 1.5
1 c: c100,000
Erenerhariene
Burevaaaene c0.5% 1.5 10 3.0
wetha c1 c: c200,000
erenerhariene
Etiioaaene c1.5% 8.0 15 5.0
wetha c1 c: c200,000
erenerhariene
Sedation
Managesent cof cratient canxeet csust cle ca csajori caonseieriation cen corialt csurigeaalt crrioaeiuries
As cratient canxeet cenarieases, cet cofen cleaoses cneaessari cto cuse crhaarisaaoltogea cassestanae
Prieoreriativelt , corialt cseieaation csuaha cas:
1. cDeazeeras c
- sa chaeltr ca cratient criest cweltlt cthae cneghat cleforie cthae csurigeri cani crrioveie csose crielteef cof canxeet c
en cthae csorinen c
2. cLoriazeeras c
- sa cle cusefult cwhaen caisenesteriei con cthae csorineng cof csurigeri c
cNetrious coxeie c c
- friequentlt cthae cteahaneque cof cahaoeae cfori canxeous cratients cani csa cle cthae conlt cteahaneque c
riequeriei cfori csan cratients cwhao chaave cselti cto csoieriate canxeet
cDeereri cSeiation cvea centriavenous c(IV) crioute c
