The field of dentistry is a branch of medicine that is old and new with new innovative products and procedures that assist the dentist with general dental diagnostics to specialized procedures. In this section we'll talk about some of the branches of dentistry along with the special tool and products that are available to the practicing dentist.
Oral and Maxillofacial Surgery:
Oral and Maxillofacial Surgery is branch of dentistry that deals with the diagnosis and treatment of oral conditions requiring surgical intervention. It is a specialty of dentistry which includes diagnosis and surgical treatment of diseases, injuries and defects which include esthetic as well as functional aspects of soft and hard tissues surrounding the Oral and Maxillofacial region. Surgery is a discipline, based on principles that have evolved from both basic research and centuries of trial and error which has led to the Principles of Surgery. Oral and Maxillofacial Surgery includes basic surgical procedures like extraction of mobile or firm teeth and also removal of fractured roots. These procedures are to be performed in combination with local anesthesia for minor surgical procedures, special dental tools and can be aided with sedation using personal inhaler.
Oral and Maxillofacial Surgery requires the Dentist to acquire knowledge of the following:
Principles Of Surgery - Aseptic techniques, Incisions, Flap designs, Tissue Handling, Homeostasis, Decontamination and Debridement, Edema Control
-Infection Control in Surgical Practice
Armamentarium of Oral Surgical Procedures - Extractions forceps, Instruments used for incising tissue, Elevating Mucoperiosteum, Retracting Soft Tissue, Controlling Hemorrhage, Grasping Tissue, Removing Bone, Removing Soft Tissue form Bony Defects, Suturing Mucosa, Holding Mouth Open, providing suction, transferring sterile instruments, holding towels and drapes, for irrigation, Dental elevators.
- Uncomplicated Exodontia
- Complicated Exodontia
- Post operative Patient Management - Control of Post Operative Bleeding, Control of Post Operative Pain and Discomfort
- Management of Impacted teeth - Indications and Contra indications, Classification, Peri operative patient management - Pre Prosthetic Surgery
- Prevention and Management of Simple and Complex Odontogenic infections
- Diagnosis and treatment of chronic facial pain disorders
- Diagnosis and Surgical Management Oral Pathologic Lesions
- Maxillary Sinus Disorders
- Diagnosis and management of Salivary Gland Disorders
- Facial Fractures Diagnosis and Management
- Management of TemporoMandibular Disorders
History of Oral and Maxillofacial Surgery:
Oral Surgery was first documented in 500 BC to 300 BC, at the time Hippocrates and Aristotle documented various dental procedures including Extraction of teeth, treating decayed teeth, and the use of wires to support loose teeth and fractured jaws. This was the first documented report of Oral and Maxillofacial Treatment procedures such as Extractions and Splinting in case of Fractures.
In 700 BC - The first bridges The Etruscans, used gold wires to hold loose teeth together. This is also the first incarnation of a cosmetic dental practice that would come to be know as bling. Father of Surgery - Ambrose Pare in 1575 published a book called Complete Works which also contains information on Tooth Extraction and Jaw Fractures In 1728 the book "The Surgeon Dentist" by Pierre Fauchard which included basic anatomy of the mouth, as well as surgery techniques.
In 1840 the American Society of Dental Surgeons was founded the first society for Oral Surgeons. The First custom made instrument for dental Extractions was named the Pelican which was invented in 14th century by Guy de Chauliac and used until the late 18th century and later replaced by the Dental Key which was used till the 20th century which was replaced by the Extraction Forceps
Oral and Maxillofacial Surgery deals with the acquisition of knowledge and skill in advanced and complex pain control methods, including intravenous sedation and general anesthesia.
In addition an Oral and Maxillofacial Surgeon receives extensive training and experience in the initial and definitive care of the trauma patient, management of extensive odontogenic infections of the head and neck, management of oral pathologic lesions (such as cysts and tumors of the jaws), diagnosis and management of dentofacial deformities (congenital, developmental or acquired), complex maxillofacial preprosthetic surgery (including the use of dental implants), reconstruction with bone grafts of missing portions of the jaws, and management of facial pain and temporomandibular joint disorders.
Oral and Maxillofacial Surgery does not only include learning and practicing Clinical Dentistry by having sufficient training and experience in the surgical procedures but also having great psychological and mental stability towards patient management.
Anesthesiology is a branch of medicine concerned with the use of a multiple drugs or a single drug to bring upon a state of General Anesthesia. Anesthesia is a Greek word coined by Oliver Wendell Holmes which means An Without, Esthesia Sensation So we can say that it is a branch of Medicine which helps us to put the human body in a state of Reversible Analgesia, decreased responsiveness, Muscle Relaxation, Anxiolysis/Sedation/Hypnosis which decreases the patient's mental status to become unaware of the surroundings , along with temporary Amnesia. The main aspect of Anesthesia is to control the Vital Reflexes and to make sure that they do not have any effect on Breath rate, Blood Pressure and Heart Rate.
Anesthesiology is comprised of 2 basic parts
1. Pre Anesthetic Medication - This plays a very vital role in Anesthesiology to help attain proper Anesthesia and prepare the patient for General anesthesia.
2. Anesthetic Medication Pre Anesthetic Medication: It is defined as a preliminary medication, drug with specific pharmacological action administered preoperatively to aid in proper attainment of Anesthesia to the patient.
Objectives of Pre Anesthetic Medication:
1. Relieve Anxiety
4. Amnesia of Pre operative events
5. Reduction of Stomach acidity and Volume
6. Antisialogogue effect
7. Prevention of nausea and vomiting
8. Facilitation of anesthetic induction
9. Prophylaxix against any allergies
10. Vasolytic Action
The various Groups Drugs used in Pre Anesthetic Medication:
Sedatives and Hypnotics, Antiemetic and antisialogogue, Antihistamines, Analgesics, Scopolamine to cause amnesia, Antacids
The 4 Stages of General Anesthesia are:
Stage 1: Stage of Analgesia
It is the period between administration of an anesthetic agent and loss of consciousness and the start of Analgesia. Good for Venal Puncture, labor pain, dental analgesia.
Stage of Delirium or Excitement or REM stage: It is a stage where the patient becomes dangerously responsive to stimuli and rapid eyes and eye lid movement as seen in REM, heart rate and muscle movements increase rapidly along with breath holding, irregular respiration. This stage is made sure to be kept as short as possible to avoid endangering the patient.
Stage 3: Stage of Surgical Anesthesia:
It is the stage of Anesthesia in which surgical procedures are performed. Acquiring this stage is the actual reason and sole purpose behind Anesthesia. Stage of Surgical anesthesia is further divided into 4 Planes - Each plane with its particular signs and symptoms for the Anesthesiologist to have a clear idea of the effects of Anesthesia.
Stage 4: Stage of Respiratory Paralysis:
This is the stage of Overdose which leads to Respiratory arrest and Medullary paralysis. This is the stage where the patient has the highest risk of Death is not revived quickly from Stage 4.
Types of Anesthetic Agents:
Inhalation Anesthetics: Volatile Liquid
Intravenous Anesthetics: These are Non Volatile Substances which are given intravenously. Informed consent: It is another important part of the procedure which should never be avoided. Patients should be informed of the risks associated with general anesthesia as part of their informed consent. These risks include possible dental injuries from intubation as well as such serious complications as stroke, liver damage, or massive hemorrhage. In cases where local anesthesia can be an alternative should be informed to the patient before hand to give them an alternative to choose from.
Local Anesthesia: Local Anesthesia is a local state of loss of sensation without loss of consciousness, in a circumscribed area of the body due to the depression of, excitation in nerve endings or an inhibition of the conduction process in peripheral nerves. Local anesthetic agents agents are mainly of 2 types Esters and Amides. Local anesthetic agents are administered in 2 forms, through Injection or through Spray form.
Methods of Administering Local anesthesia: Nerve Block - Field Block - Local infiltration - Topical Anesthesia - In the form of - Topical Anesthetic Gel - and Topical Spray - Intraligamantary technique - Local anesthetic agent injected into the Periodontal Ligament
In local anesthesia the number of dental instruments used for the procedure are minimal and easy to use. The only dental instruments used are Mouth mirror and a Syringe. Local anesthesia is a safer and easier way of producing localized anesthesia to perform minor surgeries which do not require the laborious and complicated process of General Anesthesia. It has been a boon to Dentists for performing many procedures under local anesthesia providing comfort to the patients and making it easier for the dentist to work with a calm patient and easily use dental instruments for the procedures without bringing fear in the patients.
History of Anesthesia:
300 BC - The first recorded use of Anesthesia to perform a Surgical procedure was documented by Bian Que in 300 BC . This procedure is recorded in the book of master Han Fei in 250 BC. The Records of the Grand Historian where Bian Que performed Gastostomy procedure on 2 patients by giving them a toxic drink which made them unconscious for 3 days and unaware of the pain.
200 AD - Another Chinese Surgeon Hua Tuo prepared a General Anesthetic agent using Hers and Mafesian to perform major surgeries which was considered as a crime in China during those days and he destroyed his composition by burning his notes just before he died.
1772 - Joseph Priestley discovered Nitrous Oxide which was later named as - Laughing gas by Humphry Davy who stressed on its use and importance in Surgical procedures
1804 - Friedrich Sertrner developed morphine from opium seeds
1846- William T. G. Morton administered diethyl ether successfully for a dental extraction
1847- James Young Simpson used Chloroform as a General Anesthetic agent
1934 - Ernest H. Volwiler used Sodium thiopental, the first intravenous anesthetic