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Braces treatment (Orthodontic treatment) is used to correct the teeth alignment prior to jaw surgery (Orthognathic surgery) for patients with discrepancy in his jaw relationship. This procedure requires close collaboration between orthodontist (dentist who does braces treatment) and maxillofacial surgeon (dentist who does jaw surgery). The objective of braces treatment before jaw surgery is to prepare the patient for surgery by placing the teeth in correct position in relative to their respective jaw bone without concern for the bite and aesthetic of patient. During this phase, patient might have compromised aesthetic and bitting ability until the jaw surgery is done. After jaw surgery, short duration of braces treatment is required to refine the final occlusion.
Reasons of braces treatment before jaw surgery
Facilitate the surgical procedures
Allow maximum surgical correction
Shorten and simplify braces treatment after the surgery
Allow production of stable bite during and after surgery
Oral cysts and tumors may develop in the jawbone or soft tissues in the mouth and face. Oral cyst is an abnormal cavity within bone or soft tissues which may contain fluid. There are many different types of cysts in the mouth.
Reason to remove oral cyst:
Size of cyst will increase with time
Very large cyst can be dangerous, they can weaken your jawbone and causes your jawbone to be break easily
Teeth adjacent to large cyst can be affected and become mobile
Oral tumor is a solid or semi-solid mass in the bone or soft tissue that is made of unusual cells. Oral tumor can be benign tumor (not cancerous) or malignant tumor (cancerous). This can be confirmed by using biopsy test (a surgery that removes part of your tumor to examine it under a microscope). Biopsy is needed to diagnose the tumor before starting any treatment.
When should I suspect that I have an oral cyst or tumor? Most of the oral lesions do not have any symptoms. Oral cyst may cause swelling, bone expansion, displacement or loosening teeth and pain (if infected). Oral tumor may present as a non-painful bump, lump, or ulcer. After your oral and maxillofacial surgeon examines the cyst or tumor, he will often recommend an X-ray to determine what kind of treatment you need.
Type of common treatments for oral tumors and cysts – Treatment options depends on the location and the type of lesion and your symptoms.
Fine needle aspiration cytology (FNAC): FNAC is a fast and less invasive tool used to diagnose a suspicious lesion or to differentiate cancerous and non-cancerous lesion before any invasive surgery done. This technique uses fine needle to obtain cells from lesion for examination under a microscope or to explore whether a lesion contains a fluid.
Surgical excision: Complete removal of lesion with the surrounding normal tissues.
Incisional biopsy: This technique removes only a small portion of a large lesion for diagnosis prior to treatment. Incisional biopsy indicated in very large lesion, hazardous location of the lesion and lesion that has the characteristics of malignancy.
Enucleation: A technique used to completely remove cyst by elevating of soft tissue flap, removing of bone overlying the cyst followed by peeling off the cyst with spoon-like instrument.
Marsupialization: Removes only a portion of the cyst lining and the cystic lining is sutured to the oral mucosa to keep the cavity open. The open cavity will trap food and takes many months to heal. This technique rarely used, unless associated structures, such as adjacent nerve, nose, and maxillary sinus are at the risk of damage during enucleation.
Multiple dental extraction is defined as removal of more than one tooth in a single dental visit. This procedue usually will be done under general anaesthesia (GA) in the hospital setup. Dental extraction under GA also can be performed on children who is anxious, uncooperative or having medical condition such as cerebral palsy or hyperactive child. In some cases, dental extraction under GA is done on children with badly decay teeth which needed multiple dental visit for extraction. It is therefore, better to have it done under general anaesthesia.
The indications of dental extractions under general anesthesia are:
Young child with rampant decayed teeth
Children who is unsuitable for local anesthetic or conscious sedation due to lack of cooperation
Patient with medical condition such as cerebral palsy or severe seizure
Patient who required lot of tooth extraction
Dental extraction under GA di performed in the hospital setup as day-care (no hospitalization). The patient (or the child) is usually health (ASA I) and fasting since midnight. The anesthesiologist will assess the child and written consent is taken before the procedure started.
In the operating room, the anesthesiologist will put a tube in patient’s throat to administer ‘sleeping’ gas allowing patient to ‘sleep’ during the whole procedure. The oral surgeon will come in to perform the dental extraction. After the procedure, the tube with be removed from the patient’s throat, and he will placed in the recovery room. He will be allowed to discharge from the hospital when fully conscious and ambulated.
Upon the procedure, a minor bleeding in extraction site, swollen tongue/lip/chin/cheek, temporary mouth opening limitation are the sequelae or conditions to be expected.
Advantage of extraction under GA
Very useful to traet uncooperative patient
Patient has no experience of the awlful dental extraction
No need many dental visit for extraction
Other dental procedures such as fillings and dental cleaning can sometimes be done in the same visit
Disadvantage of extraction under GA
Patient has to be healthy for GA
The procedure has to be done in the hospital setup with OT facility
Treatment will cost more as the patient has to be admitted in the hospital as well as GA fees
In intravenous sedation, a cannula is placed into a vein and a drug is administered directly into the patient’s blood stream with the patient in supine position.
A cannula (thin plastic tube) will be put into a vein in the back of one of your hands.
The primary goal of IV sedation is to reduce your anxiety, make you feel relaxed and less aware of the dental procedure.
The use of intravenous sedation is indicated in the management of patients with high level of dental anxiety or patients that unable to tolerate stress (epileptic, stroke patient).
During the procedure, adequately sedated patient is demonstrated by expressionless face, drowsiness, and slow speech but they will still be able to understand and respond to verbal contact. However, this patient may not be able to recall events that occurred during the procedure after the treatment.
The major side effect with midazolam sedation is respiratory depression. Thus, the use of a pulse oximeter (device attached to your finger to measure oxygen level and heart rate) is mandatory to monitor patient from this potentially dangerous side effect during the procedure.
Patient who is allergy to benzodiazepines is an absolute contraindication but is extremely rare. IV sedation should be aware in pregnant patient, patient with kidney, liver and heart disease, elderly patient, and children.
Before intravenous sedation
Take your routine medicines at usual times and discuss your medical history and the medicines you took with your dentist
Inform your dentist if you think you may be pregnant
Have a light meal 2 hours before your appointment
Do not take alcohol in any form
Bring an adult that can bring you home and take care of you afterwards
After intravenous sedation
You will need to stay in our recovery room for at least one hour before you leave the clinic.
The effects of sedation can last up to 12 hours, thus during this period:
Do not drive any vehicle, or operate any machinery, or travel alone
Do not take alcohol in any form
Do not use internet and social media
Do not return to work
Do not make any important decisions or sign any legal documents
When compared to general anaesthesia, intravenous sedation is simpler, easier to administer, faster onset with fewer complications and contraindications, patient remains conscious and can breathe on their own throughout procedure.
In general anesthesia (GA), drugs are administered by intravenous or inhalation routes which makes the person to be unconscious and do not feel or remember anything during the surgery. This patient is not wakened even by painful stimulation. General anaesthesia currently can only be performed in the operating room under the hospital setup where the sleep doctor (anaesthesiologist) will be the one to make the patient sleep.
GA is recommended for:
Complicated, extensive, and prolonged treatment to be performed
Working in difficult or multiple areas in the mouth
Patient with special needs
Patient with extremely dental anxiety – only if other form of sedation are ineffective
The patient is unconscious – allows the dentist to perform surgery without concern of constantly moving, uncooperating or anxiety patient.
Patient do not feel pain
Patient cannot remember events occurred during the surgery
Longer operating time
The patient is unconscious – can be life threatening
Higher risk of complications – higher risk of airway obstruction because patient unable to cough
Patient cannot control the situation – do not respond to sound and touch
Require assistant to maintain a patent airway – patient cannot breathe on his own
Very expensive – require special equipment
Patient must fast at least 8 hours before surgery
Requires adequately and specially trained doctor (anesthesiologist) to perform
Time consuming procedure – long recovery period
Before administering GA, the patient should be assessed thoroughly by the anesthesiologist by taking detailed medical history, drug history, physical test, and extensive laboratory test. The patient should be explained about the procedure and informed consent form should be signed by the patient. Patient must fast at least 8 hours before the procedure.
Then, GA drug administered intravenously or by inhalation to induce general anaesthesia.
After GA is induced, the doctor will secure your airway by placing a tube into your lung via the nose, mouth or a opening in the neck to ensure sufficient oxygen to reach your lung before dental treatment begins.
When dentist has finished the dental treatment, the doctor will stop the administration of GA drugs and begins to bring the patient back to consciousness. The patient should be monitored for 1-2days before discharging.
The uses for general anesthesia in dentistry have decreased over the years as other less invasive sedation techniques have evolved. Nevertheless, there are still many situations that require the use of GA.
Minor oral surgery is a field in dentistry that involves surgical treatment that performed within the mouth. This surgery can be done under local anaesthesia with or without sedation. In most situations, it requires only a relatively short recovery period. Types of Minor Oral Surgery
Removable appliance is an appliance that is not fixed to teeth but can be removed by the patient. It usually contains spring, screws, clasps and acrylic base plate. This appliance is often used in situation whereby simple teeth movement are needed only and it can allow patients to perform better oral hygiene by removing it. However, this appliance requires compliance from the patient to wear it.
Fixed appliance is probably the most common type of orthodontic appliances in use today. They consist of small brackets that are attached onto the front surface of the teeth and a thin wire which is often held in place by elastic loops.This appliance allows multiple tooth movements simultaneously and more effectively as compared to removable appliance. The treatment usually lasts from 6 months to 30 months depending upon the severity of the problem. It is very important to maintain an excellent oral hygiene and dental health throughout the orthodontic treatment