Oral Surgery Summary

 
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A Summary of Oral Surgery for General Dental Practitioners

Harriet Jones

FGDP Yorkshire would like to thank Cristina Frezzini for presenting at our recent evening lecture on Oral surgery: An Update for General Dental Practitioners. The evening covered an update on guidance regarding the management of specific conditions affecting medically compromised patients & referral pathways. 

A summary of information provided regarding management of medically compromised patients is below. Full guidelines are available online at SDCEP, Published Guidance. The link includes additional information, useful flowcharts & patient information leaflets. 

Medication-related Osteonecrosis of the Jaw (MRONJ) 

Patients at risk of MRONJ are those taking antiresorptive or antiangiogenic drugs, these can be used to treat non-metastatic disease or metastatic bone disease. Risk assessment should be carried out for these patients based on indication for drug, oral or IV administration, duration, use in conjunction with glucocorticoids & previous occurrences of MRONJ. Those at low risk can have extractions carried out in general practice, for those at high risk extractions should be avoided unless absolutely necessary, referral to secondary care may be appropriate. A thorough dental assessment should ideally be carried out before starting drug therapy and preventative care is essential. 

Osteoradionecrosis (ORN)

Defined as an area of exposed devitalized irradiated bone that fails to heal over a period of 3-6 months in the absence of local neoplastic disease. It can progress to sequestrum, oro-cutaneous fistula or pathological fracture. This can occur spontaneously or after dental trauma. Prevention is key for patients at risk of ORN and a thorough assessment of dentition must be carried out prior to commencing treatment; teeth of poor prognosis should be extracted >10 days prior. After radiotherapy, high risk preventative approach is essential and extractions should be avoided where possible. 

Antiplatelets & anticoagulants

These are used in the management of patients with atherosclerosis, cardiac arrhythmias & thrombotic disorders. Management of these patients requires assessment of both patient risk; based on single/dual therapy or patients INR and procedure risk. For procedures that are likely to cause bleeding use an atraumatic technique, limit the initial treatment area and pack & suture. Treat these patients early in the day & week and consider consulting with the patients GP regarding their medication. Guidance on management of specific drugs and drug combinations is available online.   

Diabetes

A metabolic disease in which there are high blood sugars over a prolonged period. DM Type 1; Lack of insulin (failure of the pancreas to produce insulin). DM Type 2; Insulin resistance (by peripheral tissues, can lead to reduction of insulin secretion). Diabetic patients are at risk of hypoglycaemia or hyperglycaemia if not properly managed. Awareness of the signs of hypoglycaemia and its management is essential.  Patients should be advised to have their normal food and normal insulin, ideally treatment should be carried out early in the day and avoid delays in appointment times. These patients have an increased risk of infection and poor wound healing. They are more likely to suffer cardiovascular disease & periodontal disease.