An Evaluation of A Practice-Based Minor Oral Surgery Service

2018 ◽  
Vol 7 (3) ◽  
pp. 30-36
Author(s):  
Thomas Anthony Dyer ◽  
Jessica Ga Lai Lau ◽  
Thomas Anthony Dyer ◽  
Jessica Ga Lai
Keyword(s):  
Oral Surgery ◽  
Waiting Times ◽  
Service Evaluation ◽  
Surgical Removal ◽  
Complication Rates ◽  
Third Molars ◽  
Information Giving ◽  
Mean Waiting Time ◽  
Minor Oral Surgery ◽  
Better Than

Aim To report the findings of a service evaluation of an NHS practice-based minor oral surgery service. Method A service evaluation including a retrospective analysis of activity and outcome data and assessment of patient and practitioner satisfaction. Results 623 appointments were arranged, with a mean waiting time of 43 days. Treatment provided included: surgical removal of third molars and non-third molars, surgical endodontics and other surgical and oral medicine cases (29.7%, 44.1%, 3.0% and 23.4% of cases respectively). Antibiotics were prescribed at 16.1 % of treatment appointments and 1.9% required appointments for post-operative complications. All participants reported overall satisfaction with their care and strongly agreed/agreed with positive attitudinal statements about the oral surgeon's communication/information giving, technical competence and understanding and acceptance; 77.5% were seen on time and none were seen more than 15 minutes late; 87.5% felt the standard of the service was better than expected than at a hospital and none felt it was worse. Over 80 of practitioners agreed that waiting times were better than expected at a hospital, urgent problems were seen quickly and the referral process was easy and understandable. All practitioners strongly agreed/agreed they that they were happy with the service provided. Conclusions A range of minor oral surgery procedures can be provided with low complication rates, acceptable waiting times and accessibility, and high patient and referring practitioner satisfaction from a practice-based specialist oral surgery service.

scholarly journals TO COMPARE THE EFFECT OF PRE-EMPTIVE DEXAMETHASONE AND METHYLPREDNISOLONE EITHER BY INTRAMUSCULAR OR BY SUBMUCOSAL ROUTE FOR THE POSTOPERATIVE CONTROL OF PAIN, SWELLING, AND LIMITED MOUTH OPENING FOLLOWING THE EXTRACTION OF IMPACTED THIRD MOLARS

2020 ◽  
pp. 1-7
Author(s):  
Kiran Shubha ◽  
Ravi Narula ◽  
Navneet Kaur
Keyword(s):  
Intramuscular Injection ◽  
Third Molar ◽  
Mouth Opening ◽  
Surgical Removal ◽  
Third Molars ◽  
Limited Mouth Opening ◽  
Submucosal Injection ◽  
Impacted Mandibular Third Molars ◽  
Mandibular Third Molars ◽  
Better Than

Introduction: The surgical removal of impacted mandibular third molars is an invasive procedure that involves extensive tissue trauma and a considerable postoperative inflammatory response. Although the inflammatory process is necessary for healing when exacerbated it may cause pain, swelling and limited mouth opening. Corticosteroids are among the most widely employed pre-operative medication administered for the control of such complications. Objective: To compare the effects of single dose of pre-operative Injection Dexamethasone versus Injection Methylprednisolone via Intramuscular or Submucosal route for controlling the post-operative pain, swelling and limited mouth opening in the removal of impacted mandibular third molars. Material and Method:. The present study was conducted on 40 healthy adult patients with bilaterally symmetrical impacted mandibular third molar, reporting to the Department of oral and Maxillofacial Surgery of Guru Nanak Dev Dental College and Research Institute, Sunam. Clinically, pain, swelling, mouth-opening were evaluated pre-operatively as baseline and post-operatively on 1st, 3rd and 7th post-operative days. Results: The results of our study are summarized below: In Group A: Submucosal injection of dexamethasone gave better results in controlling pain, swelling and trismus in comparison to Intramuscular injection of dexamethasone. In Group B: Submucosal injection of methylprednisolone showed better results in terms of pain, swelling and trismus when compared with Intramuscular injection of methylprednisolone. In Group C: Intramuscular injection of dexamethasone gave better results in terms of pain and mouth opening but, swelling was reduced with Intramuscular methylprednisolone. In Group D: Submucosal injection of dexamethasone showed better results in terms of pain, but swelling and mouth opening was reduced when methylprednisolone was used submucosal. Conclusion: The results of our study concluded that Dexamethasone is better than Methylprednisolone in controlling post-operative sequelae after third molar surgery. This can attributed to the higher potency and longer half-life and less sodium retaining capacity of dexamethasone than methylprednisolone. The results of our study also concluded that submucosal route of administration of drug is better than Intramuscular route because of the repository effect of the submucosal route, also this route is beneficial to the patient as well to the surgeon because needle penetration is done in the pre-anesthetized area, also it is an easy technique to be mastered by the surgeon.

scholarly journals Does a preoperative cone beam CT reduce complication rates in the surgical removal of complex lower third molars? A retrospective study including 486 cases

2021 ◽  
Vol 17 (1) ◽  
Author(s):  
Jan C. Klatt ◽  
Tony Sorowka ◽  
Lan Kluwe ◽  
Ralf Smeets ◽  
Martin Gosau ◽  
...  
Keyword(s):  
Neurological Disorders ◽  
Inferior Alveolar Nerve ◽  
Third Molar ◽  
Cone Beam ◽  
Surgical Removal ◽  
Complication Rates ◽  
Radiographic Imaging ◽  
Third Molars ◽  
Nerve Bundle ◽  
Neurological Damage

Abstract Backround This study was designed to analyse the value of preoperative Cone Beam CTs (CBCT) prior to the surgical removal of complex lower third molars. Furthermore, the aim was to assess injuries to the inferior alveolar nerve (IAN) bundle and postoperative neurological disorders depending on the position of the lower third molar and the inferior alveolar nerve bundle. Methods In this retrospective examination preoperative Cone Beam CTs and Orthopantomographs (OPT) of 324 patients were analysed concerning the location of the lower third molars in relation to the mandible and the inferior alveolar nerve bundle. Surgery protocols of all patients who underwent the surgical removal of at least one complex lower third molar were analysed concerning patient data, length of surgery, intraoperative haemorrhage, intraoperative exposure of the inferior alveolar nerve bundle, postoperative swelling and postoperative neurological disorders. The data was then compared to data from international studies. Results In all 324 patients a permanent neurological damage was not found. Temporary neurological damage was recorded in 13 cases (2.6%). A caudal nerve position with no measurable distance to the root of the lower third molar was associated with the highest risk of a temporal neurological damage. A vestibular touching nerve route also correlated with postoperative sensitivity impairment. If a mesioangulation (Winter) or a Pell and Gregory Type IIIC appears in the OPT, risk of neurological damage is at its highest. Conclusions Three-dimensional radiographic imaging, in our patient group, does not significantly affect the risk for complications during the surgical removal of complex lower third molars. Therefore, it should only be utilized for risk assessment, especially in cases of symptom-free lower third molars. A preoperative orthopantomogram still can be accepted as standard for radiographic imaging. An intraoperative exposure of the IAN bundle does not necessarily predict simultaneous neurological damage. Exposure of the IAN bundle is no indication for a discontinuation of the surgery.

scholarly journals Impact of electro-neuro-feedback on postoperative outcome of impacted lower third molar surgery

2018 ◽  
Vol 12 (01) ◽  
pp. 077-088
Author(s):  
Giacomo Oteri ◽  
Antonia Marcianò ◽  
Gabriele Cervino ◽  
Matteo Peditto
Keyword(s):  
Clinical Outcome ◽  
Biochemical Parameters ◽  
Oral Surgery ◽  
Third Molar ◽  
Postoperative Outcome ◽  
Third Molar Surgery ◽  
Surgical Removal ◽  
Third Molars ◽  
School Of Dentistry ◽  
The Impact

ABSTRACT Objective: The purpose of this study was to evaluate the impact of a treatment with electro-neuro-feedback (ENF), a portable transcutaneous electrical nerve stimulation (TENS) device, on the clinical outcome and inflammatory biochemical parameters related to the impacted lower third molar surgery. Materials and Methods: A randomized, split-mouth, and single-blind study was conducted on 32 patients requiring lower third molars extractions and referred to the Oral Surgery Unit of the School of Dentistry of the University of Messina. Every patient underwent surgical removal of both lower third molars. The first extraction included a placebo (electrodes placement with turned-off device) treatment following the surgery, while the second had the ENF used next to the avulsion and the following days. Clinical parameters were collected 4 days before, immediately after, 2, 4, and 7 days after the surgical procedure. Biochemical parameters were obtained 1 day before the surgical removal and 7 days after. Data were processed using Wilcoxon–Mann–Whitney test, with significance being set at P < 0.05. Results: Clinical outcome parameters showed a significant improvement after the ENF treatment, while considered inflammatory markers expressed different patterns. Conclusions: ENF, a reliable portable TENS device, has demonstrated to be a useful tool in the managing of the postsurgical phases, reducing edema, pain, and consequent pain-killers consumption.

scholarly journals The Growth Factors in Advanced Platelet-Rich Fibrin (A-PRF) Reduce Postoperative Complications after Mandibular Third Molar Odontectomy

2021 ◽  
Vol 18 (24) ◽  
pp. 13343
Author(s):  
Anna Starzyńska ◽  
Magdalena Kaczoruk-Wieremczuk ◽  
Michele Antonio Lopez ◽  
Pier Carmine Passarelli ◽  
Paulina Adamska
Keyword(s):  
Growth Factors ◽  
Postoperative Complications ◽  
Clinical Features ◽  
Oral Surgery ◽  
Third Molar ◽  
Surgical Removal ◽  
Third Molars ◽  
Platelet Rich Fibrin ◽  
Impacted Mandibular Third Molars ◽  
Mandibular Third Molars

Surgical removal of impacted mandibular third molars constitutes one of the most frequently performed procedures within oral surgery. This surgery procedure is associated with many post-operative complications. Advanced platelet-rich fibrin (A-PRF) belongs to the second generation of platelet concentrates and is rich in numerous growth factors. The aim of this study was to assess the influence of A-PRF on selected clinical features following the surgical removal of impacted mandibular third molars. The research was conducted on 100 generally healthy patients, who underwent a lower third molar odontectomy in Department of Oral Surgery, Medical University of Gdańsk, Poland, between 2018 and 2019. The research group consisted of 50 patients (immediate A-PRF socket filling) and control group (50 patients without A-PRF socket filling). During the study, the following clinical features were assessed: pain (visual analog scale), analgesics intake, the presence of trismus, edema, hematomas within the surrounding tissues (e.g., cheek), prevalence of pyrexia, dry socket, secondary bleeding, presence of hematomas, skin warmth in the post-operative area, and bleeding time observed by the patient were analyzed on the 3rd, 7th, and 14th day after the procedure. There was a significant association between A-PRF socket filling and pain intensity, the analgesics intake, trismus, and edema on the 3rd and the 7th day (p < 0.05). The presence of hematomas and skin warmth on the 3rd day after the surgery (p < 0.05) were also statistically associated with A-PRF use. The study showed that in reducing the incidence of postoperative complications, A-PRF was more important than the position of the tooth or the duration of the procedure. The growth factors in A-PRF reduce postoperative complications, such as pain, trismus, edema, analgesics intake, presence of hematomas, and skin warmth, after mandibular wisdom teeth odontectomy.

scholarly journals Does a preoperative Cone Beam CT reduce complication rates in the surgical removal of complex lower third molars? A retrospective study including 486 cases.

2020 ◽  
Author(s):  
Jan Klatt ◽  
Tony Sorowka ◽  
Lan Kluwe ◽  
Ralf Smeets ◽  
Martin Gosau ◽  
...  
Keyword(s):  
Neurological Disorders ◽  
Inferior Alveolar Nerve ◽  
Third Molar ◽  
Cone Beam ◽  
Surgical Removal ◽  
Complication Rates ◽  
Radiographic Imaging ◽  
Third Molars ◽  
Nerve Bundle ◽  
Neurological Damage

Abstract Backround This study was designed to analyse the value of preoperative Cone Beam CTs (CBCT) prior to the surgical removal of complex lower third molars. Furthermore, the aim was to assess injuries to the inferior alveolar nerve (IAN) bundle and postoperative neurological disorders depending on the position of the lower third molar and the inferior alveolar nerve bundle.Methods In this retrospective examination preoperative Cone Beam CTs and Orthopantomographs (OPT) of 324 patients were analysed concerning the location of the lower third molars in relation to the mandible and the inferior alveolar nerve bundle. Surgery protocols of all patients who underwent the surgical removal of at least one complex lower third molar were analysed concerning patient data, length of surgery, intraoperative haemorrhage, intraoperative exposure of the inferior alveolar nerve bundle, postoperative swelling and postoperative neurological disorders. The data was then compared to data from international studies. Results In all 324 patients a permanent neurological damage was not found. Temporary neurological damage was recorded in 13 cases (2.6%). A caudal nerve position with no measurable distance to the root of the lower third molar was associated with the highest risk of a temporal neurological damage. A vestibular touching nerve route also correlated with postoperative sensitivity impairment. If a mesioangulation (Winter) or a Pell and Gregory Type IIIC appears in the OPT, risk of neurological damage is at its highest.Conclusions Three-dimensional radiographic imaging, in our patient group, does not significantly affect the risk for complications during the surgical removal of complex lower third molars. Therefore, it should only be utilized for risk assessment, especially in cases of symptom-free lower third molars.A preoperative orthopantomogram still can be accepted as standard for radiographic imaging. An intraoperative exposure of the IAN bundle does not necessarily predict simultaneous neurological damage. Exposure of the IAN bundle is no indication for a discontinuation of the surgery.

scholarly journals Incidence of impacted mandibular third molars in population of Bosnia and Herzegovina: a retrospective radiographic study

2013 ◽  
Vol 3 (2) ◽  
pp. 151-158 ◽  
Author(s):  
Sadeta Šečić ◽  
Samir Prohić ◽  
Sanja Komšić ◽  
Amra Vuković
Keyword(s):  
Bosnia And Herzegovina ◽  
Statistical Difference ◽  
Oral Surgery ◽  
Third Molar ◽  
Dental Arch ◽  
Surgical Removal ◽  
Third Molars ◽  
Dentigerous Cysts ◽  
Impacted Mandibular Third Molars ◽  
Mandibular Third Molars

Introduction: Impaction may be defined as the failure of complete eruption into a normal functional position of one tooth within normal time due to lack of space in the dental arch, caused by obstruction byanother tooth or development in an abnormal position. The mandibular third molar is the most frequently impacted tooth. The incidence varies from 9.5% to 68% in different populations.Methods: The study was conducted in Department of Oral Surgery, Faculty of Dentistry, University in Sarajevo. Study represents retrospective analysis of panoramic radiographs (orthopantomograms) of patientsreferred to Department of Oral Surgery from January 2010 to February 2013 with indication for surgical removal of impacted third molars.Results: Of the 2000 radiographs, 761 presented with at least one impacted third molar (38%). A total of 1034 impacted mandibular third molars were present (51.7%). The most common age group was thirddecade (61.2%). Signifi cant statistical difference in incidence of third molar impaction was found between females and males (p<0.05), but there was no statistical difference in incidence in urban and suburbanpopulation (p=0.374). Vertical angulation was the most common pattern of impaction (65%). Frequency of third molars erupted into their normal position (class IA) was 42%. Impacted mandibular molars wereassociated with periodontal pockets in 134 (6.5%) cases and with dentigerous cysts in 5 cases (0.2%).Conclusion: The present study provides useful data regarding the clinical status of third molars in population of Bosnia and Herzegovina.

Improving Access to Oral Surgery Services in Primary Care

2009 ◽  
Vol os16 (4) ◽  
pp. 137-142 ◽  
Author(s):  
Nick Kendall
Keyword(s):  
Primary Care ◽  
Oral Surgery ◽  
Waiting Times ◽  
Primary Care Trust ◽  
Hospital Setting ◽  
Substantial Improvement ◽  
Dental Services ◽  
Collaborative Working ◽  
World Class ◽  
Further Development

This paper describes the innovative use of National Health Service (NHS) dental commissioning powers to develop specialist primary care based oral surgery services. The outcomes, after one full year of the scheme, have been substantial improvement in access and reduced waiting times for patients, further development of NHS primary care dental services through commissioning processes, increased use and engagement of oral surgery specialists outside of a hospital setting, and considerable ongoing savings to the NHS. Collaborative working between hospital consultants and managers, Primary Care Trust dental commissioners, general dental practice providers, specialist oral surgeons and a dental public health consultant has resulted in sustainable benefits to patients and the NHS within the World Class Commissioning framework.

493 Evaluation of Patient Waiting Times for Plain Radiographs Whilst Attending Outpatient Clinics in A Tertiary Orthopaedic Centre

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
Z Hayat ◽  
E Kinene ◽  
S Molloy
Keyword(s):  
Waiting Time ◽  
Waiting Times ◽  
Time Frame ◽  
Outpatient Clinics ◽  
Contributing Factors ◽  
Time Data ◽  
Work Related ◽  
Mean Waiting Time ◽  
Appointment Time ◽  
Related Stress

Abstract Introduction Reduction of waiting times is key to delivering high quality, efficient health care. Delays experienced by patients requiring radiographs in orthopaedic outpatient clinics are well recognised. Method To establish current patient and staff satisfaction, questionnaires were circulated over a two-week period. Waiting time data was retrospectively collected including appointment time, arrival time and the time at which radiographs were taken. Results 84% (n = 16) of radiographers believed patients would be dissatisfied. However, of the 296 patients questioned, 56% (n = 165) were satisfied. Most patients (89%) felt the waiting time should be under 30 minutes. Only 36% were seen in this time frame. There was moderate negative correlation (R=-0.5); higher waiting times led to increased dissatisfaction. Mean waiting time was 00:37 and the maximum 02:48. Key contributing factors included volume of patients, staff shortages (73.7%), equipment shortages (57.9%) and incorrectly filled request forms. Eight (42.1%) had felt unwell from work related stress. Conclusions A concerted effort is needed to improve staff and patient opinion. There is scope for change post COVID. Additional training and exploring ways to avoid overburdening the department would benefit. Numerous patients were open to different days or alternative sites. Funding requirements make updating equipment, expanding the department and recruiting more staff challenging.

scholarly journals Evaluation of Panoramic Radiographs in Relation to the Mandibular Third Molar and to Incidental Findings in an Adult Population

2020 ◽  
Author(s):  
Josefine Cederhag ◽  
Nina Lundegren ◽  
Per Alstergren ◽  
Xie-Qi Shi ◽  
Kristina Hellén-Halme
Keyword(s):  
Incidental Findings ◽  
Adult Population ◽  
Inferior Alveolar Nerve ◽  
Third Molar ◽  
Patient Positioning ◽  
Vertical Position ◽  
Surgical Removal ◽  
Third Molars ◽  
Panoramic Radiographs ◽  
The Third

Abstract Objectives The aim was to evaluate the characteristics of the mandibular third molars, especially in relation to the inferior alveolar nerve. Further aims were to investigate incidental findings in panoramic radiographs in an adult population, and to investigate image quality related to patient positioning. Materials and Methods From a previous study with 451 randomly selected adult participants who lived in Sweden, 442 panoramic radiographs from four dental public health clinics were used. The third molars’ characteristics and relation to inferior alveolar nerve were evaluated. Incidental findings and patient positioning were recorded. Statistical Analysis Frequency analysis was used to investigate the occurrence of all findings and their possible interconnections. Whether the patients’ age or gender had an impact or not was also analyzed. Results The third molars were erupted in vertical position among 73% regardless of age. When retained or semi-retained, they were most commonly in mesioangular positions. The inferior alveolar nerve was located inferior to the roots in 52%, whereas an overlapped position was most common if the third molar was retained (90%), semi-retained (83%) or the age was less than 30 years (66%). Common incidental findings were apical radiolucencies, idiopathic osteosclerosis, and tooth fragments. Suboptimal patient positioning was found in one-third of the radiographs. Conclusions Panoramic radiography is a useful method to evaluate third molar prior to surgical removal and may be the only image required. Most incidental findings on panoramic radiographs does not seem to require any further odontological management.

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