Oral Surgery: Lec.1 Part 1 DR - Nawres Bahaa Oral and Maxillofacial Surery

ORAL SURGERY
Lec.1 part 1
Dr.Nawres Bahaa
ORAL AND MAXILLOFACIAL SURERY:-
Definition: it's one of the dental specialties dealing with management of
diseases, injuries and defects of human jaws and associated structures. Oral
surgery forms the connecting link between medical and dental specialties.
Diagnosis in surgery:-
Oral diagnosis is the art of using the scientific knowledge to identify the
oral diseases and also to distinguish one disease from another.
The diagnostic process classically involves the following steps:
1- History taking
2- Clinical examination.
3- Investigation.
4- Provisional diagnosis.
5- Definitive diagnosis and treatment plan.
In oral surgery practice, clinician is often faced with the diagnosis of

the Following conditions:-
1- Dental and facial pain.
2- Swelling (lump, mass).
3- Ulcers.
4. Injuries (dental, facial bones).
5- Temporomandibular joint problems.
6- Medically compromised patient.
7- Facial deformity.
History taking:-
The art of taking an accurate case history is probably the most important Single
step in the diagnosis of medical or surgical conditions. History taking should be
systematic, using special set or sequences. During history taking the clinician
or the dental surgeon listen to the patient's story or talks and list the symptoms
in order of severity or importance by patient's words.
Symptoms:-
Means a subjective problem that the patient describes e.g. pain. Paraesthesia
Signs:-
Means an abnormal presentation detectable by the clinician(objective), e.g.
swelling, ulcer. So detection of signs and symptoms of a disease may aid
in diagnosis of that disease.
Objectives of taking history:-
1- To provide the dentist with information that may be necessary for
making diagnosis.
2- To establish a good or positive professional relationship with the
patient which affect cooperation and confidence.
3- To provide dentist with information concerning patient's past and
present medical, dental and personal history.
4- To provide information about patient's systemic health which may greatly
affect the treatment plan and prognosis and diseases that could be transmitted
to the dentist, his staff or other patients.
5- It serves as a legal document.
How can you take history:-
During history taking the dentist should encourage his patient to describe
his symptoms in his own words, interrupting his story only to explain a
point or stop a useless talk.
A clear and concise summary of patient's complaints should be recorded in
the case sheet. The symptoms should be recorded or being listed in order of
its importance (e.g. pain, swelling, bleeding).
During taking the history give your patient your whole attention and never
take shortcuts(try to be a good listener).
You have to avoid speed in taking the history, so you have to give the patient
a suitable time to give all information, because hurry in taking history may
lead to many pitfalls that affect the accuracy or completeness.
You have to avoid the leading questions (e.g. does the pain comes on taking
hot or cold?) It's better to ask him what is or what are the things that brings
pain to you? Or anything hurt you?
During taking history don't depend on the patient diagnosis or the diagnosis of
a previous doctor, so you have to ask the patient to describe his complaining
only to establish your diagnosis process.
Components of the patient history:-
The case history may include commonly the following sections or components:-
1 - Biographic data (personal history).
2- Chief complaint (C.C).
3- History of the chief complaint (history of the present illness) H.P.I.
4- Past dental history( P.D.H.)
5- Medical history and systems review(M.H).
6- Family history.
Biographic data:-
Includes the full name of the patient, age, sex, address and telephone number
and occupation, these information may aid or contribute to the diagnosis since
some medical problems have a tendency to occur in a particular age group,
sex or race. The patient occupation maybe associated with a particular disease
or may influence the type of therapy.
Chief complaints (C.C):-

The chief complaint is usually the reason for the patient's visit. The chief
complaint(s) is best stated in the patient's own words in a brief summary of the
problems (e.g. pain, swelling, and ulcer. Paraesthesia, numbness, clicking,
halitosis, bleeding, trismus). If the patient complaining of several symptoms
in such case they should be listed, but with the major complaint first.
History of the present illness (H.P.I):-

This part of the story must be gone into complete details and let the patient to
tell the story in his fashion, never ask the patient leading questions and you
have to see if the patient in a condition able to give you a history which is
reliable and his statement can be relied upon. In some conditions like children
or mental retarded patients we can rely on parents or other relatives. It's best to
start by asking the patient :-
1- Duration (record the length of the complaint).
2- Onset (date of onset, manner of onset).
3- Precipitating/predisposing factors, (e.g. hot, cold, sweet).
4- Characteristic, and this includes:-
a) Nature e.g. (continuous, intermittent, stabbing).
b) Severity e.g. mild, sever, very sever).
c) Location.
d) Radiation (feeling of pain in site other than that of causative lesion,
called referred pain).
e) Temperature features.
f) Aggravating-factors,
g) Relieving factors.
h) Associated constitutional symptoms and signs.
5- Course and progress.
6- Therapy:-
a) Type of therapy and dose and Provider.
b) Effect of therapy
c)Date of therapy,
7- Other information.
So if the patient comes with a chief complaint (pain) very detailed history of
the pain should be taken and particular attention paid to the following points
a) The duration of pain: Whether any incident which might have played some
part in the aetiology of the pain precede its onset (e.g. a blow on the jaw.
dental treatment), duration record the length of the pain.
b) Site of the pain: The patient should be asked to point to the place where
the pain is felt, using his finger.
c) Any radiation of the pain: If the pain radiates, the patient should be asked to
demonstrate its course with the tip of his finger. On other occasions pain maybe
felt in a site other than of the causative lesion or remote from the diseased area
and this type called "referred pain", e.g. pain of pericoronitis radiates to the ear.
d) The precise characteristic of the pain: the pain maybe described as sharp,
sever, dull, throbbing, excruciating, lancinating, mild, continuous, intermittent, all
these objectives can be applied to the pain in different pathological process which
may help you in the diagnosis. (In acute pulpitis, the pain is sharp and sever, in
acute dental abscess the pain is dull, throbbing and sever and the tooth tender, in
acute maxillary sinusitis the pain is dull, throbbing and continuous).
e) Timing of pain: Some pains are characteristically worse at particular time
in the day e.g. pulpal pain often wakens the patient at night and tend to keep
him awake, in acute periodontitis the pain is worse at meal time.
f) Any factors which precipitate the pain: Pulpal pain is often precipitated by
thermal and osmotic stimuli, hot, cold, sweet). Periodontal pain often
precipitated by biting and chewing.
g) Factors or Any drugs which relieve the pain: This will give you an idea
about the nature, severity and duration of the pain
h) The presence of other symptoms: Like the patient that says that the pain
started for two days, then a swelling appeared after that or discharging sinus
appeared or a discharge of pus, or pain, swelling then Paraesthesia of the lower
lip...etc.
i) The patient also may be asked about relevant past medical history which may
assist you in the diagnosis of the pain like patient with Facial pain of vascular
origin like migraine, or chronic psychosomatic origin or angina (angina pectoris)
pain. In addition to that the patient asked about his opinion of the cause of
the pain.
Another example of complaint is:-
Patient presented with a "lump or mass":-
The oral surgeon must be ascertain by asking some questions:
1 - How long the swelling has been present 2- Whether it is getting larger
or smaller or fluctuated in size. 3- What are the symptoms of the lump: The
lump maybe painful or not. If the lump is associated with Paraesthesia or
numbness of the lower lip for example.
4. Whether there is any possible cause for the swelling e.g. trauma,
injuries. or systemic illness known to the patient.
5- What made the patient notice the lump? By feeling or because it is
painful or someone else noticed it and told him.
Past dental history (P.D.H):-

The past dental history includes:-
1- The frequency of previous visits (eg, previous extractions or oral
surgical procedures),
2- Any difficulties or complications (e.g. excessive bleeding or fainting).
3- Determination of the availability of past dental or oral radiographs. In
other words, it is important to ask the patient about any type of dental or oral
treatment received before, and if there is any complications or un satisfaction
arise and his impression about the type of treatment
Medical history and systems review (M.H):-
The patient's medical history includes review, the past and the present illness
or diseases because:-
1- These information (M.H) may aid in the diagnosis of various
conditions occurring or has oral manifestations that are related to
specific systemic disease (e.g. aids, leukemia).
2- The presence of many diseases may lead or need modification for
the treatment plan, and affect the manner in which therapy is provided.
3- Drugs used in treatment of some systemic diseases can also have effects
on the mouth (have oral manifestations), or dictate some modifications to the
dental or surgical treatment (e.g. anticoagulant drugs, chemotherapy).
The past medical history includes:-
1 - Previous serious illness or diseases.
2- Childhood diseases.
3- Hospitalization.
4- Operations.
5-Injuries to the head and neck.
6- Allergy to drugs or general allergy.
7- Listing of medication taken in the last six months.
Some examples of serious illness:-
Heart attack or diseases (e.g. myocardial infarction, angina pectoris).
Stroke (cerebrovascular accident C.V.A).
Hypertension.
Heart failure.
Bleeding disorders.
Diabetes.
Rheumatic fever or disease.
• Hospitalizations may indicate past disease and how it was treated.

• Aids (acquired immune-deficiency syndrome).
• Viral hepatitis.
Neoplasm and the method of treatment (surgical, cytotoxic drugs) especially
if the growth in the head and neck region or previous radiation (radiotherapy)
• Allergic reaction to drugs.
Review of the systems: Is that part of medical history covering each major system
of the body. Review of systems lead to concentration on the signs and symptoms
related to that system disorders, which dictate us to more investigations or
referring of the patient for medical evaluation and preparation.
The review of systems includes:-
Cardio vascular system, respiratory system central nervous system,
genitourinary system, musculoskeletal system, endocrine system, ears, eye,
vital signs (blood pressure, pulse, temperature, respiratory rate)

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ORAL SURGERY

In oral surgery practice, clinician is often faced with the diagnosis of

Chief complaints (C.C):-

History of the present illness (H.P.I):-

Past dental history (P.D.H):-

• Hospitalizations may indicate past disease and how it was treated.

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