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welcome

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by

atamna hamood

on 9 April 2016

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Transcript of welcome


Clinical case 1

Name: Radu L.
Age: 1994
Sex: male
Address: Chisinau

welcome
Ministry of Health of the Republic of Moldova
State University of Medicine and Pharmacy
"Nicolae Testemitanu”

Faculty of Dentistry The Department of Stomatological Propaedeutics and Dental Implantology “P. Godoroja”

"pericoronitis"
surname:- alemi ahmed
5th year,group 3516
Scientific adviser Dr. Natalia Dacin

Chisinau 2014
introduction
Pericoronitis also known as operculitis, is inflammation of the soft tissues surrounding the crown of a partially erupted tooth,including the gingiva (gums) and the dental follicle. The soft tissue covering a partially erupted tooth is known as an operculum, an area which can be difficult to access with normal oral hygiene methods.The synonym operculitis technically refers to inflammation of the operculum alone.
Pericoronitis is often associated with partially erupted and impacted mandibular third molars (lower wisdom teeth),often occurring at the age of wisdom tooth eruption (15-24). Other common causes of similar pain from the third molar region are food impaction causing periodontal pain, pulpitis from dental caries (tooth decay), and acute fascial pain in temporomandibular joint disorder.
The most highest frequency of pericoronitis occurrence is registered at the age between 21 and 30 years - 77.8% which represents the age with a very high work capacity.
Women suffer of acute pericoronitis more often than men - 71.9%, which can be explained by the small size of the facial skeleton.

Goal
The purpose of this study is to evaluate the optimal surgical treatment of pericoronitis avoiding postoperative complications and relapse.
Objectives
1. Detailed analyses of bibliographical and statistical data about pericoronitis.

2. Complete study of contributory factors to pericoronitis occurrence.

3. Analyze optimal treatment methods in different types of pericoronitis and underlying teeth.

Classification of acute pericoronitis
A. serous acute pericoronitis (congestive )

B. acute purulent pericoronitis ( suppurative )

Etiology
Pericoronitis occurs because the operculum creates a "plaque stagnation area", which can accumulate food debris and micro-organisms (particularly plaque). This leads to an inflammatory response in the adjacent soft tissues.
Sometimes Pericoronal infection can spread into adjacent potential spaces (including the sublingual space, submandibular space, parapharyngeal space, pterygomandibular space, infratemporal space, submasseteric space and buccal space ) to areas of the neck or face resulting in facial swelling, or even airway compromise (called Ludwig's angina)

Symptoms
• Pain • Tenderness, erythema
• Halitosis resulting from the bacteria putrefaction of proteins
• Bad taste in the mouth from exudation of pus
• Intra-oral halitosis
• Formation of pus
• Signs of trauma on the operculum
• Trismus
• Dysphagia
• Cervical lymphadenitis
• Facial swelling, and rubor
• Pyrexia (fever).
• increased white blood cell count.
• Malaise (general feeling of being unwell
• Loss of appetite
• The radiographic appearance of the local bone can become more radiopaque in chronic pericoronitis.
Clinical diagnosis
Symptoms of acute pericoronitis
pericoronitis include lymphadenitis (submandibular and portions of the deep cervical lymph nodes), facial/cervical edema, and erythema, edema and tenderness (upon palpation) of the operculum surrounding the third molar, malaise, bad taste/breath, purulent exudates (expressed upon palpation) and occasionally loss of appetite. When left untreated, fever is a common finding.

Symptoms of Sub-acute pericoronitis
sub-acute attacks generally lack systemic involvement (e.g. fever) and lymphadenitis is typically limited to the submandibular nodes.Rarely, severe acute attacks will result in fever above 101° F, cellulitis and severe uncontrolled discomfort.

Symptoms of chronic pericoronitis
butthey include palpable non-tender submandibular lymph nodes and macerated buccal tissue consistent with cheek biting. Chronic recurrence following an acute episode is likely to occur in 3 to 15 months

Treatment
The treatment of acute pericoronitis preferentially takes place in outpatient, the laboratory investigations are not characteristic for such patients.
The treatment of acute pericoronitis may be :
a. Medicamentary
 Local
 General
b. Surgical
 Conservative
 Radical

In the presence in the pericoronal space of suppurative inflammation manipulations above mentioned are preceded by pericoronotomy, the incision of the hood, under local or loco-regional anesthesia, allowing drainage of purulent focus . To prevent the evolution of the inflammatory process is administered the treatment with antibiotics, analgesics, desensitizing drugs. The election drug in the antibiotic treatment are penicillin drugs in association with anti-beta-lactamase drugs - sulbactam or clavulanic acid . Also, are recommended using the immune-modulatory drugs . Nonspecific vaccines, vitamin therapy may be administered
Under local or loco-regional anesthesia is made a circumscribed incision around the crown of third molar starting with disto-oral angle of the second molar and ending with the disto-buccal angle of the same tooth . Is applied Iodoform bandage in the wound, bearing function to prevent relapse of the hood and at the same time, protects the wound antiseptically.
To increase the success of the intervention, and in order to reduce postoperative symptoms and the treatment period can be applied diatermocoagulator incision. Using thermal knife ensures the operative wound hemostasis, substantially decreases the degree of postoperative discomfort to patients.
In literature data are reported the use of surgical laser in spending this intervention. When applying photon scalpel is required a more complicated and laborious technique. This is caused by the need for mucosal and wisdom tooth protection from laser action to exclude the combustion. Mucosal protection can be achieved with soaked gauze, the tooth is protected by placing a waterproof screen for laser surgery.

Bacteria
Tooth position
General data
Complaints: pain in left mandibular posterior region, food retention, sometimes bleeding at teethbrushing or mastication.
Anamnes morbis: these symptoms appeared 6 months ago, last for a week then disappeared, so was 2-3 times, at the dentist he didn’t address.
Anamnes vitae: developed well, no physical and psychological problems. Hepatitis, AIDS – negative, allergies absent, no bed habits, he doesn’t suffer from general diseases. Teeth brushing he performs regularly, two times a day.

Examination
Intraoral examination: tooth number 38 erupted on the dental arch in correct position, disto-occlusal side is totally covered by oral mucosa, which is with hyperemia and edema. At palpation the mucosa is painful and is bleeding, under it are left food rests.
Diagnosis: Acute serous pericoronitis of the tooth number 38.
Treatment
Mandibular nerve block at Spina Spix and Buccal nerve block
Circumscribed incision around the crown of tooth 38, overlying mucosa excision
Antiseptical process of the wound with H2O2, and Furacillin solution
Applying of iodoform bandage for 2 days.
Local and general treatment indicated to the patient
Clinical Case 2
Name: Andre .L .
Age: 1989
Sex: male
Address: Chisinau

General data
Complaints: pain in left mandibular posterior region, food retention, sometimes bleeding at teeth brushing or mastication.
Anamnes morbis: these symptoms appeared 7 months ago, last for a week then disappeared, so was 2-3 times, at the dentist he didn’t address.
Anamnes vitae: developed well, no physical and psychological problems. Hepatitis, AIDS – negative, allergies absent, no bed habits, he doesn’t suffer from general diseases. Teeth brushing he performs regularly, two times a day.

Examination
Intraoral examination: tooth number 38 erupted on the dental arch in correct position, disto-occlusal side is totally covered by oral mucosa, which is with hyperemia and edema. At palpation the mucosa is painful and is bleeding, under it are left food rests
Diagnosis: Acute serous pericoronitis of the tooth number 38 and need to extract it
Treatment
• Mandibular nerve block at Spina Spix and Buccal nerve block.
• Circumscribed incision around the crown of tooth 38, overlying mucosa excision.

remove the periocoronitis
• Extraction of the tooth 38.


• Antiseptical process of the wound with H2O2, and Furacillin solution.
• Suture the wound.
• Anti inflammatory solution.
Was based on the observation of 124 patients, which were addressed to Republican Dental Polycliniclinic and were diagnosed with one or the other pathologies of third molar eruption. Of the total number of cases were detected 22 cases of acute pericoronitis, which is 17.74%, of which the serous have proved to be 9 (7.25%) and purulent - 13 (10.48%) . Patients report proved to be gender female priority, (63.15% female), men - 31.81%. The average age of patients suffering from acute pericoronitis, is 25 - 26 years.
conclusions
Work being accomplished objectives given at the same time research has raised a number of unresolved questions in the field, causing concern to a larger study , specialized and qualified in the future.

1-) The patient that suffering from the III molar eruption 17.74% of thus patient have acute pericoronitis , 7,25% have a serous periocoronitis , 10,48% have purulent.
63.15% female , men 36.85%. With the average age 25 - 26 years.
33.33% of patient have the tissue edema, 22,22% of patient have the fever , 69.23% of the patient have disturbance function stomatognathic system. Treatment: extraction was performed in 84.61 %

2-) - Etiology : Pericoronitis occurs because the operculum creates a "plaque stagnation area", which can accumulate food debris and micro-organisms. This leads to an inflammatory response in the adjacent soft tissues.
- Signs and symptoms: pain, redness, swelling, bad taste.
- Classification: A:serous acute pericoronitis B. acute purulent pericoronitis.
- Treatment : A: Medicamentary B: Surgical.
.

3. Studying different existing methods of pericoronitis treatment I assume that each case is individual depending on the patient symptoms, objective data, underlying tooth state and position and of course, on patient desire. If the tooth under the hood has correct position and space on the dental arch than just operculectomy is indicated and the tooth is preserved. If the underlying tooth is partially impacted and with dystopia then there is used a radical surgical treatment of pericoronitis – tooth extraction.


Multumim pentru atentie
Thanks for attention
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