MEDICAL COMPROMISES IN DENTAL PRACTICE

Dental treatment such as tooth extraction is an invasive therapy which could damage the tissues and cause systemic complication. There are 9 medical compromises in dental practice, which are:

1. Syncope (vasovagal syncope)
2. Hypoglycemia
3. Lidocaine toxic reaction
4. Angina pectoris
5. Stroke (cerebral vascular accident)
6. Epilepsy attack (epileptic seizure/ fit)
7. Asthma (asthmatic attack)
8. Infarct myocardium
9. Shock anaphylactic

The percentage of compromises is 90% from syncope and 10% from the rest. As a dentist, syncope might be the most medical compromise to deal with. It is important to understand how to treat this condition. The quick and exact action is needed to maintain respiration (ventilation) and heart rate until the patient get definitive treatment. Thus, Basic Life Support is considered as everybody’s competence, not just paramedic like doctor, dentist, nurse, but also non paramedic like housewife.

GENERAL PROCEDURE

The general procedure consists of assessment in AIRWAY, BREATHING, CIRCULATION, and DISSABILITY, which is shortening as A-B-C-D. This assessment is important because it will help determining the emergency type and intervention could be done exactly. There are two things to keep in mind:

(1) ABCD assessment and intervention does not stand alone. If there is an airway problem, then we need to do breathing intervention. And if there is a breathing problem, then we need to do circulation intervention, and so fort.

(2) It has to be done in a series and recur. For example: when doing “C” aspect assessment, “A” and “B” evaluation also must be done.

A. AIRWAY

Assessment results are:

1. Free airway => no obstruction
2. Blocked airway => half obstruction
3. Clogged up airway => total obstruction

The airway obstruction occurs when skeletal muscle tonus decreasing. So, patient with unconscious condition need to be observed carefully. It can be helped by doing this action as follow:

1. Clean the oral cavity from foreign thing, for example denture
2. Suck saliva which accumulated in orofaring using suction apparatus
3. Do chin lift or jaw thrust in order to avoid tongue to drop to the posterior area

Chin lift is done to the patient with half conscious. Jaw thrust is done to total unconscious patient, because if the patient is conscious, he will be nervous as this technique press the angulus mandibula.

B. BREATHING

If the patient is unconscious, the breathing assessment needs to be done as follow:

1. Look => up and down movement of patient thorax
2. Listen => breathing voice
3. Feel => patient gasp by putting ear and cheek near enough to ensure while the breathing is adequate or not.

The normal frequency is 12-16 times/ minute. If it is more than 25 times/ minute, it shows a respiratory distress. While if it less than 8 times/ minute, it is said that as bradypneu (breath depression).

Unconscious patient who experiencing conscious lost/ reduction needs to be given pure oxygen (O₂ 100%) with flow 6-8 liter/ minute through face mask. This oxygen also needs to be moistened in order to avoid stimulation respiration gland secretion and causing blocked respiration way.

C. CIRCULATION

The circulation parameter is:

1. Pulse : pulse rate, strength, rhythm
2. Blood pressure

The mean artery pressure could be measured by adding 1/3 diastole and 2/3 systole. Those are influenced by two factors, which are: (1) cardiac output (heart rate x stroke volume) and (2) blood vessel (vascular resistance). For example: a patient who experiences anaphylactic shock => venous return decreasing, but the blood volume is constant.

The normal pulse is about 70 times/ minute. if the pulse is more than 90 times/ minute and weak, then the pulse is less than 80mmHg. If the pulse (radial artery) is not palpated and weak, trying palpated the carotid artery. It the carotid artery is able to be palpated, the systolic pressure is 60mmHg, and does the intervention immediately to repair the cerebral blood flow. Don’t forget to put the patient in supine position or shock position.

D. DISSABILITY (Neurologic Disturbance)

The assessment consists of:

1. Consciousness

- level of consciousness: decreasing or lost

- conscious disorsder

2. Motoric system

Pericoronitis

Pericoronitis is a swollen gum which surrounded tooth crown area. The swelling usually happened surrounded a partially erupted third molar of mandibular (wisdom teeth).

The Symptoms

Redness on gum, sometimes with pus, pain if touched, swelling cheek, limited mouth opening. Sometimes, the pain spreads to the neck and ear area.

Why can it happen?

1. The open gum around the tooth becomes food accumulation tooth place and bacteria reproduction house. The inflammation on this area cause swelling gum.
2. The swelling gum may cause the upper tooth to bite down on the lower gum especially during the chewing period and it will cause more pain.

What should we do?

1. Wash your mouth with warm salty water or antiseptic mouthwash
2. If the pain continues, call your dentist immediately

Swollen Gum

Gum is a periodontal tissue which is very sensitive to oral cavity condition. Tooth and oral disease usually characterized with swollen gum and pain.

Why can this happened?
Swollen gum can be caused by the infection in the decayed tooth. Swollen on a gum surface can continue to deeper tissue and cause an inflammation. If we don't treat it properly, bacteria will multipicate and the gum is getting more swollen, sometimes accompanied by pus.

Symptoms
1. Swollen usually accompanied by fever and pain.
2. The swollen area is soft when it touched.

Treatment:

1. Wash your mouth with warm salty water or antiseptic mouthwash according to direction of use.

2. Visit the dentist for further treatment.

Tooth pain

Tooth pain can be caused by inflammed tooth pulp or pulpitis. The pain usually very great and disturbing.

How can this happened?
1. Big tooth decay which reaches the tooth pulp (tooth part which contain nerves and blood vessels).

2. Fractured teeth involving the tooth pulp.




What can we do?
1. Take the analgesic medication to reduce the pain

2. Wash your teeth with traditional ingredient.
How to make it? Mix together 2 pieces of crushed betel leaves, one teaspoon of salt, and one glass(200 ml) of hot water. Stir until salt is dissolved. Wait until cool.

3. Visit your dentist immediately.

Fractured Tooth

Fractured tooth is the missing of a tooth part including the tooth crown or the root. Fractured tooth usually caused by trauma. If the damage were involving most part of the tooth, you will feel the pain. The pain happened because the damage were involving the tooth nerves. The pain can be continous or intermittent. But if there's only a little damage in the tooth, sometimes we can't feel the pain.

How can this happened?
Fractured or cracked tooth, usually caused by trauma, for example biting hard things, or because of an accident. In children, fractured tooth can be happened because they falled while playing. Big caries on the tooth can also caused the fractured tooth.

What to do?
1. If a big piece of tooth was fractured, and you can find that piece, clean it with the flowing water and bring it to the dentist, as soon as possible. For some situation, the piece of fractured tooth can be put back on the tooth.

2. When bleeding, take the cottons and push the bleeding area with the cottons in about 10 minutes until it stop bleeding.

3. If you feel the pain, you can compressed the surroundings area with the ice bag.

4. After doing emergency treatment, visit your dentist as soon as possible to get the next  treatments.

the proper way in handling fractured tooth is the key off successful treatment

Avulsed Tooth!

Avulsed tooth (loss of tooth from it place) may be caused by problems on the periodontal tissue and traumatized teeth (eg accidents, knock, fall, etc.). In some circumstances, avulsed tooth can be restored to its original position, called replantation.

What can we do?

1. Keep your gum clean.

2. If the tooth is dirty, clean it under flowing water. Always always hold the teeth in the crown.

3. Visit your dentist immediately.



4.During the trip to the dentist, put the tooth under the tongue, or the vestibule mouth, or in a glass of milk

Food, Drink, and Caries 

Sweet food and drink, is still being the main predisposing factor of caries, especially for childrens. Microorganism will stay and change glucose to acid which can make a caries on a tooth. After eat a sweet food, you must rinse your mouth and brush your teeth. Beside sweet food, soda also have a negative effects for the teeth, because it has a low PH so it can broke the enamel.

To avoid all the negative effects from thatkind of food and drink, clean your teeth by rinse your mouth and brushing after the meal.