12/02/1435

Dent 423; Common Oral

Conditions
Aceil Al-Khatib DDS, MS, Diplomate
ABOM

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Dental Abscess; Management

Use antibiotics in conjunction with, and not as

an alternative to, local measures
Local measures
Drain by extraction of the tooth or through
the root canals. Where this is not possible and
there is extensive swelling:
Drain pus in local tissues by incision

Dental Abscess; Drug Treatment

1st Choice
Amoxicillin Capsules, 500 mg, 15 capsules, 1
capsule three times daily
Or Metronidazole 400mg 15 tablets, 1 capsule
three times daily
2nd Choice
Erythromycin 500mg ,20 tablets, 1 tablet 4 times
daily
***In patients with spreading infection or pyrexia
use amoxicillin and metronidazole

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Pericoronitis
Local measures
Use irrigation and debride affected areas
Chlorhexidine mouthwash
Drug treatment ( only for severe cases):
1st choice:
Metronidazole 400mg tds for three days
2nd Choice
Amoxicillin 500mg tds for three days

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Antibiotic Prescribing Guidelines

Avoid the use of antibiotics if glandular fever is
suspected
Keep antibiotic prescribing to the essential
minimum.
Check whether the patient is currently taking
antibiotics
Antibiotics should only be prescribed for the
treatment of an infection and in conjunction with
local measures.
Reasons for prescribing should always be
recorded

Antibiotic Prescribing Guidelines

There is no need to use any cephalosporin or
clindamycin in general dental practice
Ensure that the full course of treatment is
completed by the patient (resistance)
Do not prescribe antibiotics without seeing
the patient
If the patient re-presents after 48 hours with
no response to the antibiotic, the treatment
should be changed if possible

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When Are Antibiotics Appropriate For

Oral Infections?
Where there is evidence of spreading infection
(cellulitis, lymph node involvement, swelling) or
systemic involvement (fever, malaise)
In acute necrotising ulcerative gingivitis and
pericoronitis where there is systemic involvement
or persistent swelling despite local treatment
***Where there is significant trismus, floor-of-
mouth swelling or difficulty breathing, transfer
patients to hospital as an emergency

Management of Pain of Dental Origin

Most odontogenic pain can be relieved effectively
by non-steroidal anti-inflammatory drugs
(NSAIDs), such as ibuprofen and aspirin
Paracetamol is also effective in the management
of odontogenic or post-operative pain but has no
anti-inflammatory activity
Aspirin is a potent and useful NSAID but should
be avoided in children and those with an aspirin
allergy

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NSAIDS Prescribing Precautions

In hypersensitivity to aspirin or any other
NSAID
If patient reports history of attacks of asthma,
angioedema, urticaria or rhinitis related to
NSAID
In patients with previous or active peptic ulcer
disease
In pregnant women, nursing mothers,

NSAIDS Prescribing Precautions

In those taking oral anticoagulants such as
warfarin, coagulation defects, and those with
an inherited bleeding disorder
Use with caution in patients with renal,
cardiac or hepatic impairment
In the elderly ,and patients with allergies
*** Prescribe analgesics only as a temporary
measure for the relief of pain, and manage the
underlying cause

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Mild To Moderate Odontogenic Or

Post-operative Pain
Paracetamol Tablets, 500 mg, 40 tablets,
2 tablets four times daily
*** Paracetamol can be taken at 4-hourly
intervals (maximum of 4 g for adults).
***Overdose with paracetamol is
dangerous because it can cause hepatic
damage

Mild To Moderate Odontogenic Or

Post-operative Inflammatory Pain
Ibuprofen Tablets, 400 mg, 20 tablets
1 tablet four times daily
*** In adults, the dose of ibuprofen can be
increased, if necessary, to a maximum of 2.4 g
daily
*** If paracetamol or ibuprofen alone is not
effective; use paracetamol and ibuprofen
alternately (i.e. ibuprofen can be taken first and
then paracetamol 2 hours later, and so on

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For Moderate To Severe Inflammatory

Or Post-operative Pain
Diclofenac Tablets, 50 mg, 15 tablets
1 tablet three times daily
***Advise patient not to exceed the
recommended daily dose (maximum of 150
mg)
*** Same NSAIDS precautions

Fordyces Granules

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Fibroepithelial Polyp

Mandibular Tori

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Torus Palatinus

Papilloma

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Varicosities

Fissured Tongue

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Geographic Tongue

Papillary Hyperplasia

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Hairy Tongue

Exostosis

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Habitual Cheeck Biting

Mucocele

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Linea Alba

Leukoedema

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Epulis Fissuratum

Candidal leukoplakia

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Traumatic Ulcer

Leukoplakia

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Erythroplakia

Thrush

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Herpetic Lesions

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Keratosis

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Extraoral Examination; Cranial

Nerves Assessment
Dr. Aceil Al- Khatib DDS, MS,
Diplomate ABOM

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Some Say Money Matters But My

Brother Says Big Brains Matter More:
Oh Once One Takes The Anatomy Final
Very Good
Vacations Are Heavenly

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I. Olfactory Nerve (smell sensations)

II. Optic Nerve (controls vision)
III. Oculomotor Nerve (eye movement
upward, downward and inward)
IV. Trochlear Nerve (controls the movement
of the eye downward and inward)

CN V: Trigeminal

greater auricular nerve (C2)

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CN V: Trigeminal

Facial sensation: sterile sharp item ( probe )on

forehead, cheek, jaw.
Repeat with dull object. Ask to report sharp
or dull.
If abnormal, then temperature [heated/
water-cooled tuning fork], light touch [cotton].
Motor: pt opens mouth, clenches teeth
(pterygoids).
Palpate temporal, masseter muscles as the
patient clenches.

Sensory
- Patients eyes
closed,
test light touch on
face with cotton
wisp
Test forehead,
cheeks, and chin
Assess patients
ability to detect
sharp,
dull, light pressure,
hot and cold

http://student.ahc.umn.edu/

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CN V: Trigeminal

Corneal reflex: patient looks up and away.

Touch cotton wool to other side.
Look for blink in both eyes, ask if the patient
can sense it.
Repeat other side [tests V sensory, VII
motor].

CN V: Trigeminal

Sensory:

Corneal reflex

Intra-oral:
Mucosa
Teeth

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CN V: Trigeminal
Motor
- Muscles of mastication
- Have patient clench
teeth
- Have patient protrude
mandible against
resistance
- Have patient go into
lateral excursive
movements against
resistance

CN V: Trigeminal Nerve
Test: Have patient bite
down while you palpate
the masseter muscle

Test: Touch patient with an open

paperclip and ask sharp or dull

Test: Touch cornea with a

wisp of cotton. Patient
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should blink

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CN VII: Facial Nerve

5 Branches
1. Temporal
2. Zygomatic
3. Buccal
4. Mandibular
5. Cervical
Function:
Somatic Motor to muscles of facial expression
Parasympathetic (motor) to lacrimal and
salivary glands
Sensory taste to anterior 2/3 tongue
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CN VII: Facial
Inspect facial droop or asymmetry. Facial
expression muscles: pt looks up and wrinkles
forehead.
Examine wrinkling loss.
Feel muscle strength by pushing down on
each side [UMNL (upper motor neuron lesion )
preserved because of bilateral innervation]
Pt shuts eyes tightly: compare each side.

CN VII: Facial
Pt shuts eyes tightly: compare each side.
Pt smiles: compare nasolabial grooves.
Ask patient to frown, show teeth, puff out
cheeks.
Test corneal reflex ( if CN VII IS intact pt will
blink)

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CN VII: Facial
Motor
- Muscles of facial
expression
A central lesion (e.g.,
stroke) on one side
affects mainly the lower
face on the contra lateral
side of the lesion
Bell palsy: paralysis of
entire face

Test The Motor Division Of The Facial

Nerve
First, have the
patient wrinkle the
forehead and check
for asymmetry

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Test The Motor Division Of The Facial

Nerve
Next, have the patient
shut the eyes tightly
while you attempt to
open them

Test The Motor Division Of The Facial

Nerve
Finally, have the patient
show his/her teeth or
smile and compare the
nasolabial folds on
either side of the face
Have the patient
whistle, and puff their
cheeck

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The Sensory Division Of The Facial

Nerve
Taste to the anterior 2/3 of the tongue
Loss or altered taste can occur following a
stroke or damage to the lingual nerve (local
anesthetic injection, laceration of tongue)
Apply sugar, salt, or lemon juice on a cotton
swab to the lateral aspect of each side of the
tongue and have the patient identify the taste

CN IX Glossopharyngeal
Nerve
Sensory
Sensation to the posterior 1/3 of the tongue
including taste and to the mucous membranes
of the pharynx
Gag reflex done by stroking the back of the
pharynx with a tongue depressor and
watching the elevation of the palate (as well
as causing the patient to gag)

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CN IX Glossopharyngeal
Nerve; The Gag Reflex Test

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CN X Vagus Nerve
Motor
- Soft palate, pharynx, and larynx
- Patient say Aah and watch soft palate rise
symmetrically without deviation
Sensory
Not tested (Sensation to the inferior pharynx,
larynx, heart,lungs, and gut).

CN X Vagus Nerve

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CN XI Accessory Nerve
Sternocleidomastoid
muscle
Trapezius muscle

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Trapezius muscle wasting on the right side

left spinal accessory nerve palsy

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CN XII Hypoglossal Nerve

Motor
- Muscles of tongue
- Geniohyoid and
thyrohyoid muscles
Tongue will deviate
toward side of lesion
when tongue is
protruded.

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