10: Surgical Procedures

CHAPTER 10 Surgical Procedures

Introduction

Oral surgery deals with the treatment and ongoing management of irregularities and pathology of the jaw and mouth that require surgical intervention. In the UK, oral surgery is a specialty regulated by the General Dental Council and includes the specialty previously called surgical dentistry. Oral surgery procedures are sometimes termed dento-alveolar surgery (or minor oral surgery) and are commonly undertaken in the dental surgery.

Oral and maxillofacial surgery deals with mouth, jaws, face and neck surgery. In the UK, this specialty is regulated by the General Medical Council. Oral and maxillofacial surgery is sometimes termed major oral surgery, and is undertaken mainly in a hospital. Oral and maxillofacial surgeons can also undertake oral surgery.

As a dental nurse, you must have the knowledge and understanding of the procedures required to:

The dental nurse may assist the clinician undertaking dento-alveolar surgery, which may involve:

Dental nurses in a hospital may also assist in major oral and maxillofacial surgery, which deals with:

Consent

Informed consent is required before any operative procedure, especially before surgery. Written informed consent must be obtained from all patients having any surgical procedure. The possible benefits of treatment must be weighed against the risks and always discussed by the person carrying out the procedure. If for some good reason this is not possible, a delegated person with the appropriate expertise should do so.

‘Informed’ consent means that the patient must be fully aware of the procedure, its intended benefits, its possible risks, and the level of these. In particular, patients must be warned carefully and clearly about:

An example of a patient information sheet is given in Box 10.1. To read more about patient consent, see Subchapter 3.2.

BOX 10.1 Patient Information Sheet: Removal of Wisdom Teeth

Dear Patient,

As you know we feel that your wisdom teeth should be removed. Here is some information that we hope will answer some of your questions.

Wisdom teeth removal is often necessary because of infection (which causes pain and swelling), decay, serious gingiva (gum) disease, the development of a cyst or because teeth are overcrowded. Wisdom teeth are removed under local anaesthetic (injection in the mouth), sedation or general anaesthetic in hospital, depending on your preference, the number of teeth to be removed and the difficulty of removal.

It is often necessary to make a small incision in the gingiva, which is stitched afterwards. After removal of the teeth, your mouth will be sore and swollen and mouth movements will usually be stiff. Slight bleeding is also very common. These symptoms are quite normal, but can be expected to improve rapidly during the first week. It is quite normal for some stiffness and slight soreness to persist for two to three weeks. Pain and discomfort can be controlled with ordinary painkillers, such as paracetamol, and you might be prescribed antibiotic tablets. A clinician will be available to see you afterwards if you are worried, and will want to check that healing is satisfactory.

Complications are rare, but occasionally wisdom tooth sockets become infected, when pain, swelling and stiffness will last longer than normal. Occasionally patients have tingling or numbness of the lower lip or tongue after lower wisdom teeth removal. This is because nerves to these areas pass very close to the wisdom teeth and may get bruised or damaged. The numbness nearly always disappears after about one month, but very occasionally lasts for a year or more. Jaw fracture is very rare.

Please let us know if we can give you any more information.

Surgical procedures

Soft Tissue Surgery

A range of instruments are used for soft tissue surgery.

The disposable surgical scalpel blades used are:

Cryosurgery

This procedure uses freezing to destroy tissue.

Surgery Involving Hard Tissues (Bone and Teeth)

Bone and teeth are usually cut with rotating instruments (burs) in a surgical handpiece. This involves the production of heat, so simultaneous cooling by constant running sterile water or sterile saline (irrigation) is important. Air-rotors are less commonly used as they can contaminate wounds unless using a sterile coolant, and occasionally cause surgical emphysema (see Chapter 16). Laser and ultrasonic cutting are uncommonly used. Piezosurgery is a new but expensive technique that cuts only hard tissues, increasingly used in apical and implant surgery as the danger of damage to nerves or arteries or the sinus membrane is less. However, this kind of surgery can generate significant heat, and cutting is slower than with many high-speed drills.

Wound Closure

Incisions are usually an integral part of surgery. The wound thus created needs to be closed so that it heals by primary intention. The would is closed usually with cyanoacrylate tissue adhesive or tapes (e.g. Steri-Strip), or sutures (stitches) (Box 10.2). This results in a small line of scar tissue, which is the goal whenever a wound is closed. In some circumstances, an open wound is left to heal by secondary intention. In the mouth it is then protected by a dressing such as Coepak. Wounds in bone are sometimes protected by BIPP (bismuth iodoform paraffin paste), or Whitehead’s varnish (compound iodoform paint).

BOX 10.2 Closing a Wound

Surgical operations: safeguards

Operating on the Wrong Patient

Prevention

The role of a dental nurse in oral surgery

Before the Procedure

Basic Surgical Tray (Figure 10.4)

Instrument Purpose
Scalpel blade (Nos 11,12,15) To cut the flap
Scalpel handle (e.g. Swann Morton)  
Mitchell’s trimmer To raise the flap
Periosteal elevator (e.g. Howarth’s) To raise the flap and protect soft tissues
Surgical handpiece To remove bone or cut tooth
Surgical selection of burs  
Retractors: flap; cheek; tongue To retract flap for visibility to operative site, and protect tissues
Surgical aspirator To remove saliva, blood, water and debris
Irrigation syringe To irrigate the site with sterile saline or water
Suture To reposition and fix mucoperiosteal flap
Needle holders To hold the suture needle
Rat-toothed tissue dissecting forceps To hold the flap while suturing
Suture scissors To cut sutures
Gauze swabs  
Cotton wool rolls  

Extraction of teeth (exodontia)

Jan 8, 2015 | Posted by in Dental Nursing and Assisting | Comments Off on 10: Surgical Procedures
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