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Maranan, Aira Angeli G.

41-C
SURGERY: Odontectomy

September 2, 2015
CASE HISTORY

I. Identifying Data
Name: Guerrero, Ma. Veronica Mae
Gender: Female
Address: Mandaluyong City
Contact Number: 09279486272
Age: 22 years old
Date of birth: May 25, 1993
Civil Status: Single
Nationality: Filipino
Occupation: HR assistant
Primary care physician: None
II. Chief complaint
Ang sakit ng bagang ko, di ko maikagat.
III. History of present illness
A year ago, patient felt pain on the most posterior area of the ridge so she went to her dentist for
consultation. The dentist suggested to her to take a panoramic xray to check if her wisdom teeth are
already erupting. Her dentist recommended to her to have it extracted to prevent complications and further
pain. However, patient cannot afford the treatment. Recently, two weeks ago, her right cheek was swollen
and radiating pain triggered. Her dentist prescribed him Amoxicillin 500mg 3 times a day for a week and
mefenamic acid 500 mg if necessary. After a week, the swollen cheek subsided, but it is still painful
whenever she occludes her teeth.

IV.Medical History
a. Family/Social History
Mother - Diabetes
Father - No systemic disease
Siblings - no systemic disease
(-) drinking alcohol
(-) smoking
b. Allergies
(-) food allergies
(-) drug allergies
c. Systemic Diseases
(-) Cardiovascular Disorders
(-) Respiratory Disorders
(-) Renal Disorders
(-) Hepatic Disorders
(-) Coagulation Disorders
(-) Endocrine Disorders
e. Medications
None

V. Dental History

The patient does not have any unpleasant experience with a dentist. She has restorations on teeth
17, 16,15,14, 24,26,27,37, 36, 46 and 47.

VI. Clinical Examination

a. Extra-oral examination
1. Symmetrical face
2. (-) TMJ clicking sound
3. (-) Swellings
4. (-) Cracks/ fissures/ ulcers at lips
5. (-) Palpable lymph nodes
b.Intraoral examination
1. Good oral hygiene
2. Coral pink gingival color
3. Firm consistency of gingiva
4. Normal tongue position
5. (-) elevations, depressions or color changes
6. Straight facial profile
- There is absence of oral manifestations of any systemic disease.
VII. Radiographic Evaluation
Tooth 48 is in Class I Position B Mesioangular
VIII. Treatment Plan
a. Oral Prophylaxis
b. Extraction of 48
c. Restoration on tooth 25 and 36
d. Recall
IX. Pre-operative procedures
1. Sterilize instruments
2. Proper protective apparel
3. Good patient draping
4. Let patient gargle with 1% Povidone Iodine solution

X.Armamentarium
-

Surgical Gloves

Overgloves

Towel, Soap, and Alcohol

Waste Receiver with plastic

Drape

Disposable headcap

Mask

Eye protector

Mouth Mirror

Explorer

Cotton Plier

Spoon Shaped Excavator

1% Povidone Iodine

10% Povidone Iodine

Sterile Gauze

Cotton swab

Topical Anesthesia

Breech-Loading Aspirating metallic Syringe

Carpule with anesthetics

Long Dental needle

Scalpel Handle No.3 and No. 15 Blade

Molt Periosteal Elevator

Minessota Retractor

Handpiece

Surgical Burs

Hypodermic syringe

301, 304 Straight Elevators

Cross Bar

Surgical Curette

Bone file

Suture Materials

Swaged Needle

Needle Holder

Adson Tissue Forceps

Iris Scissors

XI. Surgical Procedure


1. Patient Preparation
a. Make sure the patient is wearing all protective attire for infection control. All instruments have
undergone infection control.
b. Ask patient to gargle 1% Povidone Iodine
2. Anesthesia
Dry area well, then apply topical anesthesia on the area of puncture of local anesthesia.
Nerves anesthetized: Inferior alveolar nerve, lingual nerve and long buccal nerve
Anesthetic solution: 2% Lidocaine 1:100,000 epinephrine
INFERIOR ALVEOLAR NERVE BLOCK
The 4TH quadrant would be the area of operation specifically tooth 48 and is anesthetized using
Inferior alveolar nerve and its subdivisions, mental nerve, incisive nerve and occasionally, lingual and
long buccal nerve. If the inferior alveolar nerve block would not include lingual and long buccal nerve,
supplementary injection is done for the lingual nerve to anesthetize 2/3 of the tongue, floor of oral
cavity and mucosa and periosteum on the lingual side of the mandible and for the long buccal nerve,
buccal mucous membrane and periosteum of the mandibular area. This is administered using
aspirating syringe, cartridge and a long needle.
3. Once anesthesia has taken effect or to test effectivity of anesthesia, periosteal elevator is used
4. Make an Incision with vertical releasing insicion in mesiobuccal groove of the 47
5. Reflect the mucosa using a Molt #9 Periosteal Elevator and expose the overlying bone
6. Using a #8 Round Carbide Bur remove the bone with mesiodistal direction on buccal surface of 48
7. Using a Straight Bur for ditching and Sectioning of the Crown
8. Luxate crown with the use of 301, 304 elevator
9. Split the root area and elevate using 301 and 304 elevator
10. After removing teeth, examine the alveolar socket. If there is a pathologic condition, curette the
socket. Irrigate the socket with Normal Saline Solution(NSS). If there are irregular margins use the

bone file to smoothen it.


11. Suture using a interrupted type and approximate the tissue properly.
12. Give postoperative care and instructions to the patient, recall the patient 5 to 7 days for suture
removal
XII. Possible complications and tissue management
a. Swelling
- Apply ice packs for first 12 hours to help control swelling
b. Bruising
-Should not cause any alarm, it will disappear in 7 to 14 days
c. Stiffness
-Patient might experience jaw musculature stiffness and limited opening of the mouth. It
will improve in 5 to 10 days
d. Inadvertent incisions
- Proper finger rest and guard
XIII. Post operative management and medication
1. There will be little discomfort when anesthesia wears off, take one capsule Mefenamic Acid 500mg every
four to six hours for pain. If pain disappears, stop medication. Take Amoxicillin 500mg every 8 hrs for 7
days
2. Avoid Smoking for first 12 to 24 hours
3. Do not drink alcoholic beverages
4. Do not use straw in drinking liquids
5. Eat high-caloric, high volume liquid diet best for first 12 to 24 hours
6. Avoid hot food or liquids for first 24 hours after operation
7. Chew on the non-operated site
8. Avoid vigorous spitting and gargling
9. Avoid playing with extraction site
10.

During the 1st day, apply ice / cold compress on the operated site every 30 minutes for first 24 hrs.

11.

Oral Hygiene: Do not rinse mouth or brush teeth for at least 8 hours after surgery.
12. No strenuous activities for 12 hours after surgery
13. On the third day after surgery, apply warm compress on the area of surgery for

20 minutes every hour.


14. Mild bruising on the area of surgery may be expected. This will disappear in 7-14
days.
15. Stitches will be removed after 5 to 7 days.