Guest guest Posted November 18, 2011 Report Share Posted November 18, 2011 Hi everyone. Please could you help me and my friend with Treatment plan. Patient 25yr old Chief Complaint :pain in the lower jaw towards the back end inability yo open the mouth completely. H/O Presenting complaint:first had this character of pain 6 month ago lasted for a few weeks and then subsided.Recently the pain has returned and is similar in character and has been present for a week.No teeth are sensitive or tender on mastication. Pt finds is difficult to open the mouth completely Past Dental history:unremarkable. Medical history: insulin dependant diabetes; warfarin. Social history: smoker 20 ciggs/day for 20 yrs. Problem list:E/O-NAD I/O pericoronitis LR8 impacted mandibular right and left third molar Final diagnosis:impacted wisdom teeth secondary to arch lenght. Treatment plan? Please could you tell me how would you answer it on the exam. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 18, 2011 Report Share Posted November 18, 2011 I would refer to OMFS for removal of these teeth,considering option such as LA,cons.sed,GA..CHECK INR within 72hr,do in the morning,early in a weekunder LA-one tooth removal+ packing with oxydise cellulose+ suturing ,say abt AB(not metronidasole)and bleeding,infection and excellent OHI+m/to preven bleeding-tranexamic acid M/wash...not straight away...Under cons sed-need fasting...the same..Under GA- hospital, Bloood test,urea ,electrolytes,random glucose.PT needs to come evening before surgery to have a dextrose and insulin sliding scale Complication as above+risk of having infection,all sorts of complications...but here you can remove TWO TEETH...but EXPLAIN ABT DRAWBACKS....not sure abt it...coz of warfarin... SincerelyLyudmyla From: innayarovikova <innaiarovikova@...> Sent: Friday, 18 November 2011, 10:33 Subject: Treatment plan ORE 2 Hi everyone. Please could you help me and my friend with Treatment plan. Patient 25yr old Chief Complaint :pain in the lower jaw towards the back end inability yo open the mouth completely. H/O Presenting complaint:first had this character of pain 6 month ago lasted for a few weeks and then subsided.Recently the pain has returned and is similar in character and has been present for a week.No teeth are sensitive or tender on mastication. Pt finds is difficult to open the mouth completely Past Dental history:unremarkable. Medical history: insulin dependant diabetes; warfarin. Social history: smoker 20 ciggs/day for 20 yrs. Problem list:E/O-NAD I/O pericoronitis LR8 impacted mandibular right and left third molar Final diagnosis:impacted wisdom teeth secondary to arch lenght. Treatment plan? Please could you tell me how would you answer it on the exam. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 21, 2011 Report Share Posted November 21, 2011 Hi. Thank you very much for TP. What about pain control and infection control.Patient in pain.We can not to do irrigation due to limited mouth opening.Do we prescribe antibiotic? Best regards. With respect .Inna. > > I would refer to OMFS for removal of these teeth,considering option such as LA,cons.sed,GA.. > CHECK INR within 72hr,do in the morning,early in a week > > under LA-one tooth removal+ packing with oxydise cellulose+ suturing ,say abt AB(not metronidasole)and bleeding,infection and excellent OHI+m/to preven bleeding-tranexamic acid M/wash...not straight away... > Under cons sed-need fasting...the same.. > Under GA- hospital, Bloood test,urea ,electrolytes,random glucose.PT needs to come evening before surgery to have a dextrose and insulin sliding scale > > Complication as above+ > risk of having infection,all sorts of complications...but here you can remove TWO TEETH...but EXPLAIN ABT DRAWBACKS....not sure abt it...coz of warfarin... > >  > Sincerely > Lyudmyla > > > ________________________________ > From: innayarovikova <innaiarovikova@...> > > Sent: Friday, 18 November 2011, 10:33 > Subject: Treatment plan ORE 2 > > >  > Hi everyone. > Please could you help me and my friend with Treatment plan. > Patient 25yr old > Chief Complaint :pain in the lower jaw towards the back end > inability yo open the mouth completely. > > H/O Presenting complaint:first had this character of pain 6 month ago lasted for a few weeks and then subsided.Recently the pain has returned > and is similar in character and has been present for a week.No teeth are sensitive or tender on mastication. > Pt finds is difficult to open the mouth completely > Past Dental history:unremarkable. > Medical history: insulin dependant diabetes; warfarin. > Social history: smoker 20 ciggs/day for 20 yrs. > Problem list:E/O-NAD > I/O pericoronitis LR8 > impacted mandibular right and left third molar > Final diagnosis:impacted wisdom teeth secondary to arch lenght. > > Treatment plan? > Please could you tell me how would you answer it on the exam. > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 21, 2011 Report Share Posted November 21, 2011 yes you can..but not metronidasole and erthromicyn...coz pt on warfarin SincerelyLyudmyla From: innayarovikova <innaiarovikova@...> Sent: Monday, 21 November 2011, 10:47 Subject: Re: Treatment plan ORE 2 Hi. Thank you very much for TP. What about pain control and infection control.Patient in pain.We can not to do irrigation due to limited mouth opening.Do we prescribe antibiotic? Best regards. With respect .Inna. > > I would refer to OMFS for removal of these teeth,considering option such as LA,cons.sed,GA.. > CHECK INR within 72hr,do in the morning,early in a week > > under LA-one tooth removal+ packing with oxydise cellulose+ suturing ,say abt AB(not metronidasole)and bleeding,infection and excellent OHI+m/to preven bleeding-tranexamic acid M/wash...not straight away... > Under cons sed-need fasting...the same.. > Under GA- hospital, Bloood test,urea ,electrolytes,random glucose.PT needs to come evening before surgery to have a dextrose and insulin sliding scale > > Complication as above+ > risk of having infection,all sorts of complications...but here you can remove TWO TEETH...but EXPLAIN ABT DRAWBACKS....not sure abt it...coz of warfarin... > >  > Sincerely > Lyudmyla > > > ________________________________ > From: innayarovikova <innaiarovikova@...> > > Sent: Friday, 18 November 2011, 10:33 > Subject: Treatment plan ORE 2 > > >  > Hi everyone. > Please could you help me and my friend with Treatment plan. > Patient 25yr old > Chief Complaint :pain in the lower jaw towards the back end > inability yo open the mouth completely. > > H/O Presenting complaint:first had this character of pain 6 month ago lasted for a few weeks and then subsided.Recently the pain has returned > and is similar in character and has been present for a week.No teeth are sensitive or tender on mastication. > Pt finds is difficult to open the mouth completely > Past Dental history:unremarkable. > Medical history: insulin dependant diabetes; warfarin. > Social history: smoker 20 ciggs/day for 20 yrs. > Problem list:E/O-NAD > I/O pericoronitis LR8 > impacted mandibular right and left third molar > Final diagnosis:impacted wisdom teeth secondary to arch lenght. > > Treatment plan? > Please could you tell me how would you answer it on the exam. > Quote Link to comment Share on other sites More sharing options...
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