Professional Documents
Culture Documents
Presented By:
EXTRACTIO N
Also reffered as Exodontia Extraction is defined as : The removal of a tooth from oral cavity by means of elevators and forceps.
INDICATIONS OF EXTRACTION:
A tooth that cannot be restored
Pulp necrosis or periapical abses ; untreatable by endodontic therapy, root canal treatment patient refusal Severe periodontal disease; Bone loss,grade 3 mobility,furaction involvement
INDICATIONS OF EXTRACTION:
Malposed teeth Suprenumerary teeth
Economic considerations
Cracked teeth from trauma Teeth in the line fracture Aesthetic considerations
Planned radiation or IV bisphosphonate treatment
CONTRAINDICATIONS OF EXTRACTION
LOCAL
Therapeutic irradation
SYSTEMIC
PREPARATION
Anasthesia
The patient should not eat or drink anything for at least
Should be made for a friend or relative to drive the patient home after surgery.
PROCEDURE
elevate the gingival soft tissue attachment luxate the tooth with small and large straight elevators
PROGNOSIS
the wound heals completely in about 2 weeks. multiple teeth are extracted, the healing time may be longer. A 3 to 6 month period may be required for bone and soft tissue to be completely healed and restructured, especially in more complex procedures. More than six teeth extracted in each arch is considered a more complex procedure with increased healing time. Most extractions result in complete healing without complications.
INFECTIVE ENDOCARDITIS
Infective Endocarditis (IE): an infection of the hearts endocardial surface
Classified into five groups: Native Valve E Prosthetic Valve IE Intravenous drug abuse (IVDA) IE Nosocomial IE Pacemakeer IE
NVE Classification
Acute Affects normal heart valves Rapidly destructive Metastatic foci Commonly Staph. If not treated, usually fatal within 6 weeks
Subacute Often affects damaged heart valves Indolent nature If not treated, usually fatal by one year
Epidemiology
Incidence - varies according to location Males > females May occur at any age and increasingly common in elderly (> 50 y) Mortality 20-30%
Predisposing Factors
Iv drug use Central line Prosthetic valve Previous IE Murmur Dental procedure Rheumatic disease Miscellaneous
Representation of the pathophysiological role of the endothelium in endocarditis. Once bacteria have entered the blood stream and attached to the endothelium of the heart valves, bacterial virulence factors induce endothelial damage. Alternatively (in non- bacterial) or concomitantly (in infective endocarditis) increased shear stress also induces endothelial damage. The stressed endothelial cells produce tissue factor and induce platelet activation with the consequence of vegetation formation. Moreover, endothelial activation attracts inflammatory cells that lead to the destruction of the valve leaflets. Vegetation is then again colonized by more bacteria thereby initiating an ongoing process
Clinical features
Clinical features
Laboratory Findings in IE
Normochromic, Normocytic anemia (90%) WBC usually normal, can be increased High ESR (90-100%) Positive Rheumatoid factor (50%) Hypergammaglobulinemia (20-30%) (false positive lyme or VDRL serology) Proteinuria (50-65%), hematuria (30-50%)
Blood Cultures
Minimum of three blood cultures Three separate venipuncture sites 5- 10mL in children to 1hr apart Out of three one should be for anaerobic organisms Positive Result
Imaging
Chest x-ray
Look
EKG
Rarely
Minor criteria:
Predisposition: predisposing heart condition or intravenous drug use. Fever: temperature 38C (100.4F). Vascular phenomena: major arterial emboli, septic pulmonary infarcts, mycotic aneurysm, intracranial haemorrhage, conjunctival haemorrhages, Janeways Lesion. Immunologic phenomena: glomerulonephritis, Oslers nodes, Roths spots, rheumatoid factor. Microbiological evidence: a positive blood culture but not meeting a major criterion as noted above, or serological evidence of an active infection with an organism that can cause infective endocarditis. Echocardiogram: findings consistent with infective endocarditis but not meeting a major criterion as noted above.
Treatment
complications
And then direct evidence for the relationship between the prevalence of
periodontal disease and the incidence of infective endocarditis remains to be investigated. Cohort studies are expected to provide better evidence to
Pathophysiology
Early steps in bacterial valve colonisation(A) Colonisation of damaged epithelium: exposed stromal cells and extracellular matrix proteins trigger deposition of fibrinplatelet clots to which streptococci bind (upper panel); fibrin-adherent streptococci
attract monocytes and induce them to produce tissue-factor activity (TFA) and
cytokines (middle panel); these mediators activate coagulation cascade, attract and activate blood platelets, and induce cytokine, integrin, and TFA production from neighbouring endothelial cells (lower panel), encouraging vegetation
growth.(B) Colonisation of inflamed valve tissues: in response to local inflammation, endothelial cells express integrins that bind plasma fibronectin, which microorganisms adhere to via wall-attached fibronectin-binding proteins, resulting
Pathophysiology of IE
CONCLUSION
Common extraction, even non-surgical dental procedures, often cause bacteremia that can result in infective endocarditis in people who have a predisposing risk for this disease, such as valvular heart diseases including prosthetic valves, congenital heart diseases, cardiomyopathy, coronary artery disease, pacemaker implantation, etc. The infection is established when all 3 conditions simultaneously occur, i.e., a predisposing impairment in the heart, the introduction of bacteremia and the virulence of the introduced bacteria. Common dental procedures often cause bacteremia and periodontally diseased patients may even suffer from bacteremia after extraction. Antibiotics have to be used adequately in order to prevent such infections during dental procedures, however, theirfrequent use can also generate drug-resistant mutant bacteria. The development of novel drugs to be used as an alternative to the current antibiotics is therefore highly desired.
THANK YOU..