Thursday, January 18, 2018

Complications in Oral and Periodontal Surgery-#DrDonDeForge 18Jan2018

Donald H. DeForge, VMD
Fellow of the Academy of Veterinary Dentistry
17 Seemans Lane
Milford, CT 06460
The New England and NY Animal Dental Health Services
P 203-877-3221
F 203-877-8301


Image result for Picture of a high speed dental rear venting handpiece for oral surgery

The new Millennium has brought great advances to the oral care of companion animals.  Veterinary dentists are now preserving teeth routinely with root canal therapy.  Damaged dentition can be preserved with full jacket crowns or caps.

We are very close to tooth implants in animals becoming a reality.  These will be especially beneficial for working dogs.

Patients with advanced periodontal disease no longer have to suffer.  Through the usage of periodontal surgery; antibiotic implants; supportive periodontal therapy by an animal dentist; and excellent anti-plaque home care programs, pets can now have a quality and pain free life.  Teeth that formerly were extracted, in many instances, can now preserved.

Digital oral radiology has become the major diagnostic tool for the animal dentist and the general practitioner performing routine oral care.  Hand held dental x-ray generators and digital x-ray processing combined with teledentistry [oral x-ray interpretation] has made detailed oral diagnostics in reach of all veterinarians.  The patient benefits with precise treatment based on oral radiology diagnostics leading to a pain free quality of life.

Many general practices now have dental units with high speed and low speed dental handpieces to permit atraumatic care in the treatment of a plethora of oral conditions.

Courses have become available nationwide to train dental practitioners in the correct implementation of these dental drills.

With all technology, there are risk factors that must be understood to prevent inadvertent trauma to the patient.
One of these risks is associated with the high speed air turbine drill and the 3-way air/water syringe.

The high speed air turbine dental drill makes the removal of difficult dentition less complicated.  This is especially the case with root fusion to bone [ankylosis]; in retained root removal; and in mass removal [cysts or tumors attached to bone].

The complication of air embolism, to be described, is uncommon but can occur in people as well as animals.

Subcutaneous emphysema can occur with pressurized air from the dental hand-piece or the 3-way air syringe that is found on most dental tables manufactured for the human dentist, animal dentist, and general practitioner performing extractions. 

During oral surgery or periodontal surgery, the air from these handpieces can become entrapped in fascial planes and accumulate in tissues.  The sublingual spaces communicate with the retropharyngeal space which can continue to the mediastinum. Air can enter and spread with pathogenic microorganisms.  

Air embolism from a dental drill or 3 way air syringe- used with air-on or air-water on can be injected [with mandibular oral surgery] into the facial and/or pterygoid venous plexus which communicates with the superior vena cava and the right atrium and ventricle.  It is postulated that the air can pass on to the pulmonary circulation causing arrhythmias and potential cardiac arrest.

Facial emphysema has also been reported with orbital spread and retinal artery collapse.  This could lead to permanent blindness.  Reports have indicated that air spread down the neck can cause a mediastinal emphysema; tension pneumothorax, pneumoperitoneum, and even death.

As stated, human dentists, veterinary dentists, and veterinary practitioners daily use high speed air turbine drills and 3-way auto syringes in the air and air-water combination without complication or life-threatening outcomes.  

That is not a reason to ignore the potential for serious complications.  Never use the 3-way syringe in the air mode or air-water mode during any surgical procedure.  Use the high speed air turbine drill judiciously after surgical flap creation.  Never place the air driven handpiece deep into tissue planes blindly.

The other alternative in oral surgical extractions and periodontal surgery cases is avoiding the standard air driven handpiece that is used for restorative procedures which produces a stream of water and compressed air to the operative field.  Substitute a high speed air turbine driven surgical handpiece which vents air to the back of the handpiece.  These are called rear-venting handpieces.

Excellent surgical techniques and judicious use of handpieces is recommended in all procedures.  If you feel the case is beyond your expertise consult with an animal dentist.

Continue your education in all periodontal and oral surgery applications by taking laboratory courses on-site.  

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