dent 423 common oral conditions cranial nerves

8/13/2019 Dent 423 Common Oral Conditions Cranial Nerves

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Dent 423; Common Oral

Conditions

Aceil Al-Khatib DDS, MS, Diplomate

ABOM


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Dental Abscess; Management Use antibiotics in conjunction with, and not as

an alternative to, local measures

Local measures

Drain by extraction of the tooth or through

the root canals. Where this is not possible and

there is extensive swelling: Drain pus in local tissues by incision

Dental Abscess; Drug Treatment 1stChoice

Amoxicillin Capsules, 500 mg, 15 capsules, 1capsule three times daily

Or Metronidazole 400mg 15 tablets, 1 capsulethree times daily

2nd

Choice Erythromycin 500mg ,20 tablets, 1 tablet 4 times

daily

***In patients with spreading infection or pyrexiause amoxicillin and metronidazole


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Pericoronitis

Local measures

Use irrigation and debride affected areas

Chlorhexidine mouthwash

Drug treatment ( only for severe cases):

1stchoice:

Metronidazole 400mg tds for three days

2ndChoice Amoxicillin 500mg tds for three days


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Antibiotic Prescribing Guidelines

Avoid the use of antibiotics if glandular fever issuspected

Keep antibiotic prescribing to the essentialminimum.

Check whether the patient is currently takingantibiotics

Antibiotics should only be prescribed for thetreatment of an infection and in conjunction with

local measures. Reasons for prescribing should always be

recorded

Antibiotic Prescribing Guidelines

There is no need to use any cephalosporin orclindamycin in general dental practice

Ensure that the full course of treatment iscompleted by the patient (resistance)

Do not prescribe antibiotics without seeingthe patient

If the patient re-presents after 48 hours withno response to the antibiotic, the treatmentshould be changed if possible


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When Are Antibiotics Appropriate For

Oral Infections? Where there is evidence of spreading infection

(cellulitis, lymph node involvement, swelling) or

systemic involvement (fever, malaise)

In acute necrotising ulcerative gingivitis and

pericoronitis where there is systemic involvement

or persistent swelling despite local treatment

***Where there is significant trismus, floor-of-

mouth swelling or difficulty breathing, transfer

patients to hospital as an emergency

Management of Pain of Dental Origin Most odontogenic pain can be relieved effectively

by non-steroidal anti-inflammatory drugs

(NSAIDs), such as ibuprofen and aspirin

Paracetamol is also effective in the management

of odontogenic or post-operative pain but has no

anti-inflammatory activity

Aspirin is a potent and useful NSAID but should

be avoided in children and those with an aspirin

allergy


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NSAIDS Prescribing Precautions In hypersensitivity to aspirin or any other

NSAID

If patient reports history of attacks of asthma,

angioedema, urticaria or rhinitis related to

NSAID

In patients with previous or active peptic ulcer

disease In pregnant women, nursing mothers,

In those taking oral anticoagulants such aswarfarin, coagulation defects, and those withan inherited bleeding disorder

Use with caution in patients with renal,cardiac or hepatic impairment

In the elderly ,and patients with allergies

*** Prescribe analgesics only as a temporarymeasure for the relief of pain, and manage theunderlying cause

NSAIDS Prescribing Precautions


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Mild To Moderate Odontogenic Or

Post-operative Pain Paracetamol Tablets, 500 mg, 40 tablets,

2 tablets four times daily *** Paracetamol can be taken at 4-hourly

intervals (maximum of 4 g for adults).

***Overdose with paracetamol is

dangerous because it can cause hepatic

damage

Ibuprofen Tablets, 400 mg, 20 tablets

1 tablet four times daily

***In adults, the dose of ibuprofen can beincreased, if necessary, to a maximum of 2.4 g

daily

***If paracetamol or ibuprofen alone is noteffective; use paracetamol and ibuprofenalternately (i.e. ibuprofen can be taken first andthen paracetamol 2 hours later, and so on

Mild To Moderate Odontogenic OrPost-operative Inflammatory Pain


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For Moderate To Severe Inflammatory

Or Post-operative Pain Diclofenac Tablets, 50 mg, 15 tablets

1 tablet three times daily

***Advise patient not to exceed the

recommended daily dose (maximum of 150

mg)

*** Same NSAIDS precautions

Fordyces Granules


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Fibroepithelial Polyp

Mandibular Tori


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Torus Palatinus

Papilloma


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Varicosities

Fissured Tongue


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Geographic Tongue

Papillary Hyperplasia


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Hairy Tongue

Exostosis


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Habitual Cheeck Biting

Mucocele


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Linea Alba

Leukoedema


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Epulis Fissuratum

Candidal leukoplakia


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Traumatic Ulcer

Leukoplakia


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Erythroplakia

Thrush


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Herpetic Lesions


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Keratosis


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I. Olfactory Nerve (smell sensations)

II. Optic Nerve (controls vision)

III. OculomotorNerve (eye movement

upward, downward and inward)

IV. TrochlearNerve (controls the movement

of the eye downward and inward)

CN V: Trigeminal

greater auricular nerve (C2)


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Facial sensation: sterile sharp item ( probe )onforehead, cheek, jaw. Repeat with dull object. Ask to report sharpor dull. If abnormal, then temperature [heated/water-cooled tuning fork], light touch [cotton].Motor: pt opens mouth, clenches teeth

(pterygoids). Palpate temporal, masseter muscles as thepatient clenches.

CN V: Trigeminal

http://student.ahc.umn.edu/

Sensory

- Patients eyes

closed,

test light touch on

face with cotton

wisp

Test forehead,

cheeks, and chin

Assess patientsability to detect

sharp,

dull, light pressure,

hot and cold


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CN V: Trigeminal Corneal reflex: patient looks up and away.

Touch cotton wool to other side.

Look for blink in both eyes, ask if the patient

can sense it.

Repeat other side [tests V sensory, VII

motor].

Sensory:

Corneal reflex

Intra-oral: Mucosa

Teeth

CN V: Trigeminal


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Motor

- Muscles of mastication

- Have patient clenchteeth

- Have patient protrude

mandible againstresistance

- Have patient go into

lateral excursivemovements againstresistance

CN V: Trigeminal

56

CN V: Trigeminal Nerve

Test: Have patient bite

down while you palpate

the masseter muscle

Test: Touch patient with an openpaperclip and ask sharp or dull

Test: Touch cornea with a

wisp of cotton. Patient

should blink


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CN VII: Facial Nerve

5 Branches

1. Temporal

2. Zygomatic

3. Buccal

4. Mandibular

5. Cervical Function:

Somatic Motorto muscles of facial expression

Parasympathetic (motor)to lacrimal andsalivary glands

Sensorytaste to anterior 2/3 tongue


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Motor

- Muscles of facial

expression

A central lesion (e.g.,

stroke) on one side

affects mainly the lower

face on the contra lateral

side of the lesion

Bell palsy: paralysis of

entire face

CN VII: Facial

Test The Motor Division Of The FacialNerve

First, have the

patient wrinkle the

forehead and check

for asymmetry


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Next, have the patient

shut the eyes tightly

while you attempt to

open them

Test The Motor Division Of The Facial

Nerve

Finally, have the patient

show his/her teeth or

smile and compare the

nasolabial folds on

either side of the face

Have the patientwhistle, and puff their

cheeck

Test The Motor Division Of The FacialNerve


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Taste to the anterior 2/3 of the tongue

Loss or altered taste can occur following a

stroke or damage to the lingual nerve (local

anesthetic injection, laceration of tongue)

Apply sugar, salt, or lemon juice on a cotton

swab to the lateral aspect of each side of the

tongue and have the patient identify the taste

The Sensory Division Of The FacialNerve

CN IXGlossopharyngealNerve

Sensory

Sensation to the posterior 1/3 of the tongue

including taste and to the mucous membranes

of the pharynx

Gag reflex done by stroking the back of the

pharynx with a tongue depressor and

watching the elevation of the palate (as well

as causing the patient to gag)


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CN IXGlossopharyngealNerve; The Gag Reflex Test


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CN XVagus Nerve

Motor

- Soft palate, pharynx, and larynx

- Patient say Aah and watch soft palate rise

symmetrically without deviation

Sensory

Not tested (Sensation to the inferior pharynx,

larynx, heart,lungs, and gut).

CN XVagus Nerve


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CN XIAccessory Nerve

Sternocleidomastoid

muscle

Trapezius muscle


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Trapezius muscle wasting on the right side

left spinal accessory nerve palsy


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CN XIIHypoglossal Nerve

Motor

- Muscles of tongue

- Geniohyoid and

thyrohyoid muscles

Tongue will deviate

toward side of lesion

when tongue is

protruded.


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dent 423 common oral conditions cranial nerves

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