Edema Edema usually manifests postoperatively within 24 to 48 hours. Researchers believe that some patients have a greater potential for swelling than others (Yaedu et al., 2018). Longer and more involved procedures increase the potential for swelling, especially when more osseous tissue is incised. This swelling is normally related to the transection of lymphatics and capillaries as well as the inflammatory process caused by the surgical flap and bone removal. Performing an oral surgery procedure expediently, with as little trauma to the tissues as possible, may minimize edema. Postoperatively, edema can be minimized by placing an ice pack on the outside of the affected area every 20 minutes (on and off) during the first 24 hours. Application of cold Trismus Trismus, or difficulty opening the mouth, may result from infection or temporomandibular joint trauma. Trismus is also commonly the result of injury to the medial pterygoid muscle during the administration of local anesthesia for an inferior alveolar nerve block. Inflammation resulting from wisdom tooth removal can also cause trismus as the muscles near the extraction site become involved in the inflammatory process (Hupp et al., 2014; Larsen et al., 2021). Trismus often peaks within 24 hours and then begins to abate. When wisdom teeth are removed surgically, patients should be advised ahead of time that they may not be able Infection Postoperative dental infection is either acute or chronic. The dental practitioner should take the patient’s baseline body temperature before surgery to avoid confusing swelling from an infection postsurgery with iatrogenic traumatic swelling from the surgery itself. Postsurgical patient complaints that include malaise, a bad taste in the mouth, swelling, trismus, or pus drainage may indicate an infection. Odontogenic infections often can be treated effectively with either penicillin VK or amoxicillin. For moderate infections in an adult patient with no history of antibiotic allergy, penicillin VK can be given at a dosage of 250 to 500 mg three times daily (Ahmadi et al., 2021; Gilbert et al., 2016). However, in actual dental practice, the typical dosage for a moderate oral infection is 500 mg of penicillin VK taken four times a day for an adult patient and 250 mg for a pediatric patient for seven days. Amoxicillin is a broad-spectrum antibiotic that is often used as the first-line choice to treat patients who aren’t allergic to penicillins (Ahmadi et al., 2021). Recommended dosage is 500 mg four times per day. There is conflicting evidence as to whether antibiotics interfere with the effectiveness of oral contraceptives, but a recent review suggests there is a low level of concern when taking nonrifamycin antibiotics (et al., 2015; Simmons et al., 2018). Still, it is standard practice to warn female patients taking oral contraceptives of possible drug interactions that may occur and to advise the practice of alternate methods of birth control while taking a prescribed antibiotic regimen. A macrolide or lincosamide is preferred if the patient has penicillin sensitivity. Of the macrolides, azithromycin 500 mg on day one and then 250 mg daily for the following four days (e.g., Z-Pak) would be the drug of choice. Erythromycin should be avoided. Of the lincosamides, clindamycin 150 to 300 mg three times a day would be the drug of choice (Ahmadi et al., 2021; Gilbert et al., 2016). In actual dental practice, the typical dosage for a moderate oral infection is clindamycin 150 mg taken three times a day for seven days.
compresses constricts the capillaries and reduces swelling at the surgical site (Fernandes et al., 2019). Corticosteroids may also be administered to decrease swelling and inflammation. Either dexamethasone or methylprednisolone may be administered intravenously, orally, or intramuscularly (Nehme et al., 2021; Shoohanizad & Parvin, 2020). Studies have found that dexamethasone administered in the submucosa can control edema when administered either before or after oral surgery (Sreesha et al., 2020). Patients should be advised to decrease physical activity for a few days following oral surgical procedures to decrease the risk of elevated blood pressure, which may result in increased edema. to fully open their mouths for one to two days after the procedure. After about one week, surgical inflammation and trismus usually resolve (Hupp et al., 2014; Santiago-Rosado and Lewison, 2021). If the patient continues to experience moderate trismus more than one week after surgery, a baseline interincisal opening measurement should be recorded (Oral Cancer Foundation, 2016). Gentle passive motion should be implemented at that time to decrease inflammation and pain. Solutions range from inserting an increasing number of tongue depressors into the mouth to using a custom-made device several times daily until the trismus has subsided (Yu-Hsuan et al., 2019). If the infection is fluctuant, the preferred treatment is incision and drainage followed by antibiotic therapy (Ahmadi et al., 2021). When incision and drainage are required, the incision should be made through the mucosa and submucosa, and the wound should be undermined with a closed, curved hemostat to open loculations of pus in the abscess. A drain, as simple as a piece of dental dam, should then be placed. It should be sutured to the margin of the wound to keep the wound from closing until drainage has occurred. The dentist should obtain a Gram stain, aerobic and anaerobic cultures, and a sensitivity test. Sensitivity testing may indicate the need for clindamycin, penicillin plus metronidazole, or cephalosporin. Even though clindamycin therapy has been associated with severe colitis, with sometimes fatal results (Wu et al., 2015), it is still routinely used in dental practice as the antibiotic of choice for patients who have an allergy to penicillin (Ahmadi et al., 2021). Nevertheless, clindamycin should be reserved for serious infections for which less toxic antimicrobial agents are ineffective. Metronidazole has been demonstrated to be effective in treating mild to moderate Clostridium difficile infection (Banawas, 2018). While metronidazole has been the antibiotic of choice for the treatment of C. difficile infection, recent clinical trials have highlighted the use of a 10-day course of vancomycin or fidaxomicin as the first line of therapy for C. difficile infections (Kociolek, 2018). This type of infection can be asymptomatic or can be characterized by symptoms ranging from mild diarrhea to pseudomembranous colitis. Colitis is usually characterized by severe, persistent diarrhea and severe abdominal cramps. It may also be associated with the passage of blood and mucus. The practitioner must take care when prescribing a cephalosporin derivative for patients allergic to penicillin because of the possibility of allergic cross-sensitivity
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