يتكون المقرر من جزأين :
1) التخدير الموضعي ويشمل المواد والأدوات المستخدمة ، التشريح الجراحي للفم ، المضاعفات من التخدير الموضعي وكيفية تقليل حدوثها وعلاجها . ويبدأ المقرر بالتعرف على فسيولوجية الألم وكيف يمكن منع وصوله إلى المراكز العليا بواسطة التخدير الموضعي ثم التعرف على التاريخ الطبي للمريض قبل إعطاء التخدير الموضعي أو الجراحة حيث أن بعض الأمراض تحتاج إلى احتياطات خاصة .
2) قلع الأسنان : ويشمل الطرق المختلفة لقلع الأسنان ، والأدوات المستعملة ، المضاعفات التي قد تحصل أثناء أو بعد الجراحة وكيفية التعامل معها . ويشمل كذلك التعقيم والتحكم في انتقال العدوى والأسباب لقلع أسنان .
A- Course Description:
This course is a series of weekly lectures extending over two semesters and formed of two parts.
1. Local anaesthesia: which covers patient assessment and his suitability for local anaesthesia and surgery, pain control, neuro-anatomy of the oral cavity and peri-oral tissue, neuro-physiology, pharmacokinetics of the drugs used in local anaesthesia and any local or systematic complications which may occur, and how to avoid and how to manage.
2. Exodontia [teeth extraction]: which covers sterilization, control of infection, the different methods for extraction [intra-alveolar and trans-alveolar], the used instruments [forceps and elevators], suture types and materials.
Also, it covers indications and contra-indications for teeth extraction, post-operative instructions and follow-up. Lastly, complications which may occur during or after extraction and surgery, how to reduce and manage.
B- Course Objectives:
The student should be able to:
1. Learn the art of assessing patients and their suitability for all minor
surgical procedures, by taking systematic history, including detailed medical history, thorough physical examination and the proper use of investigations.
2. Study and learn the applied surgical anatomy of the area and
understand the neuroanatomy.
3. Appreciate and understand the physiology of pain and pain conduction
in order to understand the mechanism of action of anaesthetic agents.
4. Understand the pharmacokinetics and the mode of action of the various local anaesthetic agents, the techniques employed to block nerve conduction and produce anaesthesia. The student, also, should study the possible complications, their aetiology, signs an symptoms, prevention and their management.
5. Study and learn the methods and techniques employed to institute infection control measures, sterilization, asepsis and disinfection.
6. Learn about the indications and contraindications for extraction of teeth, study the different techniques and the methods used to perform teeth removal.
7. Learn about the intra-alveolar technique and the principles of forceps and elevators use.
8. Study the indications for trans-alveolar technique, the designing of flaps, the methods employed for bone removal and the different types of suture material.
9. Understand and give post-operative instructions and medications when necessary.
10. Recognise and manage the different complications encountered during extraction of teeth or immediately following the extraction.
C - Lecture topics in details [contents]
1- Introduction: Definition of pain, pain control, pain perception
pain reaction and pain threshold.
2- Patient Evaluation: The art and science of history taking to assess the
systemic condition of the patient prior to receiving local anaesthesia,
extraction of teeth and minor oral surgery.
3- Assessment of the local and systemic contra-indications prior to extraction, learn the essential and routine investigations for patient preparation e.g. radiographs.
4- Neuro-anatomy: The Trigeminal nerve and its branches supplying the teeth and their tissues.
5- Neuro-physiology I: Nerve pathways, types of nerves, and pain theories particularly Gate Control theory.
6- Neuro-physiology II: Membrane and electrical action potential and ionic properties and spread of impulses.
7- Pharmacology I: Composition & requirement of local anaesthetic solution, classification and pharmacology of local anaesthesia drugs, and the mechanism of action. Commonly used agents e.g. Procaine, Lignocaine, and Prilocaine
8- Pharmacology II: types and function of vasoconstrictors used with local anaesthesia, Adrenaline, Noradrenaline and Felypressin.
9- Instruments for local anaesthesia:
The dental syringe: Types, side and breech-loading metal syringes.
The dental needles: parts, design and gauge.
The cartridge: parts and types.
10. Topical, Infiltration and Regional nerve block techniques:
a. Local Anaesthetic techniques used in the maxilla:
Methods of infiltration: Submucosal, Supraperiosteal, Subperiosteal, Intra-osseous, Intraligmental and intrapulpal.
Nerve Block: Infraorbital, posterior superior alveolar and maxillary nerves.
b. Local anaesthetic in the mandible:
Methods of Inferior Alveolar Nerve Block: Direct, Gow-Gates & Akinosi.
Mental Nerve block and infiltration in the anterior region.
11- Complications of local anaesthetics I: Local complications: Failure, pain haematoma, trismus, paralysis, broken needles.
12- Complications of local anaesthesia II: Systematic complication: Syncope, fainting toxicity, hypersensitivity reaction, drug interaction.
13- Instruments and Armamentarium:
Forceps, Parts and types
Elevators, Parts and types.
14- Intra-alveolar technique I: Principles of forceps extraction.
Position of the patient and the dentist. The use of the left hand.
The use of forceps to move teeth in the upper and lower jaws.
15- Intra-alveolar technique II:
Principle of elevators use.
Wedge, Lever and Fulcrum and Wheel and Axle.
Indications for their uses.
16- Trans-alveolar Technique I:
Indications, design, classification and requirement of muco-
17- Trans-alveolar Technique II:
Principle of bone removal: burs, chisels, Rongeur.
Tooth division, sutures: Types and techniques
18- Postoperative instructions and therapeutics:
Pack pressure and instructions concerning mouth wash, the use of cold and hot applications. Prescribing analgesics, antibiotics and anti-inflammatory drugs.
19. Indications and contra-indications for teeth extraction.
20- Complications of Exodontia I:
Fracture crown, roots, alveolar process and mandible.
Causes & management.
Displacement of teeth or roots into the antrum, inferior alveolar canal, the ptyregomandibular space and the infratemporal fossa: causes & management.
Dislocation of the TMJ: causes and management.
21- Complications of Exodontia II:
Haemorrhage: types, causes and management.
Nerve affection: Types, classification and management
22- Complications of Exodontia III:
Infection, dry socket: causes, predisposing factors,
clinical manifestation and management
D- Methodology: Didactic
E- Grades Distribution
Test No. Type of Evaluation Grades
1st Continuous Assessment Written 10%
Mid-Year Written 20%
3rd Continuous Assessment Written 10%
Final examination Written 60%
F- Required text books:
- Handbook of Local Anesthesiaby By Stanley F. Malamed
2. Tooth Extraction: A Practical Guide By Paul Robinson
G. Reference textbook
- Contemporary Oral and Maxillofacial Surgery By Peterson, Ellis, Hupp, Tucker. 4 edition (2003).