ABSTRACT
Impacted teeth are a medical deformity brought about by the dietary changes of modern civilization. Ample studies exist to show that the lack of a coarse, abrasive diet--an attritive diet--is the major cause of this problem in modern civilization. Our recent ancestors did not experience this problem or the problem of the underdeveloped lower jaw and resulting Class II malocclusion to the extent present in modern society. Medical and dental scientists, practitioners, and surgeons are aware of the devastation that impacted teeth can cause to the jaws and overall health of an individual and have issued numerous warnings to the profession and to the public regarding the several clear indications for the removal of impacted teeth. The issue has been clouded by the competing economic incentives present in our society, in which fee-for-service practitioners have been and are being replaced by practitioners with a disincentive to recommend surgical care for all but acutely infected or seriously symptomatic patients presenting with impacted teeth. Oral and maxillofacial surgeons practicing in the United States at this time are aware of the many clear indications for removal of impacted teeth and make every effort to communicate this information to their patients and other dental and medical practitioners. They are also aware of the contraindications to the removal of impacted teeth and advised patients appropriately when it is safe to retain and periodically observe by radiograph certain impacted teeth.
Subject(s)
Tooth, Impacted/etiology , Humans , Radiography , Tooth/transplantation , Tooth Extraction , Tooth, Impacted/complications , Tooth, Impacted/diagnostic imaging , Tooth, Impacted/surgeryABSTRACT
Oral and maxillofacial surgeons have established and maintained a record of safety in using general anesthesia for outpatient dental care. The history of anesthesia use in dentistry is reviewed, as well as numerous changes over the last 20 years.
Subject(s)
Anesthesia, Dental , Anesthesia, General , Ambulatory Surgical Procedures , Anesthesia, Dental/history , Anesthesia, Dental/statistics & numerical data , Anesthesia, General/history , Anesthesia, General/statistics & numerical data , Anesthetics , California , History, 20th Century , Humans , Monitoring, Intraoperative , Patient Care Team , Peer Review, Health CareABSTRACT
The results of the fourth anesthesia morbidity and mortality survey of the members of the Southern California Society of Oral and Maxillofacial Surgeons is presented. A questionnaire was mailed to 203 active members in February 1988. All responded or were contacted by Society staff and a response obtained. Results were compared with the three previous studies and revealed trends in training, length of time in practice, modes of practice, equipment used, medications used, numbers of anesthetic procedures performed, and specific instances of morbidity and mortality. Over the 20-year period from 1968 through 1987, seven deaths occurred in more than 4,700,000 anesthetics given, a rate of one death in each 673,000 anesthetics administered.
Subject(s)
Anesthesia, General/trends , Surgery, Oral/trends , Adolescent , Adult , Aged , Aged, 80 and over , Anesthesia, General/adverse effects , Anesthesia, General/instrumentation , Anesthetics , California , Female , Humans , Insurance, Liability , Male , Societies, Dental , Surveys and QuestionnairesABSTRACT
The application of continuous, noninvasive, transcutaneous oxygen tension monitoring during ultralight general anesthesia is investigated. Transcutaneous PO2 measurements showed a high correlation to simultaneously measured arterial PO2. Significant hypoxia was observed in patients maintained on only room air during ultralight general anesthesia. In patients receiving supplemental oxygen by nasal mask, hyperoxic levels were noted throughout anesthesia, providing a significant margin of safety from hypoxia during periods of apnea or respiratory impairment.
Subject(s)
Anesthesia, Dental , Anesthesia, General , Monitoring, Physiologic/methods , Oxygen/blood , Humans , Hypoxia/prevention & control , Monitoring, Physiologic/instrumentation , Mouth/surgery , Time FactorsABSTRACT
The morbidity and mortality experience with outpatient general anesthesia of the Southern California Society of Oral and Maxillofacial Surgeons was surveyed for a second five-year period. One hundred percent of the active members responded with data on educational background, time in practice, and equipment and drugs in use, as well as with morbidity and mortality data. No deaths resulting from anesthetics were reported during this survey period. The decreasing occurrence of problems is attributed to improved training, careful monitoring of patients, and preparation for anesthesia emergencies through mandatory in-office peer evaluation.