Oral and Maxillofacial Surgery, Orthodontics and Pedodontics
Oral and Maxillofacial Surgery
Anaesthesia and exodontia
For an inferior alveolar nerve block, deposit solution near the lingual nerve's path with the patient's mouth wide, aiming for the mandibular foramen; complications include trismus, haematoma, transient facial palsy if the parotid is infiltrated, and intravascular injection. Extraction principles: adequate access, a clear path, controlled force with forceps for delivery and elevators for purchase. Alveolar osteitis (dry socket) presents 2–4 days post-operatively with pain and an empty socket from fibrinolysis; treat by irrigation and an obtundent dressing, not antibiotics alone.
Infection and trauma
Odontogenic infections spread along fascial planes. Ludwig's angina is bilateral submandibular, sublingual and submental involvement with a board-like floor of mouth and airway compromise - secure the airway and incise and drain; the usual source is a mandibular molar. Le Fort I is a low transverse maxillary fracture, Le Fort II is pyramidal through the infraorbital rims and nasal bones, and Le Fort III is craniofacial dysjunction through the nasofrontal suture, orbits and zygomatic arches.
Special considerations
Oroantral communication after maxillary molar removal needs closure and sinus precautions. Anticoagulated patients generally tolerate simple extraction when the INR is well controlled; check current thresholds locally. Bisphosphonate-related osteonecrosis of the jaw is commoner with intravenous agents and after dentoalveolar surgery - prevention means optimising oral health before starting.
Rule of thumb
In any deep-space infection, never wait for fluctuance before draining, and always assess the airway first.
Orthodontics and Pedodontics
Growth and classification
Normal cephalometric values: SNA about 82°, SNB about 80°, ANB 2–4°. A large ANB indicates a skeletal Class II pattern, a negative ANB a Class III. Angle's classification describes first-molar relationship: Class I (mesiobuccal cusp in the buccal groove), Class II (cusp mesial to the groove), Class III (cusp distal to the groove). Class II division 1 has proclined incisors with an increased overjet; division 2 has retroclined central incisors, deep bite and often a square arch form.
Space and interceptive care
Leeway space is about 1.5 mm per side in the maxilla and 2.5 mm per side in the mandible - the difference explains mandibular crowding relief. Mixed-dentition space analysis uses Tanaka-Johnston or Moyers tables; arch-length discrepancy drives extraction versus non-extraction planning. Space maintainers (band and loop, Nance, lingual arch) hold space after premature loss; they do not replace lost function indefinitely.
Paediatric dentistry
First visit by age one or within six months of the first tooth. Behaviour guidance: tell-show-do, positive reinforcement, Frankl scale (I–IV) for cooperative behaviour. Primary molar pulp therapy: pulpotomy for coronal pulp involvement, pulpectomy when radicular pulp is involved, stainless steel crown for multi-surface loss. Dental trauma trap: an avulsed primary tooth is NOT replanted (risk to the developing permanent germ), whereas an avulsed permanent tooth is replanted immediately, after gentle cleaning, ideally within 60 minutes, holding the crown only.
Rule of thumb
Fluoride varnish (5% NaF, 22,600 ppm) two to four times yearly for high-risk children; sealants on deep pits and fissures of newly erupted molars.