Big NO NO for periodontists

[alidis]

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How the hell can Periodontists (or for that matter the general dentist) justify using "high-speed" handpieces (handpieces which blow air out the front) during their "flap surgeries/osseous surgeries" ??????????

ITS FLAT OUT MAL-PRACTICE... a disaster waiting to happen.

Do they think that because they are "periodontal plastic surgeons" that they can magically avoid an air-embolism disecting down to the mediastinum??

 

[aphistis]

How the hell can Periodontists (or for that matter the general dentist) justify using "high-speed" handpieces (handpieces which blow air out the front) during their "flap surgeries/osseous surgeries" ??????????

ITS FLAT OUT MAL-PRACTICE... a disaster waiting to happen.

Do they think that because they are "periodontal plastic surgeons" that they can magically avoid an air-embolism disecting down to the mediastinum??

Didn't you get the memo? Surgical emphysema is the new standard of care! 👍

 

[Dr. Pedo]

Didn't you get the memo? Surgical emphysema is the new standard of care! 👍

That might be the funniest post yet

 

[ISU_Steve]

😕 Is that really that big of a problem (read as: common enough to be concerned with)? Even following insertion of central vascular lines (including Swan-Ganz catheters, etc) the incidence of even small clinically recognizable air embolism is less than 2%, and that's with direct access to a large vessel. I can't find any literature specifying frequencies for dental procedures, but I can't see it being even as high as with central venous access.

Also seeing as how most critical care and pathology textbooks cite between 2 and 8 ml/kg lean body weight of air as being necessary to obstruct the RVOT and cause cardiac arrest (and between 2 and 5 ml/kg to cause pulmonary complication), you're talking somewhere in the neighborhood of 200-800 mL of air for an "average" size patient, which is quite a significant amount of air when you stop and think about it, especially given the size of the vascular structures in the oral cavity that you would have to force that amount of air into in order to produce symptoms.

But I do concede that there is a theoretical risk, and if risk can be avoiding then it should, given that the benefit of the majority isn't being forsaken for the protection of an exceedingly small minority.

 

[Dr. Pedo]

air-embolism disecting down to the mediastinum??

...dissecting 😀

 

[alidis]

first off... apology for calling it an air embolism... brain fart.

when i was a senior in dental school, i saw 3 cases that year... 2 of them so serious that the patients almost died. i can specifically recall 1 case being from a periodontist and another from a general dentist who sectioned an impacted 3rd molar with a high-speed handpiece. I don't remember what the 3rd case was. These patients were seriously ill. Also during my senior year, when I was jumping through hoops to plan my "perio surgery" for graduation reqs, perio would not let me use the hall-drill for the osteoplasty which I used on an almost daily basis during my OMFS clerkship. I raised all hell with this because I had serious issues with using the high-speed in a wide open flap. In the end, i won and was permitted to do my big-bad distal wedge and crown lengthening in oms with the aid of my trusty hall-drill. 🙂

Guess i thought about this a few days ago as i was thumbing through some old AGD journals of my girlfriend's... they had an article of air-emphysema dissecting down to the mediastinum FROM A CROWN PREP! no-flap.

Anyway, time for bed. long day tomorrow. Best wishes.

 

[ISU_Steve]

So basically your describing subcutaneous emphysema ("Michelin man syndrome" as one of our pulmonologists describes the less subtle form) with pneumomediastinum, potentially leading to a tension pneumomediastinum condition. When you start getting into airway and chest conditions you're into my area of expertise since probably the most common causes of these conditions is barotrauma from mechanical ventilation. I see where you're coming from now. It does make sense not to use such a device for reasons of risk of subcutaneous air introduction and I do apologize for coming down so hard on you in my first post. I was just unsure of how you were figuring an air embolism, but now I see what you were trying to imply.

 

[drhobie7]

Yes, you are correct that operative dentistry handpieces are NOT to be used in periodontal or oral surgery. I would be surprised if any surgeons were doing this. Every periodontist I know utilizes surgical handpieces, which exhaust air out the back. Tissue emphysema is a serious complication. It can also be caused by hydrogen peroxide rinses after surgery.

 

[north2southOMFS]

In the end, i won and was permitted to do my big-bad distal wedge and crown lengthening in oms with the aid of my trusty hall-drill. 🙂

Strong work pal. Periodontal surgery with a hall drill? And the tooth didn't look half gone when you were done!