Journal List > J Korean Assoc Oral Maxillofac Surg > v.36(1) > 1032447

Lee, Yoo, Choi, Sul, Kim, Mo, and Kim: Conservative infection control on acute pericoronitis in mandibular third molar patients referred from the prison

Abstract

In the presence of acute pericoronitis of mandilbular third molar, antibiotic therapy and early incision and drainage are the method of choice, followed by definitive surgical extraction of the tooth as soon as it becomes subacute.
If excision of the overlying tissues is decided on, it should be done adequately. All overlying tissues must be throughly excised, and the crown portion of the unerupted tooth should be completely exposed. After excision has been completed, the wound should be managed with a surgical dressing. This should be allowed to remain approximately 7 days. And then, surgical extraction of the impacted mandibular third molar can be done usually. In this operation, there are many complications, such as, postoperative bleeding, infection, trismus, dysphasia and paresthesia. The surgeon are discredited and medicolegal problem may be occurred in the presence of many distressed complications. Therefore, the relatively nonsurgical treatment is the method of choice. So, authors selected the conservative treatment methods of incision and drainage, primary endodontic drainage, operculectomy without surgical extraction of the mandibular third molars. The results were more favorable without the postoperative complication in Wonju old offender prison.

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Fig. 1.
Partial operculectomy & buccal incision & drainage view of the pericoronitis lesion. (#38)
jkaoms-36-57f1.tif
Fig. 2.
Pulp extirpation & canal opening drainage view on #48 tooth.
jkaoms-36-57f2.tif
Fig. 3.
Pulp extirpation & canal opening drainage view on #47 tooth.
jkaoms-36-57f3.tif
Table 1.
Factors in wound infection.
1. Local Factors Number of bacteria
Virulence of bacteria
Devitalized tissue
Foreign bodies (traumatic or implants)
2. Systemic Factors Anergy related to stress
Generalized sepsis
Decreased host defenses
diabetes
malnutrition
cytotoxic - immunosuppressive drugs
Extremes of age
3. Environmental Factors Operating room traffic
Defective air system
Inadequate sterilization techniques
The surgeon as source of infection
4. Endogenous Factors Patient's skin and hair
Presence of infected tissue at time of surgery (cellulitis, abscess, fistula)
Presence of resistant or opportunistic organisms in the patient's oral cavity or nasopharynx
5. Surgical Factors Insufficient hemostasis
Presence of dead space
Insufficient debridement
Tissue necrosis from sutures, retractors or dressings
Inappropriate or long-term use of drains
Excessive operating time
Primary closure of infected wounds
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