Clinical Notes

Wisdom Teeth Impacted- General Anesthesia

COVID-19 SCREENING
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Patient was pre-screened per OS protocol prior to appointment.
Patient was additionally screening via phone when they arrived outside the practice and temperature was checked. 
COVID-19 Consent was completed in addition all OS paperwork . Patient signature was verified.
Room was disinfected using Super Sani-Cloth Germicidal Disposable Wipe (EPA Reg # 9480-4 ) techniques per manufactures protocols, followed by Clorox® Clean-Up® Cleaner + Bleach (EPA Reg. No. 5813-21) Spray and room dry. Room was verified by the other assistant for completion via COVID-19 Room disinfection checklist.
Patient also rinsed with 1.5% hydrogen peroxide for 30 second 


​​Progress Note
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Patient seen at the request of the office general dentist for evaluation and extraction of wisdom teeth. Patient reports occasional discomfort in right and left jaw for several months.


Review of Symptoms
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Facial pain                    Yes                                   Snoring                        No
Pain with chewing          No                                    Bleeding Gum             No
Lumps in the neck          No                                    Difficulty Swallowing   No
Lumps in face                 No                                    Pain Swallowing          No
Shortness of breath        No                                    Limited Opening         No
TMJ pain                        No                                    Sinus Pain                   No
Dry Mouth                      No                                    Chills                            No
Fever                              No                                    Nausea / Vomiting       No
Hoarseness                     No

Past Medical History
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See med history from (in Document Center)

​​Past Surgical History
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See med history form (in Document Center)

​​Medication
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See med history form (in Document Center)


Allergies
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See med history form  (in Document Center)

Social History
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Smoking – See med history form  (in Document Center)
Alcohol - See med history form  (in Document Center)
Drugs - See med history form  (in Document Center)

​CLINICAL EXAMINATION:
Extraoral, Head and Neck exam:
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Constitutional: general appearance of patient 
No extraoral swelling or erythema
Parotid and submandibular glands soft, nonpainful to palpation bilaterally
No lesion noted on facial skin
Facial palpitation exam reviews no swelling or no lymphadenopathy
CN V1, V2, V3, CN VII intact bilaterally
No neck masses noted
Thyroid midline with no evidence of any swelling
Musculoskeletal: TMJ joint seems to be normal. No popping upon opening
Maximum mouth opening within normal range

Intraoral Soft Tissues:
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Clear saliva extruded from bilateral Wharton's and Stenson's ducts
Tongue soft and non-tender with no apparent lesions
Buccal mucosa without lesions bilaterally
Hard palate, soft palate, and pharynx are within normal limits no pathology visualized
Floor of mouth without an evidence of pathology
Gingival tissues are pink, firm, and stippled and without erythema or swelling

Dentition:
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Normal complimentary maxillary and mandibular teeth


Radiographic examination:
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Panorex reviewed demonstrates
No bony pathology.  


ASSESSMENT / PLAN / RECOMMENDATION
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Extraction of teeth # FBI 1.16,17, 32 with Local Anesthesia under IV Sedation

PROCEDURE :
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SURGEON 1:  Joseph Krajekian, D.M.D., M.D.
DENTAL ASSISTANT : Melinda and Jeff RN
OPERATION/PROCEDURE :
FBI 1,16   FBI 17 ,32

ANESTHESIA:  Local Anesthesia and IV Sedation
PREOPERATIVE DIAGNOSIS:  Impacted wisdom teeth/ Tooth Eruption Disturbance
POSTOPERATIVE DIAGNOSIS:  same
OPERATIVE INDICATIONS:  Pt presents to Dental Office for evaluation of wisdom teeth.

CONSENT
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Wisdom teeth (1,16,17,32)
Discussed risk, benefits, complication of surgery including but not limited to bleeding swelling, infection, pain, retained root tip, sinus perforation, numbness of lower lip, chin, tongue. Patient understood risks informed, verbalized understanding and consented accordingly.

PROCEDURE:
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After patient was greeted and ID confirmed. The patient was placed in dental chair.  IV Started after NPO was confirmed. Patient rinsed and spit for 30 second with peridex. Surgical Pause was performed to confirm consent, site and procedure with both assistants. Patient was then prepped and draped in standard oral and maxillofacial surgery fashion.


Wisdom Teeth Extraction

Local Anesthesia
6 carpules of 2% lidocaine with 1:100,000 epinephrine
After proper time for local anesthesia to work.

Mouth prop utilized, throat pack used followed by sweetheart.

Surgical  #32

A hockey-stick full-thickness mucoperiosteal flap was reflected extending 5mm distolateral at the external oblique ridge from wisdom teeth all the way to mesial of tooth # 31 without any vertical release.  After that was completed, high speed W&H drill with fissure bur and copious irrigation to section the tooth. Minimal about of bone was removed. Straight elevator was used to fracture the tooth after it was sections. Bone file was used to remove any sharp edges.

Surgical  #1

Attention was then given to tooth #1. Tooth was extracted in the standard oral maxillofacial surgery fashion. Incision was made intra-sulcular extending to mesial of #2. Rongeur was used to remove some of the bone. Tooth was then removed without any difficulty with appropriate straight elevator followed by appropriate concepts. Following removal of tooth any retained follicle was also removed. No sinus perforations was visualized or detected clinically.  A 3-0 gut suture was placed x 1 interrupted.

No complication

 

Left side performed in similar fashion


ESTIMATED BLOOD LOSS:  minimal

IV Fluids : 300 Lactate Ringer

DISPOSITION : Home with escort after meeting appropriate discharge criteria
FOLLOWUP :  1 week post-op with general dentist in office. 2 weeks with me if needed. Patient was provided post-op instruction/medication sheets in writing and they were also review with patient escort. Pt and escort were also provided with my 24 hour direct contact number and was also instructed to contact the office with any questions

PRISCRIPTION DISPENSED:
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Pen VK 500mg    1 tablet PO q6hrs x 7 days 
Norco 5/325        1 po q 6 hr prn x 5 pill for 3 days
Peridex               10cc Rinse and Spit bid x 7 days x 1 btl
Motrin 800mg    1 po every 8 hrs x 28 pills prn

Joseph Krajekian DMD, MD, FAAOMS, DABOMS

(C) 2020 Dr. Joseph Krajekian

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