Impacted Third Molars

This book offers a comprehensive surgical guide for the successful removal of impacted third molars. It walks readers through basic anatomy, case selection, complications, pharmacology, and anesthesia, and covers surgical principles and techniques in detail with illustrations and photos. Instruments and postoperative care are also described, and a unique chapter discusses the author′s mobile third molar practice.

Impacted Third Molars covers everything that dentists need to know to safely remove impacted third molars with efficiency and confidence.

Provides step–by–step procedures for removing impacted third molars Includes practice management, legal, and marketing advice Features procedural videos on a companion website

Impacted Third Molars is an ideal reference for the general dentist, specialist, or resident.

Preface xi

About the Companion Website xiii

1 Anatomy 1

Nerves 1

Blood Vessels 4

Buccal Fat Pad 6

Submandibular Fossa 7

Maxillary Sinus 8

Infratemporal Fossa 8

References 10

2 Case Selection 13

Medical Evaluation 13

Radiographic Assessment 20

Early Third Molar Removal 27

Prophylactic Removal of Third Molars 29

Summary 30

References 31

3 Complications 33

Paresthesia 33

Alveolar Osteitis 40

Infection 46

Bleeding and Hemorrhage 52

Jaw Fracture 54

Osteomyelitis 56

Damage to Proximal Teeth 57

Buccal Fat Pad Exposure 57

Oral ]Antral Communication 57

Displacement of Third Molars 58

Aspiration and Ingestion 61

Temporomandibular Joint Injury 62

Complications Summary 62

References 62

4 Work Space: Equipment, Instruments, and Materials 67

Equipment 68

Instruments 74

Materials 83

Bloodborne Pathogens Standard 93

References 94

5 Surgical Principles and Techniques 97

Surgical Principles 97

Surgical Technique 108

Germectomy 125

References 126

6 Pharmacology 131

Pharmacokinetics and Pharmacodynamics 131

Pharmacology for Third Molar Removal 134

Sedation 134

Pain Management 140

Inflammation 150

Infection 153

Authors Medication Regimen 156

References 157

7 Sedation Techniques 163

Sedation as a Continuum 165

ADA Definitions (Verbatim) 166

ADA Clinical Guidelines (Verbatim) 167

Medical Evaluation 173

Routes of Administration 174

Inhalation (N2O) 176

Oral Sedation 183

Sublingual Administration 184

Intravenous Sedation 185

Venipuncture 188

References 194

8 Sedation Emergencies and Monitoring 197

Patient Safety and Sedation Law 197

Sedation Emergencies 200

Monitors 207

References 212

9 Documentation 213

Informed Consent 213

Progress Notes 217

Malpractice Cases 218

Summary 223

References 224

10 The Mobile Third Molar Practice 225

Mobile Practice Benefits 227

General Dentist or Specialist 228

Mobile Practice Promotion 229

Third Molar Procedure Manual 234

Third Molar Removal With IV Sedation 235

Introduction 235

Guidelines for Third Molar Surgery 236

Instruments/Operatory Setup 237

Instruments/Sterilization 238

Emergency Procedures 238

Medical History 241

Presurgical Instructions 242

Postsurgical Instructions 243

Progress Notes 244

Progress Notes Key 245

Sedation Record 246

Third Molar Impaction Consent 247

IV Sedation and Wisdom Teeth Briefing 248

Third Molar Research 249

Contractual Agreement for Dental Services 250

Documents 253

Scheduling Letter 253

Scheduling Protocol 254

Scheduling Tips 254

Insurance/Fees 255

Summary 257

References 257

Index 259

The author
John Wayland, DDS, FAGD, MaCSD, is founder of Western Surgical and Sedation and maintains a mobile third molar practice in the San Francisco Bay Area, California, USA.