Disabilities are complex, dynamic, multidimensional and also contested; one or more key functions of the organism can be affected so to diminish an individual�s freedom of expression and of action. The transition from an individual, medical perspective to a structural, social perspective was described as a shift from a medical model to a social model where individuals are more likely considered disabled by the society then by their own bodies. Disabilities represent a part of the human condition due to its bidirectional connection with poverty: the existence of disabilities can increase the risk of poverty, and poverty can increase the risk of disability. The experience of disability that results from the interaction of the state of health, personal factors and environmental factors varies greatly. Stress, anxiety or different unpleasant moments can cause a temporary decrease in salivary flow but a constant decrease can indicate the existence of a serious health problem. Xerostomia represents the subjective sensation of dry mouth. It can be accompanied by hyposalivation, an objective phenomenon but this is not always the case. Even if the patient declares the existence of xerostomia, this does not necessarily imply the existence of hyposalivation. Xerostomia can be determined by modifications in the oral cavity, as the sensitivity level to moistening, adverse reactions to certain drugs (anti-depressants, inhibitors of the conversion enzyme). The handicap, now called disability represents a special condition of the individual, reason why he must benefit of the support of the society and of those around him. Dental treatment in patients with psychiatric disabilities must consider the general and local involutive modifications, the existent overlay polypathologies that can influence the dental treatment. The study was conducted practically and included the direct interaction as part of the medical team and the registration of 145 patients presented on request with various types of psychological disorders, sometimes covered by the mask of somatic disorders, indicating a masked depression, or a physical depression, where the emotional condition of yesterday and today differ very much. Pointing out the role of the dentist in approaching patients with physical and psychical disabilities, motivating and making them aware of the necessity of adopting a proper oral hygiene for preventing oral disorders. The dramatic impact on the psyche and the well-chosen words stressed by the clinician increase patient awareness and motivation in order to make him collaborate during the treatment.
Anesthesia and the degree of control over the perception of pain depends on the personality of the individual, the socio-economic conditions, potential previous painful experiences and, last but not least, on fatigue and fear of the dentist. The perception of pain in patients is closely connected to their mental state. Pain is defined as a sensation of discomfort, with wide variations, both in quality and intensity, for different people in seemingly identical conditions; an unpleasant sensitive and emotional phenomena connected to the threat of a wound or caused in the tissues or described in the terms of this disease. The essential element of any type of anesthesia is analgesia, an effect which in some cases cannot be achived, due to the patient�s particularities or the physician�s lack of experience in anesthesia. Locoregional anesthesia (LRA) represents the blocking of the nociceptive sensitive and sympathetic autonomic afferents as well as that of motor efferents at the level of peripheral nerves� axons, by means of local anesthetic. To achieve the set purpose, we carried out a study on a representative human sample comprised of 10.123 patients treated in the Oral and Maxillofacial Surgery Clinic (Ambulatory) from the County Clinic Emergency Hospital St. Spiridon Iasi, between 01.01.2015-31.12.2016. The reason for the exclusion of certain categories of patients in the reseach was: the patients with a special conditions background require individual pre-anesthesia schemes, personalised for the nature of the pre-existing general condition, which must be further approved by the attending specialist physician : cardiologist, internist, diabetologist; children under 18 years old, with a high degree of anxiety; a high precentage of elderly patients, over 60 years old, possess a combination of general issues, thus requiring a special approach. The thoroughness lying at the core of the anesthetic practice, most especially the safegurading of a technical accuracy in the performance of anesthesia [12,], instead of improvisations, the lack of anatomical and stomatological training in general and the resulting inefficiency as such, is the underlying in-depth structuring element of this paper.
Post-operative bleeding is a topical issue in dental practice, fact reflected by the etiopathogenic, morpho pathological and therapeutic aspects; may occur at any time as a complication of dental extraction, due to local factors or general factors. The peculiarity of the dental extraction complication lies in the fact that the physician must immediately resort to firm measures leading to its solving in the shortest while, the most prolonged bleeding can put the patient�s life at risk. Therefore surgery must be justified and applied only when the noticing methods are not effective.Knowing the pathology of the patient and its medication are of major importance in order to prevent post-operative hemorrhage complications. Dental extraction is the most frequent intervention of oral surgery that is addressed to both the dentist and the dento-alveolar surgeon, and is performed almost daily in the surgery.One of the local complications of dental extraction is post-surgical hemorrhage. Establishing a therapeutic, prophylactic and curative plan for this complication by conducting a good history of the patient accompanied by paraclinical examinations, the use of a well-established surgical technique can prevent post- operative hemorrhagic complications. The statistical survey was conducted between 2015 -2017; performed on a group of 225 patients. Knowing the methods of prophylaxis and treatment for post-operative bleeding, as well as the correct diagnosis of its causes are mandatory for every practitioner. Post-operative hemorrhage is a complication that can be prevented by making a correct and complete anamnesis, having as its etiology local causes (the most common) or general causes.
In surgical practice, the problems raised by diabetics are extremely complex and require for solving the knowledge of both the physiopathological disorders characteristic of these disease and the changes caused on this pathological field by various dental aggressions. Sometimes, patients with complications of undiagnosed diabetes mellitus are present in the dentistry where all problems of dental and metabolic therapeutics must be solved by the dentist. The lack of knowledge of the general pathophysiology data of the diabetic mellitus disease and of the metabolitical rebalancing methods of these patients on dental aggressions as well as the lack of early knowledge of the events that precede the installation of real metabolic dramas can lead to disaster. The diabetic patient may present in time various dental conditions, some of which are directly or indirectly related to diabetic disease - lesions in the oral cavity are polymorphic and physiologically interpreted in a very different way. The oro-dental changes in diabetes mellitus have as substrate the degenerative arterial involvement in the context of early tissue aging. The hypoglycemia is a factor that makes doctors reluctant to maintain normal blood sugar levels in diabetic anesthetized patients. Hyperglycemia leads to glucosuria, then polyuria, which in turn causes dehydration of the patient through osmotic diuresis. Hyperglycemia decreases the patient�s ability to resist infections.During a period of 6 years, 2011-2016, we observed, treated and monitored a number of 75 patients with diabetes mellitus. Of these, 45 were men and 30 women and the age was between 18-65 years, with the highest incidence between 45-60 years.The importance of diabetic mellitus field in dental practice is not only determined by the high frequency of complications requiring surgery, but also that in these patients any aggression, even limited, can cause entry into a vicious circle where the local lesion aggravates the diabetic state and in turn it worsens the local development of the lesions. The appropriate premedication, protective antibiotic therapy, quality loco-regional anesthesia, rigorous applying of aseptic and antisepsic rules, soft, non-traumatic maneuvers, are mandatory measures addressed to the diabetic patient for performing risk-free surgery.
Oro-facial soft parts may be the site of benign or malignant tumors, which, although presenting histological similarities, aspects and clinical development vary depending on the affected region. An upper lip lesion that does not heal in a few days could be a big health problem. Also, the presence of chronic inflammation, thickening, or whitish appearance in the lip are all alarm signals. Lip cancer is manifested by the presence of the upper or lower lip tumor, which may be solitary or multiple, ulcers that do not heal for more than three weeks, haemorrhages in the tumor. Sometimes it is considered as being a trenant/delayed herpes, the spinocellular carcinoma of the lip is the most common form of localized cancer in the head and neck level. The lip cancer occurs predominantly in men between 50 and 70 years of age but cases have been identified in young patients aged 20-30 years, too. The study includes 95 patients with lower lip cancer studied in 2016-2017. A good collaboration between ablative surgeon and restorer surgeon gives the patient the best opportunity for complete resection and restoration of the shape and function of the involved structures; the ablative surgeon can remove the tumor without compromising the excision due to a specific reconstruction plan. Reconstruction possibilities from the lower lip were adapted to each patient, depending on the size of the tumor and the properties of the facial tissues.
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