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#15 – Assists Oral Surgeon

Oral Surgery Protocols

Wisdom Teeth Evaluation:
Protocol: Panoramic XR (if not taken within 1 year)
Pre-sedation form (vital signs, health history)
Lay out mirror, stethoscope and have panoramic XR available
Dr  will speak with patient about procedure
Escort patient to front desk for scheduling
Give patient a copy of pre-sedation instructions to take home
Extraction with Local Anes:
Protocol: Check chart for referral from DDS
Have recent X-ray available for review
Fill out consent form and have patient sign
Have patient rinse with peridex for 30 seconds.
Set-up: Discuss with oral surgeon if it will be a surgical vs simple ext.
Surgical: #15 scalpel, surgical extraction cassette, sterile saline with irrigation syringe, chromic gut sutures, 4 x 4 gauze, large gloves, mask, head light. Have impaction drill ready for use with a 703 fissure bur available.
Simple: #9 periosteal elevator, 301 elevator, 92 elevator, 150 forceps (maxillary), 151 forceps (mandibular), sterile saline with irrigation syringe, 4 x 4 gauze, large gloves, mask, head light.

IV Sedation/ ext of wisdom teeth:
Protocol: Ensure patient has followed NPO protocol (nothing to eat or drink x 8 hrs)
Ensure patient has escort. Have patient sign consent form. Record escort’s name on sedation form.
Seat patient. Have patient rinse with peridex for 30 seconds.
Ask patient if there have been any changes in med history. Any changes in pregnancy status for females. Record this on sedation form.
Place monitors on patient and record initial vital signs.
Have a recent panoramic XR up.
Ensure O2 supply is ready with back-up canister available (check pressure)

Set-up:
Surgical ext cassette, #15 scalpel blade x 2, sterile saline in basin, irrigation syringe, large gloves, mask, head light, 4 x 4 gauze, have yankaur suction available, 1 bag of IV fluids with tubing (bleed the tubing line), venipuncture equipment (20 and 22 gauge IV caths, alcohol wipe, tourniquet, IV dressing/tape, 2 x 2 gauze, Coban dressing, impaction drill with a 703 fissure bur. Medication syringes appropriately labeled with 18 g needles (Versed in 10cc syringe, fentanyl in 3 cc syringe, dexamethasone in 3 cc syringe). Place O2 nasal cannula and set to oxygen (3 liters/ min). Have patient rinse with peridex for 30 sec prior to procedure.

Post-surgery:
Escort patient to recovery chair with IV in place. Do not discontinue IV until patient is ready for discharge. Never leave a sedated patient alone. Confirm with oral surgeon prior to discharge. Place patient in wheel chair and help patient into car with escort.

Follow-up for wisdom teeth:
Set-up: Mouth mirror. Monoject irrigation syringe, sterile saline. Have dry socket supplies available (gelfoam, eugenol, topical anes, cotton forceps).