8. Oral Surgery Flashcards
What 3 medications effect extractions?
Bisphosphonates
NOAC’s
Warfarin
List the 6 post op instructions following XLA:
- Restful day
- No smoking or alcohol for 24 hours
- If bleeding occurs, bite down on clean cotton
- Pain killers
- Avoid rinsing for 24 hours
- Then hot salty mouthwash daily
List the 6 common post extraction problems:
Pain
Bleeding
Bruising
Swelling
Infection
Dry socket
List 4 complications of odontogenic infections:
Cellulitis
Ludwigs angina
Cavernous sinus thrombosis
Sepsis
Cellulitis
Diffuse swelling
Ludwigs angina
Bilateral swelling
List the 4 principles of managing odontogenic infections:
- Eliminate the cause of infection
- Provide a path for drainage of infection
- Manage symptoms
- Review
Sinusitis
Inflammation of the sinus secondary to infection
Sinusitis: signs and management
Pain, tenderness, posterior teeth TTP, congestion
Tx: mucolytic inhalations and antibiotics
Oral antrum communications: signs and management
Fluid escaping through nose, altered voice, nasal obstruction, nasal bleeding
Tx: surgical closure, antibiotics, mucolytic inhalation
Pericoronitis
Inflammation of the tissues around a partially erupted or impacted tooth
Pericoronitis: signs and Tx
Trismus, pain, malaise, bad taste, redness, halitosis
Tx: irrigate with saline, OH measures, analgesics, antibiotics, removal of any trauma
List the 6 indications for wisdom tooth removal:
Pericorontis episodes x2
Unrestoable
Infection
Cellulitis
Periodontal disease
Ortho request
List the 2 contraindications for wisdom tooth removal:
Asymptomatic tooth
Nerve involvement
List the 3 options for wisdom teeth:
- Monitor
- Extraction
- Coronectomy
List the 5 stages of surgical extractions:
- Flap design
- Incise and reflect flap
- Overcome any obstacles
- Elevate tooth
- Remove tooth
What is a crevicular incision?
An incision that follows the gingival margin
What is a reliving incision?
An incision that goes from the gingival margin towards the tooth apex
List 2 types of surgical flap:
Triangular
Envelope
List the 5 teeth most commonly effected by impaction:
Third molars
Maxillary canines and incisors
Mandibular premolars and canines
List the 4 possible angles of impaction:
Vertical
Horizontal
Mesioangular
Distoangular
What are the 5 Tx options for impacted teeth?
- Monitor only
- Interceptive XLA of baby tooth
- Exposure of impacted tooth
- Removal of impacted tooth
- Transplantation of impacted tooth to another place
What are the 2 exposure techniques for impacted teeth?
Open = flap cut and tooth left exposed
Closed = flap cut and gold chain attached to tooth and Ortho appliance
List the 3 possible complication categories for extractions:
Bone related
Bleeding related
Sepsis related
Alveolar osteitis: signs and management
Worsening pain, dull ache/throb, bad taste, discharge, halitosis
Tx: irrigate with saline and place sedative alvogel dressing
List the 5 possible bone complications assosiacted with extractions:
Alveolar osteositis (dry socket)
Sequestrum
Exposed bone
Mronj
Osteoradionecrosis
MRONJ: signs and Tx
Exposed done that persists for 8+ weeks in pts with history of antiresporptive or angiogenic drugs, delayed healing, pain, infection, swelling, numbness
TX:
Osteoradionecrosis: signs and Tx
Non healing bone, severe pain, infection, halitosis, fistulas, suppuration, fractures
TX:
List 3 Hereditary conditions that effect bleeding:
Haemophilia A and B
Bon williebrands
Elers disease
List 5 Aquarius conditions that effect bleeding:
Liver disease
Alcoholism
Haematological malignancy
Lymphoma
Leukaemia
List 3 other conditions that effect bleeding:
Cardiac conditions
Strokes
Pregnancy
List 3 types of medications that effect bleeding:
Antiplatelets
Anticoagulants
NOACS
How long should normal bleeding last?
2-5 minutes
How would you manage prolonged or exaggerated bleeding?
- Pressure
- Haemostasis agent (such as gelatin, collagen or vitamin K)
- Suture
Sepsis
An extreme body response to infection when a pre existing infection initiated a systemic sequence of events
Sepsis: signs and Tx
Extreme body temp, high HR, high resp rate, high bp, increased WBC
Slurred speech, shivering, no urination, breathlessness, rash
Tx: blood cultures, urine output measurement, fluids, antibiotics, lactate measurement, oxygen
List 5 signs of Oral Cancer:
Persistent ulcers
Speckled Erythroleukoplakia
Cervical lymphadenopathy (enlarged, firm, fixed, non tender)
Worsening pain
Referred pain
Weight loss
What 4 investigations hold be done if oral cancer was suspected?
Biopsy
Blood tests
Scans
Endoscopy
How is diagnosis of oral cancer obtained?
Via clinical imaging and tissue histology
What is the system used for staging cancer?
TNM
What are the 4 options for treating oral cancer?
Surgery
Radiotherapy
Chemotherapy + Radiotherapy
Immunotherapy
What is a biopsy?
Removal of tissue for histopathological examination
List 4 reasons you would biopsy a lesion:
Benign lesions
Bulbous, ulcerative, desquamtive lesions
White patches
Suspected malignancy
List the 2 types of biopsy:
Excisional
Incisional
List 4 types of salivary gland disease:
Sialadenitis
Sialolithiasis
Ranula
Tumours
Sialadenitis definition and management
Viral or bacterial infection of salivary glands
Tx: antibiotics, fluids, sialagoes, analgesics, incise and drain, surgery
Sialolithiasis: signs and management
Salivary gland obstruction
Swelling
Pus
Systemic symptoms
Tx: stone removal, gland removal
Salivary gland tumours: signs and Tx
Swelling
Pain
Change in salivary flow
Tx: referral
List the 8 stages of orthognathic surgery:
- Referral from GDP
- Assessment and diagnosis
- Joint clinic
- Pre surgery orthodontics
- Orthognathic surgery
- Post surgery Ortho Tx
- Retainers
- Reviews
When does orthognathic treatment take place in males and females?
Once growing has fully stopped.
18 years - females
20 years - males
List the signs and symptoms of cysts:
Initially asymptotic
Boney expansion (egg shell)
Fluctuate swelling (fluid filled)
Displaced teeth
Sinus
Pain if infected
Pathological fractures if left untreated
What 3 further investigations should you carry out if you find a cyst?
- Vitality test teeth
- Radiographs
- Biopsy
What are the 2 Tx options for cysts?
Enucleation
Marsuplisation
What is cyst enucleation?
Complete removal of the cyst lining
What is cyst marsupialisation?
When a hole is created in the cyst lining
