Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

BDS4 > CDS Oral Surgery > Flashcards

CDS Oral Surgery Flashcards

1
Q

Process of acute apical abscess formation

A

Irreversible pulpitis - loss of tooth vitality - apical periodontitis - acute apical abscess

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Infection from maxillary molar spreads buccally above the insertion of the buccinator

A

Spreads into buccal space causing buccal swelling

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Maxillary molar infection breaks through buccally below the insertion of the buccinator

A

Drains into the mouth creating a draining sinus on the attached mucosa
Quite painless usually but a bad taste and possibly a bubble present

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Why is infection from a maxillary molar more likely to spread buccally than palatally?

A

Infection follows the path of least resistance, bone is less dense buccaly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Which tooth in the upper arch is most likely to have infection spread palatally?

A

Lateral incisor - root is quite palatally placed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What happens if infection from maxillary tooth spreads upwards?

A

Into maxillary sinus - can cause sinusitis, rare

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Infection from lower tooth spreads lingually and perforates the bone above the insertion of mylohyoid

A

Spreads into the sublingual space, creating a sublingual abscess

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Infection from lower tooth spreads lingually and perforates the bone below the insertion of mylohyoid

A

Spreads into the submandibular space

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Does sublingual or submandibular infection cause more problems?

A

Submandibular

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Infection from lower tooth spreads buccally and perforates the bone above the insertion of buccinator

A

Draining sinus into the mouth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Infection from lower tooth spreads buccally and perforates the bone below the insertion of buccinator

A

Buccal space infection and swelling

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Which direction is infection in the posterior lower teeth likely to spread?

A

Lingually - bone is thinner than buccally

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Which direction is infection in the lower anterior teeth likely to spread?

A

Labially

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What determines whether infection spreads into sublingual or submandibular space from the lower teeth?

A

Which tooth is affected in relation to the mylohyoid line
Premolars more likely to end up in the sublingual space
7 or 8 infections most likely into the submandibular space

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Masticatory spaces

A

Pterygomandibular space
Infratemporal space
Deep temporal space
Superficial temporal space
Masseteric space
Infection can easily spread between lots of these spaces as all of them communicate with each other

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Result of infection spreading to masticatory spaces on the muscles

A

Severe trismus - the muscles go into spasm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Pterygomandibular space

A

Bound by the mandible, medial and lateral pterygoid muscles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Infratemporal space

A

Infratemporal fossa region

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Deep temporal space

A

Deep to temporalis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Superficial temporal space

A

Superficial to temporalis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Masseteric space

A

Between the masseter and the ramus of the mandible

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Path of infection spreading to masticatory spaces

A

Sublingual/submandibular spreads backwards into the jaw

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Where can infection spread to from masticatory spaces?

A

Lateral pharyngeal space
then
Retropharyngeal space
then
Prevertebral space

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Clinical appearance of infection in the lateral pharyngeal space

A

Oral cavity has an area being pushed in around the lateral pharyngeal space, a bulge in the pharynx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Where can infection in the retropharyngeal space spread to?

A

Upwards - base of the skull
Downwards - superior mediastinum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Where can infection in the prevertebral space spread to?

A

Upwards - base of the skull
Downwards - inferior mediastinum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What can infection spread to the mediastinum cause?

A

Cardiac tamponade

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What can infection spreading to the base of the skull lead to?

A

Abscess on the brain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Infection in the cavernous sinus

A

Infection can spread into the cavernous sinus, resulting in a cavernous sinus thrombosis - rare

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Path of upper vs lower tooth infection to cavernous sinus

A

Upper - infraorbital space - valveless veins in this region - cavernous sinus
Lower - Lateral pharyngeal space - infratemporal space - pterygoid plexus which communicates with the brain - valveless veins - cavernous sinus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Infection from upperr anterior spread

A

Lip
Nasiolabial
Lower eyelid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Infection from upper lateral incisor spread

A

Palate
Face

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Upper premolars and molars infection spread

A

Cheek
Infra-temporal region
Maxillary antrum (v rare)
Palate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Chronic draining abscess

A

Infection drains into mout
Blister forms, bursts, bad taste, disappears then comes back

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Clinical sign of infraorbital infection

A

Loss of nasiolabial fold

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Lower anterior teeth infection spread

A

Mental and submental space
Tend to stick there but could spread into the sublingual or submandibular space

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Lower premolars and molars infection spread

A

Buccal space
Submasseteric space
Sublingual space
Submandibular space
Lateral pharyngeal space

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Clinical sign of submandibular space infection

A

Can’t feel the border of the mandible

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Surgical management of large abscesses

A

Sometimes under local, otherwise it requires hospital admission and GA
Establishment of drainage - get rid of pus
Incise the skin if necessary - if possible do this intra-orally, may need to be extra-orally
Remove source of infection - extirpate pulp or extract - ideally immediately but v difficult to anaesthetise pt when they have severe infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Antibiotic therapy for large abscesses

A

Depends on lots of factors
Not offered if you can remove the cause and obtain proper drainage and no need in pts that are not systemically unwell
Consider
Toxicity
Desirability
Medical history

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

SIRS

A

Systemic inflammatory response syndrome
Raised temp
Raised HR
Raised resp rate
Raised white cell count

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

What does SIRS indicate?

A

Antibiotic therapy and urgent hospital referral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Anatomical consideration when incising submandibular abscess

A

Consider the marginal mandibular branch of the facial nerve, which runs down the border of the mandible and ends at the corner of the mouth.
Always go at least 2 fingers with below the inferior border of the mandible. If the branch is damaged it can stop patients smiling on that side of the face.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

How to drain abscess once incised

A

Finger into the hole or Hilton technique

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Hilton technique

A

To drain an abscess - use scissors or instrument with two ends, insert instrument in closed position and open in the incision, stretching the tissues.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Once you have surgically drained an abscess how is it managed?

A

Drain is sutured in for a few days and covered with a dressing
Dressing is repeatedly replaced until it is clean

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Ludwig’s angina

A

Bilateral cellulitis of the sublingual and submandibular spaces

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Ludwig’s angina features

A

Raised tongue
Difficulty breathing
Difficulty swallowing
Drooling
Diffuse redness and swelling bilaterally in submandibular region
SIRS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Why does Ludwig’s angina require urgent treatment?

A

Can compromise the airway

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Is gram positive or gram negative purple?

A

Gram positive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Cocci vs bacili

A

Cocci - round
Bacili - rod shape

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Streptococcus structure

A

chains

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Capnophilic bacteria meaning

A

Need carbon dioxide to survive and grow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

What type of microorganism does metronidazole work on?

A

Only strict anaerobes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Types of acquired resistance

A

Mutation
Acquisition of new DNA - transformation, transduction or conjugation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

DNA transformation

A

Uptake of short fragments of naked DNA by naturally transformable bacteria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

DNA transduction

A

Transfer of DNA from one bacterium into another via bacteriophages

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

DNA conjugation

A

Transfer of DNA material via sexual pilus, required cell to cell contact

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

Altered target site antibiotic resistance

A

The path of entry for the antibiotic into the bacteria cell has changed shape and the antibiotic can no longer get in the attack the inside of the bacteria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

Pulp hyperaemia

A

Increased blood supply to the pulp
Pulp can recover from minor trauma at this stage, going back to normal or an acute pulpitis could develop
Sharp pain lasting for seconds when stimulated, resolving after stimulus
Caries approaching pulp but tooth can still be restored without treating pulp
Reversible pulpitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

Acute pulpitis

A

Sudden onset inflammation of the pulp
Constant severe pain
Reacts to thermal stimuli
Referral of pain/ poorly localised pain
Little response to analgesics
Becoming irreversible
This can become a chronic pulpitis which will flare up every now and then (goes between acute and chronic)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

Chronic pulpitis spread out of the pulp chamber becomes

A

Acute apical periodontitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

Acute apical periodontitis can develop into ___ when actual infection is present (not just inflammation)

A

Acute apical abscess

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

Abscess

A

A collection of dead neutrophils and other cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

Chronic apical infection

A

Can go back and forth with acute apical abscess, when the abscess subsides but there is ongoing low grade infection around the apex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

Apical cyst

A

Can form from long term chronic apical infection
Painless but can increase in size over time or become infected - painful

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

Open pulpitis symptoms

A

Can be less severe as the exposed pulp releases pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

Acute pulpitis diagnosis

A

History
Visual exam
Negative TTP usually as PDL is not yet inflamed
Pulp testing is ambiguous
Radiographs won’t show much except from a big cavity
Diagnostic LA - numb the pt next to suspected tooth and see if the pain goes away
Removal of restorations if necessary

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

What can happen once there is an acute pulpitis?

A

It can to and fro with chronic pulpitis or develop into an acute apical periodontitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

Acute apical periodontitis diagnosis

A

Easy diagnosis
TTP
Tooth is non vital (unless traumatic)
Radiographs - loss of lamina dura, radiolucent shadow (may indicate an old lesion eg. flare up of apical granuloma), delay in changes of apex of tooth, widening of apical periodontal space and possible resorption of the root

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

Cause of traumatic periodontitis

A

Parafunction - clenching or grinding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

Diagnosis of traumatic periodontitis

A

Clinical exam of the occlusion - functional positioning, posturing
TTP
Normal vitality
Radiographs - may show generalised widening or periodontal space

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

Treatment for traumatic periodontitis

A

Occlusal adjustment
Therapy for parafunction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

Causes of acute apical abscess

A

Acute apical periodontitis can develop into this
Pericoronitis - inflammation around a crown, usually PE
Periodontal abscess - pulp is fine, abscess develops directly in the periodontium
Sialadenitits - infection of the glands, usually one of the major salivary glands, resulting in swelling and redness, dryness and pus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

Acute apical abscess organisms

A

Polymicrobial
Anaerobes play an important part
Strep anginosus, prevotella intermedia both common

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

Antibiotics effective against strep anginosus examples

A

Penicillin
Erythromycin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

When does antimicrobial resistance occur?

A

When microorganisms such as bacteria viruses fungi and parasites change in ways that render the medications used to cure the infections they cause ineffective

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

How do antibiotics fight infection?

A

Inhibit bacterial cell wall synthesis, damage cell membranes, disrupt bacterial metabolism and restrict the ability to multiply

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

Broad spectrum antibiotics

A

Target several classes including good bacteria, making them unsuitable for self limiting conditions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

Where can antibiotic resistant bacteria occur?

A

In anyone who uses antibiotics, and can live in that person for up to a year

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

Altered target site

A

Mechanism of antibiotic resistance
The way that the antibiotic gets into the bacteria cell has changed shape and the antibiotic can no longer get in to attack the inside of the bacteria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

Enzymatic inactivation

A

Mechanism of antibiotic resistance
Bacteria produces enzymes which destroy antibiotics or prevent binding to target sites and having effect on the bacteria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

What is the usual antibiotic resistance mechanism of prevotella and fusobacterium?

A

Beta-lactamase enzymes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

Carbapenems

A

New class of beta lactam antiobiotics developed to counteract ESBLs
Almost generate a forcefield around the beta lactam molecule
(BUT bacteria have developed a carbapenemase enzyme)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

ESBLs

A

Extended spectrum beta lactamases
Enzyme produced by bacteria which reduce the choice of antibiotics that can work

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

CPE

A

Carbapenemase producing eneterobacterales - almost untreatable

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

Enterobacterales

A

Group of gram negative bacili found in common infections such as E.coli

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

Last therapeutic option to treat complex infections caused by multi drug resistant bacteria

A

Carbapenems

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

Decreased uptake mechanism

A

Mechanism of antibiotic resistance
Thick gelatinous capsule around bacterial cell wall - very difficult to get antibiotics to penetrate the mucopolysaccharide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

What is the key to treating any dental infection?

A

Remove the source - extraction or extirpation of the pulp

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

Methods of resistance

A

Mutation
Inactivation
Efflux - antimicrobials pumped out of cell

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

Two routes of infection from oral cavity to periapical region

A

Through crown - carious cavity or trauma -> pulp -> apical foramen
Via periodontal ligament

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
93
Q

Endogenous infection

A

Infectious agent is derived from our own flora

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
94
Q

Examples of microbial agents involved in acute dental infection

A

Strep anginosus (gram +ve cocci)
Prevotella intermedia (gram -ve bacili)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
95
Q

What clinical specimen is best for investigation of microbials in acute periapical infection?

A

Aspirated pus (has not been contaminated with saliva flora)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
96
Q

Examples of microbial agents involved often in periodontal abscess

A

Anaerobic streptococci
Prevotella intermedia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
97
Q

Treatment for localised infection

A

Establish and document a diagnosis
Remove the source of infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
98
Q

Examples of microbial agents involved in pericoronitis

A

Predominantly mixed oral anaerobes - e.g. P intermedia, S.anginosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
99
Q

Treatment for pericoronitis

A

Local measures such as operculectomy, systemic tx only if systemic symptoms, metronidazole if appropriate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
100
Q

Microbial cause of dry socket and tx

A

Localised alveolar osteitis
Mixed oral flora
Does NOT require antibiotics, local tx such as curettage of socket, rinse, alvogyl

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
101
Q

Predisposing factors for osteomyelitis of the jaws

A

Bisphosphonate therapy
Impaired vascularity of bone (radiotherapy, Pagets disease)
Foreign bodies (implants)
Compound fractures
Impaired host defences (diabetes)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
102
Q

Treatment of osteomyelitis of the mandible

A

LA, curettage, IV antibiotics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
103
Q

Microbiology involved in osteomyelitis of the mandible

A

Anaerobic gram -ve bacilli
Anaerobic streptococci
S anginosus, S aureus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
104
Q

Management of salivary gland infection

A

Drain the pus
Flucloxacillin and metronidazole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
105
Q

Microbiology of salivary gland infection

A

S aureus and mixed anaerobes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
106
Q

What needs documented when treating an infection?

A

Diagnosis
Antibiotic choice, dose, route and duration
Review date
Document deviation from guidance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
107
Q

Ludwig’s angina

A

Bilateral infection of the submandibular space
Most commonly caused by anaerobic gram negative bacilli
Strep anginosus and anaerobic streptococci, could be staph aureus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
108
Q

Most common microbial associated with hospitalisation from dental infection

A

S milerii and mixed anaerobes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
109
Q

Sepsis

A

Life threatening organ dysfunction caused by disregulated host response to infection
SIRS + suspected/confirmed infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
110
Q

SIRS

A

Systemic inflammatory response syndrome
Temp <36 or 38+
Heart rate >90/min
Resp rate >20/min
WCC <4000/μL or >12000/μL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
111
Q

Sepsis six

A

Give high flow oxygen
Take blood cultures
Give IV antibiotics
Give a fluid challenge
Measure lactate
Measure urine output

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
112
Q

S I R for choice of antibiotics

A

Susceptible at standard dose
Susceptible at increased dose
Resistant even with increased dose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
113
Q

What is a breakpoint of an antibiotic?

A

A chosen concentration (mg/L) of an antibiotic which defines whether a species of bacteria is susceptible or resistant to the antibiotic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
114
Q

Resistance

A

A high likelihood of therapeutic failure even when there is increased exposure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
115
Q

Stewardship

A

An organisational or healthcare system wide approach to promoting and monitoring judicious use of antimicrobials to preserve their future effectiveness
A coherent set of actions which promote using antimicrobials responsibly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
116
Q

2 key ways of tackling AMR

A

Reducing the need for and unintentional exposure to antimicrobials
Optimising the use of antimicrobials

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
117
Q

Responsibilities of stewardship

A

Vaccination
Infection prevention and control
Public health interventions - e.g sanitation, oral health
Antimicrobial prescribers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
118
Q

WHO global action plan on antimicrobial resistance 5 strategic objectives

A

Improve awareness and understanding
Strengthen the knowledge through surveillance and research
Reduce the incidence of infection
Optimise the use of antimicrobial medicines
Ensure sustainable investment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
119
Q

Recommended first line when antibiotics required for acute dento-alveolar infection

A

Phenoxymethylpenicillin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
120
Q

What is penicillin V most effective against?

A

Oral streptococci
Anaerobes
Selected gram negative cocci

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
121
Q

Amoxicillin compared to Pen V

A

Possesses the same spectrum plus more active against gram negative cocci and members of the family enterobacteriaceae

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
122
Q

Strep anginosus is invariably sensitive to _____

A

Amoxicillin and Pen V

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
123
Q

what is the problem with using amoxicillin over Pen V?

A

Broader spectrum of activity so it has a greater impact on selection of resistance in the host micro flora

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
124
Q

Recommended dose of first line antibiotics for acute dentoalveolar infection

A

Phenyoxymethylpenicillin
500mg 6 hourly 5 days
Important to review after 24-48 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
125
Q

Examples of unacceptable reasons for dental antibiotic prescribing

A

Workload pressures
Unsure of diagnosis
Treatment had to be delayed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
126
Q

Three examples of oral health conditions that antibiotics DO NOT WORK FOR

A

Acute pulpitis
Gingivitis
Sinusitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
127
Q

Alternative causes of acute apical abscess (not usual route of acute pulpitis to apical periodontitis)

A

Periodontal abscess - pulp is fine, abscess develops directly in the periodontium
Pericoronitis - inflammation around a crown, usually partially erupted
Sialadenitis - infection of the glands, usually one of the major salivary glands, resulting in swelling and redness, dryness and pus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
128
Q

Cervico-facial actinomycosis

A

Very chronic pus producing infection which can develop after an extraction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
129
Q

5 cardinal signs of inflammation

A

Heat
Swelling
Pain
Redness
Loss of function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
130
Q

Symptoms of early stage abscess before the infection has broken through bone and into soft tissues

A

Almost identical to acute apical periodontitis
Severe unremitting pain
Acute tenderness in function
Acute tenderness to percussion
No swelling, redness or heat until the abscess spreads out from within the jaw bone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
131
Q

Symptoms of acute apical abscess that has perforate through bone

A

Pain often remits initially due to release in pressure (unless in the palate)
Swelling, redness and heat (in soft tissues) become increasingly apparent
As swelling increases pain returns
There is initial reduction in tenderness to percussion of the tooth as pus escapes into the soft tissues

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
132
Q

Factors determining the site of spread of dental infection

A

Position of the tooth in the arch
Root length
Muscle attachments

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
133
Q

Potential spaces in proximity to lesion that dental infection could spread into

A

Submental space
Sublingual space
Submandibular space
Buccal space
Infraorbital space
Lateral pharyngeal space
Palate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
134
Q

Need for antibiotics in case of dental infection is determined by

A

Severity
Absence of adequate drainage
Patients medical condition
Local factors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
135
Q

Local factors denoting need for antibiotics

A

Toxicity (if pt is systemically unwell)
Airway compromisation
Dysphagia
Trismus
Lymphadenitis
Location - floor of mouth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
136
Q

Systemic factors denoting need for antibiotics in case of dental infection

A

Immunocompromised pt - acquired causes (HIV), drug induces (steroids/cytostatics), blood disorders (leukaemias), poorly controlled diabetes, extremes of age

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
137
Q

Reversible pulpitis

A

A level of inflammation in which returning to a normal state is possible if noxious stimuli removed
The pulp is inflamed due to caries or a restoration etc, if the cause is removed, the pulp will recover to normal health
Usually mild to moderate tooth pain, no pain without stimulus, subsides in <5secs, no mobility, no pain on percussion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
138
Q

Irreversible pulpitis

A

Higher level of inflammation where the dental pulp has been damaged beyond the point of recovery
Sharp throbbing sever pain upon stimulation and pain may be spontaneous or occur without stimulation, pain persists after stimulus is removed, >5secs
TX - RCT or extraction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
139
Q

Periapical granuloma

A

Chronic apical periodontitis
Mass of chronically inflamed granulation tissue at apex of tooth (plasma cells, lymphocytes and few histocytes with fibroblasts and capillaries)
NOT a true granuloma because not granulomatous inflammation (it has epithelioid histiocytes mixed with lymphocytes and giant cells)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
140
Q

Etiology of an apical radicular cyst

A

Caries/trauma/periodontal disease
Death of dental pulp
Apical bone inflammation
Dental granuloma
Stimulation of epithelial rests of Malassez (remnants of embryological origin)
Epithelial proliferation
Periapical cyst formation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
141
Q

% of minor salivary gland tumours that are malignant

A

40-50%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
142
Q

Coughing blood suggests

A

Lung cancer
Could be pharynx or larynx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
143
Q

When to make an urgent referral for suspected oral cancer?

A

Persistent unexplained head and neck lumps >3 weeks
Unexplained ulceration or swelling/induration of the oral mucosa persisting >3 weeks
All unexplained red or mixed red and white patches of the oral mucosa persisting for > 3weeks
Persistent (not intermittent) hoarseness lasting for >3 weeks
Persistent pain in the throat or pain on swallowing lasting for >3weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
144
Q

Ludwig’s angina

A

Pus either side of the mylohyoid line

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
145
Q

Mylohyoid line

A

Bony ridge on the internal surface of the mandible, running posteriosuperiorly.
The site of origin for the mylohyoid muscle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
146
Q

Most important issue associated with Ludwig’s angina

A

Airway problems due to the swelling causing the tongue to rise up

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
147
Q

Upper central infection tends to cause swelling where?

A

Lip

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
148
Q

Upper laterals, canines and first premolar infections are likely to cause swelling where?

A

Eye

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
149
Q

Upper 2nd premolar and molar infections are likely to spread and swell where?

A

Sinus, cheek, temple

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
150
Q
A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
151
Q
A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
152
Q

Where is a lower incisor infection likely to cause infection?

A

Mental/submental

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
153
Q

Where are infections of lower canines and premolars likely to cause swelling?

A

Submandibular

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
154
Q

Where are lower molar infections likely to cause swelling?

A

Pharynx/cheek

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
155
Q

What determines the spread of infection of a dental infection?

A

The root length of the tooth and its position in the arch in relation to the mylohyoid line

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
156
Q

Triangle of danger

A

Named so because of the connection from the facial veins into the cavernous sinus
Infection which enters the veins in this area can cause cerebral abscess

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
157
Q

Cavernous sinus

A

A vascular space under the pituitary gland, with nerves and blood vessels running through it

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
158
Q

Types of elevators

A

Warwick James - right left and straight
Cryer’s - right and left
Coupland’s - size 1, 2, 3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
159
Q

Name and what they are used for

A

Left to right
Upper root forceps - retained roots
Upper straight forceps - upper anteriors
Upper universals - canines and premolars
Upper molar forceps (left and right)
Upper third molar bayonet forceps

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
160
Q

Describe upper molar forceps and why are they shaped this way?

A

One rounded and one pointed beak
The pointed beak is designed to engage the furcation on the buccal side

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
161
Q

Name and what they are used for

A

Left to right
Lower root forceps - retained roots
Lower universal forceps - lower incisors, canines and premolars
Lower molar forceps
Cowhorn forceps - lower molars, often broken down ones that are not easily gripped

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
162
Q

Patient positioning for extractions

A

Upper tooth - supine 45-90 degrees
Lower tooth - more upright 0-45 degrees
At a comfortable height for the operator

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
163
Q

Where should the operator be positioned for an extraction of a lower right tooth?

A

Behind the right shoulder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
164
Q

Where should the operator be positioned for extraction of an upper right tooth?

A

To the front of the patient on their RHS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
165
Q

Where should the operator be positioned for extraction of an upper left tooth?

A

To the front of the patient on their RHS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
166
Q

Where should the operator be positioned for extraction of an lower left tooth?

A

To the front of the patient on their RHS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
167
Q

Describe extraction technique with forceps

A

Make sure soft tissues are clear of the forceps
Position forceps as far down the tooth as possible without traumatising the gingivae
Place the thumb and forefinger of the non dominant hand on the alveolar bone to support it
Apply apical pressure and carry out extraction movements - on multi rooted teeth such as molars this is buccal expansion and figure of 8, on single rooted teeth (and sometimes premolars) use rotation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
168
Q

Procedure following extraction

A

Check apices are intact
Check socket is clear
If RR or bony sequestrum that is easily removed, remove it
Place dampened gauze and get patient to bite, applying pressure
Check for haemostasis after 5-10 minutes
Give post-op instructions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
169
Q

What are luxators and elevators for?

A

Used to aid extraction of retained roots and teeth
Used to aid mobility before using forceps

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
170
Q

Luxator

A

Used to tear and sever the periodontal ligament, creating mobility

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
171
Q

How do elevators work?

A

By creating space by using
- Wedge
- Lever
or
- wheel and axle
motions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
172
Q

How to tell the difference between a luxator and a coupland’s elevator?

A

Luxators have a rounded edge

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
173
Q

Name and what are they used for

A

Warwick James (left, straight, right)
Used as elevators to create space
Particularly handy when extracting third molars

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
174
Q
A

Left and right
Used as elevators to create space
Particularly useful when used in the furcation area of a molar tooth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
175
Q

How to hold elevators?

A

Bottom of the handle in the palm
Curve middle, ring and pinkie fingers around the handle
Put index finger on the shank for support and control

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
176
Q

How to use a luxator?

A

Position the same as when using forceps
- Support alveolar bone with non dominant hand
- Luxate in the buccal sulcus from mesial to distal
Lack of stability can cause soft tissue trauma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
177
Q

How to use a Coupland’s?

A

Lever or wedge motion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
178
Q

Correct positioning when extracting a tooth allows you to..

A

Keep your arms close to your body
Provides stability and support
Allows you to keep your wrists straight enough to deliver adequate force with your arm and shoulder, and not with your fingers/hand, the force can thus be controlled in the face of sudden loss of resistance from a root or fracture of the bone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
179
Q

Types of suture technique

A

Simple interrupted
Horizontal mattress
Vertical mattress
Figure of 8
Continuous

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
180
Q

What type of suture is this?

A

Vertical mattress

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
181
Q

What type of suture is this?

A

Vertical mattress

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
182
Q

What type of suture is this?

A

Horizontal mattress

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
183
Q

Approximately how far from the wound edge should sutures be placed?

A

2-5mm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
184
Q

Describe a vertical mattress suture

A

A shallower, more superficial suture closer to the wound edge, within a deeper, further from the wound edge suture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
185
Q

Why use resorbable sutures?

A

In areas where the suture requires to be buried, or is difficult to remove
Used for most intra-oral wounds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
186
Q

Why use non resorbable sutures?

A

Sutures retain tensile strength and remain in the tissue until removed
Often used in areas where high tensile strength is required for a longer period of time
Such as OAC, skin closure, or to hold dressings when exposing canines

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
187
Q

Example of resorbable mono filament suture

A

Monocryl

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
188
Q

Example of resorbable polyfilament suture

A

Vicryl, Velosorb, Polysorb

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
189
Q

Example of non resorbable monofilament suture

A

Nylon
Prolene

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
190
Q

Example of non resorbable poly filament suture

A

Silk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
191
Q

What is the difference between monofilament and polyfilament?

A

Monofilament - sutures are made from a single strand. These are less likely to facilitate an infection because it is more difficult for bacteria to colonise on a single strand
Polyfilament - Sutures are made from several smaller strands twisted together and can be easier to handle. They are often contraindicated in contaminated wounds due to wicking

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
192
Q

What is wicking/the wick effect?

A

Studies have shown multifilament sutures can absorb fluids and bacteria thus enabling infection to penetrate the body along the suture tract

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
193
Q

Advantage of polyfilament sutures

A

Can be easier to handle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
194
Q

Disadvantage of polyfilament sutures

A

Wicking/ the wick effect

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
195
Q

Advantage of monofilament sutures

A

Less likely to facilitate an infection because it is more difficult for bacteria to colonise a single strand

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
196
Q

Consideration of LA in pregnant women

A

Citanest contains felypressin which may induce labour

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
197
Q

Which type of elevator’s are you more likely to use wheel and axle motion with?

A

Cryer’s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
198
Q

Required INR for warfarin patients for extraction and which guidelines?

A

SDCEP
1-4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
199
Q

How do new oral anti-coagulants work?

A

by inhibiting the action of factor 10a on the coagulation cascade

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
200
Q

Bones associated with the TMJ

A

Temporal
Sphenoid
Zygomatic
Maxilla
Mandible

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
201
Q

Describe the structure of the mandible

A

2 superior processes - condyloid and coronoid
The mandibular notch is between the two
Inferior to this is the neck, the ramus and then the angle
Moving anteriorly there is the body of the mandible, beginning just lateral to the mental foramina, where the mental nerve exits to provide sensory innervation to the chin and some of the mandibular teeth. In the midline of the body is the mandibular symphysis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
202
Q

Describe the internal aspect of the mandible

A

The mandibular foramen, where the inferior alveolar nerve enters into the mandibular canal and the submandibular fossa, which the submandibular gland is pressed against are on the internal aspect

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
203
Q
A

A - Coronoid process
B - Angle
C - Ramus
D - Neck
E - Condyloid process
F - Mandibular notch

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
204
Q
A

Body of the mandible (left)
Mental foramen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
205
Q

Where is the mental nerve derived from?

A

It is a branch of the inferior alveolar nerve which is a branch of the mandibular nerve which is the third division of the trigeminal nerve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
206
Q

What does the mental nerve innervate?

A

It provides sensory innervation to the chin and lip, anterior buccal mucosa and some mandibular teeth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
207
Q

Where does the mental nerve exit the skull through?

A

Mental foramen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
208
Q

Through what does the inferior alveolar nerve enter the mandibular canal?

A

Through the mandibular foramen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
209
Q

Where does the condyloid process articulate with to give the TMJ?

A

Mandibular fossa of the temporal bone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
210
Q

What is anterior movement of the TMJ limited by?

A

Articular eminence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
211
Q

Where is the articular eminence located?

A

On the zygomatic arch, just anterior to TMJ

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
212
Q
A

A - zygomatic arch
B - articular tubercle/eminence
C - mandibular fossa
D - Styloid process
E - Mastoid process
F - External auditory meatus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
213
Q

What type of joint is the TMJ?

A

Synovial

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
214
Q

What is the TMJ?

A

A synovial joint at the articulation between the condyloid process of the mandible and the mandibular fossa of the temporal bone, found in the a region known as infratemporal fossa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
215
Q

What is the region of the skull that TMJ is found in?

A

Infratemporal fossa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
216
Q

What splits the TMJ into an upper and a lower compartment?

A

Articular disc

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
217
Q
A

A - articular disc
B - articular tubercle/eminence
C - Articular capsule
D - Ramus of mandible
E - Mandibular condyle
F - Inferior joint cavity
G - Superior joint cavity
H - Mandibular fossa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
218
Q

what is the difference between the upper and lower compartments of the TMJ?

A

Gliding movements such as protrusion and retraction or side to side are permitted in the upper
Rotational movements such as elevation and depression are permitted in the lower

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
219
Q

What must happen before depression of the mandible will be allowed?

A

The condylar process must move anteriorly within the upper compartment of the TMJ

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
220
Q

What will happen if the condylar process moves anteriorly beyond the articular eminence and how is this fixed?

A

MoM will spasm and TMJ will become dislocated
Put downward pressure on the lower molars and guide the head of the mandible back into the mandibular fossa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
221
Q

What is the lateral temporomandibular ligament and its role?

A

Attaches to zygomatic arch and posterior portion of the neck of the mandible
Limits posterior movement of the mandible

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
222
Q

What limits posterior movement of the mandible?

A

Lateral temporomandibular ligament

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
223
Q
A

1 - joint capsul
2 - lateral temporomandibular ligement
3 - sphenomandibular ligament
4 - styloid process
5 - stylomandibular ligament

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
224
Q

What are the medial ligaments to the TMJ?

A

Sphenomandibular ligament
Stylomanidbular ligament

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
225
Q

What is the function of the sphenomandibular and stylomandibular ligaments?

A

Limiting lateral movement of the TMJ

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
226
Q

Where does the sphenomandibular ligament run from/to?

A

From the ramus to the sphenoid bone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
227
Q

Where does the stylomandibular ligament run from/to?

A

From the ramus to the styloid process

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
228
Q

Muscles of mastication

A

Temporalis
Masseter
Lateral pterygoid
Medial pterygoid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
229
Q

Which bone are the pterygoid plates part of?

A

Sphenoid

230
Q

Where are the pterygoid muscles located in relation to the mandible?

A

The pterygoid muscles are located medial to the mandible

231
Q

Describe medial pterygoid structure

A

Has two heads
Deep head - attached to medial aspect of the lateral pterygoid plate
Superficial - attached to the maxilla and the palatine bones
Both heads run posterior inferiorly to reach a point at which they fuse and will then insert onto the ramus of the mandible

232
Q
A

1 Lateral pterygoid
2 Medial pterygoid

233
Q

Describe lateral pterygoid structure

A

Superior head attaches to the roof of the infratemporal fossa and the lateral portion of the lateral pterygoid plate
Inferior head attaches to lateral portion of lateral pterygoid plate
Moving posteriorly both heads will fuse and attach to the condylar process of the mandible

234
Q

What happens when lateral pterygoid muscles act bilaterally?

A

They protrude the jaw

235
Q

Which action of the lateral pterygoids is paramount to the opening of the mouth?

A

Acting bilaterally to protrude the jaw

236
Q

What does unilateral contraction of the lateral pterygoids do?

A

Swings the jaw to the contralateral side

237
Q

What does bilateral action of the medial pterygoid muscles do?

A

Closes the jaw and assists in protrusion

238
Q

What does unilateral contraction of medial pterygoid muscles do?

A

Swings the jaw to the contralateral side

239
Q

Where does temporalis arise from and attach to?

A

From the temporal fossa, attaching to the coronoid process of the mandible

240
Q

Describe the difference between the anterior and posterior fibres of temporalis

A

The anterior fibres run vertically and will assist in closing the jaw
The posterior fibres run horizontally and will retract the mandible

241
Q

Where is masseter located?

A

On the lateral side of the mandible

242
Q

Structure of masseter

A

Superficial head - attached to zygomatic bone
Deep head - attached to zygomatic arch
Inferiorly both heads attach to the ramus and angle of the mandible

243
Q

Action of masseter

A

Elevates the mandible to close the mouth

244
Q

Innervation of muscles of mastication

A

All innervated by the mandibular division of the trigeminal nerve

245
Q

When is the TMJ most stable?

A

When the jaw is closed with teeth in occlusion

246
Q

What is the most common kind of TMJ displacement?

A

Anterior dislocation - the condyloid process moves anterior to the articular eminence and the MoM spasm, preventing retraction of the mandible

247
Q

What opposes anterior dislocation of the TMJ?

A

Articular eminence, lateral temporomandibular ligament, and the contraction of medial pterygoid, masseter and temporalis

248
Q

Origin of the masseter

A

2 origins
Zygomatic buttress of the zygomatic bone and medial aspect of zygomatic process of the temporal bone

249
Q

Insertion of the masseter

A

Lateral surface of the angle of the mandible

250
Q

Origin of temporalis

A

Temporal fossa

251
Q

Insertion of temporalis

A

Coronoid process

252
Q

Origin of medial pterygoid

A

Medial surface of the lateral pterygoid plate

253
Q

Insertion of the medial pterygoid

A

Medial side of the angle of the mandible

254
Q

Lateral pterygoid origin

A

2 origins
Lateral surface of lateral pterygoid plate and the base of skull/top of infratemporal fossa

255
Q

Insertion of the lateral pterygoid

A

Pterygoid fovea at the condyle

256
Q

Blood supply to the TMJ

A

Deep auricular artery (branch of the 1st part of the maxillary artery)

257
Q

Nerve supply to the TMJ and why is this relevant to symptoms?

A

Auriculotemporal, masseteric, posterior deep temporal nerve
Auriculotemporal nerve also supplies parts of EAM and some with TMD get pain in the ear

258
Q

Suprahyoid muscles

A

Digastric
Mylohyoid
Geniohyoid
Stylohyoid

259
Q

Infrahyoid muscles

A

Thyrohyoid
Sternohyoid
Sternothyroid
Omohyoid

260
Q
A

A Digastric (anterior belly)
B Geniohyoid
C Mylohyoid
D Stylohyoid
E Digastric (posterior belly)

261
Q
A

A Thyrohyoid
B Sternothyroid
C Omohyoid (superior belly)
D Sternohyoid
E Omohyoid (inferior belly)

262
Q

Which part of the articular disc can not feel pain and why?

A

The anterior band of the articular disc
Does not have sensory innervation

263
Q

What does the articular disc do during jaw movements?

A

Slides back and forth with the condyle

264
Q

Causes of TMD

A

Myofascial pain (muscles)
Disc displacement (anterior with or without reduction)
Degenerative such as osteoarthritis or rheumatoid arthritis
Chronic recurrent dislocation
Ankylosis (very rare)
Hyperplasia (one condyle grows more)
Neoplasia (tumours)
Infection (incredibly rare)

265
Q

What could be a localised degenerative cause of TMD?

A

Osteoarthritis

266
Q

What could be a systemic degenerative cause of TMD?

A

Rheumatoid arthritis

267
Q

What does it mean if anterior disc displacement is ‘with reduction’?

A

With reduction - disc eventually slips back into place
Without reduction - stuck in front of the condyle permanently

268
Q

Appearance of condylar hyperplasia

A

Facial asymmetry
Chin points away from the side of the condyle that is growing more

269
Q

Possible neoplastic causes of TMJ (rare)

A

Osteochondroma - overgrowth of bone and cartilage
Osteoma - benign bony tumour
Osteosarcoma - malignant bone tumour

270
Q

How to relocate a dislocated TMJ?

A

Hold jaw with thumbs inside the mouth on the buccal surfaces of lower molars and push down and backwards slowly
Sometimes muscle relaxants such as benzodiazepines are necessary

271
Q

Possible pathogenesis to myofascial pain TMJ

A

Inflammation in the MoM or TMJ secondary to parafunctional habits
Trauma - either directly to the joint or indirectly such as sustained opening
Stress
Psychogenic
Occlusal abnormalities (no evidence)

272
Q

Social history considerations for a TMD patient

A

Occupation, stress, home life, sleeping pattern, recent bereavement, relationships, habits, hobbies

273
Q

E/O exam of TMD patient

A

MoM
Joint - clicks/ crepitus
Jaw movements
Facial asymmetry

274
Q

Intra-oral exam for TMD patient

A

Interincisal mouth opening - could use Willis bite gauge
Signs of parafunction - tongue scalloping, biting cheeks, linea alba, occlusal NCTSL

275
Q

When are you more likely to do special investigations for TMD?

A

Suspicion of pathology

276
Q

Common clinical features of TMD

A

Females > males
Age 18-30
Intermittent pain of several months or years
Muscle/joint/ear pain, particularly on waking
Trismus/locking
Clicking/popping
Headaches

277
Q

Potential differential diagnoses for TMD

A

Dental pain
Sinusitis
Ear pathology
Salivary gland pathology
Referred neck pain
Headache
Atypical facial pain
Trigeminal neuralgia
Angina
Condylar fracture
Temporal arteritis

278
Q

What is temporal arteritis?

A

Inflammation of the temporal artery which can result in blindness
Presents as very severe pain in the temporal region

279
Q

Treatment for TMJ dysfunction

A

Patient education
Counselling
Jaw exercises
Medication
(Electromyographic recording)

280
Q

What medication can be used to treat TMD?

A

NSAIDs
Muscle relaxants
Tricyclic antidepressants
Botox
Steroids

281
Q

What does TMD counselling include?

A

Soft diet
Masticate bilaterally
No wide opening
No chewing gum
Don’t incise food
Cut food into small pieces
Stop parafunctional habits
Support mouth on opening such as yawning

282
Q

Physical therapy for TMD

A

Physiotherapy
Massage/heat
Acupuncture
Relaxation
Ultrasound therapy
TENS
Hypnotherapy

283
Q

Examples of irreversible treatment for TMD

A

Occlusal adjustment
TMJ surgery

284
Q

How might patients with TMJ disc displacement present?

A

Painful clicking TMJ
The click is due to a lack of coordinated movement between the condyle and the articular disc
Jaw tightness/locking
The mandible may deviate initially to the affect side

285
Q

What can happen if TMJ disc displacement is left untreated?

A

Osteoarthritis

286
Q

Treatment for TMJ disc displacement

A

Counselling, limited mouth opening, bite raising appliance (occasionally surgery)

287
Q

What is this?

A

Jaw screw
For trismus
Placed between incisors then on twisting, opens the mouth

288
Q

Treatment for trismus

A

Physio therapy
Therabite jaw rehabilitation system
Jaw screw

289
Q

Guidelines for TMJ dysfunction

A

NICE

290
Q

When would you refer a TMD patient to oral med or OMFS?

A

History of trauma or fracture to TMJ complex
Markedly limited mouth opening suggesting disc displacement without reduction
Pain or reduced function in people with rheumatic joint disease
Worsening symptoms lasting >3 months despite primary care tx
Other chronic pain comorbidities
Recurrent dislocation
Severe pain and dysfunction not responding to conservative management

291
Q

What should you consider before assessing a trauma case?

A

ATLS - Advanced Trauma Life Support, treat the greatest threat to life first
ABCD - Airway, breathing, circulation, disability

292
Q

What is the Glasgow Coma Scale?

A

Used to assess head injuries
Eye opening, verbal response and motor response are all considered and given points in order to give a GCS score

293
Q

Glasgow Coma Scale scores

A

Mild 13-15
Moderate 9-12
Severe 3-8

294
Q

Glasgow Coma Scale Eye opening scores

A

Spontaneous - 4
To sounds - 3
To pressure - 2
None - 1

295
Q

Glasgow Coma Scale verbal response scores

A

Orientated - 5
Confused - 4
Words - 3
Sounds - 2
None - 1

296
Q

Glasgow Coma Scale motor response scores

A

Obey commands - 5
Localising - 5
Normal flexion - 4
Abnormal flexion - 3
Extension - 2
None - 1

297
Q

Indicators of mandible fracture

A

Sublingual haematoma
2 point mobility vertically
Abnormal sensation contralateral to the side of injury
Pain contralateral to the side of injury
Numbness that can’t be explained by direct injury to the nerve

298
Q

What is needed to diagnose a mandible fracture?

A

2 regular Xrays or a CT scan
(there is no role for half OPGs)

299
Q

How to manage a mandible fracture

A

Fast the patient
Analgesia - can swallow tablets with small amount of water
Antibiotics for open fractures - amoxicillin and metronidazole or equivalent
Liquid diet
Immediate discussion with OMFS team

300
Q

What region would be considered a midface fracture?

A

Eyebrows to maxillary teeth, including zygoma

301
Q

Important signs of broken bone in the midface

A

Epistaxis (nose bleed) without a blow to the nose
V2 numbness without a direct blow to the nerve
Subconjunctival bleed
Midface mobility
Malocclusion
Surgical emphysema around eye
Swelling after nose blowing
Diplopia
Change of appearance
Clear liquid CSF running out of nose

302
Q

Diplopia

A

Double vision

303
Q

What causes a subconjunctival bleed?

A

Seen in some midface fractures
Conjunctiva has been torn by the fracture, and blood turns the white of the eye deep red (not the whole eye)

304
Q

Epistaxis

A

Nose bleed

305
Q

How to check for midface mobility?

A

Hold forehead still and pull palate backwards and forwards

306
Q

What is meant by surgical emphysema?

A

Air in the soft tissues
Seen around the eye in some midface fractures

307
Q

What is required to assess a midface fracture?

A

2 Xrays

308
Q

Le fort fractures

A

The face breaks in three particular patterns in the midface
All fractures extend into the pterygoid columns, if the pterygoids aren’t broken then you don’t have a Le Fort fracture

309
Q

How to tell which type of Le Fort fracture?

A

Hold head and pull on teeth
If teeth move - Le Fort I
If nose moves - Le Fort II
If eyes move - Le Fort III

310
Q

Management of zygoma fracture

A

No indication for routine antibiotics
Call OMFS - vast majority will be followed up in 7-10 days
No nose blowing
Soft diet for their comfort
Give warning re retrobulbar bleed, as this can lead to blindness (rare)

311
Q

Retrobulbar bleed

A

Rare, sight-threatening emergency, that results in accumulation of blood in the retrobulbar space

312
Q

Orbit fracture

A

Breaking of just the eye socket, deep segments rather than the rim - would be zygoma fracture

313
Q

Management of orbit fracture

A

Ensure visual acuity and diplopia documented
Discuss with OMFS
Don’t bother CTing
No need for routine antibiotics
No nose blowing
Give warning re retrobulbar bleed

314
Q

Indicators of an orbit fracture

A

Eyebrow sign - gas leaks and rises to just below eyebrow
Eye may be sunken or dropped down

315
Q

When would you give warning about retrobulbar bleed?

A

Zygoma fracture
Orbit fracture

316
Q

Management of maxilla fracture (le fort type)

A

Fast the patient
Antibiotics
Discussion with OMFS
Liquid diet
No nose blowing
Most will need assessed on the day

317
Q

Pathognomic features of zygoma fracture

A

Unilateral epistaxis when the noe has not been injured
Eyebrow sign
Paraesthesia when trauma was distant to extraosseous infraorbital nerve
Buttress tenderness

318
Q

Nasal Orbital Ethmoidal fracture pathognomic features

A

Retropositioned nose
Buttress not tender
Epistaxis
Often numb
Steps at IOR, pyriform, glabella
Hyperteloric (eyes drift apart)

319
Q

Naso-maxillary fracture pathognomic features

A

Tender IOR/pyriform
Buttress intact
Often numb
Unilateral epistaxis without blow to the nose
Same as zygoma EXCEPT buttress

320
Q

Where is the parasymphasis of the mandible?

A

Anterior to mental foramen

321
Q

Most common imaging for midface fractures?

A

OPG and PA mandible
(two angulations of PA mandible for zygoma or orbit)

322
Q

What does SIRS stand for?

A

Systemic inflammatory response syndrome

323
Q

SIRS Systemic Inflammatory Response Syndrome criteria

A

Fever 38C +
Hypothermia <36C
Tachycardia - high pulse >90bpm
Tachypnoea - high breathing rate >20 breaths/min
Change in blood count (WBC count >1200)
Partial pressure CO2 <32mmHg

324
Q

Hot potato syndrome

A

Infection causes raised floor of mouth, patient talks like they have hot potato in their mouth

325
Q

Where must you never incise an intraoral abscess in GDP?

A

Floor of mouth

326
Q

Should you suture the wound from draining an abscess?

A

No - allows more drainage

327
Q

What are rongeurs?

A

Bone nibblers
Used to remove small fragments of bone

328
Q

What excisional soft tissue surgery might be used for before provision of dentures?

A

Frenoplasty
Papillary hyperplasia
Flabby ridges
Denture induced hyperplasia
Maxillary tuberosity reduction
Retromolar pad reduction

329
Q

Why might a labial frenoplasty be required?

A

Oral hygiene issues

330
Q

What risk must be considered during a buccal frenoplasty?

A

Risk of damaging the mental nerve

331
Q

When might a lingual frenoplasty be necessary?

A

Tongue tie

332
Q

When might a buccal frenoplasty be necessary?

A

High buccal frenum in a denture patient
This would break the seal and displace the lower denture every time the patient moves

333
Q

What should be done if denture associated papillary hyperplasia does not resolve with removal of the denture?

A

Excisional surgery

334
Q

Vestibuloplasty

A

Surgery to deepen the sulcus in order to achieve better denture retention by having more space for extending the flange

335
Q

When might hard tissue excisional surgery be considered before provision of dentures?

A

Removal of retained teeth/roots/pathology
Ridge defect correction (alveoplasty)
Mandibular tori
Maxillary tori
Maxillary tuberosity
Exostoses
Undercuts
Genial tubercle reduction
Mylohyoid ridge reduction

336
Q

Why might retained roots or “buried” teeth become a problem in denture provision?

A

If the ridge resorbs these may end up palpable or visible and interfere with the fitting surface

337
Q

What can be seen here and what is the most likely cause?

A

Well defined, unilocular, corticated radiolucency
Residual cyst - apical radicular cyst in relation to one of the teeth in the region, tooth has been removed but the cyst has remained

338
Q

How would you manage this?

A

Biopsy to determine what it is
CBCT to see relation to the IAN
Then decide on final tx plan

339
Q

What surgical technique would be used for this and why?

A

Alveoplasty to prevent interference with denture retention

340
Q

What is the likely cause of this?

A

Retained lower anteriors for much longer than the posteriors

341
Q

What is this and how would you manage it/why?

A

Knife edge ridge
This is sharp and can be uncomfortable when wearing a denture or traumatic to soft tissues
Smooth this ridge to make it more comfortable but do not take too much away as this could negatively affect denture retention

342
Q

Management of a maxillary torus in denture patients

A

Surgically remove the bony projection OR design denture around it e.g. horseshoe shape

343
Q

Why might a large maxillary tuberosity occur?

A

Large bony tuberosity OR lots of excess fibrous tissue surrounding normal bone

344
Q

Which two structures on the mandible can become prominent and might require removal/reduction with very sever bone resorption?

A

Genial tubercle
Mylohyoid ridge

345
Q

Examples of hard tissue augmentation procedures that might be done for denture patients

A

Autografts
Allografts
Xenografts
Synthetic grafts

346
Q

Autografts

A

Bone taken from elsewhere in the body for a graft
eg hip bone being used to augment the maxillary ridge

347
Q

Allografts

A

Bone taken from human cadavers for bone grafts
Commonly used for alveolar bone for implants

348
Q

Xenografts

A

Bone from animals, usually cows, can be horses
Used to provide framework for bone regeneration

349
Q

Pros/cons of synthetic bone grafts

A

No risk of disease transmission
No cultural/religious/ethical issues
Can be very effective but some can have a lower rate of being accepted by the body
Customisable to be exact shape/size/porosity that you want

350
Q

When would inferior alveolar nerve relocation be done? And describe the procedure

A

In severe cases of bone resorption the mental foramen can end up at the surface
In some cases the entire IAN can be just covered by soft tissue rather than by bone
Denture fitted to these tissues will press on the nerve causing numbness and pain
To reposition you would open up to expose the nerve, drill a channel deeper down in the body of the mandible and reposition the nerve further down

351
Q

Why might implants be provided for complete denture patients?

A

For implant retained overdentures

352
Q

23 year old pt attends reporting pain from LL for 18 months, pt says pain is from wisdom tooth and asks for it to be removed. What do you want to know?

A

SOCRATES
HPC - past episodes of pericoronitis/antibiotics/swelling history
Systemic MH, meds, allergies
PDH, anxiety, previous extractions, any problems
SH - smoking, drinking, occupation, caring responsibilities

353
Q

How will you carry out a comprehensive assessment of someone reporting signs of pericoronitis?

A

Extra oral
TMJs
Lymphnodes
Asymmetry
MoM
Mouth opening
Intra oral
Soft tissues
Dentition
Caries
Perio
OH
Working distance
L8 erupted?
Condition of adjacent 7
Presence of other 8s

354
Q

Assessment findings

A

LL8 partially erupted- approx 1/2 occlusal surface is visible
LL8 appears vertically impacted on clinical examination
Operculum appears infllamed

355
Q

Patient reports recurrent episodes of pain from LL quadrant and on examination you find this. What is your next step?

A

OPT

356
Q

Report

A

OPT diagnostically acceptable
Vertical/slighty distoangular LL8 superficial impaction
LL8 crown healthy - no signs of caries
LL8 crown wider than roots
LL8 has at least 2 roots
LL8 apices appear close to ID canal but no signs of intimate relationship
LL7 appears sound
Adequate bone levels

357
Q

Pericoronitis recurring LL8
What are the treatment options

A

Clinical review - monitor at regular examination, only require radiographs if change in signs or symptoms
Surgical removal of LL8
(No indication for further imaging or coronectomy in this case as no intimate relationship with ID canal, no indication for XLA UL8 as doesn’t look to be occluding against operculum)

358
Q

What information do you need to give to ensure pt is making informed decision about surgical removal of LL8?

A

Discuss option of LA/Conscious sedation/GA (and referral if required)
Regarding procedure:
Pain, Swelling, Bleeding, Infection, Jaw stiffness, Dry socket
Temporary (2-20%) or Permanent (<1%) damage to nerve, possibility of numbness, tingling or painful sensation
Areas affected could include side of chin, lip, tongue, gums or cheek
Small risk of loss of taste
Surgical approach: cut in gum, bone removal which will feel like vibration/water, pressure, stitches (dissolving)

359
Q

Usual age of eruption for third molars

A

18-24 years

360
Q

When can crown calcification of 8s start to be seen radiographically?

A

7-9 for uppers
8-10 for lowers
(completed by about 18)

361
Q

What age is root calcification of 8s complete?

A

18-25

362
Q

How common is it that and adult has 1 or more third molars present?

A

1 in 4

363
Q

Agenesis

A

Failure of an organ to develop

364
Q

Is third molar agenesis more common in mandible or maxilla?

A

Maxilla

365
Q

Is third molar agenesis more common in men or women?

A

Women

366
Q

What age would you expect to see third molars radiographically, after which they almost never develop?

A

14

367
Q

What is a common reason for older patients to have issues with third molars?

A

Third molars causing problems with dentures

368
Q

Impacted

A

Tooth eruption is blocked
Failure to erupt into either a full or partial functional position, or at all

369
Q

What is the most common reason for third molars failing to erupt?

A

Impaction

370
Q

What are M3Ms usually impacted against?

A

Adjacent tooth, alveolar bone, surrounding mucosal soft tissue or a combination of these factors

371
Q

Eruption of impacted third molars

A

Impacted third molars can be unerupted, partially erupted or fully erupted

372
Q

Fully erupted

A

Whole occlusal surface through the mucosa and exposed to the oral cavity

373
Q

Incidence of impacted lower 3rd molars

A

36-59%

374
Q

Consequences of third molar impaction

A

Caries (in 8 or 7)
Pericoronitis
Cyst formation (often results from the failure of the follicle to separate)

375
Q

What does it mean if a tooth appears unerupted clinically, but radiographically there is caries?

A

This suggests that there is a communication between this tooth and the oral cavity, since the bacteria is able to reach it and cause caries
Probe carefully distal to 7 to try to find this communication

376
Q

4 nerves at risk during 3rd molar surgery

A

Inferior alveolar nerve
Lingual nerve
Nerve to mylohyoid
Long buccal nerve

377
Q

Which two nerves are most likely to be damaged during third molar surgery?

A

Inferior alveolar nerve
Lingual nerve

378
Q

Inferior alveolar nerve

A

Peripheral sensory nerve formed from the mandibular division of the trigeminal nerve.
Supplies all the mandibular teeth (on its side) and mucosa and skin of the lower lip and chin on that side

379
Q

Inferior alveolar nerve and third molar relationship

A

Position in relation to the mandibular third molar varies greatly
Usually need radiograph before third molar surgery to see this
Risk to the nerve should be considered

380
Q

Lingual nerve

A

Branch of the mandibular division of the trigeminal nerve supplying anterior two thirds of the dorsal and ventral mucosa of the tongue
Also gives off a branch which supplies lingual gingivae and FoM

381
Q

Lingual nerve position

A

Lingual nerve varies in position
Close relationship to the lingual plate in the mandibular and retromolar area
At or above level of the lingual plate in 15-18%
Between 0.3-5mm medial to mandible
Must be very careful to avoid during third molar surgery

382
Q

Guidelines for 3rd molar surgery

A

NICE and SIGN basically dictate that because of the related risks, you must be able to justify third molar surgery with pathology - caries, significant infection, perio, cyst
RCS FDS - more recent acknowledges that you might be delaying inevitable surgery which could make it more difficult in future, and recommended changing from a solely therapeutic approach to a mixed range of interventions

383
Q

Therapeutic indications for third molar surgery

A

Infection - caries, pericoronitis, perio, local bone infection, most common
Cysts
Tumours
External resorption of 7 or 8

384
Q

If there is any history of pericoronitis..

A

Removal of any symptomatic third molar should always be considered

385
Q

1st and 2nd most common reasons for removal of third molars

A

1st caries
2nd pericoronitis

386
Q

Why is restoring a caries lower 8 usually not done?

A

Access and moisture control make it very difficult
8s are not really necessary

387
Q

What type of third molar impaction is more prone to causing bone loss distal to the lower 7

A

Horizontal and mesio angular impaction

388
Q

What is the best way to reduce bone loss distal to a 7, if there is a horizontally or mesio angular impacted 8?

A

Early extraction of the third molar
Late removal, especially after age 30 has not been shown to improve periodontal status of the adjacent 7

389
Q

Most common age range for cyst formation

A

20s-50s

390
Q

When do cysts normally first become symptomatic?

A

When they become very large and/or infected

391
Q

Most common type of cyst to be found associated with third molars

A

Indigenous cyst

392
Q

Indigenous cyst

A

Arises from the reduced enamel epithelium separation from the crown

393
Q

Are cysts associated with third molars more common in mandible or maxilla?

A

Mandible

394
Q

Why is prophylactic removal or coronectomy of a disease free lower 8 to prevent cyst formation not routine?

A

This would prevent development of a cyst but the number of cysts that you’re going to prevent by doing this would be fairly small so it is not usually an indication

395
Q

Tumours as indication to removal third molars

A

If the tumour is close to the lower 8 it might be extracted as part of a cancer, in part of the dissection as may other teeth
If the pt has tumour anywhere in the body and will be having radiotherapy, it might be indication to remove lower 8 because of the future ORN risk

396
Q

Why might resorption be indication for third molar removal?

A

External resorption is the destruction of tissue, the cause of inflammation is often unclear but left untreated it is usually progressive
External resorption of the third molar or of the second molar caused by the third molar should always make us consider third molar removal

397
Q

Most common age for external resorption of lower 7 by lower 8

A

21-30
(relatively rare)

398
Q

Non therapeutic indications for extractions of third molars

A

Surgical indications
High risk of disease
Medical indications
Accessibility
Patient age
Auto transplantation
General anaesthetic

399
Q

Examples of possible surgical indications for third molar removal

A

Tooth is within surgical field - orthognathic, fractured mandible, in resection of diseased tissue

400
Q

What are high risk of disease indications for third molar removal?

A

Mesio angular or horizontally impacted lower 8
High risk of caries for 8 or 7 and of periodontal bone loss

401
Q

Medical indications for removal of third molars

A

needing signed off dentally fit e.g. Awaiting cardiac surgery
Immunosuppressed (or about to become)
Before going on bisphosphonates
Before starting radiotherapy or chemotherapy

402
Q

When might you be more likely to consider removal of 8s in a perfectly healthy patient?

A

If they have limited access to the dentist e.g. submariners

403
Q

Why is patient age an indicator in 3rd molar removal?

A

Complications and recovery time increase with age, so it might make sense to taje the tooth out while the patient is young

404
Q

Where would an 8 usually be moved to in autotransplantation?

A

Lower 6 position

405
Q

Why might you be more inclined to take out a third molar in someone alongside other dental treatment?

A

If they were going for GA

406
Q

Pericoronitis

A

Inflammation around the crown of a partially erupted tooth
Tooth is normally partially erupted

407
Q

What causes pericoronitis?

A

Food and debris gets trapped under the operculum of a partially erupted tooth, resulting in inflammation or infection

408
Q

Describe pericoronitis infection

A

Usually transient and self-limiting

409
Q

Most common age for pericoronitis

A

20-40

410
Q

General health factor in pericoronitis

A

Upper respiratory tract infection can become pericoronitis

411
Q

What type of microbes are likely to be involved in pericoronitis?

A

Anaerobes

412
Q

Examples of bacteria found in pericoronitis infections

A

Streptococci
Actinomyces
Prioponibacterium
Beta-lactamase producing prevotella
Bacteroides
Fusobacterium
Staphylococci

413
Q

Pericoronitis signs and symptoms

A

Pain
Swelling
Bad taste/halitosis
Pus
Occlusal trauma to operculum
Ulceration of operculum
Evidence of cheek biting
Limited mouth opening
Dysphagia
Pyrexia
Malaise
Regional lymphadenopathy

414
Q

What might be seen in severe pericoronitis?

A

Extra oral swelling
Most commonly starting at the angle of the mandible
Can spread anywhere, commonly submandibular areas

415
Q

If pericoronitis infection spreads distobuccally under the masseter, what is this called? and give a characteristic sign

A

Submasseteric abscess
Pt can not open mouth

416
Q

What symptom might arise from spread of pericoronitis infection into the parapharyngeal space?

A

Dysphagia
This might present with drooling

417
Q

Pericoronitis treatment

A

IF pt is acutely symptomatic you might
- Incise pericoronal abscess
- Irrigate under operculum with chlorhexidine or saline using blunt syringe (10-20ml)
- Extract upper third molar if traumatising operculum
- Instruct pt on warm salt water or chlorhexidine MW
- Antibiotics if systemically unwell, extra-oral swelling, immunocompromised
- If large extra oral swelling, significantly unwell, trismus, dysphagia - refer to OMFS or A&E
(generally do not remove the third molar during an acute episode of pericoronitis)

418
Q

Why is operculectomy now not done very often?

A

Within weeks or months the operculum grows back to where it was so not much is gained

419
Q

Method of pericoronitis management that is no longer in favour

A

Operculectomy

420
Q

Predisposing factors for pericoronitis

A

Partial eruption and vertical or distoangular impaction
Opposing maxillary 2nd or 3rd molar causing mechanical trauma
URTI
Stress/fatigue
Poor OH
Insufficient space between ascending ramus and distal aspect of M2M
White race
Full dentition

421
Q

Most current guidelines on third molar management

A

RCS FDS

422
Q

When is it appropriate to take out a third molar with no associated pathology?

A

If the risk and likelihood of it causing problems at some point in the future is too high

423
Q

History during assessment of patient presenting with third molar

A

General appearance - asymmetry, difficulty speaking, look unwell
C/O and HPC
Medical history
Dental history
Social history

424
Q

3 components of assessment of pt presenting with third molar

A

History
Clinical examination
Radiographic assessment (if indicated)

425
Q

HPC for pericoronitis

A

How long, how many episodes, how often, severity, requirement for antibiotics
SOCRATES

426
Q

Underlying systemic diseases that might interfere with normal healing

A

Diabetes
Chronic renal disease
Liver disease
Bleeding disorder
Immunosuppressed
Radio or chemotherapy

427
Q

Medications relevant during third molar treatment planning

A

Contraceptive - increased risk of dry socket
Steroid therapy - increased risk of wound infection and delayed healing
Bisphosphonates - MRONJ
Anticoagulants and antiplatelets

428
Q

What would you ask if a patient has previous extractions, and you are planning third molar management?

A

How did they find it?
Any sedation/GA
Surgical
Any delay in healing
Any issues post op

429
Q

Extra-oral exam of patient presenting with third molars

A

TMJ
Mouth opening
Lymphadenopathy
Facial asymmetry
MoM

430
Q

Why is it important to examine TMJ when a patient presents with third molars?

A

TMD can give pre-auricular pain very similar to pericoronitis
Good to know if there’s a click before surgery so that pt does not think surgery caused this

431
Q

Intra-oral examination of patient presenting with third molar

A

Soft tissues
Dentition
M2M
Working space
Eruption status of M3Ms
Condition of dentition
Occlusion
Oral hygiene
Caries
Perio

432
Q

When would you do radiographic assessment of a patient presenting with third molars?

A

Only if surgical intervention is being considered

433
Q

What radiograph(s) would you take to assess third molars?

A

OPT

434
Q

What can be determined from an OPT to assess third molars?

A

Presence or absence of disease
Anatomy of 3M (crown size, shape, condition, root formation, crown:root)
Depth of impaction
Orientation of impaction
Working distance
Follicular width
Periodontal status
Relationship or proximity of U8s to maxillary sinus, and L8s to IAN canal
Any other associated pathology

435
Q

Superficial impaction

A

When the crown of the 8 is sitting at the same height as the crown of the adjacent seven

436
Q

Deep impaction

A

When the crown of the 8 is at the same level as the roots of the adjacent 7

437
Q

Moderate impaction

A

When the crown of the 8 is level with crown and root of the adjacent 7

438
Q

Dental follicle

A

Tissue that surrounds the crown of a developing tooth
As the tooth pushes into oral cavity you normally lose this but if a tooth is unerupted this would appear as radiolucency

439
Q

What does dental follicle becoming bigger than expected indicate?

A

Suggests pathology such as a cyst
Concern at anything over 2.5-3mm

440
Q

Why is it important to discuss the relationship of the M3M with the inferior dental CANAL (not the nerve) when discussing radiographs?

A

Nerves can not be seen radiographically, you are looking at the canal

441
Q

Signs of close proximity of M3Ms to the inferior dental canal

A

Interruption of the white lines/lamina dura of the canal
Darkening of the root where crossed by the canal
Diversion/deflection of the inferior dental canal
Deflection of root
Narrowing of canal
Narrowing of root
Dark and bifid root apex
Juxta apical area

442
Q

Three radiographic signs associated with significantly increased risk of nerve injury during third molar surgery

A

Interruption of the white lines of the canal
Diversion of the canal
Darkening of the root where crossed by the canal

443
Q

Juxta apical area

A

A well circumscribed radiolucent region lateral to the root of the third molar, usually not right at the apex
Usually well defined, can appear corticated
Lamina dura of the root still intact and appearance not pathological

444
Q

What do guidelines suggest about further imaging after OPT for third molars

A

Where conventional imaging has shown a close relationship between the third molar and the inferior dental canal, CBCT may be of benefit

445
Q

What information can CBCT give you on the relationship between M3M and inferior alveolar nerve canal?

A

Is there bone between the ID canal and apices of the tooth
Is the tooth actually compressing the canal

446
Q

Why is CBCT better than CT for third molar assessment?

A

Limited FoV of CBCT is advantageous in terms of image reconstruction and the radiation dose to the patient

447
Q

% of different angulations of third molars

A

Vertical 30-38%
Mesial around 40%
Distal around 6-15%
Horizontal 3-15%
Transverse or aberrant less common

448
Q

Most difficult third molar angulation to remove

A

Distal

449
Q

Most common third molar angulation

A

Mesial

450
Q

What is angulation of third molars measured against?

A

Curve of Spee

451
Q

Curve of Spee

A

Curve as you follow the natural cusps of the dentition

452
Q

Angulation of M3Ms

A

LR8 is mesially impacted
LL8 is horizontally impacted

453
Q

Why is it important to measure angulation of lower third molar impactions against the curve of spee?

A

It is easy to confuse a distal angulation with a vertical angulation
Distal is much more difficult to extract

454
Q

Why are distally impacted M3Ms so difficult to extract

A

it is very unlikely you will get it out intact without distal bone removal, and the roots of distally impacted 8s are often very close to roots of the 7 so it can be difficult to get and application point and you need to be very careful not to damage the 7

455
Q

Angulation of L8s

A

LR8 is horizontally impacted
LL8 is distally impacted

456
Q

Angulation of L8s

A

LR8 is vertically impacted
LL8 is distally impacted

457
Q

Angulation of LR8

A

LR8 is transversely impacted

458
Q

Position of LL8

A

Aberrant position

459
Q

Why is it good to assess depth of impaction radiographically?

A

Gives an indication of the amount of bone removal required

460
Q

Depth of impactions of L8s

A

LR8 is moderate
LL8 is superficial

461
Q

Depth of impaction

A

Superficial

462
Q

Depth of impaction

A

Moderate impaction

463
Q

What must be considered if 7 next to an impacted 8 has a large or overhanging restoration?

A

Risk of restoration fracture during extraction of the 8 - pt must be warned of this if they have
- Large restoration
- Crown
- Overhangs
If this happens the tooth would need to be temporised and dealt with later

464
Q

Common treatment options for impacted M3Ms

A

Referral
Clinical review
Removal
Extraction of the maxillary 3rd molar
Coronectomy

465
Q

Clinical review of M3M

A

Review signs and symptoms associated, can be done at regular review
No indication for radiographic assessment unless clinically there are signs/symptoms

466
Q

Coronectomy of M3M

A

Removing the crown and leaving the roots in situ
Only usually considered if close relationship between M3M and IAN canal

467
Q

Less common treatment options for M3Ms

A

Operculectomy
Surgical exposure
Pre-surgical orthodontics
Autotransplantation

468
Q

Important aspects of decision making in M3M treatment planning

A

Decision should be made jointly between patient and clinician
Patient involvement - communicate findings, risk status, tx options including risks and benefits
Good notekeeping
Current status of patient and M3M
Risk of complication
Patient access to treatment

469
Q

How to manage asymptomatic 3rd molars with disease present or high risk of disease development

A

Clinician should use their expertise to assess the risk eg of caries, perio, etc then consider surgical intervention
This might be affected by risk of complications eg proximity to IAN canal in which case the decision might be active surveillance

470
Q

Active surveillance of M3M

A

Monitoring the tooth with radiographs at regular intervals
Sometimes done for asymptomatic M3Ms either with disease present or high risk of disease developing

471
Q

What can you consult for M3M treatment planning?

A

Summary of the management of patients with Mandibular Third Molars from the RCS FDS guidelines

472
Q

Management of asymptomatic M3M with no disease present/low risk of disease

A

Clinical review is likely to be the most appropriate management
Pt medical history may change this e.g. if tooth is in surgical field

473
Q

Management of symptomatic M3M with high risk of or disease present

A

Consider cause of the symptoms - caries, perio etc
Then consider tx options

474
Q

Management of symptomatic M3Ms with no disease present and low risk of disease

A

Consider other causes of symptoms - consider TMJ, salivary gland disease
It would not be indicated to remove a deeply impacted M3M if it is disease free

475
Q

Which patients may only be able to tolerate 3rd molar removal under GA?

A

Extremely anxious
Contraindications to sedation
Other factors complicating the surgery e.g. extensive resection being done at the same time

476
Q

When would you explain risk of jaw fracture to a patient having extraction of M3M?

A

Edentulous/atrophic mandible
Aberrant lower 8 close to lower border
Large cystic lesion associated with the tooth

477
Q

How would you explain the procedure of M3M surgical extraction to a patient?

A

Minor surgical procedure
Cut flap
Possible drilling
Stitches - 2-3 weeks to dissolve
If tooth is likely to need sectioned explain this

478
Q

Risks to explain to pt having M3M removal

A

If 2nd molars have large restorations explain risk of restoration fracture
Pain
Swelling
Bruising
Jaw stiffness/limited mouth opening
Bleeding
Infection
Dry socket
Numbness or tingling

479
Q

Why is the jaw sometimes stiff with limited opening after M3M extraction?

A

Mouth has been open for a long time with pressure on the lower jaw

480
Q

Factors making dry socket more common

A

Extraction of 8s
Females
Mandible
Smokers
If pt has had dry socket before
Contraceptive pill

481
Q

Nerve anaesthesia feeling

A

Numbness

482
Q

Nerve paraesthesia feeling

A

Tingling

483
Q

% of patients who experience temporary IAN damage after M3M extraction

A

10-20%

484
Q

% of patients who experience permanent IAN damage after M3M extraction

A

<1%

485
Q

% of patients who experience temporary lingual nerve damage after M3M extraction

A

0/25-23%

486
Q

% of patients who experience permanent lingual nerve damage after M3M extraction

A

0.14-2%

487
Q

What is the time frame for nerve recovery?

A

Most will happen within 9 months but nerves have been shown to have recovery up to 18-24months after surgery
After this any recovery very unlikely

488
Q

Chorda tympani

A

Carries taste sensation from anterior two third of the tongue
Carries fibres via lingual nerve
Arises from facial nerve

489
Q

Most common sensation from nerve damage during M3M surgery

A

Numbness - anaesthesia
Tingling - paraesthesia

490
Q

Rarer sensations from nerve damage during M3M surgery

A

Painful uncomfortable sensation - dysaesthesia
Reduced sensation - hypoaesthesia
Increased sensation - hyperaesthesia

491
Q

When would you not opt for CBCT having seen close relationship of M3M and IAN canal on OPT?

A

IF the results will not change the txp
- Patient wants full surgical removal regardless of the risk
- Grossly carious lower 8 not suitable for coronectomy

492
Q

What must be included in a M3M referral letter

A

SBAR
Situation
Background (HPC)
Assessment
Recommendation

493
Q

When is a surgical removal required?

A

When tooth cannot be removed with forceps alone

494
Q

Basic principles of surgical extraction

A

Risk assessment
Aseptic technique
Minimal trauma to hard and soft tissues

495
Q

Surgical removal process

A

Anaesthesia
Access
Bone removal as necessary
Tooth division as necessary
Debridement - ensure all apices are accounted for
Suture
Achieve haemostasis
Post op instructions

496
Q

Access for surgical removal

A

Access to the tooth is gained by raising a buccal mucoperiosteal flap
(+/- raising a lingual flap)
Maximum access with minimal trauma
Larger flaps heal just as quickly as smaller
Use scalpel in one continuous stroke
Minimise trauma to papillae

497
Q

Reflection of soft tissues for surgical extraction

A

Commence reflection at base of relieving incision
Undermine/free the papillae before proceeding with reflection distally to avoid tears (Warwick James)
Reflect with periosteal elevator firmly on bone
in order to avoid dissection occurring superior to periosteum and reduce soft tissue bruising/trauma

498
Q

Instruments used to reflect surgical flap

A

Mitchel’s trimmer
Howarth’s periosteal elevator
Ash periosteal elevator

499
Q

Instruments used to retract surgical flap

A

Howarth’s periosteal elevator
Rake retractor
Minnesota retractor

500
Q

Why is it important to retract the flap during surgical extractions

A

Access to the operative field
Protect the soft tissues

501
Q

Name left to right

A

Howarth’s periosteal elevator
Rake retractor
Minnesota retractor

502
Q

What is important for atraumatic retraction of soft tissues during surgical extractions?

A

Rest firmly on bone
Awareness of adjacent structures e.g. mental nerve

503
Q

Why are air driven handpieces not used during surgical extractions?

A

May cause surgical emphysema

504
Q

Bone removal process for surgical extraction

A

Electrical straight handpiece with SS or Tungsten carbide saline cooled bur (to avoid bone necrosis)
Round bur used to cut buccal gutter and on to distal aspect of impaction, starting distally and coming mesial (reduces risk to lingual nerve and other soft tissues behind M3M)
Buccal gutter as narrow and deep as poss
Bone removed to allow application of elevators

505
Q

What is done after bone removal during surgical extraction?

A

Operator must assess the possibility of removing the tooth in one piece with elevators and forceps
If this is not possible and adequate bone has been removed the tooth should then be sectioned with drillOPerator
Most commonly sections between crown and roots, then sometimes further separation of the roots from each other
Operator may prefer to section vertically

506
Q

A 68 year old female with history of a fractured neck of femur has been given 2 drugs to prevent her getting another fracture. Give two drug types and examples that this could be

A

Anti-resorptives - bisphosphonates - zoledronic acid
Vitamin supplements - Vit D

507
Q

What significant oral condition may arise from taking some anti-resorptive drugs?

A

Medication related osteo necrosis of the jaw

508
Q

Four ways in which MRONJ can be prevented

A

Patient education
OHI
Consider high fluoride toothpaste
Make pt dentally fit before starting antiresorptives
Remove risk factors where poss eg sharp denture flange
Smoking cessation advice
Non-invasive alternative treatment such as RCT

509
Q

Management options for MRONJ

A

Monitoring
Specific OHI for exposed bone
Antiseptic MW
Occasionally antibiotics
Minimal surgical debridement in select cases
Primary closure where possible
Remove traumatic causes
Consult GMP to check if drug modification or replacement is appropriate
Symptomatic relief
Topical analgesics
Radiographs to establish differential diagnosis
Referral to secondary care

510
Q

Top to bottom

A

Frontal sinus
Sphenoid sinus
Ethmoidal air cells
Maxillary sinus

511
Q

Which of the sinuses are most well formed at birth?

A

Maxillary and ethmoid
Formation occurs withing 3-4th foetal month

512
Q

Functions of paranasal sinuses

A

Resonance to the voice
Reserve chambers for warming inspired air
Reduce the weight of the skull

513
Q

Which of the sinuses is usually the largest?

A

Maxillary

514
Q

Maxillary sinus description

A

Pyramid shaped cavity within the body of each maxilla
Volume approx 15ml in average adult
37mmH 27mmW 35mmAP on average

515
Q

Ostium of the maxillary sinus

A

Located medially near the roof of the maxillary sinus
Drains into middle meatus
Approx 4mm diameter
Lined with mucosa
Can become narrowed or blocked during episodes of inflammation or disease

516
Q

What is generally found on the posterior wall of the maxillary sinus cavity?

A

The alveolar canals that transport the posterior superior alveolar vessels and nerves to the maxillary posterior teeth

517
Q

Roots of maxillary molars and sometimes premolars may project into ____

A

The floor of the maxillary sinus
The roots may perforate the bone so that only the mucosal lining of the sinus covers them

518
Q

Epithelium of the sinuses

A

Pseudostratified ciliated columnar epithelium

519
Q

What is the role of the cilia in the maxillary sinus

A
  1. Mobilised trapped particulate matter and foreign material within the sinus
  2. Move this material towards the ostia for elimination into the nasal cavity
520
Q

Possible issues with maxillary sinus

A

OAC - acute
OAF - chronic
Root (or entire tooth) pushed into the sinus
Sinusitis
Benign lesion
Malignant lesions

521
Q

How is an OAC usually created?

A

On extraction of upper molar with roots projecting onto the floor of the maxillary sinus, a communication between the sinus and the mouth is created by either breaking the bone, or tearing the lining of the sinus

522
Q

Why is an OAC a problem?

A

Bacteria from the mouth can now enter into the sinus, which can result in sinusitis and make other functions problematic

523
Q

How do you diagnose an OAC?

A

Size of tooth
Radiographic position of roots in relation to sinus
Bone at trifurcation of roots
Bubbling of blood
Nose holding test
Direct vission
Good light and suction - echo
Blunt probe

524
Q

Which two ways that you would investigate whether an OAC has been created could potentially create an OAC if not careful?

A

Nose holding test
Probing

525
Q

OAF

A

Oro-antral communication that persists as an opening, and a sinus tract forms and become epithelialized
Oro antral fistula

526
Q

When might a pre-op assessment suggest likelihood of and OAC?

A

Roots of the tooth for XLA appear to by within the sinus or projecting onto lining of the sinus
Very thin bone in the area

527
Q

What is this?

A

OAC

528
Q

What is this?

A

OAF

529
Q

What is shown here?

A

OAF radiographic appearance

530
Q

Management of OAC

A

Tell the patient
If small or sinus lining intact - encourage clot, suture margins, possible antibiotic, post op instructions minimising pressure formation within sinuses and the mouth - avoid straws, balloons, singing, smoking, blowing nose
If large or lining torn - close with buccal advancement flap, can refer urgently to OS for this

531
Q

OACs <2mm prognosis

A

Usually heal with normal blood clot formation and routine mucosal healing

532
Q

What type of flap is usually used to close an OAC?

A

Buccal advancement flap

533
Q

Buccal advancement flap

A

Three sided flap with a crestal incision and two relieving incisions
Flare base to ensure that there is bloody supply to all of the flap

534
Q

Procedure of closing OAC with buccal advancement flap

A

Lift the flap of mucosa, sometimes need to chip away some buccal bone. This flap will not stretch easily across so you need to incise the periosteum of the flap (fresh blade) on the underside. This will make the flap loose enough to stretch it over the OAC.
Be very careful when incising the periosteum not to cut the flap off.
One initial suture. Usually resorbable sutures, but sometimes these dissolve too quickly. Then follow with more sutures for complete primary closure.

535
Q

Patients with an OAF may complain of

A
  • Problems with fluid consumption, fluids from nose
  • Nasal quality to speech and singing
  • Problems playing brass/wind instruments
  • Problems smoking or using a straw
  • Bad taste/odour/halitosis/pus discharge
  • Pain/sinusitis type symptoms
536
Q

OAF management

A

The same as the OAC closure except first you must excise the epithelialized sinus tract, then perform buccal advancement flap.
Sometimes an antral washout is also required - if chronic sinusitis and sinus is full of infection, this is flushed out and aspirated.
This can cause reduction in sulcus depth.

537
Q

Potential flap designs for OAC/ OAF closure

A
  • Buccal advancement flap
  • Buccal fat pad with buccal advancement flap - if bigger OAF or OAC, two layer closure, very effective
  • Palatal flap - incredibly painful, leaves exposed bone on the palate
  • Bone graft/collagen membrane
  • Rotated tongue flap (historical)
538
Q

Aetiology of fractured maxillary tuberosity

A
  • Single standing molar
  • Unknown unerupted molar or wisdom tooth
  • Pathological gemination/concrescence
  • Extracting in wrong order (you should start posterior and move forward)
  • Inadequate alveolar support
539
Q

Diagnosis of fractured maxillary tuberosity

A
  • Noise
  • Movement noted both visually or with supporting fingers
  • More than one tooth movement
  • Tear in soft tissue of palate
540
Q

Management of maxillary tuberosity fracture

A

if noticed early enough
Reduce and stabilise
* Orthodontic buccal arch wire with composite
* Arch bar
* Splints (lab made)
If bone removed - dissect out and primary closure of wound

541
Q

If maxillary tuberosity fracture is treated by splinting tooth must remember:

A
  • Remove or treat pulp
  • Ensure it is out of occlusion
  • Consider antibiotics and antiseptics
  • Post-op instructions
  • Remove the tooth surgically 4-8 weeks later
542
Q

Management of a root or tooth in the maxillary sinus

A

Confirm radiographically by OPT, occlusal or periapical (+/-CBCT)
CBCT should be done on the day of retrieval as it can move around
Decision on retrieval
If in doubt or retrieval difficult - refer

543
Q

How to manage?

A

You can leave this piece of root because if it has not torn the lining, it will not cause sinusitis or other problems and it will not move from there

544
Q

Removal of root in the maxillary sinus process

A

Open fenestration with care
Suction - efficient and narrow bore
Small curettes
Irrigation or ribbon gauze
Close as for OAC
Careful not to tear lining
If this doesn’t work - Caldwell-Luc approach (buccal window cut in bone)
If unretrievable - refer to ENT for endoscopic retrieval

545
Q

What must you remember when examining patients with maxillary discomfort?

A
  • Close relationship of the sinuses and the posterior maxillary teeth
  • The aetiology of paranasal sinus inflammation and infection
  • Patients with sinusitis often present to the dentist first
546
Q

Aetiology of Sinusitis

A

Mostly precipitated by the effects of a viral infection (debate over antibiotics)
Inflammation and oedema
Obstruction of ostia
Trapping of debris within sinus cavity
Mucociliary clearance patterns may be altered by allergens, inflammation, anatomic abnormalities
Normal function further disrupted by cellular damage to mucosal lining, affecting ciliary function
Build up in sinus and bacterial overgrowth

547
Q

2 effects of sinus not being able to evacuate its contents efficiently

A

Build up of pressure
Stagnation in sinuses - opportune situation for bacterial overgrowth of normal flora

548
Q

Signs and symptoms of sinusitis

A
  • Facial pain
  • Pressure
  • Congestion
  • Nasal obstruction
  • Paranasal drainage
  • Hyposmia
  • Fever
  • Headache
  • (dental pain)
  • Halitosis
  • Fatigue
  • Cough
  • Ear pain
  • Anaesthesia/paraesthesia over cheek
549
Q

Dental causes that must be ruled out with similar symptoms to sinusitis

A
  • PA abscess
  • Periodontal infection
  • Deep caries
  • Recent extraction socket
  • TMD
  • Neuralgia or atypical facial pain/chronic midfacial pain
550
Q

Specific indicators of sinusitis, that indicate the symptoms do not have a dental cause

A

Discomfort on palpation infraorbitally
A diffuse pain the maxillary teeth
Equal sensitivity from percussion of multiple teeth in the same region
Pain that worsens with head or facial movement (jump up and down, bend and stand up)

551
Q

Treatment aims for patients with sinusitis

A

Treat presenting symptoms
Reduce tissue oedema
Reverse obstruction of the ostia

552
Q

Sinusitis treatments

A

Decongestants to reduce mucosal oedema - ephedrine nasal drops 0.5% one drop up each nostril up to three times daily when required (max 7 days as will cause atrophy of sinus and nose lining)
Humidified air also helpful (steam/menthol inhalations)

553
Q

Why can’t you use decongestants long term?

A

Will cause atrophy of the lining of the sinus and the nose

554
Q

Antibiotics for sinusitis

A

Only to be used if symptomatic treatment not effective/symptoms worse
AND
Signs and symptoms point to bacterial sinusitis
Amoxicillin 500mg 3x daily 7 days
Doxycycline 100mg 1x daily 7 days (200mg loading dose)
SDCEP guidance

555
Q

Fungal infections of sinuses

A

Very rarely non-resolving sinusitis may be due to a fungal infection
This can cause expansion of the bony walls by increased mucous secretion and fungal growth (this can happen with other types of infection too)

556
Q

What types of trauma can cause sinusitis by violating the integrity of the bony cavity and sinus membrane?

A

Sinus wall fractures
Orbital floor fractures
RCT
Extractions
Implants/sinus lifts
Deep perio treatment
Nasal packing
Nasogastric tubes
Mechanical (nasal) intubation

557
Q

What is a sinus lift?

A

Procedure used to reduce volume of the sinus to increase amount of bone available usually for implants

558
Q

Benign sinus lesions

A

Polyps, papillomas, antral pseudocysts, mucoceles, mucous retention cysts, odontogenic cysts/tumours expanding into the sinus

559
Q

Malignant lesions of the maxillary sinus

A

Primary tumours
Local spread from adjacent sites

560
Q
A
561
Q
A
562
Q
A
563
Q
A
564
Q
A
565
Q
A
566
Q
A
567
Q
A
568
Q
A
569
Q

How much alveolar bone support should you have for a post?

A

At least half of post length into the root in bone

570
Q
A

BDS4 (18 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions