Brainscape's Knowledge GenomeTM

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


See full index

Oral Surgery 2 > Compromised Wound Healing > Flashcards

Compromised Wound Healing Flashcards

1
Q

bone remodeling allows what?

A

for our bones to repair from daily micro-trauma

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

what are some common reasons of compromised wound healing?

A
  1. medications
  2. radiotherapy (XRT)
  3. infection
  4. systemic disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

disease associated with bone healing problems

A
  1. drug (medication) related osteonecrosis (MRONJ) of the jaws
  2. osteo-radio-necrosis (ORN)
  3. osteomyelitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

drugs associated with MRONJ

A
  1. bisphosphonates
  2. anti-resorptive agents
  3. anti-angiogenic medications
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

example of anti-resorptive agents

A
  1. denosumab (Prolia, Xgeva)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

example of anti-angiogenic medications

A
  1. tyrosine kinase inhibitors
  2. monoclonal antibodies targeting VEGF
  3. Sunitinib
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what are bisphosphonates (BP)?

A

synthetic analogs of inorganic pyrophosphate

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

how does bisphosphonates (BP) work?

A
  1. high affinity for Ca2+
  2. inhibition of osteoclasts
  3. may inhibit capillary neo-angiogenesis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

indications for ORAL bisphosphonates (BP)

A
  1. osteoporosis
  2. osteopenia
  3. Paget’s disease
  4. osteogenesis imperfecta
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

indicatiosn for IV bisphosphonates (BP)

A
  1. bone metastases associated with solid tumors
  2. hypercalcemia of malignancy
  3. multiple myeloma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

diagnosis of MRONJ

A
  1. current or previous tx with bisphosphonates (BP)
  2. exposed bone in the maxillofacial region that has persisted for more than EIGHT weeks
  3. no history of radiation therapy to the jaws
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

commonly prescribed ORAL bisphosphonates (BP)

A
  1. Fosamax (alendronate)

2. Actonel (risedronate)

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

commonly prescribed IV bisphosphonates (BP)

A
  1. Aredia (pamidronate)
  2. Zometa (zolendronate)
  3. Reclast (zolendronate)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

commonly prescribed ORAL AND IV bisphosphonates (BP)

A

Boniva (inandronate)

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

how does Denosumab (Prolia, Xgeva) work?

A

stops the osteoclasts

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

how does anti-angiogenic agents work?

A

stop the blood supply in certain areas

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

what can happen when anti-angiogenic agents stop the formation of new vessels?

A

affects healing of soft tissues and patient can et necrosis

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

why necrosis in the jaws?

A
  1. increased bone turnover in the jaws

2. thin overlying oral mucosa due to jaw anatomy

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

remodeling rate of jaw is how many times more than long bones?

A

10x

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

according to AAOMS position paper, how do you manage a patient about to begin IV therapy?

A
  1. delay therapy, if systemic conditions permit
  2. optimize oral health prior to initiating therapy
  3. allow adequate osseous healing and wait until the surgery sites become mucosalized
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

how long does it take for surgery sites to become mucosalized?

A

14-21 days

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

according to AAOMS position paper, how do you manage an asymptomatic patient receiving IV therapy?

A
  1. maintain oral hygiene

2. avoid osseous injury

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

T/F: according to AAOMS position paper, managing an asymptomatic patient taking oral bisphosphonates (BP) is still lacking sound recommendations

A

true

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

according to AAOMS position paper, how do you manage an asymptomatic patient taking oral bisphosphonates (BP) for <4 years?

A

proceed with planned tx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
according to AAOMS position paper, how do you manage an asymptomatic patient taking oral bisphosphonates (BP) for <4 years and risk factor (steroid/anti-angiogenic meds)?
stop BP therapy 2 months prior to tx
26
according to AAOMS position paper, how do you manage an asymptomatic patient taking oral bisphosphonates (BP) >4 years?
drug holiday for 2 months
27
according to AAOMS position paper, when you should resume tx on asymptomatic patient taking oral bisphosphonates (BP)?
when osseous healing has finished in ~14-21 days
28
T/F: while there have been limited studies on drug holidays for tx of MRONJ, currently there have yet to be studies to confirm drug holidays are effective in prevention of MRONJ without increasing the skeletally related risks of low bone mass
true
29
drug holidays should be a medical decision based primarily on what?
medical decision based primarily upon the risk for skeletally related events (e.g. fractures)
30
clinical stage 1 of MRONJ
1. exposed/necrotic bone 2. asymptomatic 3. no infection
31
tx of clinical stage 1 of MRONJ
oral antimicrobial rinses (e.g. Peridex)
32
clinical stage 2 of MRONJ
1. exposed/necrotic bone 2. pain 3. infection
33
tx of clinical stage 2 of MRONJ
1. oral antimicrobial rinses | 2. antibiotic therapy
34
clinical stage 3 of MRONJ
1. exposed/necrotic bone 2. pain 3. infection 4. one or more of the following... a. fracture b. extra-oral fistula c. oro-nasal communication d. osteolysis
35
tx of clinical stage 3 of MRONJ
1. surgical debridement of resection | 2. antibiotic therapy
36
how to manage patient who is about to start IV bisphosphonates (BP)?
get healthy before
37
how to manage patient who is receiving IV bisphosphonates (BP)?
avoid osseous surgery if possible
38
how to manage patient who is taking oral bisphosphonates (BP)?
informed consent/medical consult if considering drug holiday
39
how to manage patient who has established MRONJ?
consult and refer
40
T/F: you should take thorough medical hx before performing extraction
true
41
osteo-radio-necrosis (ORN)
a condition in which irradiated bone becomes exposed through a wound in the overlying skin and/pr mucosa and persist without healing for 3 to 6 months
42
3 H's theory of pathogenesis
1. hypoxia 2. hypovascularity 3. hypocellularity
43
stage 1 osteo-radio-necrosis (ORN)
superficial involvement, only cortical bone exposed
44
tx for stage 1 osteo-radio-necrosis (ORN)
chlorhexidine mouthwash
45
stage 2 osteo-radio-necrosis (ORN)
localized involvement with involvement of cortical and medullary bone
46
tx for stage 2 osteo-radio-necrosis (ORN)
1. local debridement with or without HBO (hyperbaric oxygen) | 2. chlorhexidine mouthwash
47
stage 3 osteo-radio-necrosis (ORN)
diffuse involvement including inferior border
48
tx for stage 3 osteo-radio-necrosis (ORN)
surgical resection and reconstruction
49
stage 3 osteo-radio-necrosis (ORN) is usually associated with what?
pathologic fracture and possible osteo-cutaneous fistula
50
what does hyperbaric oxygen (HBO) therapy stimulate?
1. collagen synthesis 2. angiogenesis 3. epithelialization
51
osteomyelitis
inflammatory process of the bone marrow that involves cancellous and cortical bone with a tendency of progression
52
pathogenesis of osteomyelitis
1. bacterial infection 2. inflammation/edema of bone marrow 3. compression of blood vessels in the bone marrow 4. ischemia 5. necrosis (osteomyelitis)
53
T/F: osteomyelitis occurs more often in the maxilla than the mandible
false, mandible > maxilla
54
why does osteomyelitis occur more often in the mandible vs the maxilla?
maxilla has a lot of blood supply compared to mandible
55
predisposing factors of osteomyelitis
1. immune-compromised patients 2. diabetes mellitus 3. alcoholism (malnutrition) 4. myeloproliferative disease: leukemia, sickle cell 5. chemotherapy 6. fractures and odontogenic infections in immune-compromised patients 7. osteopetrosis (Albers-Schonberg disease)
56
radiographic findings of osteomyelitis
1. "moth-eaten" appearance | 2. radio-opacities which are due to sequestras
57
sequestra
islands of necrotic non-resorbed bone
58
signs and symptoms of osteomyelitis
1. pain 2. swelling 3. fever, malaise, trismus 4. parasthesia/anesthesia 5. tenderness of involved area 6. exposed bone 7. osteo-cutaneous fistula with purulent discharge
59
medical management of patients with osteomyelitis
1. abx (long term) | 2. hospitalization may be required for IV abx
60
what is the abx of choice to tx patients with osteomyelitis
clindamycin
61
how long are patients with mild cases of osteomyelitis | hospitalized for in order to get IV abx?
4 weeks
62
how long are patients with severe cases of osteomyelitis | hospitalized for in order to get IV abx?
up to 6 weeks
63
surgical management of patients with osteomyelitis
debridement/marginal resection/segmental resection (depend on involvement to remove dead bone)
64
how can you tell if bone is healthy?
if it's bleeding
65
how long does dry socket last for?
not longer than 1 week

Oral Surgery 2 (13 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions