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Oms > Exo > Flashcards

Exo Flashcards

1
Q

Possible complications of removing impacted upper molar

A

Tuberosity fracture
OAC
Perforated maxillary sinus
Damage adjacent teeth

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2
Q

Name some indications for exo

A

Grossly carious and cannot be restored

Acute/chronic pulpitis, cannot be restored by RCT

> 1/2 alveolar bone loss

Tooth fracture (root, longitudinal, lie in fracture line)

Bony lesion lies over tooth

Impacted

Ortho

Supernumerary

Pre bisphosphonate therapy

Retained deciduous

Tooth hurting soft tissue

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3
Q

Contraindications fro exo

A

Cardiac disease eg valvular heart disease

Blood disorders eg severe anemia

Liver disease, vit k deficiency

Pregnancy 1st and 3rd trimester

Malignancy (if extraction is around tumour site)

Patient on steroids

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4
Q

What must you do before exo

A

Time out

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5
Q

Why is it compulsory to take pre exo radiograph

A

Root morphology, proximity to vital structures, impacted teeth, periapical pathology, accompanying conditions eg sinusitis

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6
Q

How long does 2% lidocaine with 1:100000 epinephrine provide anaesthesia for

A

1 hour of dental pulp analgesia

3-5 hours of soft tissue analgesia

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7
Q

Possible complications of IDN block

A

Infection
Patients have tendency to bite tongue and lips
Nerve injury

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8
Q

How much to inject for IDN block

A

1.5-2ml

If lingual block required, withdraw needle 0.5cm and inject 0.5ml

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9
Q

Mental nerve block target

A

Apex of second premolar

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10
Q

How to use luxator

A

Wedge. Thin and sharp tip insert into narrow apical space between bone and tooth to slide in further

Rotating motion

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11
Q

How to use dental elevator

A

Prying motion, leverage

To loosen tooth prior to forcep use

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12
Q

How to use periotome

A

Sharp tip, tapering blade, insert between tooth and surrounding bone to cut PDL

Rotating, twisting motion

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13
Q

Motion when using forceps to extract mandibular molars

A

Buccolingual motion, more lingual motion because lingual plate thinner

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14
Q

What are the principles in expanding the bony socket

A

Socket dilatation
Small fractures of buccal plate and interradicular septa
Loose bone must be removed

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15
Q

How should patient be positioned for extraction of q4 tooth

A

Mandibular occlusal plane parallel to floor
Working height elbow level
Operator stand behind patient

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16
Q

How should patient be positioned for q2 extraction

A

Occlusal plane about 60º to the floor
Elbow level
Operator stand in front of patient

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17
Q

Extraction movement for upper incisors

A

Rotation only

18
Q

Extraction movement for lower incisors

A

Labolingual movement

19
Q

Extraction movement for upper canines

A

Rotation followed by labiolingual if required

20
Q

Extraction movement for upper premolars

A

Buccopalatal movement

21
Q

Extraction movement for lower premolars

A

Rotary

22
Q

Extraction movement for lower molars

A

Buccolingual movement

23
Q

Indications for trans alveolar removal

A

Very dense bone

Severe root curvature

Prominent external oblique ridge

Gross caries/caries below bone crest

High risk of oap

hypercementosis

24
Q

Post op instructions for exo

A 
Bite on gauze for 30min 
No rinsing out for 24h
No high intensity activities for 2-3 days
Soft diet, eat on other side
Sleep with head slightly inclined
Judicious pain control
25
Q

Possible complication sduring extraction

A

Failure to obtain adequate anaesthesia

Fracture of crown, root, tuberosity, opposing tooth

TMJ dislocation

Displacement of root into maxillary sinus, aspiration

Excessive hemorrhage

Wrong tooth extracted

Damage to soft tissue, nerves, adjacent teeth, maxillary sinus (oac)

26
Q

Possible complications post exo

A

Post op pain

  • damage t hard and soft tissue
  • dry socket
  • acute osteomyelitis
  • traumatic TMJ arthritis

Post op swelling

  • Edema
  • Hematoma
  • Infection
  • Trismus
  • Oroantral communication

Post op trismus ie myositis ossificans

Post op numbness due to nerve injury

27
Q

Clinical signs of OAC

A

Visualisation of sinus in socket

Part of sinus floor attached to root

Water enter nose from mouth

Misting of mirror on occluding nasal passage

Acute sinusitis — pus discharge, pain and erythema over sinus

28
Q

What is considered a small oac

A

<2mm

29
Q

How to trea moderate OAC

A

2-6mm, can heal on its own with local measures (surgical and suture)

nasal precautions for 10-14 days. ab, decongestants/antihistamines (syst or nasal spray) to maintain ostium patency and reduce thickness of mucous membrane, chlorhexidine m/w, dont sneeze with your mouth closed, no straw/smoking

30
Q

Post op instructions after surgery to fix large oac >6mm

A

No nose blowing, sneezing, straw drinking for 10 days

Nasal decongestant

Augmentin for 2 weeks

STO ≥10 days

31
Q

How long does it take for sinus membrane to reform

A

2 weeks

32
Q

Incidence of alveolar osteitis

A

5-20%

33
Q

Symptom of dry socket

A

Increasingly severe pain 3-7 days after exo

34
Q

Patient had tooth extracted. Begins to feel pain 4 days after extraction that becomes increasingly severe. Patient notices a bad smell. Possible cause?

A

Alveolar osteitis. Dissolution of blood clot, exposing lamina dura to the oral environment. Fibrinolysis due to increased fibrinolytics activity

35
Q

How to treat dry socket

A

Heals by itself within 2 weeks,

but symptomatic relief – irrigate and pack alveogyl, review after 1 week

36
Q

How to retrieve small root in antrum

A

2-3mm

Retrieve through irrigation

37
Q

Risk when leaving behind root in antrum

A

Risk of sinusitis

38
Q

Available local hemostatic agents

A

Gel foam, surgicel, collagen ring, transexamic acid

39
Q

What is secondary bleeding

A

Bleeding 7-10 days after exo possible due to infection

3 possible sources

  1. Bony socket
  2. Soft tissue
  3. Neurovascular bundle
40
Q

Healing process of extraction wound

A

Formation of blood clot filling the socket

Organisation of clot

Epithelialisation

Formation of woven bone filling the socket (1-2 months)

Woven bone is replaced by trabecular bone, alveolus remodelling

Oms (24 decks)

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