Exo

Question 1

Possible complications of removing impacted upper molar

Answer 1

Tuberosity fracture
OAC
Perforated maxillary sinus
Damage adjacent teeth

Question 2

Name some indications for exo

Answer 2

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

Question 3

Contraindications fro exo

Answer 3

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

Question 4

What must you do before exo

Answer 4

Time out

Question 5

Why is it compulsory to take pre exo radiograph

Answer 5

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

Question 6

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

Answer 6

1 hour of dental pulp analgesia

3-5 hours of soft tissue analgesia

Question 7

Possible complications of IDN block

Answer 7

Infection
Patients have tendency to bite tongue and lips
Nerve injury

Question 8

How much to inject for IDN block

Answer 8

1.5-2ml

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

Question 9

Mental nerve block target

Answer 9

Apex of second premolar

Question 10

How to use luxator

Answer 10

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

Rotating motion

Question 11

How to use dental elevator

Answer 11

Prying motion, leverage

To loosen tooth prior to forcep use

Question 12

How to use periotome

Answer 12

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

Rotating, twisting motion

Question 13

Motion when using forceps to extract mandibular molars

Answer 13

Buccolingual motion, more lingual motion because lingual plate thinner

Question 14

What are the principles in expanding the bony socket

Answer 14

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

Question 15

How should patient be positioned for extraction of q4 tooth

Answer 15

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

Question 16

How should patient be positioned for q2 extraction

Answer 16

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

Question 17

Extraction movement for upper incisors

Answer 17

Rotation only

Question 18

Extraction movement for lower incisors

Answer 18

Labolingual movement

Question 19

Extraction movement for upper canines

Answer 19

Rotation followed by labiolingual if required

Question 20

Extraction movement for upper premolars

Answer 20

Buccopalatal movement

Question 21

Extraction movement for lower premolars

Answer 21

Rotary

Question 22

Extraction movement for lower molars

Answer 22

Buccolingual movement

Question 23

Indications for trans alveolar removal

Answer 23

Very dense bone

Severe root curvature

Prominent external oblique ridge

Gross caries/caries below bone crest

High risk of oap

hypercementosis

Question 24

Post op instructions for exo

Answer 24

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

Question 25

Possible complication sduring extraction

Answer 25

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)

Question 26

Possible complications post exo

Answer 26

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

Question 27

Clinical signs of OAC

Answer 27

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

Question 28

What is considered a small oac

Answer 28

<2mm

Question 29

How to trea moderate OAC

Answer 29

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

Question 30

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

Answer 30

No nose blowing, sneezing, straw drinking for 10 days Nasal decongestant Augmentin for 2 weeks STO ≥10 days

Question 31

How long does it take for sinus membrane to reform

Answer 31

2 weeks

Question 32

Incidence of alveolar osteitis

Answer 32

5-20%

Question 33

Symptom of dry socket

Answer 33

Increasingly severe pain 3-7 days after exo

Question 34

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

Answer 34

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

Question 35

How to treat dry socket

Answer 35

Heals by itself within 2 weeks, but symptomatic relief -- irrigate and pack alveogyl, review after 1 week

Question 36

How to retrieve small root in antrum

Answer 36

2-3mm Retrieve through irrigation

Question 37

Risk when leaving behind root in antrum

Answer 37

Risk of sinusitis

Question 38

Available local hemostatic agents

Answer 38

Gel foam, surgicel, collagen ring, transexamic acid

Question 39

What is secondary bleeding

Answer 39

Bleeding 7-10 days after exo possible due to infection 3 possible sources 1. Bony socket 2. Soft tissue 3. Neurovascular bundle

Question 40

Healing process of extraction wound

Answer 40

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