Exodontia 2

Question 1

Which tooth structure has proprioception, mechanoreceptors, and nociceptors?

Answer 1

PDL

Question 2

What are the goals of anaesthesia?

Answer 2

Relief from sharp pain. Not necessarily from the dull feeling of pressure.

Question 3

What does level of anaesthesia achieved depend on?

Answer 3

Dose and concentration

Diffusion to site

Removal by circulation

Question 4

What are the types of LA used? What is the maximum dose?

Answer 4

Lignocaine 2% with 1:80000 adrenaline. Max dose 4.4mg/kg

Prilocaine 3% with Felypressin .03 i.u/ml. Max dose 6mg/kg

Articaine 4% with 1:100000 adrenaline. Max dose 7mg/kg

Bupivacaine 0.5% with 1:200000 adrenaline. Max dose 1.3mg/kg

Question 5

What gets anaesthetised in an inferior alveolar nerve block?

Answer 5

All mandibular teeth

FoM

Anterior 2/3rds of the tongue

Gingivae on lingual surface of mandible

Mucosa and skin of lower lip and chin

Question 6

What are the possible complications of IAN block?

Answer 6

Transient hemi-facial paralysis

Muscle trismus

Haematoma

Infection

Needle breakage

Question 7

What does the long buccal nerve block anaesthetize?

Answer 7

Buccal gingivae of molars and premolars

Question 8

What does the mental and incisive nerve block anaesthetize?

Answer 8

Teeth anterior to the mental foramen

Buccal soft tissue opposite premolars, canines, and incisors.

Mucosa and skin of lower lip and chin

Question 9

Which teeth are anaesthetised by anterior superior alveolar nerve block?

Answer 9

Pulp of incisors and canines and labial mucoperiosteum

Question 10

Which teeth are anaesthetised by middle superior alveolar nerve block?

Answer 10

Pulp of premolars and mesio-buccal root of first molar and buccal mucoperiostium

Question 11

What does the posterior superior alveolar nerve block anaesthetise?

Answer 11

Pulp of molars except the mesial-buccal root of first molar and buccal mucoperiosteum

Question 12

What does the nasopalatine nerve block anaesthetize?

Answer 12

The palatal mucosa of six anterior teeth.

Question 13

What does the greater palatine nerve block anaesthetize?

Answer 13

Palatal mucosa of ipsilateral teeth from canine back

Question 14

What are the indications for tooth extraction?

Answer 14

Unrestorable caries

Pulpal necrosis

Periodontal disease

Prosthetic reason

Orthodontic reason

Malposed teeth

Impacted teeth

Supernumerary teeth

Fractured teeth

Associated with pathological lesions

Teeth damaged by trauma

Prophylactic prior to radiotherapy, chemotherapy, heart valve surgery, transplant surgery

Question 15

How are teeth evaluated prior to exodontia?

Answer 15

Medical assessment

Access to the tooth

Mobility of tooth

Condition of the crown

Radiographic examination to assess relationship to structures, configuration of roots, condition of surrounding bones

Question 16

How does mobility affect extraction?

Answer 16

Makes extraction easier but also more bleeding.

If ankylosed may require surgical extraction.

Question 17

What is the problem that condition of the crown can cause when extracting?

Answer 17

RCT treated teeth and severely carious teeth can end up fracturing

Teeth with adjacent restorations should be checked for proneness to displacement during extraction

Teeth with large
carious lesion or
large amalgam
restorations are more
likely to fracture
during extraction

Question 18

What informations do radiographs give us about extraction?

Answer 18

Assessment of relationship to adjacent structures.

Configuration of roots can be assessed

Angulation and depth of impacted third molars

Relationship to IAN

Associated pathology

Question 19

What signs suggest juxtaposition of mandibular canal to third molar roots?

Answer 19

Radiolucency accross roots

Deviation or narrowign of canal

Interruption of white line of canal

Deflection of third molar roots

Narrowing of third molar roots

Question 20

What medical issues should be looked out prior to extraction?

Answer 20

Cardiac complaints (angina/MI/BP/pacemaker/artificial valve/rheumatic fever/irregular heartbeat)

Blood disorders

Hepatitis/jaundice or liver problems

Breathing difficulties/asthma/shortness of breath +/- on exertion/sleep apnoea/TB

Diabetes/thyroid disease

Epilepsy

Stomach ulcers/acid reflux/GIT problem

Bladder or kidney problems

Osteoporosis or other bone diseases

Problems with extractions or wound healing.

Past or current serious illnesses

Radiotherapy or chemotherapy

Hospitalised / operations

Problems with past operations or
anaesthetics

Females-pregnant or possibly pregnant

Smoke – how many pack years

Alcohol – not more than 21 standard drinks per week

Medications

Allergies to medications or chemicals

Dental and social history

Question 21

What are the potential complications of exodontia?

Answer 21

Excessive haemorrhage

Alveolar osteitis (dry socket)

Trismus

Infection including acute osteomyelitis of mandible

Creation of oro-antral communication

Displacement of root into soft tissues or maxillary antrum

TMJ dislocation

Fracture roots of teeth

Damage to soft tissues

Fracture of alveolar bone

Fracture of tuberosity

Fracture of mandible

Damage to adjacent teeth

Delayed healing

Question 22

What should be done for patients on warfarin?

Answer 22

Do NOT stop warfarin

Organise blood test for INR within 24 hours of surgery

If INR <2.2, proceed with surgery

If INR 2.2 - 4.0, proceed with surgery and use tranexamic acid mouthwash

4.8% Tranexamic acid mouthwash 10ml rinse for 2 minutes, 4 times daily for 5 days

Or crush 500mg tablets and dissolve in 10ml of water to make up 5% solution

Question 23

What is alveolar osteitis?

Answer 23

Dry socket, caused by failure of healing resulting in post op pain and caused when blood clot is disintegrated within socket. With or without halitosis.

Resolves spontaneously within 2 - 3 weeks.

Question 24

how is alveolar osteitis treated?

Answer 24

Dress socket with obtudent dressing and symptomatic measures.

Question 25

How should ONJ be treated>

Answer 25

Debridement and achievement of mucosal coverage.