Exodontia 2 Flashcards
Which tooth structure has proprioception, mechanoreceptors, and nociceptors?
PDL
What are the goals of anaesthesia?
Relief from sharp pain. Not necessarily from the dull feeling of pressure.
What does level of anaesthesia achieved depend on?
Dose and concentration
Diffusion to site
Removal by circulation
What are the types of LA used? What is the maximum dose?
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
What gets anaesthetised in an inferior alveolar nerve block?
All mandibular teeth
FoM
Anterior 2/3rds of the tongue
Gingivae on lingual surface of mandible
Mucosa and skin of lower lip and chin
What are the possible complications of IAN block?
Transient hemi-facial paralysis
Muscle trismus
Haematoma
Infection
Needle breakage
What does the long buccal nerve block anaesthetize?
Buccal gingivae of molars and premolars
What does the mental and incisive nerve block anaesthetize?
Teeth anterior to the mental foramen
Buccal soft tissue opposite premolars, canines, and incisors.
Mucosa and skin of lower lip and chin
Which teeth are anaesthetised by anterior superior alveolar nerve block?
Pulp of incisors and canines and labial mucoperiosteum
Which teeth are anaesthetised by middle superior alveolar nerve block?
Pulp of premolars and mesio-buccal root of first molar and buccal mucoperiostium
What does the posterior superior alveolar nerve block anaesthetise?
Pulp of molars except the mesial-buccal root of first molar and buccal mucoperiosteum
What does the nasopalatine nerve block anaesthetize?
The palatal mucosa of six anterior teeth.
What does the greater palatine nerve block anaesthetize?
Palatal mucosa of ipsilateral teeth from canine back
What are the indications for tooth extraction?
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
How are teeth evaluated prior to exodontia?
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
How does mobility affect extraction?
Makes extraction easier but also more bleeding.
If ankylosed may require surgical extraction.
What is the problem that condition of the crown can cause when extracting?
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
What informations do radiographs give us about extraction?
Assessment of relationship to adjacent structures.
Configuration of roots can be assessed
Angulation and depth of impacted third molars
Relationship to IAN
Associated pathology
What signs suggest juxtaposition of mandibular canal to third molar roots?
Radiolucency accross roots
Deviation or narrowign of canal
Interruption of white line of canal
Deflection of third molar roots
Narrowing of third molar roots
What medical issues should be looked out prior to extraction?
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
What are the potential complications of exodontia?
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
What should be done for patients on warfarin?
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
What is alveolar osteitis?
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.
how is alveolar osteitis treated?
Dress socket with obtudent dressing and symptomatic measures.
How should ONJ be treated>
Debridement and achievement of mucosal coverage.
