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D2: 622 Oral Surgery > Exodontia: Slides > Flashcards

Exodontia: Slides Flashcards

1
Q

Last tooth in arch is mobilized with…

A

Straight elevator

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2
Q

What is ALWAYS used when performing and extraction

A

Gauze throat pack

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3
Q

How many steps are there in a routine extraction

A

5

All should be considered, but some can be skipped in certain situations

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4
Q

What is general step 1 of an extraction

A

Loosen soft tissue

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5
Q

What instrument(s) do you use to loosen soft tissue

A

1 Woodson Elevator

Periosteal elevator (Moldt #9)

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6
Q

What is step #2 of a routine extraction

A

Luxate tooth with elevator

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7
Q

What instrument is used to Luxate tooth

A

Usually the small straight elevator #301

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8
Q

What should be used as a fulcrum

A

The bone, not the adjacent teeth

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9
Q

What is step 3 of a routine extraction

A

Adapt Forceps to Root

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10
Q

Seat lingual beak first

Position beaks apically under soft tissue

Grasp root

Keep beaks of forceps parallel to root

A

Sub steps to General Step 3 (Adapt Forceps to Root)

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11
Q

As beaks are worked ______, bone ______ and movement of tooth out of socket may even begin

A

apically, expands

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12
Q

What is step 4 of a general extraction

A

Luxate tooth with forceps

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13
Q
  1. Strong apical pressure
  2. Slow, firm pressure
  3. Buccal first and most (usually), alternate buccal and lingual pressure
  4. Always apical pressure, with some combo of
    Luxation
    Rotation
  5. Reapply apical pressure
A

Substeps of General Step 4 (Luxate tooth with Forceps)

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14
Q

What is general step 5 in a routine extraction?

A

Remove tooth from socket

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15
Q
  1. Gentle traction, usually toward buccal
  2. Luxation or rotation must first
    expand socket
    Disrupt periodontal ligament
  3. Teeth are never removed by “pulling”
A

Substeps of General Step 5 (Remove tooth from socket)

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16
Q

What does socket debridement mean

A

Remove granulation tissue with curette

Irrigate if debris is present

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17
Q
  1. Debride if needed
  2. Check for sharp bone margins, smooth if needed (bone file/Rongeur)
  3. Trim excess gingiva
  4. Place gauze for pressure over extraction site
  5. Consider suture if papillae significantly loosened
A

Steps of Closure

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18
Q

General Order of Extraction

A

Maxillary First
Posterior First
Most difficult (First or Last?)
Symptomatic teeth first if an doubt re: ability to complete procedure in a single setting

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19
Q

What can occur if you over-luxate the tooth?

A

Buccal plate fracture

Root fracture

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20
Q

What direction are you moving the tooth when you talk about traction

A

Incisally out of the socket

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21
Q
  1. No absolutes, just general principles
  2. Position self based on good ergonomics and ability to apply controlled, effective forces
  3. Palm up and palm down grip on forceps both have applications
  4. Patient position may vary with chair design
  5. Most operators stand, though some are effective with seated technique
A

General Rules for Patient and Operator Positioning

22
Q

General Guideline for Patient Positioning for Maxillary Teeth

A

Patient semi-reclined so that maxillary oclusal plane is about 60 degrees to the floor

height should be at elbow level

23
Q

General Guidelines for patient positioning for mandibular teeth

A

Patient somewhat upright, so that lower occlusal plane is nearly parallel to floor

Height adjusted so the arms are comfortable bent (could be elbow level or below)

24
Q

Specific technique for Mx First Premoalrs

A

Gentle buccal/palatal luxation

25
Specific technique for Mx 2nd Premolars
Rotation and Traction
26
Specific technique for Mx Molars
1. Luxate molar to buccal first 2. Luxate to palate 3. Repeat 4. Eventually unseat the palatal root 5. Deliver the tooth to the buccal
27
Specific Techniques: Mandibular Incisors to 2nd Bicuspid
Combination of apical pressure, rotation, traction Usually minimal luxation is used
28
What should be balanced in exodontia
Controlled force and Finesse
29
Specific techniques: mandibular molars What instruments should be used
Cowhorn forceps if there is a clearly developed furcation Otherwise, use universal forceps
30
Specific Techniques: 1. Squeeze to seat into furcation 2. Pump to begin to raise tooth out of socket 3. Subtle figure 8 motion to complete delivery
Special technique for cowhorn forceps
31
1. Keep clear field of vision 2. Protect teeth and soft tissues (watch lip impingement by instruments) 3. irrigate during bone removal 4. support jaw 5. Pass instruments 6. General emotional support for patients
Role of the Assistant
32
How would the assistant help keep a clear field of vision
Retraction Suction Light adjustment
33
1. Prepare patients for expected course 2. Identify potential complications 3. Provide a point of contact
Purpose of Post-op Instructions Give both written and orally
34
1. Mild to moderate pain | - increased with flap or bone removal
Post-op instructions for pain and swelling
35
What drugs should be used to manage post extraction pain
OTC analgesics are appropriate for simple extractions mild narcotic combinations for surgical flaps, bone removal, difficult extractions, low pain threshold patients
36
1. Narcotic analgesics are now recognized as gateway to heroin use 2. Amount of oral narcotics in circulation is staggering 3. Be part of the solution, not the problem
Reasons to avoid over-prescribing opiods
37
1. Little of none for simple extractions 2. Little to a lot for flaps, bone removal 3. Ice to face 20 minutes on/20 off for 24 hours 4. Keep head elevated 5. Swelling peaks after 48 hrs then should decrease
Swelling post-op
38
1. Should be minimal 2. A little blood mixed with saliva may look like more than it is 3. Gauze pressure 4. Repeat if necessary throughout first day, call if bleeding persists 5. Expect some slight ooze first 24 hours
Bleeding post-op
39
1. Soft, cool foods for the first day, avoid hot liquids 2. Chew gently in surgical area for several days (avoid if possible) 3. Avoid anything that could dislodge clot (sucking on food or wound, smoking)
Diet, post-op
40
1. Avoid rinsing for the first day 2. Rinse mouth with warm salt water several times a day beginning day after surgery 3. Brush gently/may need to avoid surgical site for first few days
OHI post-op
41
Instructions for rinsing mouth with warm salt water several time a day
1. 1/2 tsp salt in 8 oz | 2. Hold in mouth, swish gently, spit and repeat
42
1. Avoid vigorous exercise on day of surgery | 2. May resume usual activities as tolerated
Activity, post-op
43
Activity restriction for simple extractions
rarely more than 24-36 hours
44
Activity restriction for surgical extraction
several days
45
1. none is best 2. Cutting back is second best, the less the better 3. greatly increases risk of dry socket of alveolitis
No smoking post-op
46
1. Rare, post-op antibiotics are not warranted in healthy patients 2. Prophylactic antibiotics appropriate in some 3. Continuing antibiotics (post-op) appropriate in others 4
Post-op infection instructions
47
When should patients call you back after extraction
1. If swelling is increasing rather than decreasing after 48 hours 2. Induration, skin erythema, persistent fever, difficulty swallowing or opening
48
Increase in pain after 3-5 days Lack of improvement after 3-5 days Worsening taste or odor in mouth Patients should be instructed to call and return for re-eval if these signs occur
Signs of Dry Socket
49
Patients must be able to contact doctor Answering service Cross coverage Include phone number in written instructions
Point of contact
50
What should you always do after surgery or long, difficult procedures?
Call your patient to check on them

D2: 622 Oral Surgery (7 decks)

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