EXTRA- ORAL SURGERY Flashcards
What does internal derangement of the TMJ mean
A localised mechanical fault in the joint which interferes with its smooth action
What might pts with internal derangement of their TMJ complain of
- Clicking of the joint
- Locking of the joint
- Pain in the joint
What causes clicking of the joints
Displacement of the disk which prevents the condyle from moving smoothly and if the disk and condyle jump over each other then this is felt to the pt as a clock or pop
What causes locking of the jaw
the disc may be displaced and prevents the condyle from moving normally within the fossa. this can lead to locking of the Jaw
List some features of trigeminal neuralgia
- Spontaneous
- Trigger area
- Does not disturb sleep
- Sharp shooting electric type pain
- Short acting
Name some medications effective in trigeminal neuralgia
- Carbamazepine
- Phenytoin
- Gabapentin
- Oxacarbazepine
5 Baclofen
Give some features that may predispose a patient to dry socket
- Smoking
- Oral contraceptive pill
- Mandibular extraction
- Difficult extraction
- Single extractions
- Posterior extraction
- Immunosuppression
- Bony pathology
List some possible etiological factors for recurrent apthae
- Genetic predisposition
- GI diseases
- immunocompromised
- Stress
- Hormone changes
What are the treatment options for recurrent apthious stomatitis
- Treat underlying systemic disease
- Difflam (benzydamine) mouth wash
- Corticosteroids
- Tetracycline mouthwash
- Chlorohexidine mouthwash
What is annual chelitis
Inflammation of the skin and labial mucosa of the commissures of the lips
What is actinic chellitis
A premalignant condition win which keratosis of the lips is caused by UV radiation from sunlight
What can predispose a pt to angular chelitis
- Wearing dentures and having denture related stomatitis
- Nutritional deficiencies
- Immunocompromised
- Decreased OVD
Give examples of candela infections we can see as dentist
- Pseudomembranous candidiasis
- Acute atrophic candidiases
- Chronic atrophic candidiases
- Chronic erythematous candidiases
- Chronic hyperpalstic candidiases
- Angular stomatitis
- Chronic mucocutanous candidiases
Describe the presentation of Pseudomembranous candidiasis
Whiteish yellow plaques or flecks that cover the mucosa but can be wiped off leaving erythematous mucosa underneath h
Give examples of drugs used to treat candidate infections
Azoles eg miconazole or flucanazole
Nystatin
Amphotericin
Name the most common types of white patches
- Lichen planus
- Frictional keratosis
- Leukodema
- Candodal infection
- Cheek biting
- Lichenoid reaction
Name some causes of dry mouth
- Sjogrens
- Medication related
- Radio and chemotherapy
- Damage to salivary glands
- Anxiety
- Diuretics
- Diabetes
What tests can be carried out to confirm a diagnosis of sjogrens
- Labial salivary gland biopsy
- Parotid salivary flow rate
- Blood tests
- Sialography
What oral feature might acute leukaemia present with
Gingival hypertrophy and bleeding
What oral feature might AIDS present with
Kapsoi sarcoma
What oral feature might HIV carrier present with
Hairy leukoplakia
What oral feature might rheumatoid arthritis present with
Recently developed anterior open bite
What oral feature might crohns disease present with
Cobblestoned buccal mucosa
What oral feature might measles present with
Koplik spots
What oral feature might Lichen planus present with
Wickham striae
What oral feature might syphilis present with
Moon molars
What is erythroplasia
Any lesion of the oral mucosa that presents as a red velvety plaque which cannot be characterised clinalaly or pathologically as any other condition
List some features of atypical facial pain
- Pain unrelated too the anatomical divisions of nerves and often crossing the midline
- No organic cause can be found
- Investigations do not show anything abnormal
- Long standing and continuous often with no exacerbating or relieving factors
- Often described as unbearable
What are the tx options for atypical facial pain
Medically with tricyclic antidepressants
When describing a lesion what things must you mention
Site
Size
Shape
Outline
Colour
Surface texture
What can cause white patches in the mouth
- normal mucosal variants
- Lichen planus
- Infections
- Traumatic lesions
- inherited epithelial diosorders
- Unknown causes like leukoplakia
- Smoking related causes such as keratosis
- Squamous cell carcinoma
Give examples of infections that present as a white patch intra orally
- Thrush
- Chronic hyper plastic candidosis
- Hairy leukoplakia
- Chronic mucocutaneous candidosis
Give examples of traumatic lesions that present as a white patch intra orally
- Frictional keratosis
- Chemical burn
- Cheek and tongue biting
What can cause red patches in the mouth
- Trauma
- Infection
- Lichen planus and similar conditions
- Idiopathic or smoking
- Neoplasia
Give examples of trauma that can present as a red patch intra orally
- Chemical burn
- Cheek biting
Give examples of infection that can present as a red patch intra orally
- Thrush
- Chronic hyprepalstic candidiases
What is another term for thrush
Acute hyper plastic candidiasis
How would you assess the possibility of a mandibular fracture
- Pain swelling and tenderness at the fracture site
- Bleeding bruising and haematoma at the fracture site
- Displacement or step deformity
- Change in the occlusion
- Mobility of fragments or of teeth
- Difficulty opening the mouth or movement in lateral
excursion - Paraesthesia or anaesthesia in the distribution of nerves
involved near the fracture.
What are the principles for screening of a disease
Diagnosis of asymptomatic early disease or precursor lesions
this is to improve outcomes improve quality of life and cost efficiency
Need to test the at risk population
Describe the roel of the primary care dental team in the care of patients with a diagnosis of oral cancer
- Identify suspicious lesion and referr
- Before tx: identify teeth with poor prognosis and XLA + prevention
- Managemtn of mucositis
- Mitigate side effects fo tx such as dry mouth and osteoradionecrosis
- Rehabilitation
- Follow up
How do we assess airway following trauma
Speech
swallowing
bleeding
conscious status
How do we asses sbreahtign following trauma
Chest movements
How do we assess circulation following trauma
Pulse and bleeding
When extracting an upper molar and it seems to have broken and a piece gone missing where should you look
- In the suction
- In the mouth
- On the floor
- Patients clothed
- In soft tissues
- in the antrum
If the root has been sucked into the antrum then what should you fo
- Gentle sanction in the socket
- can you see it
- If not dont raise a flap and remove bone
if you have pushed the root into the antrum and can’t find tit what should you do
Refer to secondary care where they will attempt a
Caldwell luc approach
How do we check for an OAC
- Check the tooth- is there any bone
- Check the socket
- Can you see all the sockets
What should do you if you are not sure if you have crated an OAC
- Surgical and store
- Avoid nose blowing
- Pt may notice blood if they blow their nose
- Review socket in 4 week s
What should you do if you have an obvious oAC
- Advice that patient
- Suture the socket and if you have the confidence buccal advancement flap
- Review
- If symptomatic/ not healing then refer
What can happen if an OAC doesnt heal
Will form an OAF which is less likely to heal
What would you do if a patient has an OAF
Routine referral to oral surgery
What are the principles of treatment for an OAF
- Give it time to heal 6 week minim
- Warn the pt about rs of failure
3.. surgery
Which teeth are at increased risk of fractured tuberosity
- Upper 8s
- Lone standing molars
- Roots in the antrum
What is an addisonian crisis
Adrenal insufficiency
What are some of the symptoms of adrenal insufficiency
non specific symptoms:
- Maliase
- Weight loss
- Nausea, vomitting abdominal pain
- Fatigue
- Depression
- Muscle pain
- joint pain
What do patients with Addisons disease have
Primary adrenal failure
What do patient with Addisons disease have to do
Have to take steroids daily as they do not have the capacity to produce endogenous steroids
who is at risk of an addisonian crisis
- Patients with Addisons disease
- Patients with secondary adrenal suppression or atrophy
When would patients with Addisons disease need steroid cover
- Restorative / PERIO work: additional dose an hour before
- Extractions: double the dose pre op for 24 hours
- Surgery: 100mh hydrocortisone pre op and double dose 24 hours pr op
What post op
What post op would you tell pts if addisonian crisis
- Patient education
- Dry socket, infection and post op pain
- Maintain fluids
- Take the steroids
- Be aware of symptoms of an adrenal crisis
- Take additional steroids if needed
When would we carry out a CBCT
- Implant planning
- Position of impaction
- Foreign body
- Never injury
- Predict risk of nerve injury
What is an ulcer
A pathological disintegration of the surface epithelium
How do we assess for sjogrens
- Autoimmune
- Dry mouth
- Dry eyes
What test might oral medicine do to confirm a diagnosis of Sjogren
- Salivary flow test
- Schirmer test
- Scarring ulceration of cornea (need to be seen my optometrist)
- Auto antibodies
- Labial gland biopsy
WHow do we assess for sjogrens
- Autoimmune
- Dry mouth
- Dry eyes
What are some of the complications of sjogrens
- Reduced quality of life
- Caries
- periodontal disese
- Scarrign in the eyes
- Reduced vision
- 5% Risk of lymphoma
How do we manage sjogrens
- See an opthalmologist
- Pt education about lymphoma risk
- Specialist referral to oral med for diagnosis confirmation
How do we manage dry mouth
- Diet, floruide and OHI
- Manage fungal and bacterial infection
- Stimulation of saliva
- Sugar free sweets and chewing gum
- Sialoagogues
- Artificial saliva
