Final Flashcards
T/F: Loss of natural teeth leads to progressive bone resorption.
True
What are some properties that can alter the amount of bone resorption?
Systemic: Nutrition, osteoporosis, endocrine dysfunction
Local: alveoloplasty, dentures, facial form
The ________ is the workhorse for removing sharp edges in bone.
rongeur
What is alveoloplasty?
Removing/recontouring bone abnormalities in preparation for prosthesis
T/F: Digital compression and interseptal alveoloplasty involve releasing a flap.
False
When should you do interseptal alveoloplasty?
When the interseptal bone seems loose after extraction
What type of flap should be raised for surgical alveoloplasty?
Full thickness
_______ is an overgrowth of bone on buccal surface of mandible or maxilla.
Exostosis
T/F: Exostosis are usually seen in maxillary molar areas.
True
T/F: Tori are found on the lingual aspect of the mandible.
True
T/F: Tori are more difficult to remove than exostosis.
True
What are the two major difficulties with maxillary tori removal?
- Torus may be pneumatized - communicate with nasal passage
2. Closure of wound is difficult - thin tissue
T/F: You will always remove bone when reducing a maxillary tuberosity.
False
Can be soft tissue, bone, or both
Patients not using proper care when wearing their denture can develop a fungal infections leading to ____________.
inflammatory papillary hyperplasia
What is inflammatory fibrous hyperplasia (epulis fissuratum)?
Inflammation for poor fitting denture
Need to cut it off
What is a special consideration when cutting off epulis fissuratum?
Must send for histological evaluation
Also patient may have an open wound
What could be some problems with an abnormal labial/lingual frenum?
Diastema, speech problems, in the way of a denture
T/F: Management and prevention of odontogenic infection is one of the biggest causes of morbidity/mortality and litigation.
True
T/F: The majority of odontogenic infections are from aerobic bacteria.
False
Mostly anaerobic but the majority of infections are a mixed group of bacteria
Most odontogenic infections are initiated by __________ bacteria that create an environment succeptible to _________ bacteria.
Aerobic; anaerobic
Which types of bacteria contain most of the toxins and antibiotic deactivating enzymes?
Anaerobic
What are the three stages in a natural course of infection?
Cellulitis -> abscess -> fistula
Cellulitis is primarily caused by what bacteria?
Streptococcus
T/F: Advanced cellulitis is diffuse and hard.
True
Life threatening
An abscess is primarily _________ bacteria.
Anaerobic
What are some factors for where an infection might spread?
Muscle attachment, bone thickness, root angulation
T/F: Maxillary infections are more likely to spread buccally than palatally.
True
T/F: An infection in the posterior maxilla is likely to stay within the buccinator muscle.
False
Anterior max: vestibular infection (inside muscle)
Post max: buccal space (outside muscle)
Where are infections of the 2nd/3rd molars in the mandible likely to spread?
Submandibular space
Where will infections of mandibular premolars likely spread?
Sublingual space
T/F: Submental infections are often directly from an anterior tooth.
False
Often some other pathology or spread from other areas
What is a Ludwig’s Angina?
Bilateral submandibular, sublingual, and submental space cellulitis - life threatening airway obstruction possible
What should you be worried about if a patient comes in and truly cannot open their mouth?
Infection to secondary spaces by muscles of mastication - superficial/deep temporal, infratemporal, pterygomandibular, masseteric
T/F: Pterygomandibular space infection could be caused by a needle tract infection.
True
Infections that spread to the ______________ can cause a variety of serious problems due to having access from the skull to the mediastinum.
Lateral pharyngeal space
T/F: High speed hand pieces should be used to section teeth for extractions.
False
Can cause infection
What can result from using a pneumatic hand piece to section a tooth for extraction?
Rapid fascial space infection
T/F: If you have a patient with severe trismus it is likely the infection has spread to a secondary space.
True
What is the first step in therapy of infection?
Determine severity
T/F: Patients with secondary or neck space infections should be referred immediately.
True
T/F: Temperatures over 101 indicate systemic involvement.
True
T/F: Oral temperatures are accurate for evaluating systemic involvement.
False
T/F: WBC count is a good measurement of the severity of an odontogenic infection.
False
Remains elevated throughout treatment
What is the most important surgical goal of treatment?
Remove source of infection!
Also, drain pus and relieve tension
T/F: Incisions should be made through healthy tissue to drain pus.
True
Heals better
What is the empiric therapy with antibiotics?
No time for culture so you give antibiotics for what you think bacteria is
If the patient is penicillin allergic what would you give them?
Clindomycin
What is the first line of antibiotics for infection?
Amoxicillin
Possibly with metronidazole
T/F: Most recurrent infections are do to poor antibiotic use.
False
Inadequate surgery: source remains, all spaces not explored, inadequate drainage
What are some steps to take if the infection is not improving?
- Confirm pt is complying
- Look for additional source
- Get another CT scan
What is a metastatic infection?
Occurs at a place other than the operation site
What are the four criteria to get a metastatic infection?
- Surgical manipulation
- Transient bacteremia
- Distant susceptible site
- Infection
What are the three conditions (post 2007) that require antibiotic prophylaxis?
- Prosthetic cardiac valve
- Previous infective endocarditis
- Cardiac transplant with valve defects
T/F: The vast majority of SBE (subacute endocarditis) from dentistry is streptococcal and following extractions.
True
T/F: Scaling and root planing requires prophylaxis.
True
What is standard prophylaxis regimen?
Amoxicillin 2gm - 1 hour before operation
T/F: Amoxicillin is better because it effects a broader spectrum of bacteria.
False
Better absorption, higher plasma level, slower excretion
What will you give patients for prophylaxis who have penicillin allergy?
Clindamycin 600mg - 1 hour pre-op
T/F: If a patient is already taking antibiotics they don’t need another one for prophylaxis.
False
T/F: Ventricular shunts (in brain) need to be prophylaxed.
True
T/F: A patient with an AV dialysis shunt needs prophylaxis.
True
T/F: All patients with artificial joints should be prophylaxed.
False
2015 paper showed it is not necessary
T/F: If the patient wishes to be prophylaxed with an artificial joint you should do it.
False
What is the most important way to prevent infection?
Superb technical surgery
When should the first dose of antibiotic be for wound prophylaxis?
Before surgery
What is the correct dosage for prophylaxis of wound?
2x the therapeutic dose
T/F: For wound prophylaxis, antibiotics should not be continued post-surgery.
True
What are two key indicators for taking a biopsy?
- Lesions that persist for two or more weeks with no known etiology
- Any inflammatory lesion that does not respond to local therapy within two weeks
T/F: Lesions that interfere with function should be biopsied.
True
A _______ is a raised fluid filled lesion in or under the epithelium.
Bulla
________ is a superficial ulcer.
Erosion
A __________ is a flat lesion typically brown or blue.
macule
A _________ is a small elevated palpable mass.
Papule
A __________ is a large elevated palpable mass.
nodule
A __________ is a very slightly elevated confluence of papules often seen in smokers.
Plaque
_________ are cloudy or white vesicles filled with pus.
Pustules
A macroscopic accumulation of keratin is a ________.
Scale
An __________ results in the loss of epithelium.
Ulcer
A ___________ is a small loculation of fluid in or under the epithelium.
Vesicle
What are some important factors in evaluating a lesion?
- Size and shape
- Single vs multiple
- Color
- Borders
T/F: Red, Ulcerative, bleeding lesions are all red flags for malignancy.
True
What are the four types of biopsies?
- Cytology
- Aspiration
- Incisional
- Excisional
Why can aspiration be important to do before biopsies?
See if bony lesion is vascular or not
T/F: Normal tissue should be included in a biopsy.
True
T/F: Anything greater than 1 cm should be biopsied with an incisional technique.
True
What biopsy technique should be used for suspected malignancies?
Incisional
T/F: Incisional biopsies should be broad and shallow.
False
Deep and narrow
T/F: Small (< 1cm) lesions can be biopsied with excisional technique.
True
How large of a border should you leave around a malignant soft tissue biopsy?
5 mm
T/F: High volume suction should be applied after biopsy.
False
Gauze to stop bleeding and suture
T/F: Sometimes it is necessary to undermine the tissue prior to closure.
True
T/F: A prescription is a written instruction for the preparation and administration of medication.
True
T/F: The pharmacist has the responsibility to refuse prescriptions that are unsafe or inappropriate.
True
What constitutes a patient-provider relationship?
- Chief complain and diagnostic studies
- History of illness and diagnosis
- Medical history
- Physical exam
T/F: Anti-hypertensive and hypoglycemic drugs are appropriate to prescribe as a dentist.
False
What are schedule 1 controlled substances?
High abuse with no medical use
Ex. Heroin, LSD, marijuana (in ohio)
T/F: Schedule II drugs have an accepted medical use.
True
Highly addictive (oxycodone, adderall, percocet)
T/F: Schedule V drugs have the lowest risk for abuse.
True
T/F: The date issued on a prescription can be planned ahead.
False
How must you write the quantity of drug for DEA controlled substances?
Write and spell number
Ex. Ten (10). Twenty (20).
T/F: Schedule II drugs can be refilled.
False
What does B.I.D stand for?
Twice daily
What does a.c. Stand for?
Before meals
What does H.S. Stand for?
At bedtime
What does p.o. mean?
By mouth
What does p.r.n. Mean?
As needed
What does q.i.d. Mean?
four times a day
What does q.4.h. Mean?
every 4 hours
What does t.i.d. Mean?
Three times a day
T/F: If a patient calls for a refill of narcotics they must be seen first.
True
