Final Exam Study Guide Flashcards
OMS training is vastly different from the rest of most of the dental specialty training programs and dental school education. What are the significant differences compared to general dentist education? (3)
- Extensive hospital, medical, and surgical trainings
- 100% of U.S accredited OMS training programs incorporate advanced general anesthesia training for maximum patient comfort and safety in office setting
- Bridge the gap between dentistry and medicine
List some of the various examples of OMS treatments:
- removal of teeth
- exposure of impacted teeth for orthodontic treatment
- re-contour the jaw bones
- preparation of jaws prior to XRT or placement of cardiac or orthopedic prosthetics
- reconstructive surgery
What are some reasons for an OMS to remove teeth?
A) malposed/impacted teeth
B) non salvageable teeth
What are some of the reasons an OMS may perform reconstructive surgery?
A) restoring form and function from aluvsive traumatic events, removal of pathology
& physiologic atrophy
B) restoration of continuity
C) Restoration of alveolar bone height and width
D) Restoration of osseous bulk
Give examples of some events that may cause an OMS to have to perform reconstructive surgery to restore form & function:
I) Avulsive traumatic events
II) Removal of pathology
III) Physiologic atrophy
The very first thing about writing in SOAP format:
CC
When writing a patients note, what type of patient record format is needed and recognizes in the medical profession worldwide?
SOAP Note
What do you need to ask the patient when you first meet them for SOAP note?
CC
Describe ASA I:
Normal healthy patient, no systemic disease
Describe ASA II:
Patient with mild systemic disease which is well controlled (example- well controlled HTN)
Describe ASA III:
Patient with significant systemic disease which limits activity but not incapacitating (example- CHF)
Describe ASA IV:
Patient with an incapacitating systemic disease which is a constant threat to life (example- Unstable angina pectoris)
Describe ASA V:
Moribund patient not expected to survive more than 24 hours (example- end stage kidney disease)
Normal healthy patient, no systemic disease
ASA I
Patient with mild systemic disease which is well controlled
ASA II
Patient with significant systemic disease which limits activity but not incapacitating
ASA III
Patient with an incapacitating systemic disease which is a constant threat to life
ASA IV
Moribund patient not expected to survive more than 24 hours
ASA V
Given the following situation, give ASA Classification:
Healthy 17 year old boy, no known medical history:
ASA I
Given the following situation, give ASA Classification:
43 year old female with well controlled HTN:
ASA II
Given the following situation, give ASA Classification:
54 year old male with CHF
ASA III
Given the following situation, give ASA Classification:
55 year old male with unstable angina pectoris
ASA IV
Given the following situation, give ASA Classification:
34 year old drug addict on hospice for end stage kidney failure
ASA V
What are the ways to reduce patient fear and anxiety?
- Hand holding (non-phamacological method)
- N2O/ O2
- Oral medications/ oral pre meds
- Intravenous medications
- General anesthesia
- Combinations of the above
How do you correctly write the medical consultation? What components need to be IN the consult? What are the STEPS?
STEP 1: Write an abbreviated soap note
STEP 2: Brief anticipated procedure
STEP 3: Ask the focused question and what you want to know
STEP 4: Print and fax
Whats the potential oral surgical patient logistic flow chart for UMKC dental school system?
(In other words, once a patient has been screened in DXR, what are the next few potential steps?)
Indication for tooth removal –> assessment of factors –> decision to treat or refer
Whats the potential oral surgical patient logistic flow chart for UMKC dental school system?
(In other words, once a patient has been screened in DXR, what are the next few potential steps?)
If you decide to REFER:
Refer to specialist –> follow up to manage potential complications
Whats the potential oral surgical patient logistic flow chart for UMKC dental school system?
(In other words, once a patient has been screened in DXR, what are the next few potential steps?)
If you decide to TREAT YOUR SELF:
Treat yourself –> with or without flap –> follow up to manage potential complications
In pre-surgical evaluation, how do you assess tooth mobility? How would you document this?
Assessment:
4: No mobility (high potential for ankylosis)
3: No mobility but ankyloses not a problem
2: Normal tooth mobility
1: Greater than normal mobility
documented through miller classification
Tooth mobility that is assessed as Stage 4: No mobility (high potential for ankylosis) includes teeth such as:
primarily molars, endo treated teeth or erupted 3rd molars
What is miller classification used to describe?
Tooth mobility
Describe Miller Classification for tooth mobility:
Class 1: less than 1 mm horizontal
Class 2: greater than 1 mm horizontal
Class 3: greater than 1mm horizontal and vertical mobility
The following describes
Class 1: less than 1 mm horizontal
Class 2: greater than 1 mm horizontal
Class 3: greater than 1mm horizontal and vertical mobility
Miller classification for tooth mobility
What is physiologic tooth mobility?
0.25mm
Miller classification for tooth mobility
Less than 1 mm horizontal:
Class 1
Miller classification for tooth mobility
Greater than 1 mm horizontal
Class 2
Miller classification for tooth mobility
Greater than 1 mm horizontal and vertical mobility
Class 3
Extraction forceps has handle, hinge, and beaks. When dealing with the handle, what are the different ways that a clinician can hold (grasp) on to it?
Horizontal grasp & Vertical grasp
What style of forceps are used when an operator is using a horizontal grasp?
American style forceps
“America is on the HORIZON”
Describe horizontal grasp with extraction forceps:
- American style forceps
- Handles are horizontal to the floor
When using a horizontal grasp with extraction forceps, the handles are always ____ to the floor.
For a maxillary extraction the palm should face ___
For a mandibular extraction the palm should face ___
- horizontal
- maxillary–> palm up
- mandibular –> palm down
When using the horizontal grasp with extraction forceps, what position should a right handed operator be in?
7-9 o’ clock
What style of forceps are used when an operator is using a vertical grasp?
European style forceps
“Europe is VERY fashionable”
Describe vertical grasp with extraction forceps:
- European style forceps
- Handles in vertical plane
- for removal of mandibular teeth
When would an operator use a vertical grasp with extraction forceps?
for removal of mandibular teeth
Based on the following clinical situation determine:
A) Elevator:
B) Action:
- Removal of sectioned roots following sectioning:
A) #30 & #31 (cryer)
B) wheel and axel- use with or without purchase point
Based on the following clinical situation determine:
A) Elevator:
B) Action:
- Removal of tooth or portion of tooth:
A) #41 (Crane pick)
B) Wheel and axel- use with purchase point
Based on the following clinical situation determine:
A) Elevator:
B) Action:
- Removal of maxillary 3rd molars both erupted and impacted
A) #73 and #74 (Miller) Potts
B) Wheel and axel
Based on the following clinical situation determine:
A) Elevator:
B) Action:
- Removal of larger single roots when forceps aren’t preferred
A) # 34-S & #46
B) Displacement
Based on the following clinical situation determine:
A) Elevator:
B) Action:
- Luxating teeth prior to forceps application:
A) #34-S, #46 & #301 sometimes
B) Lever action, fulcrum place on interseptal bone
Based on the following clinical situation determine:
A) Elevator:
B) Action:
- Removal of medium roots or medium size root tips when #34-S or #46 elevators are too large:
A) #301, #302, & #303
B) Displacement
Based on the following clinical situation determine:
A) Elevator:
B) Action:
- Removal of small root tips when tips have unobstructed pathway and are loose
A) Apex elevators (root picks)
B) Displacement
List the mechanical motions of extractions:
- Lever
- Widge
- Wheel & Axel
What mechanical motion is being described below?
“prying the tooth root tip from its socket”
Lever
Describe how to “lever” during an extraction:
- engage a purchase point (groove or hole in tooth)
- grip edge of the blade and use bone as fulcrum
Describe how to “wheel & axel” during an extraction:
- engage a purchase point
- use bone as fulcrum to rotate the tip out
for maxillary extractions, what is the angle of the maxillary occlusal plane to the floor?
45-60 degrees
When performing maxillary extractions, the patients shoulders are at the level of the:
surgeons elbow
When performing maxillary extractions, the operator should be standing at the ___ position
7-8 o’clock position
When performing maxillary extractions, what provides stability to the operator?
Feet spaced apart
When performing maxillary extractions, what is the function of the non-dominant hand?
provides stability and counters traction of force
For mandibular extractions, what is the angle of the mandibular occlusal plane?
Parallel to the floor
When performing mandibular extractions, the patients shoulders area at the level of the:
surgeons elbow or lower
When performing mandibular extractions, the operator should be standing at the ____ position
7-8 oclock
What provides stability when performing mandibular extractions?
feet spaced apart
What is the function of the non-dominant hand when performing mandibular extractions?
provides stability and counters traction force
Another popular OMS position for maxillary extractions is when the operator is standing at _____ o’clock instead of 7-8 o’clock. The patient should be in a ___ position. The surgeon should grasp the forceps with the palm ____. The _____ is kept close to the body to reduce ____.
What is the downfall to the alternative position?
12 o’clock; fully reclined; facing up; arm; fatigue
Downfall: way easier for object to get in airway; throat pack necessary
List all the possible forcep movements:
- ____ pressure
- _____ serves as fulcrum of rotation
- The more ____ the forceps adaptation, the shorter the fulcrum distance
- _____ movement
- BUCCAL pressure
- MIDDLE OF SOCKET serves as fulcrum of rotation
- The more APICAL the forceps adaptation, the shorter the fulcrum distance
- FIGURE 8 movement
What forcep movement is being described below?
- Expand socket on buccal side
- Detach PDL on lingual side
Buccal pressure
What is an advantage to adapting the forceps more apically and therefore shortening the fulcrum distance?
more uniform dilation of socket –> which reduces root fracture
What forcep movement is being described below?
Combination of buccal pressure, lingual pressure, and rotation:
figure 8 movement
Give an example of using figure 8 movement on the central incisor:
Basic movement is rotation because round/ovoid and conical root structure;
What may also be used to help with the figure 8 movement?
unscrew fashion
Correct forceps will:
- more apical position
- Tends to displace tooth with tearing up PDL with socket expansion at the same time
When performing an extraction, what should your non-dominant hand be doing?
The non-dominant hand should hold the jaw/alveolar process - detecting alveolar process movement
How do you detect alveolar process movement during an extraction in the maxillary arch?
pinch grasp
Describe “pinch grasp”
A way to detect alveolar process movement during a maxillary arch extraction
Thumb and index finger on either side of the alveolar process adjacent to the tooth
The pinch grasp should be used in the ___ arch
maxillary
Thumb and index finger on either side of the alveolar process adjacent to the tooth
pinch grasp (detection of alveolar process movement in maxillary arch extraction)
How do we detect alveolar process movement in the mandibular arch?
- mandibular sling grasp
- pinch grasp AND biteblock
What is the purpose of the mandibular sling grasp used to detect alveolar process movement in mandibular extractions?
- Counteracts forces of extraction
- Prevents injury to TMJ
What is the purpose of the pinch grasp AND bite block used to detect alveolar process movement in mandibular extractions?
- support TMJ
- bite block on opposite side
A common oral surgery lingo “____ flap —> ____ mistake”
small flap –> big mistake
What can occur if the flap is too small?
tearing of the tissue
A mucoperiosteal flap needs to have a _____ to ensure adequate blood supply
broad base
A mucoperiosteal flap needs to have a broad base. This is accomplished by making the:
apical portion wider than the coronal pportion
A mucoperiosteal flap needs to be large enough to provide:
both visual access & instrument access
T/F: With a mucoperiosteal flap, a large flap heals as rapidly as a small flap
true
How does a mucoperiosteal flap heal? (direction)
side to side (NOT end to end)
In regards to a mucoperiosteal flap, post surgical pain does NOT correlate with ____ but rather ____
NOT correlate with size of the flap but rather the amount of bone removed
A mucoperiosteal flap needs to be repositioned and sutured over:
solid bone
Why does a mucoperiosteal flap need to be repositioned and sutured over solid bone?
Increases the healing rate and decreases wound dehiscence
A mucoperiosteal flap needs to avoid:
major anatomical structures such as nerves ad blood vessels
Mucosperiosteal flap full thickness =
skin + subQ tissue + CT + periosteum
For a mucoperiosteal flap, the margin of the flap should be at least ____ from the margins of a ____
5mm ; bony defect
Common flap designs include: (2)
- envelope flaps
- Vertical releasing incision flap
Describe an envelope flap:
1 tooth distal & 2 teeth mesial
Describe a flap with vertical releasing incision:
1 tooth distal & 1 tooth mesial and includes papilla
WHen creating a flap with a vertical releasing incision, the vertical release incision must be originating from either:
mesial or distal line angle
