Final Exam Study Guide Flashcards
OMS training is vastly different from most of the dental specialty training and education. What are the significant differences compared to general dentist education?
- Extensive hospital, medical & surgical trainings
- 100% US accredited OMS training programs incorporates advanced general anesthesia training for maximum patient comfort and safety in office setting
- Bridge the gap between dentistry & medicine
List some examples of various OMS treatments:
- removal of teeth
- exposure of impacted teeth for orthodontic treatment
- recontour 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
b) non salvageable teeth
What are some of the reasons an OMS may perform reconstructive surgery?
a) restoring form and function from avulse traumatic events, pathology removal & physiologic atrophy
b) restoration of continuity
c) restoration of alveolar bone height & 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 and function:
i) Avulsive traumatic events
ii) Removal of pathology
iii) physiologic atrophy
When writing a patient’s note, what type of patient record format is needed and is recognized in the medical profession worldwide?
SOAP note
The very first thing about writing this format as well as what you need to ask the patient when you first meet them is:
Chief Complaint
What do you need to ask the patient when you first meet them for a soap note?
Chief complaint
Describe an ASA I:
Normal, healthy patient, no systemic disease
Describe an ASA II:
Patient with mild systemic disease which is well controlled
Example: well controlled HTN
Describe an ASA Class III:
Patient with significant systemic disease which limits activity but is not incapacitating
Example: CHF
Describe an ASA IV:
Patient with an incapacitating systemic disease which is a constant threat to life
Example: Unstable angina pectoris
Describe an ASA V:
Moribund patient not expected to survive more than 24 hours
Example: End stage kidney disease
Classify the following based on the ASA parameters:
Patient with significant systemic disease which limits activity but is not incapacitating
ASA III
Classify the following based on the ASA parameters:
Normal, healthy patient, no systemic disease
ASA I
Classify the following based on the ASA parameters:
Moribund patient not expected to survive more than 24 hours
ASA V
Classify the following based on the ASA parameters:
Patient with mild systemic disease which is well controlled
ASA II
Classify the following based on the ASA parameters:
Patient with an incapacitating systemic disease which is a constant threat to life
ASA IV
Classify the following based on the ASA parameters:
38yo female with controlled HTN
ASA II
Classify the following based on the ASA parameters:
Patient with unstable angina pectoris
ASA IV
Classify the following based on the ASA parameters:
55yo male with CHF
ASA III
Classify the following based on the ASA parameters:
40yo female with end stage kidney disease
ASA V
What are some ways to reduce patient fear & anxiety? (6)
- Hand holding (non-pharmacological method)
- N2O/O2
- Oral medications/oral pre-meds
- Intravenous medications
- General anesthesia
- Combination of all of the above
How to 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 & fax
What’s 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
What’s the potential oral surgical patient logistic flow chart for UMKC dental school system for referrals?
(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
What’s the potential oral surgical patient logistic flow chart for UMKC dental school system for treating patient yourself?
(In other words, once a patient has been screened in DXR, what are the next few potential steps IF YOU DECIDE TO TREAT YOURSELF)
Treat yourself –> with or without flap –> follow-up to manage potential complications
In the pre-surgical evaluation, how do you assess tooth mobility?
How would this be documented?
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 assesses as Stage 4: No mobility (high potential for ankylosis) includes teeth such as:
- primary molars
- endo treated teeth
- erupted 3rd molars
What is miller classification used to describe?
Tooth mobility
Describe Miller Classification for tooth mobility:
Class 1: Less than 1mm horizontal
Class 2: Greater than 1mm horizontal
Class 3: Greater than 1mm horizontal and vertical mobility
The following describes:
Class 1: Less than 1 mm horizontal
Class 2: Greater than 1mm horizontal
Class 3: Greater than 1mm horizontal and vertical mobility
Miller classification for tooth mobility
Classify the following based on the Miller Classification for tooth mobility:
Less than 1 mm of horizontal mobility
Class 1
Classify the following based on the Miller Classification for tooth mobility:
Greater than 1 mm of horizontal mobility
Class 2
Classify the following based on the Miller Classification for tooth mobility:
Greater than 1 mm of horizontal and vertical mobility
Class 3
What is physiologic tooth mobility?
0.25mm
Extraction forceps has handle, hinge & beaks. When dealing with the handle, what are the different way 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
What position should a right-handed operator be in, when using a horizontal grasp with extraction forceps?
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
-used for removable 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 or without purchase point
Based on the following clinical situation, determine:
a) Elevator:
b) Action:
-Removal of maxillary 3rd molars both erupted & impacted:
a) #73 & #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 placed 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 extraction:
- engage a purchase point (groove or hole in tooth)
- gripping the edge of the blade and use bone as fulcrum
Describe how to “wheel & axel” during extraction:
- engage 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 to 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 or 8 o’clock
When performing maxillary extractions, what provides stability to the operator?
feet spaced apart
When performing maxillary extractions, what is the function of the nondomimant hand?
provides stability and counters traction of force
For mandibular extractions, what is the angle of the mandibular occlusal plane?
parallel to floor
When performing mandibular extractions, the patients shoulders are at the level of:
surgeons elbow or lower
When performing mandibular extractions, the operator should be standing at the _____ position
7 to 8 o’clock
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 to 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 this alternative position?
12 o’clock ; fully reclined; up; arm; fatigue
Downfall: way easier got object to get into 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
- FIGURR 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 –> 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 how to use figure 8 movement on the central incisor:
basic movement is rotation because round/ovoid & conical shaped 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 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 what pinch grasp means
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 bite block
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 the 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 assure adequate blood supply
broad base
A mucoperiosteal flap needs to have a broad base, this accomplished by making the:
apical portion wider than the coronal portion
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 ____
does 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 & blood vessels
Mucoperiosteal flap full thickness =
skin + subQ tissue + CT + periosteum
For a mucoperiosteal flap, the margin of the flap should be atleast ____ from the margins of a ___
5mm; bony defect
Common flap designs include: (2)
- envelope flaps
- vertical releasing incision flap
Describe an envelope flap:
one tooth distal & one tooth mesial
Describe a flap with a vertical releasing incision:
one tooth distal, one tooth mesial & includes papilla
When creating a flap with a vertical releasing incision, the vertical releasing incision must be originating from either:
mesial or distal line angle
