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Oral Surgery > Impacted Third Molars > Flashcards

Impacted Third Molars Flashcards

1
Q

Around what age do third molars generally erupt?

A

18-24 yrs

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2
Q

What percentage of adults do not have at least 1 third molar?

A

25%

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3
Q

Which nerves are at risk during surgical removal of third molars?

A
  1. Inferior Alveolar Nerve
  2. Lingual Nerve
  3. Long Buccal Nerve
  4. Mylohyoid Nerve
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4
Q

What is the nerve supply for the tongue?

A

ANT 2/3

  • Taste (sp sensory) = chorda tympanii branch of facial nerve (CN VII)
  • Sensation = lingual branch of mandibular (V3) trigeminal nerve (CN V)

POST 1/3
- Taste and sensation = glossopharyngeal nerve (CN IX)

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5
Q

Why should the distal relieving incision be angled buccally around the retromolar pad?

A

The lingual nerve can run quite high, distal relieving; avoids damage to this nerve

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6
Q

What is the definition of an ‘unerupted tooth’?

A
  • A tooth that lies within bone of the jaw

- Completely covered by soft tissues (partially/ completely covered by bone)

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7
Q

What is the definition of a ‘partially erupted tooth’?

A
  • A tooth that may have failed to erupt fully

- Tooth partially in communication with oral cavity

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8
Q

What is the definition of an ‘impacted tooth’?

A
  • A tooth which is prevented from erupting completely

- May be due to = lack of space, obstruction by another tooth/ bone, abnormal eruption path

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9
Q

Name a guideline set in place for removal of wisdom teeth

A
  • NICE

- SIGN (withdrawn but principles still follow)

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10
Q

When is removal of wisdom teeth NOT advised?

A
  • Tooth judged to erupt successfully with functioning role
  • MH renders unacceptable risk; risk exceed benefit
  • Deeply impacted with no hx or evidence of related local/ systemic pathology
  • Risk of surgical complication unacceptably high (incl # of mand)
  • Asymptomatic contralateral tooth not adivsed to be taken out along with planned wisdom tooth
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11
Q

When is removable of wisdom teeth ADVISED?

A
  • Significant infection (associated with tooth)
  • Risk factors and lifestyle prevents ready access to dental care
  • MH renders risk of retention unacceptable (chemo/radio)
  • Risk of retention outweighs further GA
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12
Q

What are STRONG indications for removal of wisdom teeth?

A
  • At least 1 episode of infection (abscess, pericoronitis, cellulitis) or untreatable pulp/ apical pathology
  • Caries and untreatable
  • Perio disease due to 8+7
  • Dentigerous cyst/ other related pathology
  • External resorption caused by 8

OTHER

  • Autogenous transpant
  • # of mandible in that region, resection of tumour
  • Prophylactic removal (of likely to erupt 8) in certain medical conditions
  • Atypical pain (rule out TMD!)
  • Food trapping
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13
Q

What should be considered in the patient’s medical history before removal of wisdom teeth?

A
  • Medical conditions contraindicating removal
  • Medications (bleeding etc)
  • Allergies
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14
Q

What is INR?

A

International normalised ratio

  • NORMAL = 0.8 - 1.2
  • Warfarin target = 2-3
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15
Q

What is the safe limit of INR for tooth extraction?

A

3.5 or less

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16
Q

What should be assessed in a CLINICAL examination for the removal of wisdom teeth?

A
  • Eruption status
  • Local infection (and regional lymph)
  • Caries/ resorption
  • Perio status
  • Occlusal relaitonship
  • TMJ function (sometimes TMD manifest as upper 8 pain)
  • Degree of access
17
Q

What should be assessed in a RADIOLOGICAL examination for the removal of wisdom teeth?

A
  • Orientation of tooth
  • Relationship to IAN canal
  • Crown size and condition
  • Tooth and root morphology
  • Alveolar bone levels
  • Perio status incl 7
  • Associated pathology
18
Q

What are the radiological signs that there is an increased risk of nerve damage upon removal of the tooth?

A
  • Diversion/ narrowing of IAN canal
  • Darkening of roots where crossed by canal
  • Interruption of white lines of canal

–> SECOND XR image required (usually CBCT)

19
Q

What are the orientations possible?

A
  • Vertical 35%
  • Mesial 40%
  • Distal 10%
  • Horizontal 8%
  • Transverse/ aberrant
20
Q

Describe possible depths in relation to the adjacent tooth of 8s

A
  • Superficial = crown of 8 related to crown of 7
  • Moderate = crown of 8 related to crown AND root of 7
  • Deep = crown of 8 related to roots of 7
21
Q

What is ‘pericorontitis’?

A

Inflammation of soft tissues around crown of tooth occurring where there is a communication between tooth and oral cavity (bacterial involvement)

22
Q

What are the signs and symptoms of pericorinitis?

A

LOCAL

  • Pain & swelling
  • Bad taste + smell
  • Pus
  • Occlusal trauma to operculum

SYSTEMIC

  • Trismus
  • Dysphagia
  • Pyrexia
  • Malaise
  • Regional lymphadenopathy
23
Q

Where are the possible regions of swelling associated with an infected 8?

A
  • Angle of the mandible
  • Buccal space
  • Sublingual space (Ludwig’s angina)
24
Q

What is the management of an infected 8?

A
  • Incision if abscess localised
  • Irrigation with warm saline/ CHX or astringent/ antiseptic below operculum
    • -> Advise pt mw
  • Analgesia advice
  • If trauma to opererculum, compensate opposing 8
  • Systemic involvement –> AB (metronidazole)

–> DO NOT EXTR UNTIL ACUTE EP RESOLVED

  • If severe –> Max fac or A&E!
25
Q

What are the treatment options for removal of wisdom teeth?

A

ASYMPTOMATIC
- Monitor

SYMPTOMATIC

  • XLA/ SR (gold standard)
  • XLA of opposing 8
  • If close relationship with canal –> further imaging –> coronectomy
26
Q

What are some post-op complications?

A
  • Pain
  • Swelling
  • Bruising
  • Trismus
  • Numbness/ tingling (dysaesthesia)
  • Bleeding
  • Infection
  • Dry socket
27
Q

What are the percentages of permanent and temporary nerve damage?

A

IAN

  • TEMPORARY = 10-30%
  • PERMANENT = <1%

Lingual

  • TEMPORARY = 10-20%
  • PERMANENT = <1%

Oral Surgery (11 decks)

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