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BDS2 Clinical > Intro to Oral Surgery and Extractions > Flashcards

Intro to Oral Surgery and Extractions Flashcards

1
Q

MOPS

A

minor oral procedure surgery

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2
Q

what are the 2 indications for extractions

A

clinical

and/or (usually both)

radiographic
(in case of unusual anatomy)

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3
Q

10 reasons for unrestorable teeth that are indicated for extractions

A

Gross caries

Advanced periodontal disease

Tooth/root fracture

Severe tooth surface loss

Pulpal necrosis

Apical infection

Symptomatic partially erupted teeth

Traumatic position
- E.g. wisdom tooth biting into cheek

Orthodontic indications
- E.g. remove one of the premolars

Interference with construction of dentures
- Seems wrong as want more natural teeth, but if in detrimental odd anatomical position that would worsen the retention

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4
Q

straight upper anterior forceps

A

Totally flat unique
- Complete touching table surface

Cannot grab posterior teeth
- stretch cheek

Canine to canine on upper teeth
- Ideally upper central

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5
Q

upper universal forceps

A

Part of handle lifts of table

  • Prevent stretching teeth
  • Reach further back

Tip the same

Most single rooted teeth

  • Canines, 1st and 2nd molars
  • Not as good grip on molar
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6
Q

tips of straight upper anterior and upper universal forceps

A

have concave surface on either side
- Grab a root
used on Single rooted teeth

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7
Q

why is there a different design for upper molar forceps

A

3 roots
- 2 palatal and 1 buccal
Need either side
- Tips designed to engage roots regarding orientation

Point
- Designed to go into the furcation between 2 buccal roots

Triangle
- Beak to cheek

Smooth end on one side - concave like first ones
Grab single palatal root

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8
Q

point design of upper molar forceps

A
  • Designed to go into the furcation between 2 buccal roots

Triangle
- Beak to cheek

Smooth end on one side - concave like first ones
Grab single palatal root

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9
Q

lower forceps design feature

A

90 degree bend for good approach and access

No need for lower right and left
- 2 roots (Mesial and distal)
Furcation on both sides
- Pointy beak engage with furcation on buccal and lingual side

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10
Q

lower universal forceps

A

90 degree bend for good approach and access

Concave on both sides
- engage root surface

Designed for lower 5 to 5 - one root

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11
Q

lower molar forceps

A

90 degree bend for good approach and access

Pointy beaks
- Buccal and lingual furcation on lower 6s (mesial and distal root)

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12
Q

‘cowhorn’ forceps

A

90 degree bend for good approach and access

Very pointy and sharp compared to others

Narrow ended

Highly polished - smooth

Used only 2 rooted lower molars

  • Need radiographs
  • Divergent/straight/separate roots

Put into furcation gap
Squeeze handle
Points go towards each other and lift the tooth up
- less pressure - good for children as bone softer in young
- less mobilising needed
- if not deep enough can crush crown

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13
Q

how to use ‘cowhorn forceps’

A

Put into furcation gap
Squeeze handle
Points go towards each other and lift the tooth up
- less pressure - good for children as bone softer in young
- less mobilising needed
- if not deep enough can crush crown

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14
Q

advantages of ‘cowhorn’ forceps

A
  • less pressure - good for children as bone softer in young

- less mobilising needed

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15
Q

disadvantage of ‘cowhorn’ forcep

A
  • if not deep enough can crush crown
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16
Q

3 general principles of extraction

A

Mobilise teeth with special instrument

Forceps on root

Various movements to expand bone socket to give ease of getting tooth out

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17
Q

bayonet forceps design

A

Easy to reach back with Z shape

  • Bayonet pattern
  • Don’t stretch cheek
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18
Q

why need for bayonet forceps

A

Hard to access upper wisdom teeth

Can use upper molar forceps or the top one

  • Root pattern variable
  • Don’t know where furcation’s are
  • Assume one rooted
  • Can be poor grip
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19
Q

upper bayonet third molar forceps

A

like universal with Z end

Part of handle lifts of table

  • Prevent stretching teeth
  • Reach further back

tip have concave surface on either side
- Grab a root

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20
Q

upper bayonet root forceps

A

Fine tip

  • Removing little roots
  • Fracture
  • Not wisdom tooth - too narrow, no grip
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21
Q

where is right handed operator in extractions of lower right molars

A

standing behind the patient on left to pt

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22
Q

where is left handed operator in extraction of lower left molars

A

standing behind the patient on right of pt

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23
Q

when does the operator stand in front of the pt in extractions

A

All upper teeth

  • Lower left if right handed
  • Lower right if left handed
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24
Q

where does a right handed operator stand when standing in front of the pt

A

in front of the pt to the right

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25
where does a left handed operator stand when standing in front of the pt
in front of the pt to the left (mind spittoon)
26
how should you change the pt positions for maxillary extractions
lie pt more flat
27
what does the correct extraction position allow
Non dominant hand cannot support jaw - Retract cheek, hard palate, protect pt face Let light in
28
purpose of elevators
Forceps good at extracting - But straight to higher chance of breaking teeth Minimise breaking teeth and get rid of excess easier use these - Facilitate the extraction Loosen tooth - Roots are mobile - easier to get out
29
coupland's elevators
Most popular Different sizes - 1 - narrowest - 2 - 3 - widest (top) Half universal forceps - Bit sharper at end Tear PDL Elevate the tooth Individually wrapped Ends can wear with time
30
Cryer's elevators
Sets of 2 in pack (R and L) Pointy Curved Elevate broken fractured retained roots
31
how to differentiate right and left cryer's elevators
Concave is pointing towards the ceiling - smile to the sky Point to each other One in right and left is left And engraved usually
32
Warwick James elevators
Like fine Coupland Sets of 3 - Distinguish left and right like Cryers - then straight one Curved is less pointy Upper wisdom teeth - Fit better in narrow space
33
3 elevators
Coupland's Cryer's James Warwick
34
non surgical extractions
Forceps and elevators No flaps/incisions, no bone removal, no sectioning of teeth
35
surgical extractions
Incisions in gingivae/ mucoperiosteal flaps Bone removal with drills or chizels Tooth sectioning with drills
36
why would you remove gum in a surgical extraction
Expose as much as area as can Preserve soft tissue Pathology at root need to clean Radiograph indicated
37
what is oral surgery reliant on
Entirely reliant on first stage of procedure - anaesthesia Regional or block - Number of nerves with 1 injection Infiltration - Underlying Anatomy hope to catch nerve desired ID Block need to inject long buccal nerve too
38
regional or block LA
Number of nerves with 1 injection
39
infiltration LA
Underlying Anatomy hope to catch nerve desired
40
what is the first consideration prior to extraction
access | - access is success
41
corenectomy
Remove crown of tooth ``` Leave roots - Remove top of the tooth and leave roots near nerve to minimise damage - Smooth root down (when healthy) - 3mm bone around Should heal well ``` Can be used when roots are close to nerves, where surgical removal carries a higher risk of damage to the nerve - e.g. lower third molars that are half through so can have bacterial invasion - near ID nerve – bump can cause loss of sensation
42
Impacted canines and premolars treatment options
They can be uncovered (exposed to allow the orthodontist to bring them into alignment) - Expose them and attach bracket to encourage them to come through into correct alignment - Cut away gum, drill away bone and pass to ortho Or they can be surgically removed if they are causing problems, cannot be orthodontically aligned or are in the way/ preventing orthodontic tooth movement
43
issues caused by impacted canines or premolars
Permanent Canines and premolars sometimes do not erupt If left can cause problems to roots of other teeth
44
when should you palpate for erupting canines
9 years
45
Oro antral communication
acute communication between mouth and sinus
46
oro antral fistula
Chronic communication is an epithelial lined tract between mouth and sinus
47
what can cause an OAC/OAF
From canine to last molar in the upper arch – there can be a close relationship to the maxillary sinus Extraction can result in a communication between the sinus and oral cavity - As tooth roots have extended into air sinus space - Granulated track tunnel from mouth to sinus - Repeat infections - Water runs out nose
48
what must happen if OAC or OAF doesn't heal
they do not heal they need to be surgically closed Need to remove tissue and tract to get closure Can look small in soft tissue, but when remove soft tissue reveal a large hole Move tissue buccally to palate and close off with sutures
49
excision
remove the whole lesion scalpel needed
50
incision
take a sample of the lesion scalpel needed
51
punch biosy
a core: punch a circle around the lesion (excision) or within the lesion (incision) 4mm or 6mm Multiple layers of mucosa
52
3 types of soft tissue biopsy
excision incision punch biopsy
53
what is the point of soft tissue biopsies
Provide an answer to what is happening (pathological examination)
54
how can you give pathologist indication of orientation of soft tissue biopsy
May suture through biopsy to give pathologist context Medical Hx needed Mesial and distal or superior and inferior margin
55
biopsy for lesion that is suspected malignancy
do not remove whole lesion. Take a sample to identify it then produce a definitive treatment plan - representative sample
56
lichehn planus/lichenoid reaction
6 different presentation (variable) Increase risk of developing oral cancer over time Over reaction of immune system - Stimulus response - funny presentation
57
presentation of leukoplakia
White and red patches of unknown origin White - thickened Red - thinned
58
mucoceles
damaged minor salivary glands - saliva trapped in mucous extravastation cyst saliva leaked into submucosal layer
59
minor salivary gland structure
tiny, grape like
60
saliva retention cyst
tube for saliva into mouth blocked so cannot escape
61
damage to minor salivary gland leads to
leak saliva where it shouldn’t be, body walls off and its stuck - mucoceles
62
ranula
Damage to sublingual salivary gland (major salivary gland) like a large mucocele in the floor of the mouth. - frogs belly Often marsupialised. - If does not resolve requires more complex surgery for removal
63
what can cause mucoceles
trauma
64
what is the most common minor salivary gland problem
mucocele
65
what is the saliva like in mucocele
thicker, gluey consistency compared to saliva
66
appearance of mucocele
Soft bluish swelling fluid filled | - Purple/dark if blood
67
excision of mucocele
Not falsely inflate the size of the lesion - Around site Blunt dissection - Push layers of tissue off round it - Scissors in closed and then open up to remove tissue away Ellipse - Come together as straight line Burst at top
68
cysts
Epithelial lined fluid filled cavities in bone or soft tissue - Many different types
69
2 different ways of managing cysts
Enucleation - removal of entire cyst Marsupialisation - removal of part of cyst lining and leaving it open. - “De-roofing” - Body can start laying bone down as compromised
70
enucleation of cysts
removal of entire cyst
71
Marsupialisation of cyst
- removal of part of cyst lining and leaving it open. - “De-roofing” - Body can start laying bone down as compromised
72
radicular cysts associated
radicular cysts are associated with non vital or dead tooth
73
periradicular surgery
Surgery around the root of the tooth - Failed root canal treatment/ non-resolving infection/cyst - Root fractures - Post Crowned Teeth – post perforations Can involve debridement (cleaning), sealing perforations, apicectomy (removal of root apex) Can refer to endodontic team - Root treatment is as successful - Less invasive - Less risk
74
preposthetic surgery
E.g. removal of denture induced hyperplasia - Consistently rubbing on tissue - thicken and grow - Lumps in the mouth, Not worrying - But contribute to displacing denture - Like atrophic ridge – hard to get to fit Excision of Denture Hyperplasia
75
dentoalveolar infection treatment
incision and drainage
76
dentoalveolar infection
Localised collections of pus, patient not systemically unwell – Can be incised and drained in general practice under LA
77
dentoalveolar infection appearance
Bubble - Not always like this Can see sinus - dot - Chronically draining pus
78
danager of dentoalveolar infection on palate
can spread infra-orbital and reach eye painful - palate should be bound to bone, not got flex
79
how to tell if pt systemically unwell from dentoalveolar infection
Asymmetric Assessed for heart rate and respiratory - Sensitive markers of sepsis Temperature Bp To OMFS - Need more than removing source of infection of tooth and antibiotics
80
large risk for submandibular dentoalveolar infection
Cross midline – Ludwig’s angina - Risk to airway cannot see angle or lower border of mandible as lost anatomy
81
how to treat severe dentoalveolar infection
incision and drainage IV antibiotics - flush and wash out
82
what does an infection lead to at its site
inflammation - inc blood flow and fluid to area
83
cryosurgery/cryotherapy is
Liquid nitrogen/ Nitrous Oxide | - Freeze lesions
84
cryosurgery/cryotherapy on
Haemangiomas (vascular lesion) - risk of bleeding if excised malformed blood vessels congenital or developed Trigeminal neuralgia - cryo the nerve involved e.g. infraorbital nerve, mental nerve facial pain – freeze nerve so no feeling, constantly numbed
85
TMJ problems
Problems with jaw joint Pain associated with muscles of mastication Combination of muscle and joint pain Often related to tooth grinding/clenching habits - Parafunctional
86
TMJ problem treatment
be treated with conservative advice and analgesia, occlusal splints/bite raising appliances (hard/soft) Modifying habits - Can be difficult to manage - Have to manage pt expectation Habit breaking strategies

BDS2 Clinical (6 decks)

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