Introduction Flashcards
What is oral surgery?
Treatment and ongoing management of irregularities and pathology of the jaw and mouth that require surgical intervention
Describe what oral surgery is likely to involve?
- Lumps and bumps
- Ulcers
- Red or white patches
- Cysts
- Pain
- Difficult extractions
What is oral medicine?
Diagnosis and non-surgical management of chronic, recurrent and medically-related disorders of the oral maxillofacial region
Name 3 main types of disease oral medicine can involve
- Mucosal disease
- Salivary gland disease
- Non-dental causes of orofacial pain
Describe the process of a history taking and treatment plan
- Referred by and why
- Complaining of
- History of presenting complaint
- PMH
- PDH
- SH
- Extra-oral examination
- Intra-oral examination
- Provisional diagnosis
- Special investigations
- Diagnosis
- Treatment plan
What acronym would be used to take a PHC?
SOCRATES
Why is it important to gauge severity of conditions?
It may impact on treatment
Describe 2 ways to gauge the severity of a patient’s condition
- Generally the more medication the more severe the condition
- Recent or repetitive hospital admission suggests increased severity
Describe the questions you may ask a patient who suffers from angina
- Have you ever had a heart attack?
- How often do you get angina?
- Does angina come on at rest or with exertion?
- It is usually easily controlled by medication?
- Have you had stents or bypass surgery?
Describe the questions you may ask a patient who suffers from diabetes
- How is it controlled?
- Is it well controlled / Do you have hypos?
- Do you check sugars normally / What are they?
- Have you eaten and taken normal medication today?
Describe what to look for in extra-oral examination
- Demeanour, colour and facial asymmetry in patient
- Examination of the nodes
- Examination of the TMJs
Describe how to palpate lymph nodes on extra-oral clinical examination
- Ask patient to turn head to contralateral side and palpate below SCM
- May be useful to have patient tip chin forward slightly in submandibular or submental region
Describe the extra-oral clinical examination of the TMJs
- Palpate
- Not any tenderness, clicks or grinding
- Look for deviation or limitation on opening
- If limited opening, measure and document
Describe the soft tissues to examine during an intra-oral examination
- Lips
- Buccal mucosa
- Hard and soft palates
- Retromolar pads
- Tuberosities
- Gingivae
- Tongue
- Floor of the mouth
Describe the intra-oral examination of the dentition
- General condition
- Any caries present
- Fractured teeth
- Mobility
How can a lesion / ulcer be described upon examination?
- Anatomical location
- Size
- Colour
- Single / multiple
- Unilateral / bilateral
- Consistency (hard, firm, soft, fluctuant)
- Margins (regular or irregular)
- Homogenous or heterogenous
- Discrete
- Base (only for ulcer)
Describe how the colour of ulcers may change
Yellow base indicates fibrous base which is healing whereas red and granular is an ulcer which is not healing up
Name 4 examples of special investigations which may confirm or refute a provisional diagnosis
- Radiographs
- Vitality tests
- CT / CBCT scans
- Ultrasound
Describe the pneumonic which may act as a surgical sieve and give an idea of what condition is present
V - Vascular I - Inflammatory T - Traumatic A - Autoimmune M - Metabolic I - Iatrogenic N - Neoplastic
Name 5 main causes of orofacial pain
- Local
- Vascular
- Referred
- Neurological
- Psychogenic
Give 4 examples of local orofacial pain
- Dental
- Salivary glands
- Nose
- TMJs
Give 2 examples of vascular orofacial pain
- Migraine
2. Giant cell arteritis
Name 4 examples of referred orofacial pain
- Sinus
- Ears
- Eyes
- Neck
Name 4 examples of neurological orofacial pain
- Trigeminal neuralgia
- Post herpetic neuralgia
- MS
- Neoplasms
Give 3 examples of psychogenic orofacial pain
- Atypical facial pain
- Atypical odontalgia
- Burning mouth syndrome
Describe 3 conditions which may lead to dental orofacial pain
- Pulpitis
- Periapical Periodontitis
- Dentoalveolar Abscess
What is pulpitis?
Reversible or irreversible inflammation of the pulp secondary to trauma (physical or chemical) or infection (caries)
What is periapical periodontitis?
Inflammation of the periodontal membrane secondary to trauma (high restoration / blunt trauma) or infection (caries extending into pulp causing pulpal necrosis, which can progress to dentoalveolar abscess
What is a dentoalveolar abscess?
A circumscribed area of dead / dying host inflammatory cells and dead / dying bacterial cells associated with the apex of a non-vital tooth
What is the major difference between reversible and irreversible pulpitis?
Reversible pulpitis is usually only enamel caries whereas irreversible tends to be dentine caries
Describe the site, onset, duration and night waking involved with reversible pulpitis
Site - Unspecific
Onset - Hot / Cold stimuli
Duration - A few seconds
Night waking - No
Describe the site, onset, duration and night waking involved with irreversible pulpitis
Site - Unspecific
Onset - Spontaneous or Hot / Cold Stimuli
Duration - Last hours / Constantly
Night waking - Yes
Describe the site, onset, duration and night waking involved with infective periapical periodontitis
Site - Localised
Onset - Pain on biting / Pressure
Duration - Last hours / Constant
Night Waking - Yes
Describe the site, onset, duration and night waking involved with traumatic periapical periodontitis
Site - Localised
Onset - Pain on biting / pressure
Duration - Last hours / Constant
Night Waking - No
Why does pulpitis tend to be an unspecific pain?
Proprioceptors are found in the periodontal ligament so without the ligament’s involvement, it is hard to localise pain
What may influence night waking for traumatic periapical periodontitis?
A patient with a clenching habit may bite / put pressure on their teeth during the night so will awaken
