L25 Management of third molars Flashcards
What can exacerbate pericoronitis?
Trauma from opposing upper tooth
What are the tx options for pericoronitis?
- Curettage the pocket and irrigate with Chx
- Flap cauterisation (uncommon)
- Grinding opposing tooth or extracting to reduce trauma to the operculum
- Remove the flap (operculotomy)
- Extract the tooth
Should you extract a tooth in an episode of acute pericoronitis?
NO- high predisposition to acute alveolar osteitis
What pathology would indicate third molar extraction?
- Resorption
- Caries
- Cysts
How would you describe the position of an impacted wisdom tooth?
What needs to be included in a pre-op assessment for wisdom tooth extraction?
- Angulation of tooth (vertical impaction = challenging)
- Caries, restorations, fractures
- Number of roots and pattern (conical, divergent, hooked)
- Root relation to ID nerve
- Pathology, ankylosis, resorption
- Height of mandible in relation to wisdom tooth crown
- Bone (age related changes, ankylosis)
- Adjacent teeth
What features indicate a tooth closely associated to the ID bundle?
- Deviation of roots
- Deviation of canal
- Narrowing/constriction of tooth roots
- Dark+bold apices of tooth
- Visible on OPT or CBCT
Describe the principles of surgery.
- 2 sided or 1 sided flap
- Elevator held 45 degrees to the tooth
- Divide tooth vertically along long acis or horizontally, use a drill or osteotome
Describe the principles of surgery.
- 2 sided or 1 sided flap
- Elevator held 45 degrees to the tooth
- Divide tooth vertically along long acis or horizontally, use a drill or osteotome
What are the post-op complications?
- Inflammation
- Pain, maximum 12-18 hours post surgery, lasts 5-7 days
- Pre-emptive analgesia and regular post-op analgesics recommended
- Trismus for first week
- Maximum swelling 3-4 days post durgery
- May be neck bruising
When is ibuprofen contraindicated?
- 3rd trimester of pregnancy
- Cardiac disease
- Renal disease
- Asthma
- Lithium/digoxin/warfarin
What is the average infection rate post-operatively for wisdom tooth removal?
<10%
What is recommended post-surgery?
- Regular analgesics
- Corsodyl to reduce risk of post-op infection or inflammation
- Abx if surgery lasts more than 30 minutes (anaerobic gram positive cocci and anaerobic gram negative rods, penicillin effective)
Which nerve is most commonly damaged in lower wisdom tooth removal?
Lingual nerve
When do you follow up after wisdom tooth surgery?
2-3 weeks post surgery