L25 Management of third molars Flashcards

1
Q

What can exacerbate pericoronitis?

A

Trauma from opposing upper tooth

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2
Q

What are the tx options for pericoronitis?

A
  • 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
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3
Q

Should you extract a tooth in an episode of acute pericoronitis?

A

NO- high predisposition to acute alveolar osteitis

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4
Q

What pathology would indicate third molar extraction?

A
  • Resorption
  • Caries
  • Cysts
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5
Q

How would you describe the position of an impacted wisdom tooth?

A
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6
Q

What needs to be included in a pre-op assessment for wisdom tooth extraction?

A
  • 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
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7
Q

What features indicate a tooth closely associated to the ID bundle?

A
  • Deviation of roots
  • Deviation of canal
  • Narrowing/constriction of tooth roots
  • Dark+bold apices of tooth
  • Visible on OPT or CBCT
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8
Q

Describe the principles of surgery.

A
  • 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
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8
Q

Describe the principles of surgery.

A
  • 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
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9
Q

What are the post-op complications?

A
  • 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
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10
Q

When is ibuprofen contraindicated?

A
  • 3rd trimester of pregnancy
  • Cardiac disease
  • Renal disease
  • Asthma
  • Lithium/digoxin/warfarin
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11
Q

What is the average infection rate post-operatively for wisdom tooth removal?

A

<10%

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12
Q

What is recommended post-surgery?

A
  • 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)
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13
Q

Which nerve is most commonly damaged in lower wisdom tooth removal?

A

Lingual nerve

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14
Q

When do you follow up after wisdom tooth surgery?

A

2-3 weeks post surgery

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