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Oral Surgery > M6 Actual Patient Management > Flashcards

M6 Actual Patient Management Flashcards

1
Q

5 steps in preoperative preparation in tooth extraction

A
  1. Sterilization of armamentarium
  2. Preparation of the operatory, the surgeon and the patient
  3. Assessment of patient’s health status
  4. Developing a surgical diagnosis
  5. Surgical hand scrubbing and donning of sterile gloves
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2
Q

Instruments for regular tooth extraction (8)

A

Injection syringe and needle
Desmotome or gum separator
Molt periosteal elevator
Straight elevators, #301 & #304
Tooth extraction forceps
Periapical curette
Needle holder and needle
Suture scissors

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3
Q

Emergency instruments (10)

A

Chisel and mallet
Bard parker scalpel handle #3
Blade #15 and #11
Root tip elevators
Crossbar elevators
Hemostat
Seldin retractor
Minnesota retractor
Roeko suction tip
Surgical handpiece and bur

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4
Q

12 Materials and supplies used

A
  1. Anesthetic carpules, ex. 2% lidocaine with epinephrine and topical anesthetic
  2. 27-gauge short needles
  3. 3-0 black braided silk suture thread & half circle needle
  4. Gauze pads & applicator swab
  5. Antiseptic mouthwash, ex. 1% povidone-iodine
  6. Specimen container
  7. Sterile gloves, plus extra pairs
  8. Patient drape, headcap & shoe covers
  9. Hand scrub brush and antibacterial soap
  10. Cuspidor brush & detergent
  11. Cling wrap for dental headlamp handle and control buttons
  12. Plastic trash bag
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5
Q

3 things to do when preparing the operatory field

A
  1. Cover the bracket table & all control buttons & handles to be touched
  2. Lay out all necessary materials on the bracket table
  3. Pay attention to positioning of patient for visibility and access during surgery
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6
Q

How to accomplish adequate visibility and access

A
  1. Position of patient & clinician
  2. Adequate lighting
  3. Surgical field free of excess blood or other fluids
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7
Q

2 things to be done when prepping the patient

A
  1. Cover patient’s head, street clothes and shoes
  2. Ask the patient to rinse his mouth with antiseptic solution for at least 30 seconds..
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8
Q

Personal protective equipment of the surgeon includes 7

A

Scrub suit, headcap & N95 facemask
Hazmat suit
Face shield or goggles
Shoe covers
Sterile gloves (Bring extra pairs)

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9
Q

Rationale of assessing patient’s health status

A

Check for presence of a health problem that may require: medical management prior to surgery or modification of dental tretament

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10
Q

Complete health questionnaire (7)

A

Medications being taken or has taken
Past medical history
History of surgery
History of allergies
Bleeding tendencies
Diseases in the family
Past dental history

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11
Q

3 forms to accomplish comprising the patient’s records

A

Oral diagnosis form
Health questionnaire
Consent for anesthesia and surgery and waiver form

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12
Q

After accomplishing the patient’s record, what is next

A

Perform a quick physical exam.

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13
Q

After performing a physical exam, what is next?

A

Take the vital signs: body temperature, pulse rate, respiratory rate and blood pressure

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14
Q

Working diagnosis is the tentative diagnosis created prior to surgery. What is the rationale of developing a surgical diagnosis?

A

To identify the disease that would dictate the proper treatment approach

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15
Q

Sign & symptoms of patient’s condition are derived from (3)

A

Interview for case history
Present s/s from clinical examination
Radiographic evaluation

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16
Q

Where do we get the information for case history

A

Chief complaint
History of present illness

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17
Q

What do we perform in clinical evaluation?

A

Inspection, palpation, percussion

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18
Q

Surgical hand scrubbing with antiseptic soap is completed for at least

A

10 minutes.

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19
Q

3 steps of gloving without an assistant

A
  1. The 1st glove is donned by holding the glove merely by its folded cuff.
  2. No part of your bare hands or skin should touch the outside of sterile gloves.
  3. Fingers of gloved hand may be inserted into the fold of the cuff of the other glove
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20
Q

4 general steps in routine tooth extraction

A

I. Instrument set-up
II. Preparation of the operative site
III. Closed technique of exodontia
IV. Postoperative management

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21
Q

2 things to be done during instrument set-up

A
  1. Arrange the instruments in sequence according to the order by which they will be used
  2. Separate the non-sterile materials from the sterile materials.
22
Q

Rationale of arranging instruments in sequence

A
  1. minimize surgery time and consequent blood loss
  2. easily check that the instruments used are all still there before suturing up.
23
Q

Rationale of separating non-sterile materials from the sterile materials.

A

Cross-contamination is avoided

24
Q

In adjusting patient’s chair, what is the correct level of patient’s mouth when working on a. maxillary b. mandibular

A

a. Level of patient’s mouth is at the level of elbow
of operator’s working arm
b. patient’s mouth is below operator’s elbow

25
Q

The correct angulation of the occlusal plane in a. maxilla b. mandible during surgery

A

a. Maxillary plane - 60 degrees
b. Mandibular - parallel to the floor

26
Q

Rationale for correct chair height and position of dental light

A

adequate visibility and access

27
Q

8 steps in Closed technique of exodontia

A

Administer local anesthesia
Loosen surrounding soft tissues
Luxate tooth with an elevator
Grasp & luxate with extraction forceps
Deliver tooth out of the socket
Debride socket
Suture
Apply pressure dressing

28
Q

2 steps administering local anesthesia

A
  1. Apply topical anesthetic
  2. Inject 1ml approximating apex of the tooth on the labial & 0.5ml on the palatal or lingual mucosa (mucobuccal fold)
29
Q

a. Concentration of lidocaine with epinephrine
b. Maximum dose of lidocaine (mg/kg)
c. Max. no. of cartridges of lidocaine (1.8ml/carpule)

A

a. 2% w/ 1:100,000 epi
b. 7
c. 10

30
Q

4 steps in loosening the surrounding soft tissue attachment

A
  1. Using gum separator or molt periosteal elevator (MPE) #9, insert the instrument into the gingival sulcus
  2. Then proceed deeper until the crest of the alveolar ridge is reached
  3. MPE #9 or gum separator is used to sever the soft tissue attachment around the cervical area of the tooth
  4. The nondominant hand holds the alveolar process with index finger on the labial and thumb on the palatal side
31
Q

Rationale for loosening the surrounding soft tissue attachment

A
  1. allows the tip of the elevator to be seated at the crest of the alveolar bone for leverage
  2. so that the beak of forceps could grasp the bottom part of the tooth
32
Q

Mechanical principles applied when luxating the tooth

A

Lever
Wedge

33
Q

This acts as a fulcrum when luxating the tooth to be extracted using elevator

A

Alveolar crest

34
Q

To avoid trauma, do not lean to the adjacent tooth (unless the adjacent tooth is also for extraction)

A

True

35
Q

In applying the elevator as a wedge, we must establish this to minimize accidental plunging into the surrounding tissues

A

Occlusal finger stop

36
Q

Principle of wedge

A

No two things can occupy the same at the same time;
when the elevator is wedge into the periodontal space, the tooth would get displaced

37
Q

Mechanical principle applied in forceps extraction:

A

WEDGE

38
Q

Technique in tooth luxation and forceps delivery

A
  1. Adapt the beak on the root surface apical to the cervical line
  2. Apply slow deliberate pressure on the socket wall from labial then palatal area in a pendulum movement
39
Q

Rationale in tooth luxation and forceps delivery

A

Acting as a wedge, tooth is used to apply pressure on the socket walls to expand the bony socket

40
Q

Direction of pressure applied in sequence for a tooth with single conical root

A

Apical
Labial
Lingual
Rotational (mesial and distal)
Traction

41
Q

4 rules in use of elevators

A
  1. The dental elevator must always use buccal bone
  2. Concave surface of the blade must be in contact with the mesial or distal surface of the tooth to be extracted and inserted between the tooth and alveolar bone
  3. Elevation should be done at the mesio- and distobuccal line angle of the root
  4. The elevator is inserted perpendicular to the long axis of the tooth initially and directed inwards going towards the apex of the tooth
42
Q

Functions of nondominant hand

A
  1. Reflects the soft tissues of the cheeks, lips and tongue
  2. Supports the alveolar process of the maxilla (stabilize patient’s head)
  3. Supports and stabilizes the mandible (avoids injury to the TMJ)
43
Q

Rationale for socket debridement

A
  1. reduce incidence of postop or residual infection
  2. reduce possible bleeding from retained irritants
44
Q

After socket debridement, we compress the socket wall into its original position. What is the rationale behind this?

A

improve contour of the alveolar bone – the simplest form of alveoloplasty

45
Q

After compressing the socket, pass your gloved finger over mucosa of extraction site and check for sharp bony projections. What do you use to cut and smoothen bony projections?

A

bone rongeur or bone file

45
Q

After compressing the socket, pass your gloved finger over mucosa of extraction site and check for sharp bony projections. What do you use to cut and smoothen bony projections?

A

bone rongeur or bone file

46
Q

After simple alveoloplasty, what do you use to debride the socket from any loose bony particles

A

NSS

47
Q

What type of suture is done at the following:
a. Interdental papilla that had been cut
b. Wide sockets like molar sockets
c. Multiple teeth extraction

A

a. Simple interrupted suture
b. Figure of 8
c. Continuous locked suture

48
Q

Where do we place all knots of suture

A

labial/buccal side

49
Q

Proper application of pressure dressing

A

Ask patient to bite on a piece of moistened gauze as pressure pack for at least 30 minutes to control postop hemorrhage or until patient reaches his house

50
Q

Postoperative instructions for the following:
1. Rest
2. Analgesia/pain
3. Edema/swelling
4. Bleeding
5. Infections
6. Diet
7. Oral hygiene

A
  1. 1-2 days rest depending on the extent of the surgery and the patient’s physical condition
  2. prescribe analgesics or NSAID for pain control every 4-6 h, prn.
  3. cold compress (ice pack wrapped in a towel) over the surgical area for 10-15 mins and repeat every hour, for at least 4-6 h
  4. patient must bite firmly on a gauze pad placed over the wound for 30-45 min
  5. antibiotic
  6. on the day of surgery, must consist of cold, liquid foods, or semi-soft diet (or as related)
  7. No mouth rinsing for the first 24h, After 1 day, take warm saline rinses 3x per day for 3-4 days, the teeth should be brushed but area of surgery is avoided
51
Q

Follow up is done for suture removal after how many days

A

5-7 days

Oral Surgery (1 decks)

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