Midterm Flashcards
Which types of procedures require board certification?
Pathology, reconstruction, trauma, special needs, corrective jaw, hospital anesthesia
What factors go into insuring a proper incision?
- Sharp blade
- Firm continuous stroke
- Avoid anatomic structures
- Perpendicular to surface
- Proper location for closure/healing
T/F: The base of a flap should be wider than the free margin.
True
Allows optimum blood flow
What is debridement?
Surgical excision of dead and devitalized tissue and removal of all foreign matter from a wound
When is sterile surgery necessary?
Sterile wounds such as TMJ, neck surgery, and salivary gland surgery
What are the two principal requirements for surgery?
- Adequate visibility
2. Assistance
What are the three factors needed for adequate visibility?
- Adequate access
- Adequate light
- Free of excess blood/fluids
T/F: Short, interrupted strokes are preferred when making incisions.
False
Long and continuous are preferred
T/F: Incisions through attached gingiva and over healthy bone are preferred.
True
What are some complications of flap surgery?
Necrosis, dehiscence, tearing
What is the ideal length and width of a flap?
Length should be no more than twice the width of the base
What can happen from using excessive force to pull tissues together which suturing?
Dehiscence - seperation of the flap margin
Does an envelope flap involve release incisions?
No. You add release incisions to an envelope flap to allow better access
What is the most common scalpel blade for intraoral surgery?
No. 15 blade
What instrument is used to reflect the periosteum from underlying bone?
No. 9 Molt periosteal elevator
What is the use of the right-angle Austin retractor and the Minnesota retractor?
Retract cheek, tongue, flaps
The instrument most commonly used for removing bone in dento-alveolar surgery is the ___________.
rongeur forceps
________ are used for the fine smoothing of bone.
Bone files
What instrument would be used to remove soft tissue from a socket?
Periapical curette
What are the three types of elevators?
- Straight
- Triangle/pennant
- Pick
When would you use a triangular elevator?
Broken root remains and the adjacent socket is empty
What is the purpose of pick type elevators?
Remove fractured roots
What are the three basic components of extraction forceps?
Handle, hinge, breaks
Anterior teeth in the maxilla are normally removed with which forceps?`
Universal No. 150
What are the most commonly used forceps for maxillary molars?
No. 53 right and left
Which forceps are most commonly used for mandibular anterior teeth?
Universal No. 151
T/F: Right and left forceps are necessary for mandibular molar extraction.
False
Needed for maxillary molars
What is a common forceps to use for mandibular molars?
No. 17
What are three anatomical contraindications for tooth extraction?
- IAN proximity
- Sinus
- Adjacent teeth
T/F: Pregnancy could be a systemic contraindication for tooth extraction.
True
What are some factors affecting access to the tooth?
- Max incisal opening
- Angle’s class
- Tongue size
- Gag reflex
- Location of tooth
T/F: Gross calculus should be removed prior to extraction.
True
T/F: Teeth can be extracted without radiographs.
False
T/F: Radiographs used for extraction should be from within the last year.
True
What vital structures must be thought of during extraction?
Sinus and IAN
What is the most common mistake in patient positioning for extractions?
Chair to high
T/F: The behind the patient approach is sometimes used in mandibular extractions.
True
What are the three simple machine mechanisms used to extract teeth?
- Lever
- Wedge
- Wheel and axle
Which machine mechanism can make it easy to break fragile elevators or teeth and bone?
Lever mechanism
T/F: Teeth should be pulled out of the socket.
False
Push, rock, rotate
What is the primary and secondary purpose of elevators?
P: loosen teeth and create space for forceps
S: remove parts of tooth or root
T/F: Straight elevators are normally the first instruments used.
True
Expansion of alveolus and loosening tooth/PDL
T/F: The straight elevators should utilize a fulcrum on adjacent teeth.
False
How should the straight elevator be used in the mesial/distal portions of the tooth to be extracted?
Apical portion wedged against crestal bone and the coronal portion pushes the tooth
T/F: The elevator should be used to scoop out the tooth.
False
How should pressure be applied with forceps?
First apically to seat forceps.
Then buccal, lingual, rotational to expand alveolus.
Do not just pull tooth
What is the step by step approach to simple extraction?
- Confirm anesthesia
- Release soft tissue
- Elevate tooth
- Adapt forceps to tooth
- Luxate
- Remove
- Examine socket and curette
- Place gauze and compress
Can you luxate with an elevator?
Yes - perpendicular to interproximal space, or parallel to long axis
In which direction is the initial and most profound force with the forceps?
Apically - moves center of rotation, expands alveolus
T/F: Force on forceps should begin at the wrist.
False
From the shoulder/arm
T/F: Force on the tooth should be firm, steady, and sustained.
True
Which teeth are the most susceptible to fracture with rotational forces?
Teeth with multiple roots
What does it mean to compress the socket?
Post-extraction realigning the buccal plate
The major luxating forces are buccal for all teeth except…..
mandibular molars.
When making a release incision, where should the incision cross the gingival margin?
At the line angle of a tooth
What is the difference between a 3 cornered flap and a four cornered flap?
3 - one vertical release
4 - two vertical releases
How much tissue should be left between the suture and the edge of the flap?
3mm
How long are sutures left in?
5-7 days
T/F: Open extraction techniques should only be used in extreme conditions.
False
In some instances can be more conservative than closed techniques
If surgical bone removal is needed how much bone should be removed?
Bone in the buccal plate should be removed to the width of the tooth and half-2/3 the length of the root
What should be the first step in trying to remove a root fragment?
Suction and irrigation - it will sometimes come out with suction
What two instruments can be used to remove root fragments?
Root tip pick - small fragment, light forces
Straight elevator - larger fragments, still light forces
What is the open-window technique?
Drill a small hole into the bone at the apex of the tooth and push the root out
What are the four characteristics that may allow you to leave a root tip?
- Less that 4 mm
- Deeply embedded in bone
- Not infected tooth
- Not mobile
T/F: All unerupted teeth are impacted.
False
Impacted teeth have not erupted in the expected sequence
T/F: It is recommended to leave impacted teeth alone until they present with problems.
False
Much easier to remove them before they cause problems
What is the age range for eruption of third molars?
20-25
When is the ideal time to remove third molars?
Roots are 1/3 - 2/3 formed
Ages 17-20
What are some reasons for removing impacted third molars?
- Perio disease on 2nd molars
- Caries on 2nd molars
- Prevent repeated pericoronitis
- Prevent root resorption
- Under dental prosthesis
- Odontogenic cysts and tumors
How should pericoronitis be managed?
Antimicrobial rinses to eleviate symptoms -> extract tooth when symptoms are gone
What are some contraindications for removing third molars?
- Extremes of age (over 40)
- Poor medical status
- Close to adjacent structures
What classification presents the easiest mandibular third molar extraction?
Winter’s 1
Mesioangular crown
Which classification is the most difficult?
Winter’s 2
Distoangular
What is the most common maxillary third molar angulation?
Vertical
What is the most common mandibular third molar angulation?
Mesioangular
What are the two major indications for third molar removal?
Therapeutic - treat disease
Prophylactic - prevent disease
How often should gauze be replaced after surgery?
Every hour
________ can greatly increase the risk of a dry socket.
Smoking
Peak pain occurs ___ hours after surgery.
12
T/F: The pain should not last more than 2 days.
True
When should the patient take the first analgesic?
Before local anesthetic wears off
No more than ______ worth of pain meds should be prescribed.
3 days
If surgical extraction is done, how should narcotics be prescribed?
Dispense 10
Tramadol 50mg or Norco 5mg/325mg
How should narcotics be prescribed in a non-surgical extraction?
No narcotics
Dispense 10 NSAIDs
If needed dispense 5 tramadol or Norco
When is the peak swelling after extractions?
36-48 hours
When should bleeding stop after extraction?
In the second day
What is the biggest key to bleeding management?
Have it stopped before the patient leaves the office
What is the cascade of wound healing?
Hemostasis (platelets) -> acute inflammation (granulocytes) -> proliferation (monocytes) -> remodeling (fibroblasts)
When is lamellar bone/marrow seen in the remodeling phase?
12-24 weeks
How long until the socket will appear healed over?
3 weeks
How long until radiographic healing is seen?
4-6 months
What is the critical radiation levels that will delay jaw healing?
over 5000cGy
What types of drugs can impair bone healing?
Nitrogen-containing bisphosphonates and RANKL inhibitors
All must be high dose, potent drugs
What is localized alveolar osteitis?
Dry socket
T/F: A dry socket can be improved with antibiotics.
False
Not an infection
During a dry socket, the patient gets stuck in the __________ stage of wound healing.
acute inflammation
How can you diagnose a dry socket?
3-5 days post op a change in quantity or quality of pain
Gray/brown clot or total absence of clot
T/F: Dry socket is more likely in a mandibular tooth.
True
How can you decrease the risk of dry socket?
Chlorhexidine, good technique
Not antibiotics
How is dry socket treated?
Irrigation and placement of palliative dressing - allow time to heal
T/F: Most patients will heal from dry socket in 3-5 days
True
What is the difference between osteitis and osteomyelitis?
Osteitis - inflammation of bone (dry socket)
Osteomylitis - infection of bone
