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SP18: Oral Surgery > Midterm > Flashcards

Midterm Flashcards

1
Q

Which types of procedures require board certification?

A

Pathology, reconstruction, trauma, special needs, corrective jaw, hospital anesthesia

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2
Q

What factors go into insuring a proper incision?

A
  1. Sharp blade
  2. Firm continuous stroke
  3. Avoid anatomic structures
  4. Perpendicular to surface
  5. Proper location for closure/healing
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3
Q

T/F: The base of a flap should be wider than the free margin.

A

True

Allows optimum blood flow

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4
Q

What is debridement?

A

Surgical excision of dead and devitalized tissue and removal of all foreign matter from a wound

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5
Q

When is sterile surgery necessary?

A

Sterile wounds such as TMJ, neck surgery, and salivary gland surgery

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6
Q

What are the two principal requirements for surgery?

A
  1. Adequate visibility

2. Assistance

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7
Q

What are the three factors needed for adequate visibility?

A
  1. Adequate access
  2. Adequate light
  3. Free of excess blood/fluids
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8
Q

T/F: Short, interrupted strokes are preferred when making incisions.

A

False

Long and continuous are preferred

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9
Q

T/F: Incisions through attached gingiva and over healthy bone are preferred.

A

True

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10
Q

What are some complications of flap surgery?

A

Necrosis, dehiscence, tearing

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11
Q

What is the ideal length and width of a flap?

A

Length should be no more than twice the width of the base

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12
Q

What can happen from using excessive force to pull tissues together which suturing?

A

Dehiscence - seperation of the flap margin

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13
Q

Does an envelope flap involve release incisions?

A

No. You add release incisions to an envelope flap to allow better access

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14
Q

What is the most common scalpel blade for intraoral surgery?

A

No. 15 blade

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15
Q

What instrument is used to reflect the periosteum from underlying bone?

A

No. 9 Molt periosteal elevator

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16
Q

What is the use of the right-angle Austin retractor and the Minnesota retractor?

A

Retract cheek, tongue, flaps

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17
Q

The instrument most commonly used for removing bone in dento-alveolar surgery is the ___________.

A

rongeur forceps

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18
Q

________ are used for the fine smoothing of bone.

A

Bone files

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19
Q

What instrument would be used to remove soft tissue from a socket?

A

Periapical curette

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20
Q

What are the three types of elevators?

A
  1. Straight
  2. Triangle/pennant
  3. Pick
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21
Q

When would you use a triangular elevator?

A

Broken root remains and the adjacent socket is empty

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22
Q

What is the purpose of pick type elevators?

A

Remove fractured roots

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23
Q

What are the three basic components of extraction forceps?

A

Handle, hinge, breaks

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24
Q

Anterior teeth in the maxilla are normally removed with which forceps?`

A

Universal No. 150

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25
Q

What are the most commonly used forceps for maxillary molars?

A

No. 53 right and left

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26
Q

Which forceps are most commonly used for mandibular anterior teeth?

A

Universal No. 151

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27
Q

T/F: Right and left forceps are necessary for mandibular molar extraction.

A

False

Needed for maxillary molars

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28
Q

What is a common forceps to use for mandibular molars?

A

No. 17

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29
Q

What are three anatomical contraindications for tooth extraction?

A
  1. IAN proximity
  2. Sinus
  3. Adjacent teeth
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30
Q

T/F: Pregnancy could be a systemic contraindication for tooth extraction.

A

True

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31
Q

What are some factors affecting access to the tooth?

A
  1. Max incisal opening
  2. Angle’s class
  3. Tongue size
  4. Gag reflex
  5. Location of tooth
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32
Q

T/F: Gross calculus should be removed prior to extraction.

A

True

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33
Q

T/F: Teeth can be extracted without radiographs.

A

False

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34
Q

T/F: Radiographs used for extraction should be from within the last year.

A

True

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35
Q

What vital structures must be thought of during extraction?

A

Sinus and IAN

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36
Q

What is the most common mistake in patient positioning for extractions?

A

Chair to high

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37
Q

T/F: The behind the patient approach is sometimes used in mandibular extractions.

A

True

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38
Q

What are the three simple machine mechanisms used to extract teeth?

A
  1. Lever
  2. Wedge
  3. Wheel and axle
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39
Q

Which machine mechanism can make it easy to break fragile elevators or teeth and bone?

A

Lever mechanism

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40
Q

T/F: Teeth should be pulled out of the socket.

A

False

Push, rock, rotate

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41
Q

What is the primary and secondary purpose of elevators?

A

P: loosen teeth and create space for forceps

S: remove parts of tooth or root

42
Q

T/F: Straight elevators are normally the first instruments used.

A

True

Expansion of alveolus and loosening tooth/PDL

43
Q

T/F: The straight elevators should utilize a fulcrum on adjacent teeth.

A

False

44
Q

How should the straight elevator be used in the mesial/distal portions of the tooth to be extracted?

A

Apical portion wedged against crestal bone and the coronal portion pushes the tooth

45
Q

T/F: The elevator should be used to scoop out the tooth.

A

False

46
Q

How should pressure be applied with forceps?

A

First apically to seat forceps.
Then buccal, lingual, rotational to expand alveolus.

Do not just pull tooth

47
Q

What is the step by step approach to simple extraction?

A
  1. Confirm anesthesia
  2. Release soft tissue
  3. Elevate tooth
  4. Adapt forceps to tooth
  5. Luxate
  6. Remove
  7. Examine socket and curette
  8. Place gauze and compress
48
Q

Can you luxate with an elevator?

A

Yes - perpendicular to interproximal space, or parallel to long axis

49
Q

In which direction is the initial and most profound force with the forceps?

A

Apically - moves center of rotation, expands alveolus

50
Q

T/F: Force on forceps should begin at the wrist.

A

False

From the shoulder/arm

51
Q

T/F: Force on the tooth should be firm, steady, and sustained.

A

True

52
Q

Which teeth are the most susceptible to fracture with rotational forces?

A

Teeth with multiple roots

53
Q

What does it mean to compress the socket?

A

Post-extraction realigning the buccal plate

54
Q

The major luxating forces are buccal for all teeth except…..

A

mandibular molars.

55
Q

When making a release incision, where should the incision cross the gingival margin?

A

At the line angle of a tooth

56
Q

What is the difference between a 3 cornered flap and a four cornered flap?

A

3 - one vertical release

4 - two vertical releases

57
Q

How much tissue should be left between the suture and the edge of the flap?

A

3mm

58
Q

How long are sutures left in?

A

5-7 days

59
Q

T/F: Open extraction techniques should only be used in extreme conditions.

A

False

In some instances can be more conservative than closed techniques

60
Q

If surgical bone removal is needed how much bone should be removed?

A

Bone in the buccal plate should be removed to the width of the tooth and half-2/3 the length of the root

61
Q

What should be the first step in trying to remove a root fragment?

A

Suction and irrigation - it will sometimes come out with suction

62
Q

What two instruments can be used to remove root fragments?

A

Root tip pick - small fragment, light forces

Straight elevator - larger fragments, still light forces

63
Q

What is the open-window technique?

A

Drill a small hole into the bone at the apex of the tooth and push the root out

64
Q

What are the four characteristics that may allow you to leave a root tip?

A
  1. Less that 4 mm
  2. Deeply embedded in bone
  3. Not infected tooth
  4. Not mobile
65
Q

T/F: All unerupted teeth are impacted.

A

False

Impacted teeth have not erupted in the expected sequence

66
Q

T/F: It is recommended to leave impacted teeth alone until they present with problems.

A

False

Much easier to remove them before they cause problems

67
Q

What is the age range for eruption of third molars?

A

20-25

68
Q

When is the ideal time to remove third molars?

A

Roots are 1/3 - 2/3 formed

Ages 17-20

69
Q

What are some reasons for removing impacted third molars?

A
  1. Perio disease on 2nd molars
  2. Caries on 2nd molars
  3. Prevent repeated pericoronitis
  4. Prevent root resorption
  5. Under dental prosthesis
  6. Odontogenic cysts and tumors
70
Q

How should pericoronitis be managed?

A

Antimicrobial rinses to eleviate symptoms -> extract tooth when symptoms are gone

71
Q

What are some contraindications for removing third molars?

A
  1. Extremes of age (over 40)
  2. Poor medical status
  3. Close to adjacent structures
72
Q

What classification presents the easiest mandibular third molar extraction?

A

Winter’s 1

Mesioangular crown

73
Q

Which classification is the most difficult?

A

Winter’s 2

Distoangular

74
Q

What is the most common maxillary third molar angulation?

A

Vertical

75
Q

What is the most common mandibular third molar angulation?

A

Mesioangular

76
Q

What are the two major indications for third molar removal?

A

Therapeutic - treat disease

Prophylactic - prevent disease

77
Q

How often should gauze be replaced after surgery?

A

Every hour

78
Q

________ can greatly increase the risk of a dry socket.

A

Smoking

79
Q

Peak pain occurs ___ hours after surgery.

A

12

80
Q

T/F: The pain should not last more than 2 days.

A

True

81
Q

When should the patient take the first analgesic?

A

Before local anesthetic wears off

82
Q

No more than ______ worth of pain meds should be prescribed.

A

3 days

83
Q

If surgical extraction is done, how should narcotics be prescribed?

A

Dispense 10

Tramadol 50mg or Norco 5mg/325mg

84
Q

How should narcotics be prescribed in a non-surgical extraction?

A

No narcotics

Dispense 10 NSAIDs

If needed dispense 5 tramadol or Norco

85
Q

When is the peak swelling after extractions?

A

36-48 hours

86
Q

When should bleeding stop after extraction?

A

In the second day

87
Q

What is the biggest key to bleeding management?

A

Have it stopped before the patient leaves the office

88
Q

What is the cascade of wound healing?

A

Hemostasis (platelets) -> acute inflammation (granulocytes) -> proliferation (monocytes) -> remodeling (fibroblasts)

89
Q

When is lamellar bone/marrow seen in the remodeling phase?

A

12-24 weeks

90
Q

How long until the socket will appear healed over?

A

3 weeks

91
Q

How long until radiographic healing is seen?

A

4-6 months

92
Q

What is the critical radiation levels that will delay jaw healing?

A

over 5000cGy

93
Q

What types of drugs can impair bone healing?

A

Nitrogen-containing bisphosphonates and RANKL inhibitors

All must be high dose, potent drugs

94
Q

What is localized alveolar osteitis?

A

Dry socket

95
Q

T/F: A dry socket can be improved with antibiotics.

A

False

Not an infection

96
Q

During a dry socket, the patient gets stuck in the __________ stage of wound healing.

A

acute inflammation

97
Q

How can you diagnose a dry socket?

A

3-5 days post op a change in quantity or quality of pain

Gray/brown clot or total absence of clot

98
Q

T/F: Dry socket is more likely in a mandibular tooth.

A

True

99
Q

How can you decrease the risk of dry socket?

A

Chlorhexidine, good technique

Not antibiotics

100
Q

How is dry socket treated?

A

Irrigation and placement of palliative dressing - allow time to heal

101
Q

T/F: Most patients will heal from dry socket in 3-5 days

A

True

102
Q

What is the difference between osteitis and osteomyelitis?

A

Osteitis - inflammation of bone (dry socket)

Osteomylitis - infection of bone

SP18: Oral Surgery (2 decks)

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