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Oral surgery > Minor Oral Surgery SCOT > Flashcards

Minor Oral Surgery SCOT Flashcards

1
Q

5 reasons to surgically remove fresh roots

A

Large fragments
Infected/non-vital roots
Associated pathology
Risk re PMH
Orthodontic extractions

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2
Q

2 reasons to leave fresh roots

A

Small apical fragments that are not infected/no associated pathology
Small apical fragments close to important anatomical structures

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3
Q

6 reasons to surgically remove old roots

A

Large fragments not covered by bone
Painful/ulcerated through mucosa
Infected roots
Associated pathology
Risk re PMH
Prosthodontics

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4
Q

2 reasons to leave old roots

A

Symptomless
Important anatomical structures close

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5
Q

6 stages of a surgical extraction

A

Creation of a mucoperiosteal flap
Bone removal
Delivery of the root/tooth
Debridement
Wound closure
Aftercare

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6
Q

Why cut a flap with broad base

A

Ensures good blood supply to promote healing

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7
Q

Why cut flap to sub periosteal level

A

Ensures flap integrity

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8
Q

Why should the flap include inter-dental papillae

A

Promotes healing

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9
Q

3 reasons for bone removal

A

Exposes roots
Creates points of application for elevators/forceps
Provides space to facilitate delivery of roots

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10
Q

4 structures at risk during bone removal

A

Inferior alveolar nerve
Lingual nerve
Mental nerve
Maxillary antrum

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11
Q

Why must the state of bone be considered in elderly patients

A

Generally inelastic therefore requires more work to create points of application

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12
Q

Why must the angulation of the root be considered

A

Bone removal must follow the root

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13
Q

4 problems with too much bone removal

A

Can compromise creating a point of application
Increased post-op pain
Increased swelling
Slower healing

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14
Q

3 problems with too little bone removal

A

Inadequate access
Ineffective point of application
Prolongs surgery

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15
Q

3 advantages of ensuring a good wound toilet

A

Promotes healing
Reduces post-op inflammation and pain
Reduces risk of post-op infection

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16
Q

What needs to be removed during debridement

A

Fragments of bone, tooth, filling material
Granulation tissue
Haematoma
Sharp edges

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17
Q

What suture material and needle is commonly used for basic intra-oral suturing

A

3/0 vicryl rapide
22mm 1/2 circle cutting needle

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18
Q

What is the method of wound healing used for surgical extractions

A

Primary intention

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19
Q

What is the site of wound healing

A

Vascular tissue: dermis or sub mucosa

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20
Q

What is the benefit of slightly everting a wound

A

Ensures good dermis layer contact to promote rapid healing and minimise scarring

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21
Q

Where ideally should suture knots be positioned

A

Buccally or labially away from tongue

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22
Q

At which angle should the needle be forming introduced at and why

A

90 degrees to the tissue to avoid the needle cutting out

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23
Q

5 complications of tooth removal

A

Dry socket
Oro-astral fistula
Tooth displacement
Intraoperative fractures
Haemorrhage

24
Q

Describe dry socket

A

Localised inflammation of bone confined to lamina dura of a tooth socket

25
Q

6 predisposing factors for dry socket

A

Excessive mouthrinsing
Excessive LA
Excessive soft tissue damage during procedure
Smokers
Poor OHI
Contraceptive pill

26
Q

Clinical appearance of dry socket

A

Loss of blood clot from socket and exposure of vital bone
Socket margins with yellow slough

27
Q

Symptoms of dry socket

A

Constant boring pain commencing several days post-op
Radiating pain
Worse on eating

28
Q

3 management strategies for dry socket

A

Washout with saline
Packing with Alvogel
Analgesics

29
Q

Describe Alvogel

A

Dry socket treatment containing strong antiseptics to reduce bacterial load, relieve pain and prevent entry of debris into socket

30
Q

Describe oro-antral fistula

A

Epithelialised abnormal connection between oral and antral cavities

31
Q

3 causes of pro-antral fistula

A

Extraction of teeth
Injudicious use of elevators
Surgical removal of teeth/roots

32
Q

4 signs of immediate oro-antral fistula

A

Bubbling air in the socket
Obvious hole
Patient aware of air passing between mouth and nose
Change in note of the suction

33
Q

3 signs of chronic oro-antral fistula

A

Patient aware of fluid passing to nose
Chronic sinusitis
Foul taste/discharge

34
Q

3 signs of chronic oro-antral fistula

A

Patient aware of fluid passing to nose
Chronic sinusitis
Foul taste/discharge

35
Q

Management of suspected immediate OAC

A

Advise patient to avoid nose blowing

36
Q

Management of immediate obvious or long standing OAC

A

Require closure with buccal advancement flap or palatal rotational tap
Begin antial regime: antibiotics, analgesics, decongestants
May need to remove chronically infected antral lining

37
Q

5 sites of tooth displacement

A

Antrum
Sinus
Submandibular space
Lung
Stomach/GI

38
Q

Signs of root displaced into antrum

A

Sudden give causing elevator to shoot upward
No longer able to see root
Visible communication into antrum

39
Q

Management of root displaced into antrum

A

Open area to identity if lining is intact or torn
If intact: look for root between antral lining and bone
If torn: open and explore sinus and retrieve root

40
Q

3 intraoperative fractures

A

Buccal plate
Tuberosity
Mandible

41
Q

3 risk factors for fractured buccal plate

A

Single standing molar tooth
Difficult teeth (root pattern, hypercementosis, ankylosis)
Middle aged or elderly patients

42
Q

4 signs of fractured buccal plate

A

Audible crack
Sudden give in resistance
Abnormal mobility palpable buccally
Torn buccal mucosa

43
Q

Management of fractured buccal plate

A

Small fractures: no action required
Large fractures: dissect the overlying mucosa free from fractured buccal plate then continue the extraction to prevent loss of the attached gingiva

44
Q

4 risk factors for fractured tuberosity

A

Single standing maxillary molar tooth
Difficult teeth (root pattern, hypercementosis, ankylosis)
Pneumatisation of antrum mesial to single standing tooth
Middle aged or elderly patients

45
Q

5 signs of fractured tuberosity

A

Audible crack
Sudden give in resistance
Abnormal mobility palpable buccally and palatally
Altered occlusion
Torn mucosa buccally and palatally

46
Q

Management of small and large fractured tuberosities

A

Small: dissect out the tuberosity to preserve the mucosa and close wound
Large: dissect the tooth from the tuberosity to preserve the bone and mucosa, control infection/pain, dressings RCT and analgesics and antibiotics

47
Q

3 risk factors for fractured mandible

A

Thin/ resorbed mandible
Difficult teeth ( root pattern, hypercementosis ankylosis)
Elderly patients

48
Q

5 signs of fractured mandible

A

Audible crack
Sudden give in resistance
Abnormal mobility
Torn buccal/lingual mucosa
Bleeding from around the extraction site

49
Q

Management of fractured mandible

A

Stop
Assess
Inform patient
Contact (phone) local OMFS Dept

50
Q

Define primary haemorrhage

A

Haemorrhage that occurs intra-operatively

51
Q

Define reactionary haemorrhage

A

Haemorrhage that occurs 3-4 hours post operatively

52
Q

Define secondary haemorrhage

A

Haemorrhage that occurs 7-10 days post-operatively

53
Q

Management of reactionary haemorrhage

A

Gauze packs
Surgicel pack
Bone wax
Suturing
Re-issue post-op advice

54
Q

3 causes of reactionary haemorrhage

A

Vasoconstrictor wearing off
Patient interference with the wound
Inadequate pain control

55
Q

Cause of secondary haemorrhage

A

Infected socket

56
Q

Management of secondary haemorrhage

A

Gauze packs
Surgicel pack
Bone wax
Antibiotics

57
Q

Management of primary haemorrhage

A

LA containing adrenaline
Gauze packs
Surgicel pack
Bone wax
Antibiotics

Oral surgery (4 decks)

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