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OMS 2 > Munk Review > Flashcards

Munk Review Flashcards

1
Q

MX forceps and what teeth to use them on

A
  • #210 - M3s
  • #88 - M1, M2 cowhorns
  • #150 - universal; PMs, anteriors
  • #65 - MX root tips
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2
Q

Deep sedation

A
  • Pt cannot be easily aroused; responds purposefully to repeated or painful stimulation
  • Independent, spontaneous ventilation may be impaired
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3
Q

What are aveolar housing fractures and how do we tx them?

A
  • Teeth displaced as a group
  • Tx
    • LA
    • Reposition tooth/teeth into normal position
    • Consider splinting together for stability
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4
Q

What is the superscription?

A
  • Date when the prescription was written
  • Name, address, age of pt
  • R/ or Rx
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5
Q

What facial subunit is the zygomatic arch a part of?

A

Zygomaticomaxillary complex (ZMC)

Has 4 bony fusions w/ the skull

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6
Q

What are the 4 components of risk assessment evaluation?

A
  • Nature, severity, stability of the pt’s medical condition
  • Functional capacity of pt
  • Emotional status of pt
  • Type & magnitude of planned procedure (invasiveness)
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7
Q

What is azotemia?

A
  • Loss of glomerular filtration fcn = build up of non-protein nitrogen cmpds in the blood (mainly urea)
  • Basically urea in the blood
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8
Q

Can you use N2O/O2 in combination w/ a single enteral drug in minimal sedation?

A

Yes, but not 3 (unless it’s Benadryl)

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9
Q

ESRD medical tx’s. What’s the difference between them?

A
  • Hemodialysis: More commonly used; method of choice for long-term
  • Peritoneal dialysis: Can be done anywhere
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10
Q

What conditions increase risk of infective endocarditis?

A
  • Prosthetic heart valve
  • Previous IE
  • Congenital heart disease (CHD)
    • Unrepaired CHD
    • 6mo post complete CHD repair
    • Repaired CHD w/ residual defects
  • Cardiac transplants that develop cardiac valvulopathy
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11
Q

What are normal values for hemostasis?

A
  • ​Bleeding time: 2-8min
  • Platelet Function Analyzer (PFA): Closure time <175s
  • Prothrombin Time (PT): 10-12s
  • Activated Partial Thromboplastin Time (aPTT): 25-35s
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12
Q

What is infective endocarditis?

A
  • Microbial infection of endocardium or heart valves
  • Often near heart defects
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13
Q

How does blood supply affect flap design?

A
  • Base must be broader than the FGM/coronal
  • If the base of the flap is too narrow, blood supply may not be enough (ischemia) which can lead to flap necrosis
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14
Q

O.D.

A

Right eye

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15
Q

How does the center of rotation of a tooth effect its extraction?

A
  • If the center of rotation is not positioned far enough apically, excessive force is placed on the apical portion of the tooth, increasing the chance of root fracture at the apex
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16
Q

What is Grave’s? What is Hashimotos?

A

Graves = hyperthyroidism

Hashimotos = hypothyroidism

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17
Q

O.U.

A

Both eyes

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18
Q

What is the most common odontogenic deep fascial space infection?

A

Vestibular space abscess

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19
Q

q.d.

A

1x/day

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20
Q

Lateral pharyngeal space infection boundaries

A
  • Superior: Sphenoid bone (cone base)
  • Inferior: Hyoid bone (cone apex)
  • Lateral: Fascia covering medial pterygoid m., parotid, MN
  • Medial: Buccopharyngeal fascia on lateral surface of superior constrictor mm.
  • Anterior: Pterygomandibular raphe
  • Posterior: Extends to prevertebral fascia

Morbid complications if not tx’ immediately! Deep neck.

(Inverted cone or pyramid shape)

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21
Q

ASA Classification

A
  • ASA I: Healthy
  • ASA II: Mild systemic disease, no functional limitations
  • ASA III: Severe systemic disease, definite functional limitations
  • ASA IV: How are you even alive bruh
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22
Q

With what trauma would you see sublingual ecchymosis as a clinical finding?

A

Submandibular fractures

  • Most common areas of fracture
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23
Q

Minimal sedation/anxiolysis

A
  • Independently and continuously maintain airway
  • Normal response to tactile & verbal commands
  • When intent is minimal sedation for adults, initial dosing is never past MRD
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24
Q

What is anesthesia?

A

Loss of sensation resulting from pharmacologic depression of nerve function or from neurologic dysfunction

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25
Q

What are the different T stages in TNM Staging?

A
  • TX: Primary tumor cannot be assessed; information not known
  • T0: No evidence of primary tumor = carcinoma in situ; disease is still localized in the top layers of cells lining the oral cavity & oropharynx
  • T1: Tumor is <2cm across
  • T2: Tumor is >2cm but <4cm across
  • T3: Tumor is >4cm
  • T4:
    • ​T4a: Tumor is growing into nearby structures; moderately advanced local disease
    • T4b: Tumor has grown through nearby structures and into deeper areas or tissues; very advanced local disease
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26
Q

q.h.s.

A

before bed

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27
Q

What is axonotmesis?

A
  • Injury to nerve that causes loss of axonal continuity, but preserves the endoneurium
  • Caused by crushing injury
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28
Q

What are the most common causes of ESRD?

A
  1. Diabetes mellitus
  2. HTN
  3. Chronic glomerulonephritis
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29
Q

Dialysis pts: Dental appt considerations

A
  • Potential for bleeding problems, should have pre-tx labs done
  • Peritoneal dialysis: Tx as normal
  • Hemodialysis: Tx pts day after hemodialysis
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30
Q

Surgical vs. Non-surgical extractions

A
  • Surgical: Cutting tooth or bone
  • Non-surgical: Not cutting tooth or bone
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31
Q

Duration of anesthesia

A
  • 0.5% Marcaine: 6-10hr
  • 2% Lidocaine: 2-3hr
  • 3% Carbocaine: 0.5-2hr
  • 4% Septocaine: 3-4hr
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32
Q

b.i.d.

A

2x/day

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33
Q

What are the two types of zygoma fractures?

A
  • Arch fractures - Most common
  • Tripod (malar) fractures - Most serious
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34
Q

Large and small straight elevators #’s

A
  • Small: #301 **Your go to**
  • Large: #34
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35
Q

Palatal space infection boundaries

A
  • Inferior: Cortical plates of hard palate
  • Superior: Overlying periosteum
  • Lateral: Alveolar process of MX & teeth
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36
Q

What is analgesia?

A

Neurologic or pharmacologic state in which painful stimuli are moderated

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37
Q

How many mg of anesthetic in 2% lido?

A

2% = 20 mg

20mg x 1.7mL = 34mg

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38
Q

LeFort III - What’s fractured? Clinical findings? Radiographic findings?

A
  • Fractures through the MX, zygoma, nasal bones, ethmoid bones, base of skull
  • Clinical findings
    • Dish faced deformity
    • Epistaxis & CSF rhinorrhea
    • Mobility of MX, nose, zygoma
    • Severe airway obstruction
  • Rad findings
    • Fractures through zygomaticofrontal sutures, zygoma, orbital walls, nasal bone
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39
Q

What is diabetes? What is the goal HbA1c for diabetics?

A
  • Chronic disease characterized by hyperglycemia and complications (microvascular disease of kidney, eye) and variety of clinical neuropathies
  • Goal for pts in general is HbA1c <7% and goal for each individual is as close to 6% as possible w/o hypoglycemia
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40
Q

What is Cushing’s Syndrome?

A

Making too much cortisol

  • Long-term effective use of glucocorticoids can bring on Cushing’s Syndrome (mimicks Cushing’s disease)
  • Secondary adrenal insufficiency results from hypothalamic or pituitary disease or from administration of exogenous corticosteroids
  • Adrenal crisis is rare and not as severe bc aldosterone (regulates Na & K) secretion is normal
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41
Q

What is uremia?

A
  • Retention of excretory pdts and interference w/ endocrine & metabolic fcn caused by renal failure
  • Basically pee in the blood
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42
Q

What is avulsion and how do we tx it?

A
  • Tooth is completely out of the socket
  • Transport immediately in saliva or milk and re-implant w/in 20-30 min
  • Tx
    • Place into correct position
    • Splint
    • F/u - 10-14 days may need endo depending on pulp test
    • Remove splint in 6wk
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43
Q

Can you use epi in HTN pts? What is the max epi you can give HTN pt in 1 session?

A
  • In moderation
  • Use cautiously in pts on non-selective beta blockers
  • Normal
    • 200mcg in 1 session
      • 11 carps of 1:100K = 298mcg
  • Heart disease
    • 40mcg in 1 session
      • 2 carps of 1:100K = 36mcg
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44
Q

p.c.

A

after meals

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45
Q

What are elevated creatinine levels an indication of?

A
  • Impaired kidney function or kidney disease
  • As kidneys become impaired, clearance decreases = elevated creatinine
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46
Q

Pts on what drugs may experience toxic rxn to LAs if injected intravascularly? What else should be avoided with these pts?

A
  • GI diseased pts
  • Pts on H2 blockers
  • Should also avoid aspirin & NSAIDs and use abx judiciously
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47
Q

t.i.d.

A

3x/day

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48
Q

Steroid supplementation protocol

A
  • Minor stress - take usual AM steroid dose
    • <7.5mg? No supplementation
      • >7.5 mg? Double the dose day of procedure
  • Moderate stress
    • 10-15mg prednisone for 1-2 days and taper to normal daily dose
  • Major stress
    • 20-25mg prednisone for 1-2 days and taper to normal daily dose
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49
Q

What is Addison’s?

A

Primary adrenal insufficiency = Not making enough cortisol

  • Adrenal crisis is possible
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50
Q

What is the suggested instrumentation sequence for extractions?

A
  • # 15
  • # 9 periosteal elevator
  • Elevator
  • Forceps
  • Debride w/ double ended curette
  • Bone file or rongeur
  • Alveoloplasty - digital compression
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51
Q

What is luxation and how do we tx it?

A
  • Displacement of teeth; similar to alveolar housing fractures, but involving less teeth
  • Tx
    • Place into correct anatomical position and splint
    • F/u - will likely need endo in 10-14 days depending on pulp test
    • Remove splint in 6wk
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52
Q

What are the 4 stages of odontogenic infections?

A
  • Inoculation
    • First 3 days of symptoms
    • Mildly tender, soft, doughy swelling
    • This stage is the easiest to tx
  • Cellulitis
    • After 3-5 days, swelling becomes hard, red, indurated, and acutely tender as the infecting mixed flora stimulates intense inflammatory response
    • Dangerous because you don’t know where it will go and it spreads rapidly
  • Abscess
    • 5-7 days after onset, anaerobes predominate, causing liquified abscess in the center of the swollen area
    • Acute abscess is a more mature infection w/ more localized pain, less swelling, nice borders
    • Chronic abscess is slow growing and less serious than cellulitis
  • Resolution
    • When the abscess drains, immune system destroys the infecting bacteria; healing and repair begin
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53
Q

q.t.t.

A

drop

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54
Q

What is the inscription?

A

Name & strength of medication

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55
Q

What is ACTH stimulation test for?

A

Adrenal hypofunction screening; directly evalutes the level of adrenal reserve

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56
Q

T1 diabetes

A

Regular insulin. Neutral Protamine Hagedorn (NPH) and Ultralente

  • Less common than T2
  • Younger and rapid onset
  • Normal, thin body build
  • Severity is extreme
  • Almost no insulin
  • Plasma glucagons are high, suppressible
  • Few respond to oral hypoglycemics
  • Ketoacidosis is common
  • Complications are common
  • Unstable
  • Genetic locus: Chromosome 6
  • Autoimmune rxn
  • No insulin receptor defects
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57
Q

Retropharyngeal space infection boundaries

A
  • Superior: Skull base
  • Inferior: Mediastinum
  • Lateral: Lateral pharyngeal space
  • Anterior: Posterior pharyngeal wall
  • Posterior: Prevertebral fascia
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58
Q

Prevention & Tx of Alveolar Osteitis

A
  • Prevention
    • Aseptic technique
    • Atraumatic technique
    • Thorough irrigation and wound debridement
    • Primary closure of wound if possible
    • Adequate hemorrhage
    • Abx
    • Gentl antimicrobial rinse
  • Tx
    • Gentle irrigation, place medicated dressing on gelfoam
    • Medicated dressings
      • BIPP
      • ZOE cotton pellets
      • Eugenol, iodoform, butamen
      • Metronidazole, lidocaine ointment
      • Sultan dry socket paste
    • F/u w/ pt 24hr later
      • No improvement? Repack and f/u 24hr later
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59
Q

T2 diabetes

A

Lifestyle changes. Metformin, Avandia, etc. Control of risk factors for CV disease.

  • More common than T1
  • Older, slower clinical onset
  • Obese body build
  • Severity is mild
  • 25-30% of insluin
  • High, resistant plasma glucagons
  • 50% respond to oral hypoglycemics
  • Ketoacidosis is uncommon
  • Complications are less common
  • Stable
  • Genetic locus: Chromosome 11?
  • Autoimmune rxn not present
  • Insulin receptor defects often found
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60
Q

What is neuropraxia?

A
  • Injury to nerve that causes no loss of continuity of the axon or endoneurium, but disrupts myelin sheath
  • Caused by compression of the nerve or ischemia
  • No long term effects
61
Q

Submandibular space infection boundaries

A
  • Superior: Mylohyoid m., inferior border of MN
  • Inferior: Anterior & posterior belly of digastric
  • Lateral: Deep cervical fascia, platysma, superficial fascia & skin
  • Medial: Hyoglossus, styloglossus, mylohyoid m.
  • Anterior: Submental space
  • Posterior: To hyoid bone
62
Q

Over which structure do the condyle and disk translate anteriorly and inferiorly over in TMJ?

A

Articular eminence of the temporal bone

63
Q

What BP is hypertensive?

64
Q

What is incremental dosing?

A

Giving a little bit until you reach MRD, but you don’t exceed it

Titrating N2O is an example of this

65
Q

Stages of genera anesthesia

A
  • Analgesia
  • Excitement/delirium
  • Surgical - IDEAL
  • Medullary depression
66
Q

What do you Rx a pt at risk of infective endocarditis?

A

Abx prophylactically to be taken PO 30-60 min before the procedure

  • Amoxicillin 2g PO
  • If allergic to PCN,
    • Cephalexin/Clindamycin 2g
    • Clindamycin/Clarithromycin 500-600mg
67
Q

LeFort I - What’s fractured? Clinical findings? Radiographic findings?

A
  • Horizontal fracture of the MX at nasal fossa level
  • MX moves, nose doesn’t
  • Clinical findings
    • Facial edema
    • Malocclusion
    • MX moves; nose doesn’t
  • Rad findings
68
Q

What is the BP cut off in real life for dental tx?

69
Q

What is functional capacity?

A

Ability of pt to perform normal physical activity

70
Q

What does TNM stand for in TNM Staging? What is TNM Staging?

A
  • T: Tumor
  • N: Node
  • M: Malignancy

TNM Staging is cancer staging.

71
Q

What is the tx for aphthous ulcers?

A
  • Empirical and palliative only
  • No cure, you can only relieve symptoms
  • Steroids in severe cases
  • Xylocaine
72
Q

What are normal values for complete blood count?

A
  • WBCs: 4400-11K/mL
  • RBCs: 3.5-4x10^6/mcL
  • Platelets: 150K-450K/mcL
  • Hematocrit:
    • ​Male: 41-50%
    • Female: 35-44%
  • Hb:
    • ​Male: 13-17 g/dL
    • Female: 12-15 g/dL
73
Q

Name the instruments in this set up

A
  • Weider/Sweetheart retractor
  • Austin retractor
  • Minnesota retractor
  • # 15 blade
  • # 9 periosteal elevator
  • # 2 Molt curette
  • Bone file
  • Anesthetic syringe
  • Bite block
  • Suction tip
  • Needle holders
  • Hemostats
  • Scissors
74
Q

How many mg of anesthetic in 0.5% marcaine?

A

0.5% = 5mg

5mg x 1.7mL = 8.5mg

5mg x 1.8mL = 9mg

75
Q

Cavernous sinus thrombosis

A
  • Formation of blood clot w/in the cavernous sinus (cavity @ base of brain which drains deO2 blood from the brain back to the heart)
  • Cause is usually spreading infection from nose, sinuses, ears, or teeth
76
Q

What is TMJ

A

Articulation of MN condyle w/ the glenoid fossa of temporal bone

77
Q

q.o.d.

A

every other hour

78
Q

What is the signatura?

A

Directions for the pt, written in English or Latin abbreviations

79
Q

How do you tx submandibular fracture?

A
  • Closed Reduction Maxillomandibular Fixation (CR-MMF)
    • ​Wiring the jaws together
  • Open Reduction/Internal Fixation (ORIF)
    • ​Opening the wound to place fixation plate, screwing it down on both sides of the fracture to stabilize the MN
80
Q

What BZD would be indicated for a short procedure? Intermediate? Long?

A
  • Short (1-2hr): Triazolam (0.25mg)
  • Intermediate (1/2 day): ​Apprazolam (0.5mg)
  • Long (full day): Lorazepam (2g)
81
Q

How do you tx MN dislocation?

A
  • Muscle relaxation
  • May need sedation
  • Closed reduction
  • Analgesics
  • Soft diet
  • Avoid excessive mouth opening
  • Pop back into place
    • Place thumbs on lower Ms or on the ridge of MN IO, posterior to Ms, with your fingers wrapped externally around the MN. Apply firm, slow, and steady pressure in a downward and posterior direction
82
Q

What are BUN values an indication of?

A

Kidney & liver function

83
Q

What are dental implications of uncontrolled hyperthyroidism?

A
  • Using epi in local or gingival retraction cords MUST BE AVOIDED in untx’d or poorly tx’d thyrotoxic pts
  • Well-managed pts can have normal concentrations of epi vasoconstrictors
84
Q

a.c.

A

before meals

85
Q

How much epi in 1:50K? 1:100K? 1:200K?

A
  • 1:50K = 34mcg
    • 0.02mg x 1.7mL = 0.034 = 34mcg
  • 1:100K = 17mcg
    • 0.01mg x 1.7mL = 0.017 = 17mcg
  • 1:200K = 8.5mcg
    • 0.005mg x 1.7 = 0.0085 = 8.5mcg
86
Q

MN forceps and what teeth to use them on

A
  • Ash: MN anteriors
  • #151: universal; anteriors & PMs
  • #23: M1, M2 cowhorns
  • #222: M3
87
Q

Why are pts w/ uncontrolled diabetes more susceptible to infection and have slower wound healing?

A
  • Hyperglycemia, Ketoacidosis, Vascular wall disease
88
Q

How many mg of anesthetic in 3% carbo?

A

3% = 30mg

30mg x 1.7mL = 51mg

89
Q

q.4h and q.6h

A

every 4hr; every 6hr

90
Q

How does diffusion hypoxia happen?

A
  • N2O diffuses out of the blood into the alveoli upon termination of flow
  • N2O can dilute O2 = hypoxia
  • Symptoms
    • Nausea
    • Lethargy
    • Headache
    • Syncope
91
Q

What are the different M stages in TNM Staging?

A
  • M0: No distance spread
  • M1: Cancer has spread to distant sites outside the head and neck region
92
Q

Infective endocarditis prevention

A
  • Maintain good OH *more important than abx prophylaxis*
  • Abx prophylactically 30-60 min pre-procedure
93
Q

What is the tx for herpes?

94
Q

Submental space infection boundaries

A
  • Superior: Mylohyoid m.
  • Inferior: Deep cervical fascia, platysma, superficial fascia & skin
  • Lateral: Anterior body of digastric
  • Posterior: Submandibular space
95
Q

By which intention do sockets heal?

96
Q

Where do condyles articulate in TMJ?

A

Base of cranium w/ squamous portion of the temporal bone in the glenoid fossa

97
Q

General anesthesia

A
  • Not arousable, even by repeated painful stimulation
  • Independent airway often impaired
  • CV can be impaired
98
Q

Sensory innervation of MX & MN

99
Q

What would elevated K+ levels be an indication of?

A
  • Kidney disease
  • High or low K+ = heart problems
    • Low K+ = muscle cramps
100
Q

prn

101
Q

Steroids: Anti-inflammatory potencies

A

Cortisone < Prednisone < Methylpredinsone < Dexamethasone

102
Q

How many mg of anesthetic in 4% septo?

A

4% = 40mg

40mg x 1.7mL = 68mg

103
Q

What are the two types of stroke? If stroke is coming on, do we give aspirin? Why or why not?

A
  • Hemorrhagic: Cerebral BV rupture
  • Ischemic: Cerebral BV blockage
  • Don’t give aspirin b/c you cannot clinically tell which of these strokes someone is experiencing
104
Q

LeFort II - What’s fractured? Clinical findings? Radiographic findings?

A
  • Pyramidal fracture of MX, nasal bones, medial aspects of orbits
  • Clinical findings
    • Marked facial edema
    • Nasal flattening
    • Traumatic telecanthus
    • Epistaxis or CSF rhinorrhea
  • Rad findings
    • Fracture involving nasal bones, medial orbit, MX sinus, frontal processes of MX
105
Q

Alveoloplasty

A
  • Digital compression post-extraction
  • Bony areas that need recontouring should be exposed using a flap if there are gross irregularities of bone contour post-extraction
106
Q

Ellis Fracture - Class III

A

Fractures w/in the pulp

  • Vitality testing
  • Direct pulp cap procedures
  • Repair w/ composite
  • Endo tx indicated
  • If no endo, f/u w/ vitality testing @ 2wk, 3mo, 6mo, 1yr
  • Watch for color change
107
Q

Cornerstones of pt evaluation & risk assessment?

A
  • Med hx
  • Med consult as needed
  • Physical exam
  • Lab tests
108
Q

What is neurotmesis?

A
  • Injury to nerve that causes loss of axonal and endoneurium continuity,
  • Caused by severe contusion, laceration, stretching, LA toxicity
    • BLOCKING WITH SEPTO CAN CAUSE THIS!!!
    • DO NOT BLOCK W/ SEPTO!!!!
109
Q

What INR ranges are ok for us to do OS on?

A
  • INR 2-3: Normal
    • Can do extractions on pts w/o reducing the anticoagulant dose
  • INR 3
    • W/ special precautions, it is reasonably safe to do minor amounts of surgery in pnts up to INR 3 if special local hemostatic measures are taken
  • INR >3: Physician should be contacted to lower anticoagulant dose to allow for surgery
110
Q

Primary concern when tx’ing pts w/ HTN?

A

Increased BP = stroke or MI

111
Q

Dean’s Technique

A

Intraseptal Alveoloplasty

  • Alternative; not used often
  • Removing intraseptal bone and repositioning labial cortical bone, rather than removing excessive/irregular areas of labial cortex
  • Useful in MX if removing a significant amount of facial bone
112
Q

What information needs to be on a prescription?

A
  • Superscription
  • Inscription
  • Subscription
  • Signatura
  • Name of prescriber
113
Q

Accessory ligaments of TMJ

A
  • Sphenomandibular
  • Stylomandibular
114
Q

Alveolar osteitis

A

Dry Socket

  • Delayed healing, not assoc w/ infection
  • Describes appearance of the socket when pain begins
  • Pain starts 3rd or 4th day after extraction, always MN M
  • Socket looks empty w/ partial or completely missing blood clot; some bony surfaces exposed
    • Sensitive and the source of the pain
  • Smells bad, tastes bad

Pain after extraction is not always dry socket

115
Q

Steroid supplementation

A
  • Most pts w/ adrenal insufficiency can have routine dental tx w/o supplemental steroids
  • Pts on cortcosteroids have enough exogenous & endogenous cortisol to handle dental procedures if normal dose is taken w/in 2hr of surgery
  • Cortisol increases about 1-5hr post-op
  • Steroids post-op and tapering off decrease swelling, pain, trismus
  • Medrol (21-4mg pills for 6 days)
116
Q

Why is it important that we assess pt’s general appearance (inspecting exposed body areas like skin, nails, face, eyes, nose, ears, neck)?

A

Irregularities can be an indication of underlying systemic disease

117
Q

What are the two major components of the zygoma?

A
  • Zygomatic arch
  • Zygomatic body
118
Q

What is the normal range for K+?

A

3.8-5 mEq/L

119
Q

Sublingual space infection boundaries

A
  • Superior: FOM mucosa
  • Inferior: Mylohyoid m.
  • Medial: Geniohyoid, styloglossus, genioglossus mm.
  • Anterior & Lateral: Inner aspect of MN body
  • Posterior: Body of hyoid bone
120
Q

What is eAG (estimated avg glc) at 5%? 6%? Etc.

A
  • 5% = 95
  • 6% = 126
  • 7% = 154
  • 8% = 183
  • 9% = 212
  • 10% = 240
  • 11% = 269
  • 12% = 298

eAG increases by about 30 per 1% increase.

121
Q

How is azotemia measured?

122
Q

What is supplemental dosing?

A
  • After the half life of the initial dose has passed, giving another dose that doesn’t exceed 1/2 the initial dose amount.
  • Should not have an aggregate 1.5x the MRD
123
Q

Buccal space infection boundaries

A
  • Superior: Zygomatic arch
  • Inferior: Inferior border of MN
  • Lateral: Skin & subQ tissue
  • Medial: Buccinator m.
  • Anterior: Posterior border of zygomaticus major & depressor anguli oris
  • Posterior: Anterior edge of masseter m.
124
Q

Do antiresorptive medications (bisphosphonates) work on osteoblasts or osteoclasts?

A
  • Stimulates osteoclast activity
  • In the MX & MN, it causes ischemia and therefore, osteonecrosis
    • MRONJ
  • It’s important to know if pts are taking bisphosphonates before doing extractions because they are at risk for MRONJ which doesn’t heal
125
Q

What structures would be fractured in zygoma tripod (malar) fractures? What are clinical features?

A
  • Fracture through the
    • Zygomatic arch
    • Zygomaticofrontal suture
    • Infraorbital rim & floor of the orbit
  • Clinical features
    • Periorbital edema & ecchymosis
    • Hyperesthesia or paresthesia of the infraorbial n.
    • Palpatioon may reveal step off
126
Q

q.i.d.

127
Q

What are the INR targets?

A
  • INR 1: Normal, healthy pt
  • INR 2: A-fib target (2-3)
    • Most common
  • INR 3: Mechanical heart valve target
  • INR 4: Risk for uncontrolled bleeding
  • INR 5: Uncontrolled bleeding
128
Q

What are METs? What is the MET threshold and what is notable about it?

A

Metabolic Equivalent Levels

  • Measurement that pt’s ability to perform normal daily tasks is expressed in​
  • 1 MET = 1 O2 unit
    • 1 MET= 3.5 ml/kg/min @ rest
  • 4 MET is the threshold
    • Risk of a serious perioperative event (MI, heart failure) increases in pts who can’t meet a 4 MET
129
Q

Pulse oximetry. Sexy Darling mnemonic

A
  • Measures oxygenated and non-oxygenated RBCs and then spits out a ratio
  • Normal O2 saturation is 96%
130
Q

HTN: Dental appt considerations

A
  • Short, AM appt
  • Stress/anxiety support
  • Establish good rapport
  • Consider sedation
  • Obtain excellent LA
  • Intraop monitoring
  • Slow position changes to prevent orthostatic hypotension
131
Q

What is the BP cut off in the Roseman Clinic?

132
Q

Steps in administering N2O

A
  • Review med hx
  • Pre-op vitals
  • Place nose
  • Establish base line tidal volume
  • Titrate N2O to effect - increase 0.5L every 1min
  • Usually between 30-50% but must determine for each pt individually
  • Don’t go above 50% w/o faculty approval
  • Titrate down
  • 5 min of O2
  • Post vitals
  • Assign discharge score
133
Q

What is the subscription?

A

Directions for the pharmD, usually short sentences

134
Q

What is MRD?

A

Maximum recommended dose

Max FDA recommended dose of a drug for unmonitored home use

135
Q

Stages of Wound Healing

A
  • Inflammatory - begins moment that injury occurs and lasts 1-5 days
    • Vascular: Vasoconstriction and vasodilation
    • Cellular: PMNs diapedesis to remove gross stuff
  • Fibroplastic - lasts 2-3wks; fibrin strands criss cross and form latticework, on which fibroblasts begin laying down ground substance and tropocollagen
    • Migratory: Epithelial migration continues; capillary ingrowth; fibroblasts travel into found along fibrin strands
    • Proliferative: Increase in epithelial thickness; collagen fibers laid down; budding capillaries establish contact w/ counterparts
  • Remodeling - 70% of wound healing time; several months
    • Initial collagen replaced by new collagen
    • Increase in tensile strength
    • Stronger wound
136
Q

What is the protocol if a MX tooth or root is displaced in the sinus?

A

Caldwell luc

137
Q

O.S.

138
Q

What are primary, secondary, tertiary intentions?

A
  • Primary intention: Wound edges are placed together anatomically
  • Secondary intention: Gap is left between edges of wound (heals through clot formation)
  • Tertiary intention: Healing of wounds through tissue grafts bridging the wound edges together
139
Q

Moderate sedation

A
  • Independent, spontaneous ventilation
  • Pt responds purposefully to verbal commands and tactile stimulation
  • Titrating refers to moderate sedation; cannot titrate minimal
140
Q

Curved elevator #’s

A
  • # 190, 191
  • Cryer East, West
141
Q

Ellis Fracture - Class II

A

Fractures w/in dentin

  • Vitality testing
  • Indirect pulp cap
  • Repair w/ composite
  • F/u w/ vitality testing @ 2wk, 3mo, 6mo, 1yr
  • Watch for color change
142
Q

True ligaments of TMJ

A
  • Temporomandibular ligament
  • Fibrous capsule of the joint
143
Q

What does INR stand for? What is it used for?

A
  • International Normalized Ratio
  • Anti-coagulation indication (1 is normal, 5 is uncontrolled bleeding)
144
Q

What are some things that may cause ischemia in wound healing?

A
  • Suture tension
  • Poor flap design
145
Q

Ellis Fracture - Class I

A

Fractures w/in enamel

  • Vitality testing
  • Repair w/ composite
  • F/u w/ vitality testing @ 2wk, 3mo, 6mo, 1yr
  • Watch for color change
146
Q

What is HbA1c? What HbA1c %s are normal, increased risk for diabetes, and diabetes?

A
  • HbA1c: Glycolated Hb levels
    • Found in normal people too
    • HbA1c increases in the presence of hyperglycemia and reflects blood glc levels over the 6-12wk preceding the test
  • 4-6%: No diabetes
  • 5.7-6.4%: Increased risk for diabetes
  • >6%: Diabetes
147
Q

What are the different N stages in TNM Staging?

A
  • NX: Nearby lymph nodes cannot be assessed; information unknown
  • N0: Cancer has not spread to nearby lymph nodes
  • N1: Cancer has spread to one lymph node on the same side of the head or neck as the primary tumor; <3cm across
  • N2:
    • N2a: Spread to one lymph node on the same side as the primary tumor; 3-5cm across
    • N2b: Spread to two or more lymph nodes on the same side as the primary tumor; no lymph nodes are >6cm​ across
    • N2c: Spread to one or more lymphon nodes on both sides of the neck on the side opposite that of the primary tumor; no lymph nodes are >6cm across
  • N3: Cancer has spread to a lymph node that measures >6cm
148
Q

What are normal serum chemistry values?

A
  • ​Glc, fasting: 70-110 mg/dL
  • BUN: 8-23 mg/dL
  • Creatinine: 0.6-1.2 mg/dL

OMS 2 (1 decks)

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