OMS- ABGD Flashcards
Which local anesthetics do
you use?
0.5% marcaine, 1:200k epi
2% Lidocaine, 1:100k epi
4% Articaine, 1:100k epi
3% carbocaine plain
When should a coronectomy
be done?
Indications for removal of crown of
impacted tooth because the roots
are intimately contacting the IAN
What are the signs of IAN and
tooth involvement?
Darkening of the root when it crosses the IAN
Deflection of roots in area of canal
Narrowing of root implying perforation or grooving by the nerve
Bifid root apex
Interruption of cortical (white lines) of IAN
Diversion of canal
Narrowing of canal
Removing a tuberosity: if it’s
completely detached; do you reattach
it, what about if you just hear a crack?
-If completely cracked: do not reattach
-If crack is heard and tooth is out: apply pressure, close flap, suture
Oral Cancer SCC Stage 4…5 year survival?
Oral Cavity: 27%
Lip: 47%
Much better prognosis for HPV related neck mass
What are high risk sites for
SCC?
Tongue:
-posterior and lateral border-65% of time
-more than 50% of intraoral cancers
-Dorsum rarely affected
Floor of mouth:
-35% of intraoral SCC
-usually begins as leukoplakia or erythroleukoplakia
Posterior Oral Cavity/oropharynx:
-HPV related
What type of pain meds for moderate surgery and why?
Motrin: anti-inflammatory
Tylenol: controls pain
What happens if you misplace a tooth in the retromylohyoid area?
-Attempt to “milk” it into socket
-CBCT to locate
-Consider lingual flap for exposure
-May need extra oral incision if significant inferior displacement
-Possible ABOs
-Takes 1 week to fibrose
-Refer
What do you do in a situation where you are having problems stopping bleeding?
-Pressure
-Cautery
-Sutures
-Local Vasoconstriction
-Bone: pressure, bone wax, burnishing
Hemostatics:
-Gelfoam (gelatin sponge)
-Avitene (bovine collagen)
-Surgicel (cellulose)-do NOT use near nerve
-Topical thrombin
-Amicar (aminocaproic acid)
-Teabag (tranaxemic acid)
What could make a tooth harder to extract?
-Hard/soft tissue coverage
-angulation
-patient age
What ABX for sinus perforation?
Augmentin
What do you do if there is a sinus perforation?
<2mm:
-may spontaneously heal
-Consider closing with gelfoam/collaplug
-Figure 8 sutures
2-6mm:
-same as above
> 6mm:
-local flap, buccal advancement flap or buccal fad pad graft
Sinus Precautions:
-ALL CASES for 2 weeks
-No nose blowing, sneeze with mouth open
-Sudafed (30mg q6h)
-Afrin (nasal spray no more than 3 days)
-ABOs- Augmentin (875mg every 12 hours)
What to do if there is a tooth misplaced in the sinus?
-CBCT to locate
-Consider Caldwell Luck for exposure
-Possible ABOs
-Takes 1 week to Fibrose
-Refer
Fenestration and dehiscence
Fenestration: window
Dehiscence: split open from FG to apical (think door)
pKa protein binding & Lipid binding
What do these mean in regards to duration, onset with LA?
- pKa determines lipid transport
- uncharged molecule of anesthetic transports through nerve sheath
- charged molecule binds to Na channel receptor
- pKa = pH which molecule is charged
- lower pKa anesthetic has better chance of diffusing through the nerve
lipid solubility/binding with lipid molecules enhances potency and onset…ie marcaine binds better with lipids which enhance its clearance
Fascial Spaces Infections and what teeth are associated: Buccal
buccal: max molar and mand PM
Fascial Spaces Infections and what teeth are associated: Canine
Where do the apices extend past?
max canine, PM, lats (rare): extend superior to insertion of levator anguli oris
Fascial Spaces Infections and what teeth are associated: Sublingual
Around what muscle are the apices?
Sublingual: root apices SUPERIOR to insertion of mylohyoid M
Fascial Spaces Infections and what teeth are associated: submandibular
root apices INFERIOR to
insertion of mylohyoids
Fascial Spaces Infections and what teeth are associated: Lateral Pharnygeal
Lateral Pharnygeal: extension of infection
from submandibular, sublingual, buccal,
pterygomandibular, Peritonsillar
Fascial Spaces Infections and what teeth are associated: submental
Submental: mand incisors
If root apices are above mylohyoid attachment, which
space? Below?
Above: sublingual
Below: submandibular
Ludwig’s Angina: spaces, description of swelling
Submandibular, submental, sublingual
“Woody”
Worried about airway blockage
Define Neuropraxia
Contusion of nerve
Define Axontomesis
Axons disrupted
Good recovery in months
Define Neurotmesis
Sheath disrupted
Poor recovery without intervention
Neuromas, paresthesias, and dysesthesias
What are high risk factors for mandibular fractures associated with tooth removal?
mandibular atrophy
-osteoporosis
-space occupying lesion
-deep impactions requiring significant bone removal
What is the treatment for an intrusive luxation injury?
Incomplete:
-allow the tooth to re-erupt
-observe for 3 months
-if no eruption: ortho extrusion, EXT
Complete:
-reposition the tooth
-stabilize with nonrigid splint
-RCT in 10-14 days with CaOH
-replace CaOH is resorbs (F/U every 3 months for 1st year)
-GP RCT when CaOH no longer resorbs
What is the treatment for a lateral luxation?
-reposition the tooth with forceps or tongue blade
-repair soft tissue after tooth has been repositioned
-digitally apply buccal and lingual pressure to reestablish PDL contact
-nonrigid splint for 2-8 weeks
-If tx is delayed more than 48 hrs:
-spontaneous realignment is unlikely, ortho
-continue to monitor radiographically
-RCT as needed
What is the most common direction for lateral luxations?
Lingual lateral luxation
What is Versed? Its uses in dentistry?
What is the dosage and duration?
And its side effects?
Versed (midazolam)
-GABA agonist used for moderate sedation (Amnesia, anxiolysis)
-0.05 - 0.15mg/kg titrated to effect
Onset: <5 min
Duration: total recovery in < 2 hours
Side Effects:
-insignificant decrease in arterial BP and increase in HR
-may use safely in patients with ischemic heart disease
-decreased respiratory rate
-Compromised pts: slight CO2 retention and decreased pO2
-apnea after initial injection for: Elderly, CNS depressants, pulmonary compromise 15 sec- 4min
What is a reversal agent for opioids?
Naloxone:
Opioids
Dosage: 0.4 - 2mg every 2 min
Max: 10mg
What is a reversal agent for Benzodiazepines?
Flumazenil:
Benzodiazepines
Dosage: 0.2mg over 15 seconds then 0.1mg every 1 minute
Max: 1mg
Patient gets too deeply sedated, what do you do?
-Stimulate them
-Support and/or maintain airway
-Monitor patient
-Cautious consider reversal if unexplained level of sedation or concern for possible outside etiology, reaction
You gave the fentanyl too fast. What happens? And how do you manage?
-Chest wall rigidity occurs
-Give benzodiazepine first and consider muscle relaxant if desaturations and inability to oxygenate
What are the most commonly
impacted teeth?
3rd molars > Mx canines > Mn PMs >Mx PM, > Mx 2nd
Molars
What problems occur with impaction?
-migration or loss of neighboring teeth
-loss of arch length
-malocclusion
-periodontal disease
-root resorption of adjacent teeth
-internal or external root resorption of impacted teeth
-odontogenic cysts or tumors
Describe the different views
of a CBCT.
Coronal: (mask)
-a slice that separates that patient from the long axis to give an anterior and posterior view (look that the patient is facing you)
Axial: (feet)
-a slice that separates the image from top and bottom as if you are looking up the body of the patient from the POV of the
feet
Sagittal: (profile)
-a slice that separates the image from the left and right sides, the patient is sideways
Describe the mechanism of
action for local anesthetics
used in dentistry.
Inhibits nerve depolarization within neurons.
Essentially, there is a constant mix of cations and
uncharged molecules. The uncharged molecules
can diffuse through the nerve sheath. Once inside,
the cation can bind to the Na Channel to block
conduction of the nerve.
Provide Signs and Symptoms
of LA toxicity.
And Treatment.
S/Sx:
-slurred speech
-twitching
-shivering
-numbness
-warm flush
-drowsy
*could also be CV issues from EPI
Tx:
-discontinue
-monitor vitals
-airway maintenance
-911/CPR
What are the essentials of
BLS?
Responsiveness
ABCs
Pulse check: 5-10 sec
Call 911
AED
Rescue breathing
Chest compressions 30:2
Rate: 100x min (think staying alive song)
Repeat
What is the difference between cellulitis and
abscess?
Cellulitis
-acute, severe pain, large/diffuse, doughy, indurated, NO pus, DANGEROUS, mixed/facultative anaerobes
Abscess
-chronic, localized, small/well-defined, fluctuant, pus, anaerobic
Why add metronidazole for infection tx? How much?
500mg QID
Improves gram (-) coverage
What can you do to determine patient risk of MRONJ?
Consider the patient’s history Medication
(IV vs PO and duration)
Expected trauma
Utilize blood tests to consider risk (CTX-C telopeptide of Type I collagen)
Which is a marker for osteoclast activity Used to assess the level of bone resorption
What is the most common bleeding disorder? What factor is involved?
Von Willebrand’s disease
May go undiagnosed until surgery
Factor VIII disorder
What is the treatment for MRONJ?
Pre-Op: Consider non-surgical approach, pre-tx hyperbaric oxygen, OHI
Type 0: monitor
Type 1: pain meds, ABO
Type 2: Peridex
Type 3: Peridex, ABO, Pain meds, monitor, superficial debridement
Type 4: Same as 3, plus resection
What are the steps for
avulsion if dry time >2 hours?
Consider not re-implanting
PerIADT- clean, implant, stabilize (0.016” or fishing line)
tetnus, start endo in 2 weeks, ABX, monitor
Site: clean
Tooth: Remove necrotic fibers
Citric Acid x3min = opens tubules
0.9% NaCl rinse
1% stannous fluoride x5min = decreased resorption
Doxycycline x 5min
Replant, splint, monitor for ankylosis
