Oral and Maxillofacial Surgery Flashcards
what is oral and maxillofacial surgery?
The specialty of dentistry includes the diagnostic, surgical, and adjunctive treatment of diseases, injuries, and defects involving both the functional and the aesthetic aspects of the hard and soft tissues of the oral and maxillofacial regions.
DH care and instruction BEFORE SURGERY may improve a patient’s health and wellbeing by…
-Reduce oral bacterial count
-Reduce inflammation of the gingiva and improve tissue tone
-Remove calculus deposits
-Instruct in the use of foods
-interpret the dentist’s directions
-motivate the patient who will have teeth remaining
4 Stages of dental hygiene care in oral and maxillofacial surgery
- Pre-surgery treatment planning
- Patient instruction: Diet selection
- Pre-surgical Instruction
- Post-surgical care
For clients who will have surgery for oral cancer or who have a cardiovascular or other condition for which all periodontal and dental treatment is completed before surgery, this is done…
Follow up evaluation (pre-surgery treatment planning)
Which of the following is a case where complete oral care is needed before surgery?
a) When a patient is scheduled for a routine dental extraction, even in the absence of systemic conditions, to minimize any risk of localized infection affecting post-operative healing
b) When radiation or chemotherapy will be used following surgery for oral cancer, or when a prosthetic heart valve or total joint replacement will be involved
c) When a patient is undergoing elective orthognathic surgery to correct jaw alignment but has no history of systemic disease or immune compromise
d) When a patient presents with a history of seasonal allergies and mild gingivitis before a scheduled outpatient sinus surgery
b) When radiation or chemotherapy will be used following surgery for oral cancer, or when a prosthetic heart valve or total joint replacement will be involved
Which of the following has a direct and significant impact on resistance to infection, wound healing, and overall recovery?
a) The timing of routine dental cleanings in relation to surgery, even in patients without systemic conditions
b) The choice between different interdental cleaning methods, assuming oral hygiene is generally maintained
c) The number of previous minor surgical procedures, regardless of the patient’s systemic health or healing history
d) Nutritional status
d) Nutritional status
Which Nutrients are essential for the promotion of healing by building gingival tissue resistance?
-Protein
-Vitamin A
-Vitamin C
-Riboflavin
Which medication may the patient be instructed to discontinue use of following surgery?
a) Acetaminophen
b) Amoxicillin
c) Omeprazole
d) Aspirin
d) Aspirin
Can develop if patient sucks on a straw after oral surgery
alveolar osteitis (dry socket)
A hot compress can be used for swelling following oral surgery.
a) true
b) false
b) false
Surgical instrument used to apply leverage against the tooth to loosen from the periodontal ligament and ease in the distraction.
Elevator
all-purpose surgical elevators on most oral surgery trays, with many configurations, that separate tooth from the gingival tissue prior to extraction.
Periosteal elevator
surgical elevators used during extractions to loosen teeth from the PDL, remove teeth, roots, and root fragments.
Examples: Potts, Cryers, Apical…
Straight elevators
surgical instrument used to trim alveolar bone or trim away sharp pointes along the edentulous ridge, not usually used in simple extractions, but complex or multiple
Rongeurs
double-ended instrument with a spoon shaped working end used to debride and scrape the interior of the tooth socket to remove diseased tissue. Induce bleeding to help create a clot.
Surgical curettes
instrument used to smooth bone around the surgical site
bone file
What is the correct procedure for loading a blade onto a scalpel handle?
a) Use gloved fingers to carefully align the blade with the handle and press it into place
b) Pick the blade up with a hemostat and slide it into place
c) Hold the blade with cotton pliers and snap it onto the handle with firm pressure
d) Use a sterile gauze pad to grip the blade and push it onto the handle to minimize direct contact
b) Pick the blade up with a hemostat and slide it into place
hemostats can also be used to hold small soft tissue specimens.
a) true
b) false
b) false
surgical instrument used to grasp and hold onto teeth for their removal, to extract tooth from socket after application of elevators to loosen the tooth
forceps
type of forcep designed for anterior teeth extractions
straight shank
type of forcep designed for posterior teeth extractions
bent shank
What is the “goal” of forceps in oral surgery?
to remove tooth in one piece with crown and root in one piece
Surgical tool used to hold needle during suturing
Needle holder (driver)
Surgical tool used for trimming soft tissues and cutting sutures
Dean’s scissors
Surgical instrument used to hold soft tissues out of the surgical field that must rest on bone, not soft tissue.
Retractor
hand instruments to shape and contour, or remove bone during extractions
bone chisels and mallets
Surgical instruments with extra-long shanks to remove bone, or cut/split the crowns/roots of teeth
Surgical burs
3 key points in the extraction of teeth…
- Anesthesia
- Luxation of tooth
- Pushing, not pulling, tooth out of alveolus
What is the process of compressing the bone and expanding the socket of the tooth before extraction?
a) Luxation
b) Curettage
c) Suturing
d) Alveoloplasty
a) Luxation
procedure on a fully erupted tooth is known as a….
simple extraction
A more complex procedure involving bone removal, handpiece/burs, sectioning, is known as a….
surgical extraction
reshaping and smoothing of socket margins after extraction of teeth in preparation to receiving dentures
alveoplasty
oral condition in which a tooth is partially to fully covered by gingival tissue
Soft tissue impaction
oral condition in which a tooth is partially to fully covered by bone and gingival tissue
Hard tissue impaction
Which system is used to classify impactions?
a) Miller’s
b) Bass’
c) Angle’s
d) Winter’s
d) Winter’s
5 classifications of Winter’s classification
- Horizontal
- Vertical
- Distoangular
- Mesioangular
- Transverse
What is Winter’s classification based on?
a) The depth of the impacted tooth in relation to the occlusal plane
b) The inclination of the impacted wisdom tooth to the long axis of the 2nd molar
c) The degree of root development of the impacted tooth
d) The presence of infection or pathology surrounding the impacted tooth
b) The inclination of the impacted wisdom tooth to the long axis of the 2nd molar
Which of the following describes where the tooth is impacted horizontally, but in a cheek-tongue direction?
a) Transverse
b) Mesioangular
c) Vertical
d) Distoangular
a) Transverse
inflammation of the soft tissues surrounding the crown of a partially erupted tooth, including the gingiva (gums) and the dental follicle
Periocoronitis (operculitis)
Which surgical procedure can be indicated before prosthetic surgery
a) Frenectomy
b) Alveoplasty
c) Apicoectomy
d) Osteotomy
b) Alveoplasty
4 steps of a bone graft
- Extraction
- Debridement of extraction site
- Place graft material
- Place protective membrane
- Close tissue, suture
What is the common incision donation site in a bone graft but tends to be the most painful?
a) Tibia
b) Mandibular ramus
c) Iliac crest
d) Palate
d) Palate
Which teeth are usually extracted for orthodontic therapy?
1st premolars
What is important to determine before the removal of root fragments and why?
a) The length of the root fragment to assess if a larger incision is necessary for complete removal
b) Benefit-to-risk ratio if the fragment is close to a nerve or adjacent sinus, as removal could jeopardize adjacent structures
c) The density of the surrounding bone to predict the level of force needed for extraction
d) The patient’s age, since younger patients heal faster and may require a more aggressive approach
b) Benefit-to-risk ratio if the fragment is close to a nerve or adjacent sinus, as removal could jeopardize adjacent structures
What term describes the apparent direct attachment or connection of osseous tissue to an inert alloplastic material without intervening connective tissue, as seen with dental implants?
a) Fibrointegration
b) Ankylosis
c) Bioadhesion
d) Osseointegration
the surgical removal and examination of lesions in the oral cavity.
Biopsy
What are the three steps of biopsy?
a) Aspiration, incision, fixation
b) Incisional, excisional, exfoliative
c) Debridement, irrigation, suturing
d) Hemostasis, staining, microscopic evaluation
b) Incisional, excisional, exfoliative
biopsy where “section” of a lesion at least 1cm in size is removed; should include some “good” tissue
Incisional
biopsy where entire lesion, >1cm in size is removed, must include all surrounding “good” tissue
Excisional
Less invasive biopsy, known as a smear, where sample of cells is taken with a brush.
exfoliative
Used to hold tissue in place while it heals
Type depends on situation
Examples: absorbable and non-absorbable
Sutures
Typically, dental sutures are secured with ____ knots.
a) Slip
b) Granny
c) Square
d) Overhand
c) Square
Types of absorbable sutures
plain catgut
chromic catgut
synthetic
Types of non-absorbable sutures
Silk
Polyester fiber
Nylon
Absorbable suture with the fastest healing for mucous membrane and subcutaneous tissue
Plain catgut
Which is considered the “strongest” suture?
a) Nylon
b) Silk
c) Chromic gut
d) Polyester fiber
d) Polyester fiber
Absorbable sutures with slower healing but allow the internal tissues to heal first.
Chromic catgut
Which suture is known for strength and easy application?
a) Silk
b) Catgut
c) Polypropylene
d) Nylon
a) Silk
When are surgical sutures removed?
5-7 days after placement
Suture removal is in the scope of practice of dental hygienists.
a) true
b) false
a) true
What is a surgical dressing applied over an area involved in periodontal surgery to enhance healing and tissue recovery? Components may include eugenol, resin, zinc oxide, tannic acid, cocoa butter, paraffin, olive oil, and an antibiotic.
a) Coe-Pak
b) Alveolar plug
c) Periodontal pack
d) Hemostatic gauze
c) Periodontal pack
Where is cyst development the most common?
a) Around central incisors
b) Near the maxillary canines
c) Along the lateral borders of the tongue
d) Around wisdom teeth
d) Around wisdom teeth
What are the 3 major pairs of salivary glands?
parotid
submandibular sublingual
What is the branch of science that deals with the causes and treatments of malposition of the bones of the jaws?
a) Periodontics
b) Prosthodontics
c) Orthognathics
d) Endodontics
c) Orthognathics
fixation of the maxilla in occlusion with the mandible held in place by means of wires and elastic bands, the healing parts are stabilized following fracture or surgery
intermaxillary fixation
Which branch of prosthodontics is concerned with the restoration of the mouth, jaws, and associated facial structures affected by disease, injury, surgery, or congenital defects?
a) Maxillofacial prosthetics
b) Implantology
c) Removable prosthodontics
d) Fixed prosthodontics
a) Maxillofacial prosthetics
internal fixation of a fracture by mechanical means, such as metal plates, pins or screws
Osteosynthesis
a method of internal fixation of mandibular fractures utilizing miniaturized metal plates and screws
miniplate osteosynthesis
What is the motor disturbance of the trigeminal nerve characterized by spasm of the masticatory muscles and difficulty in opening the mouth (lockjaw)?
a) Bruxism
b) Trismus
c) Myalgia
d) Neuralgia
b) Trismus
Refer to the way the bone breaks in a jaw fracture
Complete, Incomplete
refers to use of surgical flap procedure to expose the fracture ends and bring them together for healing
open reduction
a surgical procedure to restore a fracture or dislocation to the correct alignment.
reduction
________ is accomplished by manipulation of the fragment parts without surgery
closed reduction
fracture in which the bone snaps into TWO OR MORE parts.
complete
fracture in which the bone cracks but does not break all the way through
Incomplete
a type of incomplete fracture where fractures has one side of the bone broken and the other side bent, happens in incompletely calcified bones like children.
“greenstick”
the mandible is the most commonly fractured facial bone.
a) true
b) false
b) false
mandibular fractures usually result from ….
direct force or trauma
classification is used widely to identify 2 general levels of maxillary fractures
Le Fort
HZ fracture line extends above roots of teeth, above palate, across maxillary sinus, below zygomatic process and across the pterygoid plates
Le Fort I
the high-level craniofacial fracture extends transversely across the bridge of the nose, across the orbits and the zygomatic arches, and across the pterygoid plates
Le Fort III
the midface fracture extends over the middle of the nose, down the medial wall of the orbits, across the infraorbital rims, and posteriorly, across the pterygoid plates
Le Fort II
all types of fractures require active intervention.
a) true
b) false
b) false
fractured jaw treatment follows these 3 key steps…
- repair of bony fractures (reduction)
- restoration of proper occlusion (fixation)
- soft tissue repair
what is the avg healing time for an uncomplicated mandibular fracture?
6 weeks
what is the avg healing time for an uncomplicated maxillary fracture?
4-6 weeks
•Follows reduction
•Method of fixation and then immobilization
•Uses wires and/or elastics inter/intra maxillary and mandibular arches
Intermaxillary Fixaion (IMF)
method with 2 special bone screws placed via skin incisions on either side of fracture, acrylic bar molded and is pressed over threads of the bone screws and locked into position with screw nuts
Used when management of a fracture cannot always be accomplished well by intermaxillary wiring alone:
External Skeletal Fixation (External Pin Fixation)
the sound or sensation of grating or clicking
crepitus
a vibration in the teeth caused by trauma from occlusal contact
fremitus
a treatment for TMJ dysfunction that “rinses” the joint with injections
Arthrocentesis
