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Odonostomatology > Oral bleeding > Flashcards

Oral bleeding Flashcards

1
Q

What are the causes of oral bleeding?

A
  • gingivitis
  • trauma
  • aplastic & pernicious anemia
  • anticoagulant & anti platelet drugs
  • vitamin K deficiency
  • liver cirrhosis
  • hemophilia
  • pyogenic granuloma
  • leukemia
  • benzene exposure
  • traumatic brushing technique
  • Werlhof dx
  • hereditary hemorrhagic telangiectasia
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2
Q

Which medicines are prescribed for oral bleeding caused by soft tissue trauma?

A
  • antibiotics
  • painkillers
  • anticoagulants & antiplatelet therapy
    > anti platelet –> Aspirin, Tiklid, Plavix
    > NOACs (New oral anticoagulants) –> Dabigatran, Rivaroxaban, Apixaban
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3
Q

How does gingivitis cause oral bleeding? Treatment?

A

bleeding can be spontaneous or elicited by tooth brushing

if not acute bleeding –> Chlorexidine to relive the gingiva
if u see pt bleeding –> compress gingiva w. sterile gauze which is wet w/ tranexamic acid (anti fibrinolytic agent)

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4
Q

Treatment of oral bleeding caused by soft tissue trauma.

A

treatment is generally always same w. oral bleeding –> 1st thing = compression of wound w. sterile gauze for 10-15min
check every 2 min if bleeding stopped –> does not stop after 10mins –> suture it

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5
Q

What should you look for in case of a dental trauma?

A
  1. soft tissue injuries/ lacerations/ devolving
  2. tooth mobility
  3. occlusal (bite) level of injured teeth
  4. any tooth/ tooth pieces missing, if so where are they?
  5. see how the mandible closes to check for TMJ problem (deviation is towards affected side)
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6
Q

How do you identify deciduous from permanent teeth?

A
  • size of tooth
  • age of pt
  • age of specific denture transition
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7
Q

Pediatric dental traumas that lead to oral bleeding.

A
  1. injuries to dental hard tissue & pulp
  2. ” “ dental hard tissue, pulp & alveolar process
  3. ” “ periodontium
  4. ” “ gingiva &/or oral mucosa
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8
Q

What is an enamel infraction ?

A

micro cracks seen within dental enamel of tooth

no specific treatment

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9
Q

Is an enamel-dentin fracture painful?

A

yes bc it affects innervated part of tooth

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10
Q

What is a crown root fracture?

A

damage goes beyond bone
much harder to treat than other fractures
no issues w/ permanent tooth underneath

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11
Q

What is affected in an alveolar fracture?

A

permanent tooth underneath may have some issues – must follow-up

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12
Q

What do you need to test to check if one of these diseases is present:

  • concussion
  • subluxation
  • extrusion
  • lateral luxation
  • intrusion
  • avulsion
A

test the patients bite

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13
Q

What is an avulsion?

A

complete displacement of a tooth from its socket in alveolar bone due to trauma

if primary (deciduous) tooth --> do not replant 
if permanent --> replant
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14
Q

How can you check if a tooth is primary (deciduous) or permanent?

A

using orthopantomography (X-ray) –> can see 2 rows of teeth, one under the other – indicates they are primary

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15
Q

Never replant a _________ tooth

A

deciduous/primary

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16
Q

For near ________, if the tooth is interfering w/ bite or is at risk of being swallowed or inhaled, ______ it

A

avulsions

extract

17
Q

What are the injuries that may occur to the gingiva and/or oral mucosa?

A
  1. lacerations - suture often needed
  2. contusion
  3. excoriation
18
Q

____ involvement produces pain, while _____ involvement increases tooth mobility

A

pulp

root

19
Q

Which neuralgia is often confused with dental problems, migraine headaches, sinusitis, eye problems, TMJ disorders out temporal arteritis?

A

trigeminal neuralgia

20
Q

S&S of temperomandibular joint/TMJ disorders

A
  • pain or tenderness of jaw
  • pain 1 or both of the joints –> if u press on joint its painful
  • aching pain in & around the ear
  • difficulty chewing or pain while chewing (facial pain)
  • locking of joint
21
Q

How do you treat a locked TMJ?

A

prescribe Muscoril (muscle relaxant, anti-inflam & analgesic) & painkillers

reposition the jaw by keeping thumbs on lower molars + apply pressure down & back

22
Q

Why can sinusitis be misdiagnosed as upper molar problems?

A

bc roots of upper molars go v close to the sinuses

23
Q

What is the approach to patients w/ sinusitis?

A
  • check if pt has allergic rhinitis or common cold
  • X-ray to see if septum is deviated (deviation can cause more infection)
  • ensure no polyps in nasal mucosa
  • see if pt underwent oral surgeries – some implants are placed in sinuses –> may have sinusitis post-op
  • CBCT
  • if emergency –> antibiotics to target gram -ve bacteria present

refer to otorhinolaryngologist, dentist/oral surgeon (if they had surgery)

24
Q

The ____ does not contain any proprioceptive fibres, so its hard for the patient to indicate which is the actual tooth involved. It is easier for them to indicate the source if the _________ ligament is involved because it contains proprioceptive fibres.

A

pulp

periodontal

25
Q

If the patient has acute pain, in 75% of cases its a ____ problem, the other 25% is pain of non-dental origin or periodontal origin.

A

pulp

26
Q

What are the 3 types of pulp-origin pain?

A
  1. dentinal pain
  2. pulpal pain
  3. periapical pain
27
Q

What is dentinal pain & what is it caused by?

A
  • pulp is healthy
  • dentinal tubules are exposed so odontoblasts can be stretched –> they contain nerve fibres –> acute, sharp pain

causes:

  • crack in tooth which exposes the tubules
  • receding gums that expose the root surface –> loss of sensibility of outer part of tooth
  • tooth decay –> dentinal tubes are filled w. fluid & retraction of odontoblasts nerves can cause pain –> SHARP, SHORT pain
28
Q

What are the stages of pulpal pain?

A
  • a process: normal pulp –> pulpits (inflammation) –> tooth necrosis

2 stages:

  1. Reversible
    - if treated, will return to normal pulp
    - SHARP, ACUTE pain of SHORT DURATION (<30s) under thermal stimulus
    - usually assoc w. history of pain in previous days
    - must remove occlusal trauma + give anti-inflam meds/ painkillers
  2. Irreversible
    - decay creates opening in tooth –> bacteria enter pulp
    - bacterial byproducts overcome tooth defenses –> inflammation + pain
    - DULL, CONSTANT pain of LONG duration (>30s) under thermal stimulus
    - faster progression + worsening
    - refer to dentist for root canal
29
Q

How does periapical pain develop?

A

occurs as necrotic products go thru apex into periodontist –> inflammation of entire area

  • is another kind of periodontal pain, but comes from apex so we treat it as a pulpal pain not a periodontal one
  • treat the pulp (which is the source of necrotic products)
30
Q

What is percussion used for in case of tooth pain?

A
  • start gently then incr pressure to see pt response
  • detects inflammation of periodontal ligament, so inflammation of socket
  • may also detect necrotic pulpal pain which has involved periodontal ligament thru the apex
31
Q

How is tooth palpation performed?

A

must be done at level of end of the root in the bones –> palpate 10mm after the endpoint of the crown –> to be at the level where the apex goes into the bone

32
Q

What is tooth palpation useful for?

A

problems in palpation occur if lesion has reached the periosteum

diagnostic for pulpal necrosis or granuloma at the apex (in pt w many root canals)

granuloma – chronic dx which leads to acute infections, if u press finger there –> pain

prescribe antibiotics to prevent abscess formation

33
Q

What is the cold test & what is it used for?

A

vital pulp can feel cold –> if you put a cold spray on cotton pad & touch the enamel (which must be dry) –> pt feels pain

  • consider how long the pain lasts
34
Q

In case of _______ or periodontal involvement, you must perform the _______ test in order to rule out periodontal involvement

A

periapical

probing

35
Q

What is pericoronitis?

A

special set of periodontal disease which involve 3rd molars

often they don’t have enough space to erupt into the bone in a chewing position –> acute pain or abscess + difficulty opening mouth due to edema & trismus

(- much more painful in half-submerged position –> create a “sack” & bacteria can enter –> pericoronitis &/or infections
- prescribe Chlorexidine rinses)

36
Q

In which position are new 3rd molars most painful, and what is prescribed?

A

much more painful in half-submerged position –> create a “sack” & bacteria can enter –> pericoronitis &/or infections

prescribe Chlorexidine rinses

37
Q

When should you prescribe antibiotics ?

A
  • tooth replantation: risk of reinfection after procedure
  • pericoronitis w/ signs of infection: if just inflammation Chlorexidine mouthwash
  • acute sinusitis
  • periodical infection w/out drainage (if drainage & pt not suffering, no need for antibiotics)
38
Q

When should you NOT prescribe antibiotics ?

A
  • reversible pulpits
  • dentinal pain
  • trigeminal neuralgia
39
Q

What are the emergency situations & how are they treated?

A
  1. ORAL BLEEDING: compression & if bleeding continues –> suture
  2. SOFT TISSUE TRAUMA: compression, suture & referral
  3. AVULSED TOOTH: replantation. encourage pts to replant themselves after cleaning under cold running water. in all other cases: store it properly
  4. PERIODONTAL PAIN or ACUTE ORAL PAIN: painkillers & antibiotics when appropriate + refer pt to dentist

Odonostomatology (2 decks)

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