oral surgery Flashcards
pericornitis
infection of the tissue surrounding the crown of a tooth
lower 3rd molars most commonly
signs and symptoms of pericornitis
mild - swelling of soft tissue around the crown of the tooth, bad taste, pain
moderate - lymphadenopathy, trismus, extraoral swelling
severe - fever, malaise, spreading infectino and abscess formation
tx pericoritis
depends on severity of infection
management of mild infections
- OHI such as cleaning around the tooth and operculum with CHX or hot salty waterreleif of trauma from opposing tooth - grind cusps or XLA
- analgesics
- antibiotics (metronidazole)
severe infection may need XLA lower third molar and incision and drainage
NICE stands for
national institute of health and clinical excellence
NICE guidelines for extraction of wisdom teeth
surgical removal of impacted third molars should be limited to pt with evidence of pathology such as
- caries
- non treatable pulpal and/or periapical pathology
- cellulitis
- absscess and osteomyelitis
- internal and external resorption of the tooth and adjacent tooth
- fracture of tooth
- tooth/teeth impeding surgery or reconstructive jaw surgery
- tooth is within the field of tumour resection
what features on a radiograph would suggest that a wisdom tooth is associated with the inferior dental nerve
loss, deviation or narrowing of the ‘tramlines’ of the inferior dental canal and a radiolucent badn across the root of the tooth
what specific information must be given to a pt prior to removal of an impacted lower wisdom tooth (wouldn’t give if removing upper wisdoom tooth)
numbness/tingling of the lower lip, chin and tongue - may be temporary or permanent
possibility of damage to inferior alveolar nerve and lingual nerve
features of an ulcer that would be suspicious of malignancy
indurated
rolled edges
present on the lateral border of tongue
people most likely to have oral malignancy
older adults
males
risk factors for oral malignancy
smoking
alcohol consumption
intraoral use of tobacco products
betel nut/pan chewing
most common oral malignancy
squamous cell carcinoma
tx for squamous cell carcinoma in the mouth
surgery
- excision and primary closure
- excision and reconstruction
surgery and radiotherpy and/or chemotherapy (combined)
internal derangement of the TMJ
localised mechanical fault in the joint which interferes with its smooth action
pt may complain of
if have internal derangement of TMJ
clickling of joint
- displacement of the disc prevents the condyle from moving smoothly and if the disc and condyle ‘jump’ over each other this is felt by the pt as a click or pop
locking of the joint
- disc may be displaced and prevent the condyle from moving normally within the fossa
pain in the joint
- may be due to joint itself, and alteration in synovial fluid, can be associated muscle spasm
if TMJ derangement is unilateral
what side would TMJ move to on opening
side with derangement
first movement is hinge - normal
after 1cm, then go onto translation - unable to on side with derangement but other side is fine so midline will move towards static condyle
imaging of TMJ
ideal
magnetic resonance imaging MRI
branch of trigmenial nerve most commonly affected by trigeminal neuralgia
mandibular > maxillary > optalmic
trigeminal neuralgia most commonly in
females
mid to old age
differential diagnosis for trigeminal neuralgia
concern if pt doesnt fit normal demographic
multiple sclerosis
central lesion
features of pain from trigeminal neuralgia
- paroxysmal
- trigger area
- does not disturb sleep
- excruciating pain
- shooting
- sharp, electric shock, burning character
- short acting
medication that is effective for trigeminal neuralgia
- carbamazepine
- phenytoin
- gabapentin
- lamotrigine
- oxcarbazepine
- baclofen
dry socket
localised osteitis that occurs in a socket follwing removal of a tooth
