Oral Surgery Flashcards
What procedures count as oral surgery?
- Simple exodontia - extractions
- Complex exodontia - MOS
- Soft tissue surgery - biopsy
- Oral pathology management - tumours
- Anxiety management - sedation
- Medical condition management
What PPE is needed for simple exodontia?
Level 2 PPE:
- eye
- mask
- apron
- gloves
What are the legal considerations needed to allow simple exodontia?
- Clear documented treatment plan
- Medical history up to date
- PreOP radiograph
- Patient confirms reason for attendance and the tooth extraction
What is the definition of luxation?
Displacement or dislocation of an object
What is the definition of elevation?
The action of moving an object from its original position in a vertical plane
What is the definition of extraction?
The complete removal of an object from its surroundings
What are the 3 forms of techniques for simple exodontia?
- Luxation
- Elevation
- Extraction
What is the definition of point of application?
The point at which an instrument becomes active and applies force to an object or surface
What is the point of application for a luxator? and in which area of the tooth?
- At the periodontal ligament space
- Used in the long axis of the tooth
What is the process of using a luxator?
- Gentle apical pressure with lateral cutting action
2. Incise the PDL, wedges between alveolar one and root surface
What is the point of application of an elevator? and what orientation and movement is it used?
- Interproximal point of application
- With a perpendicular orientation
- Rotational movement (pulley lever)
What is needed when using elevators?
Fulcrum
What is the definition of primary drive?
Refers to the action used with a luxating or elevating instrument with utilisation of lever and fulcrum rests
What is the definition of primary movement
First stages of dental extraction by severing the PDL fibres and encouraging dilatation of alveolar bone
What is the definition of secondary movement?
Forceps are applied to the coronal section of the tooth to be extracted
What is the definition of secondary drive?
Forceps are used to grip and apply apical pressure
What other movements are used when using a forcep/
Rotational movement and 8-figure movements
How to use luxators safely?
Instrument in heel of hand, index finger guides tip, supporting digits straddle alveolus of quadrant
How to use elevators safely?
Instrument in heel of and, index finger guides tio, fulcrum on alveolar bone, perpendicular to extracting tooth, supporting digits straddle alveolus of quadrant
How to use forceps safely?
Operating gand conforms to grip of instrument, supporting hand reciprocates apical pressure and lateral movements
What is the order of use when extracting a tooth?
- wide narrow luxator
- elevators: starting with smallest
- delivery of tooth with extraction forceps using secondary movements
What are the ergonomics when extracting a tooth?
- Standing
- Right handers: LRQ standing behind and other quadrants in front
- Upper teeth: patient high ad supie
- Lower teeth: patient low ad upright
- Supporting and reciprocates apical pressure and provides proprioceptive feedback
What are some peri-operative complications for simple exodontia?
- ineffective La
- excess bleeding
- crown or root fracture
- root displacement
- communication
- adjacent tooth damage
- soft tissue injury
- alveolar fracture
- instrument fracture
- tooth inhalation
What are some post-operative complication of simple exodontia?
- Pain
- Swelling
- Bruising
- Bleeding
- Dry socket
- Infection
- Trismus
- Difficulty eating
- Prolonged healing
What is normal bleeding and how to deal with excessive bleeding?
- Haemostasis within 3-5 mins If continues: - apply Pa - place haemostatic agent in socket - suture socket with resorbable suture - rest with no mouth rinsing then reapply pressure
How to deal with crown/root fracture? and what increase the risk?
- Should anticipate from pre-OP radiograph
- Heavily restored, RCT, curved morphology
- Refer to MOS`
How a communication forms? and how to deal with a sinus communication?
Loss of alveolar bone leading to communication
- Refer to MOS
How to deal with a dry socket?
- Occurs 3-5 days postOP
- Painkillers ineffective
- Bad taste
- Increased in smokers
- Treatment irrigate with saline and dress with alvogyl
What is essential to ask a patient before extracting a tooth, in regards to their wellbeing?
Have they eat?, if not offer a glucose-based supplement
What is the relevant previous medical history, when assessing the difficulty of an extraction?
Bleeding disorders
Bisphosphonates
Antibiotic allergy
Anticoagulants and Antiplatelets
Refer to the SDCEP guidelines Radiotherapy Chemotherapy Haemophilia Liver/Kidney failure
Essential to liaise with necessary colleagues
What are the radiographs of choice for a extraction?
DPT and periapical
What consentual aspects must the patient know and understand for you to undertake an extraction?
- The tooth to be extracted
- risk vs benefits
- justification for extraction
- other viable options
What medical aspects must you understand before starting an extraction on a patient?
- Changes since last visit
- Changes to bleeding and healing times (anti-coagulants, immunosuppression or bisphosphonates)
- Diabetes control
- Has the patient eaten?
What should be included on the surgical safety checklist before a tooth extraction?
- Team awareness
- Patient points to tooth
- Dentist identifies tooth
- X-rays present
- Previous medical history
- Clearly planned and recorded
What equipment is essential for an extraction?
PPE: level 2 LA: topical, long/short needle, appropriate LA for patient's needs Extraction instruments Gause Post OP instruction leaflet
What position of the patient is gold standard for a lower tooth?
Low and upright
What position of the patient is gold standard for a upper tooth?
Higher and more supine
What is the role of the working/dominant hand?
Control the extraction instrument
What is the role of the supporting hand?
Protects the patient by the digits straddling the alveolar bone providing proprioceptive feedback
What general movement is done with forceps?
Bucco-lingual movement
What movement with forceps are specific to single rooted teeth?
Rotational
What movement with forceps are specific to lower molars?
Figure of 8
What should you tell and give the patient after the extraction?
First, stop the bleeding Give verbal and written instructions Explain how to control bleeding (provide gause) Give OHI Suggest soft diet No smoking or alcohol OoH number Ask if any questions
What complications can occur during the extraction procedure?
Pain, from LA failure Excessive bleeding Soft tissue trauma Adjacent tooth damage Crown fracture Root fracture Need to refer to MOS
What complication can occur after the extraction procedure?
Pain Swelling Dry socket Infection Post-extraction hemorrhage Boney sequestration Medication related osteonecrosis of the jaw (MRONJ)
What is the definition of a cavity?
A hollow space within within the body or tissues
What is the definition of a cyst?
Cavity lined by epithelium
What is the definition of a granuloma?
A collection of macrophages that adhere together down the microscope
Nodule of red tissues seen by naked eye (granulation tissue)
What is the definition of granulation tissues?
Capillaries and fibroblasts
Arrive at injured site, capillaries keep area oxygenated and fibroblast makes a scar
What cells do chronic inflammation contains?
Lymphocytes, plasma cells, macrophages and some eosinophils
What cells do acute inflammation contain?
Neutrophils
What is the definition of odontogenic?
Derived from epithelial residues of tooth forming organ
What is the definition of non-odontogenic?
Derived from other non-tooth cells
Name 2 types of odontogenic cysts?
Inflammatory
Developmental
Name 3 examples of inflammatory odontogenic cysts?
Abscess
Periapical granuloma
Periapical cyst
What causes a periapical abscess?
Pulpal death is the cause due to caries, though may be subsequent trauma
Due to microbial infection in the root canal after pulpal death
How does an abscess form?
Neutrophils accumulate with bacteria in the centre
Granulation tissue grown in around central area
Is an abscess a cyst?
No
The abscess forms a cavity filled with pus and is lined by granulation tissue
How to treat a abscess?
Incise and drain centre
Pus drains out
Granulation tissue resolves
Small scar forms
What happens if the abscess becomes infected or injury persists?
Get cavity lined by granulation tissue that persists
Becomes a periapical granuloma
Can have chronic inflammation (plasma cells)
What can a abscess progress to?
Chronic apical periodontitis
What can inflammation stimulate in a periapical granuloma?
Stimulate epithelial remnants to proliferate and form a true cyst lining, which will become a periapical cyst or a combined periapical cyst and granuloma (can also become infected again forming another abscess)
What is left after the tooth is extracted after periapical cyst?
Residual cyst (radicular or apical periodontal cysts)
What does a periapical cyst look like under a microscope?
Fibroconnective tissue and scarring forming edge of lesion Granulation tissue Squamous epithelium Capillaries Neutrophils Plasma cells (if chronic)
If there is a lateral opening of the root canal, what is a cyst called?
Lateral radicular cyst
Name 4 developmental odontogenic cysts?
Odontogenic keratocyst
Dentigerous cyst
GIngival cyst of newborn
Rare cyst
What is a odontogenic keratocyst lined by, covered with and associated with?
Squamous epithelium, with a distinct wavy band of thin parakeratin (keratin with nuclei)
Now designated a true tumour as it often recurs
Rarely assoc with Gorlin-Goltz syndrome
What are the symptoms of Gorlin-Goltz syndorme?
Multiple keratocysts in mouth and numerous skin tumours
Caused by mutation in the receptor sonic hedgehog (developmental patterning protein)
Where are Dentigerous cysts found?
Cyst around crown
What is the pathology of a dentigerous cyst and what is it derived from?
Squamous epithelial lining with occasional mucus secreting cells
From reduced enamel epithelium
Does not recur
What are some variants of dentigerous cyst?
An eruption cyst is a dentigerous cysts forming outside the bone
Can also be called follicular cysts
Where are gingival cysts of newborn found?
In gingiva (Bohn's nodules) Resolve spontaneously
What is the pathology for a gingival cysts of newborn?
Lined with squamous epithelium and filled with keratin
Where are lateral periodontal cyst located?
Interproximally
Does not recur after enucleation
What is the pathology of an lateral periodontal cyst?
Squamous lined cyst with focal thickened areas of epithelium
Name 3 very rare developmental odontogenic cysts?
Glandular odontogenic cyst
Gingival cysts of adults
Botryoid odontogenic cyst
Where is the Glandular odontogenic cyst located and do they recur?
Anterior mandible
Recur
Where is the Gingival cysts of adults located and do they recur?
Gingiva
Not recur after enucleation
Where is the Botryoid odontogenic cyst located and do they recur?
Interproximally
Recur
What is the definition of a non-odontogenic cyst?
Derived from other non-tooth cells
Name 7 types of non-odontogenic cysts and cyst-like lesions?
Salivary mucocoele Nasopalatine duct cyst Nasolabial cyst Tru bone cyst Dermoid cyst Epidermoid cyst Thyroglossal cyst
Name 2 types of salivary mucocoelecysts?
Extravasation mucocoele Mucous retention cyst
What is the pathology and description for an extravasation mucocoele?
Not a true cyst but cyst-like as no epithelial lining
Caused from trauma
Ball of mucin
Spilled mucus from minor salivary gland duct
Granulation tissue walls of area
What is the definition of granulation tissue?
Capillaries and fibroblasts
What is the pathology and description for a mucous retention cyst?
A true cyst which usually forms when salivary duct is blocked
Lined by epithelium
Dilated salivary duct
What occurs if a mucous retention cyst enlarge?
Burst
Become a combined mucous retention cyst and extravasation mucocoele
What is 1 variation of mucosal retention cyst?
A ranula
A mucous retention cyst occurring in a large salivary gland
If it bulges out into neck its is called a plunging ranula
Describe the location, origin and the epithelial lining of the nasopalatine duct cyst?
Swelling in midline of anterior palate
Originate from epithelium of nasopalatine duct in incisive canal
Epithelial lining can be stratified squamous, respiratory, cuboidal or columnar cells
Describe the location, origin and the epithelial lining of the nasolabial cyst?
Lesion in upper lip below nose, lateral to midline
Derived from remnants of the embryonic nasolacrimal duct
Pseudostratified columnar epithelium lining
What is the meaning of ‘true’ for a true bone cyst?
True relates to the cavity wall is formed by bone forming tissue
What is the solitary bone cyst lined by?
Bone cavity lined by CT in mandible of teenager
What is a rare bone cyst and give an example?
Aneurysmal bone cyst
Not true cyst but a cavity in bone lined by CT and blood filled spaces
Describe the location, origin and the epithelial lining of the dermoid cyst?
Developmental skin cyst in young children
Embryonic remnants of skin form ‘skin’ lined cysts
Squamous lining produced by keratin and has skin appendages
Rare in FoM
Describe the epithelial lining and aetiology of the epidermoid cyst?
Squamous lined cyst which is thought to be acquired by traumatic implantation of surface epithelium
Describe the location, origin and the epithelial lining of the Thyroglossal cyst?
Common in neck but rare in mouth
Embryonic ract runs from midline back of tongue, through hyoid bone to area of thyroid gland
Rarely found at back on tongue
Lined by epithelium, with surrounding thyroid tissue in wall
