Oral Surgery Flashcards
What are the types of forceps?
Upper straights upper universal upper right molar forceps upper left molar forcpes upper bayonet third molar forceps upper bayonet root forceps
lower universals
lower molar
lower root forceps
lower cowherd
What are upper universals used for?
3-3 - anterior teeth - can’t reach far back due to curvature
What movement do we use when extracting upper anterior teeth?
Apical pressure, primary rotational movement, secondary buccal expansion (not always needed
What are upper universal forceps used for?
these are used for xla of upper single rooted teeth - pre molars and canines
they are curved forceps - dont sit flat - can reach further back
What movement do we use when extracting upper canines and pre molard
Apical pressure
Primary rotational
secondary buccal palatal expansion
What are upper right molar forceps like?
Beak on LHS means its for right tooth
BEAK TO CHEEK
Buccal - 2 buccal roots
palatal - 1 palatal root
What are the upper left molar forceps used for?
Extracting upper left molars
BEAK TO CHEEK
Beak on RHS
What is the movement for molar extraction?
Apical pressure
Primary rotation
secondary buccal to palatal
figure 8 movement
What are upper root forceps used for?
TO remove narrow single roots
What are upper bayonet 3rd molar forceps used for?
Extracting 3rd molars - reach further back without stretching pts cheek
Where do we stand for extractions?
Upper right - infrotn and right
upper left - infant and right
lower right - behind to right
lower left - infrotn to right
What position should pt be in for extraction of upper teeth?
Tipped back slightly so mouth is bit below elbow
What position do we have pt in for extraction of lower teeth?
More upright
What are lower universal forceps?
Concave on both sides
Used to extract 5-5 on lower jaw (SINGLE ROOTED TEETH)
What are lower molar forceps?
sed to extract lower molar teeth
Pointed beaks on both sides - TRIANGULAR SHAPE to engage BUCCAL and LINGUAL furcation
What is the function of a luxtor?
Used to sever the PDL and make the tooth more mobile in the socket - they look less scary and sharp than elevators but are actually much scarier and sharper
What are the function of elevators?
These are used to make the tooth more mobile by loosening them in the socket, remove retained roots, provide point of application for forceps
What are the types of elevators?
Couplands - sets of 3 narrowest to widest
Cryers - pointy and scary
Warwick and James - spoon like, L R and straight
What are the types of LA?
Lidocaine - 1:80,000 adrenaline, 2.2ml, 2%
Duration - infiltration 60 mins, block 90 mins, soft tissue 3-5hrs
44mg in cartilage, 5mg/kg max dose 7 cartilages
Articaine 1:100,000, 1:200,000, 1:400,000 adrenaline, 2.2ml, 4%, 88mg, 7mg/kg, 5 cartilages, infiltration 2hrs, block 75 mins, soft tissue 3-5 hrs
Prilocaine - contains felypressin instead of adrenaline, 2.2ml, 3%, 66mg in cartilage, 8mg/kg, infiltration 30 mins, block 60 mins, soft tissue 3-6 hrs
Mepivicaine - plain no adrenaline, 66mg, 3mg/kg, infiltration 20 mins, block 40 mins, soft tissue 2 hrs
What is most common LA to use?
LIDOCAINE - only time we wouldn’t use if it pt has severe, uncontrolled hypertension
if controlled hypertension use max of 3 cartilages
CAREFUL WITH: -TRICYCLICS BETA BLOCKERS NON K SPARING DIURETICS DRUGS SUCH AS COCAINE
What is risk with citanest/prilocaine?
Contains octypressin/felypressin which can induce labour
What are the two types of needles?
Long - yellow = 35mm
Short - blue = 25mm
What are long needles used for?
Yellow, IDB
What are short needles used for?
Infiltrations - blue 25mm
How do we set up LA?
- Pick type of LA and then needle we want
- check batch no and expiration date on cartilage
- insert cartilage into syringe
- turn right so there is a click
- unsheath and get rid
- safety mechanism
Two types of LA?
Amide
Ester
Where are amides metabolised?
Liver by enzymes
Where are esters metabolised?
Blood stream by plasma cholinesterases
How do we do an IDB?
Introduce self
ask if any changes to MH
explain procedure to patient
let pt know that after we have numbed them up you shouldn’t feel any pain but may feel pressure, you may feel tingly sensation and may feel rubbery feeling
Having pt sitting upright
Position the light
Identify the anatomy - thumb on coronoid notch, identify ptyergomandibular raphe, needle advancing from opposing premolars, fingers on posteior border of mandible to support it
Injection site is 6-10mm above the lower teeth - we aim for mandibular foramen region
Then I am going to advance the needle until I hit bone and about 3/4 of needle is in tissue and then withdraw 1mm and ASPIRATE then deposit 3/4 of cartilage then withdrawn 2-4mm and deposit rest to get lingual nerve
if needle hits bone too soon then withdraw slightly and reposition towards midline as too far anteriorly and if we dont hit bone then too posterior so withdraw and move distally
Should take 30s/ml so around a minute to do IDB
To test for numbness - probe down PBL or just use probe around gums
How do we do an infiltration?
INTRODUCE SELF
MH CHANGES
EXPLAIN PROCEDURE
LET PT KNOW THAT THEY SHOULD FEEL ANY PAIN BECUASE WE ARE NUMBING THEM UP HOWVER THEY MAY STILL FEEL PRESSURE, TINGLY FEELING
ASSEMBLE LA - BATCH NO AND DATE - AND 25MM NEEDLE, BLUE
osition pt - for infiltrations we want pt more further back
Turn on the light and position light
At this point can say that we could apply topical anaesthetic for the pt (such as benzocaine) - but this is for INFILTRATIONS not IDB (to do this we would dry the mucosa with cotton wool roll, apply the topical and leave for 2 minutes)
Ask the patient to open nice and wide, stand in front of patient
Remove topical LA and stretch mucosa as taut as possible using end of mirror
Then we place the needle over the puncture site (for buccal infiltration it will be in the buccal sulcus, just distal to the tooth we are treating and as close to apex of tooth as possible as this is where we are aiming for
Puncture mucosa quickly (can distract pt by pinching lip or pressing down on palatal mucosa)
Advance and aspirate - once ensured no blood in cartridge we can begin to deposit LA slowly (30s/ml) - give around half to 3/4 of cartilage and then the rest will be used for palatal infiltration
For palatal injection we draw an imaginary line between the gingival margin of the tooth we are treating and the median palatine raphe along long axis of the tooth and then insert the needle and inject slowly - will feel lots of pressure due to small surface area of the palate
What are post op extraction instructions?
INTRODUCE
SORE AND UNCOMFORTABLE - completely normal over next few days - this will settle, can manage it by taking pain killers - pain killers you would use for a headache can use here such as ibuprofen and paracetamol as long as you are able to take them and follow dosage on box - good ideas to get ahead of pain before LA wears off - take pain killers as soon as you leave the surgery however remember to take care as u are still numb so hot foods and drinks you will not feel and more at risk of burning mouth or biting lip
BLEEDING - blood on pillow or in saliva is completely normal however if the socket begins to ooze blood then we take piece of gauze, wet it under tap and place gentle pressure for 15-20 mins and check - if stopped great if not do same thing again for 30 mins and if not stopped can either contact us or 111 if out of hours
DONT EXPLORE SOCKET - finger, tongue, or toothbrush as the socket is trying to heal by forming a clot and this can disrupt the healing process - fine to brush as normal just take care around this area and be careful when spitting out do this gently
TRY RELAX - NOTHIGN THAT WILL RAISE BP SUCH AS EXERCISE OR STRESSFUL ACTIVITY - this can encourage re bleeding
SOFT DIET - eat on other side fo mouth soft foods nothing too hot when still numb
ALCOHOL AND SMOKING - avoid long as possible as can disrupt healing process and lead to complications - at leats 24 hours but ideally long as possible
DONT RINSE OUT MOUTH TODAY - however from tomorrow salt water rinses 3-4 times a day - spoonful of salt into ht water
BRUSINING AND SWELLING - normal and expected - usually reaches it peak by day 2 and then should start healing however if not getting better after 3 days and you are worried the give us call or 111
JAW STIFFNESS - normal as we have been putting pressure on jaw - will take 1-2 weeks to resolve, soft diet in mean time
SENSITIVITY on ADJACENT TEETH - normal, will resolve
INFO PACK AND ANY QS?
What is aspirin?
COX-1 inhibitor that affects the PLT pathway - prevents PLTs activating and prevents PLT aggregation therefore thins blood
Can we tx pt on aspirin?
Yes treat as normal however consider that they may bleed more than normal pt so may need extra local measures such a limiting tx area, staging tx, sutures etc
What is clopidogrel?
This affects the PLT pathway to block PLT activation - we can tx pt without interrupting medication dose however limit tx, small areas, consider local HA measures and suture or pack
What is warfarin?
Vitamin K antagonist
Vit K proches 2,9.7 9 10 clotting factors in the blood so by preventing this we reduce clotting
Tx of pt:
CHECK INR IDEALLY 24HRS BEFORE BUT 72HRS IF PT IS STABLE
IF INR BELOW 4 = TX! BUT CONSIDER EXTRA MEASURES
IF INR ABOVE 4 = DO NOT TX
What is apixiban?
This is a drug that inhibits factor 10a which converts prothrombin to thrombin preventing formation of soluble fibrin NORMALLY TAKEN TWICE A DAY
Tx of pt - consider BLEEDING RISK
IF LOW BLEEDING RISK THEN TX PT WITHOUT INTERUPTING MEDICATION BUT TX EARLY IN DAY AND SUTURE AND PACK ETC
IF HIGH BLEEDING RISK THEN WE MUST ASK PT TO MISS MORNING DOSE OR DELAY MORNING DOSE (TAKE AS NORMAL AT NIGHT IF HA FOR 4 HOURS)
What is considered as low risk of post op bleeding?
Simple XLA (1-3 teeth)
Incision and draining inta oral swellings
6PPC
PMPR
What are high risk procedures of post op bleeding?
Xla of more than 3 teeth or adjacent teeth
Flap rasining procedures
