Oral Surgery Flashcards

Question

How do we set up LA?

Answer 1

1. Pick type of LA and then needle we want 2. check batch no and expiration date on cartilage 3. insert cartilage into syringe 4. turn right so there is a click 5. unsheath and get rid 6. safety mechanism

Answer 2

Amide | Ester

Answer 3

Liver by enzymes

Answer 4

Blood stream by plasma cholinesterases

Answer 5

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I hit bone and about 3/4 of needle is in tissue and then withdraw 1mm and ASPIRATE then deposit 3/4 of cartilage then withdrawn 2-4mm and deposit rest to get lingual nerve if needle hits bone too soon then withdraw slightly and reposition towards midline as too far anteriorly and if we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

Answer 6

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

Answer 7

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?

Answer 8

COX-1 inhibitor that affects the PLT pathway - prevents PLTs activating and prevents PLT aggregation therefore thins blood

Answer 9

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

Answer 10

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

Answer 11

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

Answer 12

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)

Answer 13

Simple XLA (1-3 teeth) Incision and draining inta oral swellings 6PPC PMPR

Answer 14

Xla of more than 3 teeth or adjacent teeth Flap rasining procedures