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3rd Year - Module 5 > Oral Surgery > Flashcards

Oral Surgery Flashcards

1
Q

For extraction of a lower tooth, at what height should the seat be positioned?

A

Low for lowers

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2
Q

For extraction of an upper tooth, at what height should the seat be positioned?

A

Up but well retroclined for uppers

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3
Q

When applying forceps to a tooth, where should the beak of the forceps be positioned?

A

Beak to cheek/furcation

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4
Q

Where should you be standing for a lower RHS extraction and what hand position is used?

A

stand behind the patient, thumb lingual, index finger buccally

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5
Q

Where should you be standing for a lower LHS extraction and what hand position is used?

A

stand in front, ballet stance and claw support

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6
Q

Where should you be standing for an upper LHS extraction and what hand position is used?

A

stand in front, thumb to palate, index buccal

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7
Q

Where should you be standing for an upper RHS extraction and what hand position is used?

A

stand in front, thumb buccal, index to palate

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8
Q

What movement can be used to extract an upper central incisor?

A

Rotation, Buccal and back

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9
Q

What movement can be used to extract an upper lateral incisor?

A

Buccal and back only

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10
Q

What movement can be used to extract an upper canine?

A

Buccal and back, rotation

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11
Q

What movement can be used to extract an upper first premolar?

A

buccal and back

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12
Q

What movement can be used to extract an upper second premolar?

A

rotation, buccal and back

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13
Q

What movement can be used to extract an upper molar?

A

Buccal and back

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14
Q

What type of forceps are used to extract an upper central and lateral incisor?

A

Straight forceps

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15
Q

What type of forceps are used to extract an upper canine?

A

Upper universal or straight forceps

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16
Q

What type of forceps are used to extract upper premolars?

A

Upper universal forceps

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17
Q

What type of forceps are used to extract upper molars?

A

R or L upper molar forceps

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18
Q

What movement can be used to extract a lower central incisor?

A

Buccal and back

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19
Q

What movement can be used to extract a lower lateral incisor?

A

Buccal and back

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20
Q

What movement can be used to extract a lower canine?

A

Rotation, buccal and back

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21
Q

What movement can be used to extract a lower first premolar?

A

Rotation, buccal and back

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22
Q

What movement can be used to extract a lower second premolar?

A

rotation, buccal and back

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23
Q

What movement can be used to extract a lower first molar?

A

figure of 8 (or oval), buccal and back

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24
Q

What movement can be used to extract a lower second molar?

A

figure of 8 (or oval), buccal and back

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25
Q

What type of forceps should be used to extract a lower incisor?

A

lower narrow forceps

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26
Q

What type of forceps should be used to extract a lower canine?

A

Lower universal forceps

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27
Q

What type of forceps should be used to extract a lower premolar?

A

Lower universal forceps

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28
Q

What type of forceps should be used to extract a lower molar?

A

Lower molar forceps

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29
Q

What does the pink sticker on OS tell you?

A

referring department
teeth for extraction
FDI system
urgency (red/yellow/green)
radiographs present or not
Medical history

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30
Q

What information must you write on the whiteboard about your patient in OS?

A

Name
DOB
If they are having an extraction, use 4 quadrants to draw which tooth
brief description of relevant MH

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31
Q

What information must all match before extracting a tooth?

A

Pink sticker, whiteboard, patient notes and what patient says

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32
Q

Who is the dental surgical safety checklist to be filled out by?

A

A 2nd person in the room, NOT the operator

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33
Q

What should you ask a patient when you discover they are taking novel oral anticoagulants?

A

when do they take them?
Have they been advised to miss a dose before extraction? - if not, can we proceed

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34
Q

What should you ask a patient when you discover they are on warfarin?

A

up to date INR level
is INR level appropriate for extraction?
Is level the correct therapeutic level for the patient?

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35
Q

What should you ask a patient when you discover they are on bisphosphonates?

A

How long?
Oral or IV?
Use to assess MRONJ risk

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36
Q

What is the proper name for dry socket?

A

Alveolar osteitis

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37
Q

What is INR level and what is considered a normal INR level

A

An INR test measures the time for the blood to clot. Healthy people an INR of 1.1 or below is considered normal.

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38
Q

What is an effective therapeutic INR range for people taking warfarin?

A

2.0-3.0

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39
Q

In what position should the bevel be in when administering LA?

A

Facing the bone

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40
Q

Describe the points covered in extraction post operative instructions

A

1) avoid rinsing mouth for 24hrs
2) avoid alcohol today
3) avoid smoking
4) bite on clean cotton for 15mins if bleeds
5) start using hot, salty mouthwash after 24hrs to clean socket and clear debris
6) if asthmatic do not advise ibuprofen as they cannot tolerate it
7) Don’t bite lip
8) avoid strenuous exercise

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41
Q

At what five stages must you be signed off by staff during extraction?

A

1) before giving LA
2) get staff to watch LA
3) Observe during extraction
4) after notes written and haemostasis achieved
5) patient must not leave until notes signed by staff

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42
Q

What are 6 post operative problems?

A

Pain - to be expected
swelling
bleeding
bruising
infection
dry socket

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43
Q

What type of forceps can be used on heavily broken-down teeth?

A

Cowhorn forceps

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44
Q

At what angle do the beaks of the lower universal forceps sit in relation to the handle and hinge?

A

90 degrees

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45
Q

What are the beaks like on a lower molar forcep?

A

two pointed beaks to engage the mesial and distal roots’ furcation

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46
Q

What are lower roots forceps used for and how do they differ from lower universal forceps?

A

Retained roots
like the universals but narrower beaks to engage narrower part of root

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47
Q

What are the beaks like on a lower universal forcep?

A

simple beaks to engage all single and multi-rooted teeth

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48
Q

What are the beaks of the upper universal forceps like?

A

simple beaks

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49
Q

What are the beaks of the upper molar forceps like?

A

pointed beak on buccal
rounded beak on palatal

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50
Q

Where do cowhorn forceps engage with the tooth?

A

designed to slide into the furcation between the MB and MD root and the unusually placed beak is designed to engage the palatal root

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51
Q

Do you require a left cowhorn and right cowhorn or does one do both sides?

A

require LHS and RHS

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52
Q

When doing a palatal infiltration, how far away from the free gingival margin should the needle be inserted?

A

10mm from the free gingival margin

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53
Q

When carrying out an IANB, what three structures make the ‘triangle’ landmark?

A

thumbnail, palato-glossal fold and maxillary tuberosity

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54
Q

Where is the barrel of the syringe placed during an IANB?

A

Over the lower premolars on the opposite side of the mouth parallel to the FOM

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55
Q

Following IANB, if the needle is withdrawn halfway and more LA inserted, what nerve will you anaesthetise?

A

lingual nerve

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56
Q

What does SBAR stand for?

A

Situation, background, assessment, recommendation

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57
Q

Where should extracted teeth containing amalgam be placed vs non-amalgam containing teeth?

A

amalgam - tooth box tub
no amalgam - sharps bucket

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58
Q

What are the five phases involved in bone remodelling?

A

1)activation
2)osteoclast recruitment and resorption
3)reversal
4)osteoblast recruitment and bone formation
5)termination - quiescence

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59
Q

What is osteogenesis imperfecta?

A

Genetic bone disorder present at birth. Known as brittle bone disease. A child with OI may have soft bones that fracture easily, bones that are not formed normally, and other problems

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60
Q

What is osteopetrosis?

A

rare disorder that causes bones to grow abnormally and become overly dense. They are brittle and can fracture (break) easily. Bones may be misshapen and large

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61
Q

What is osteoporosis?

A

condition that weakens bones, making them fragile and more likely to break.

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62
Q

What is glucocorticoid-induced osteoporosis?

A

glucocorticoids accelerate resorption while inhibiting formation, their use is associated with early rapid bone loss

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63
Q

What is hyperparathyroidism?

A

an abnormally high concentration of parathyroid hormone in the blood, resulting in weakening of the bones through loss of calcium

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64
Q

What is Pagets disease?

A

Disease which disrupts the normal cycle of bone renewal, causing bones to become weakened and possibly deformed

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65
Q

What is fibrous dysplasia?

A

chronic disorder in which scar-like tissue grows in place of normal bone

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66
Q

How long does the bone remodelling phase take?

A

6 months

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67
Q

Name four types of drugs which affect bone remodelling

A

1) Bisphosphonates
2) Denosumab and anti-angiogenic drugs
3) steroids
4) NSAIDs

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68
Q

What are bisphosphonates?

A

non-metabolised analogues of pyrophosphate capable of localising to bone and inhibiting osteoclastic function

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69
Q

Where/what do bisphosphonates bind avidly to?

A

exposed bone mineral around resorbing osteoclasts so there are high levels of bisphosphonates in resorption lacunae

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70
Q

Why are bisphosphonates found in high concentrations in bone for such a long time?

A

They are not metabolised

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71
Q

What is the half life of bisphosphonates?

A

10 years

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72
Q

Are bisphosphonates anti-angiogenic?

A

Yes

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73
Q

What are the two classes of bisphosphonates?

A

Nitrogen containing
Non-nitrogen containing

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74
Q

How do nitrogen containing bisphosphonates work?

A

resemble pyrophosphate allowing them to be incorporated into phosphate chain of adenosine triphosphate (ATP) making it unusable for energy production in osteoclasts

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75
Q

Name an example of a nitrogen containing bisphosphonate

A

Clodronate

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76
Q

How do non-nitrogen containing bisphosphonates work?

A

prevent formation of key isoprenoid lipids in osteoclasts which anchor proteins to cell membrane and without these cell death occurs

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77
Q

Name 4 conditions treated with bisphosphonates

A

Osteoporosis
Multiple myeloma
Breast cancer
Prostate cancer

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78
Q

In the SDCEP guidelines, what bisphosphonate patients are considered low risk?

A

not yet started taking them
taking bisphosphonates for prevention or management of osteoporosis

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79
Q

In the SDCEP guidelines, what bisphosphonate patients are considered high risk?

A

previous diagnosis of MRONJ
taking as management of malignant condition
other non-malignant condition of the bone
under care of specialist for rare condition
concurrent use of systemic corticosteroids or other immunosuppressants
coagulotherapy, chemotherapy, radiotherapy

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80
Q

What treatment are you permitted to carry out in a low risk patient?

A

if unavoidable, atraumatic extractions - avoid raising flaps and achieve good haemostasis
review at 4 weeks
if not healing at 4-6 refer to maxfax

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81
Q

When should you review a low risk patient following atraumatic extraction?

A

4 weeks

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82
Q

What are the 3 criteria for MRONJ?

A

1) current or previous treatment with bisphosphonates, antiangiogenics or RANKL inhibitors
2) exposed bone in maxfax region or bone that can be probed that has persisted more than 8 weeks
3) no history of radiation therapy to jaws

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83
Q

What are the signs and symptoms of MRONJ?

A

Areas of exposed necrotic bone
internal or external discharging fistulas
pain or painless
loose or mobile teeth
bony sequestrae
paraesthesia
mandibular preference 60-70%

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84
Q

What is denosumab?

A

human monoclonal antibody that inhibits osteoclastic function

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85
Q

How quickly is osteoclastic function inhibited once denosumab has been administered and when does function return?

A

inhibited within 6 hours of SC injection and returns 6 months later

86
Q

How does denosumab work?

A

Inhibits receptor activator of nuclear factor kappa B ligand (RANKL) which is a protein which acts as the primary signal for bone removal

87
Q

Which drugs affect absorption of calcium from the stomach?

A

anti-seizure drugs eg. carbamazepine, phenytoin and long term proton pump inhibitors

88
Q

What drugs can increase renal excretion of calcium?

A

Diurectics

89
Q

What drugs can decrease androgen and oestrogen levels?

A

Drugs used in treatment of breast and prostate cancer

90
Q

Why do steroids delay healing?

A

due to their anti-inflammatory action and their inhibition of fibroblastic proliferation, collagen synthesis and epithelialisation

91
Q

How do NSAIDs interfere with the production of certain types of prostaglandins?

A

They interfere with the activity of COX enzymes to inhibit production of prostaglandins

92
Q

How can ethnic background impact the difficulty of extraction?

A

Different bone densities
afro caribbean/asian patients = dense bone

93
Q

How can a lone standing molar be difficult to extract?

A

Thickening of PDL and surrounding alveolar bone due to heavy occlusal loading

94
Q

What is impaction?

A

when the tooth is prevented from achieving a functional occlusal position

95
Q

What are the four most commonly impacted teeth?

A

Mandibular third molars
Maxillary canines
Maxillary incisors
Second premolars

96
Q

What is an operculum?

A

piece of gum lying over biting surface of a tooth

97
Q

How can crowding impact extraction?

A

prevents access for the beaks of the forceps

98
Q

Which teeth are most greatly impacted by crowding?

A

The teeth that erupt later

99
Q

What is the main difficulty when extracting maxillary third molars?

A

access - diffuicult as mouth opening brings coronoid process into space lateral to maxillary third molar. can also be buccally inclined

100
Q

What is pneumatisation of the maxillary antrum?

A

When the antrum erodes into the space where adjacent teeth may have been

101
Q

How can abrasion impact extraction?

A

crown is predisposed to fracture so beaks of forceps must be firmly on root of tooth or else fracture can occur

102
Q

Why can endodontically treated teeth be an issue upon extraction?

A

they are brittle and likely to fracture easily

103
Q

At what stage is surgery indicated rather than extraction with forceps?

A

If a root is fractured below the level of the alveolus

104
Q

What reasons would unerupted impacted teeth be removed?

A

orthodontic reasons
restorative/aesthetic reasons
pathology eg. cysts

105
Q

What are submerged teeth?

A

one that is depressed below the occlusal plane. Often when there is no permanent successor, dental ankylosis is thought to be a major cause, requires surgery.

106
Q

What is dental ankylosis?

A

tooth fuses to the surrounding bone and slowly begins to sink or submerge into the nearby gum tissue

107
Q

What are some radiographic features of difficulty upon extraction?

A

Bulbous roots
dilacerated/divergent/convergent roots
fused roots
multi-rooted teeth
hypercementosis
ankylosis
lone standing molars
deeply impacted third molars

108
Q

How are teeth with bulbous roots removed?

A

surgery

109
Q

What are convergent roots?

A

roots which curve together

110
Q

What are divergent roots?

A

more in different directions

111
Q

What is a dilacerated tooth?

A

abnormal bend in the root or crown of a tooth

112
Q

Which teeth commonly have very divergent roots and why?

A

deciduous molars as successor sits between them

113
Q

Curvature of roots can indicate a close relationship to what in the mandible?

A

Inferior dental canal

114
Q

What is hypercementosis?

A

excessive deposition of cementum on the tooth roots

115
Q

What is cemeto-osseous dysplasia?

A

replacement of normal bone by fibrous tissue and subsequently followed by its calcification with osseous and cementum-like material

116
Q

What are osteolytic lesions?

A

areas of damaged bone that most often occur in people with certain cancers, such as multiple myeloma and breast cancer - cause destruction of bone

117
Q

What is osteomyelitis?

A

inflammation of bone or bone marrow, usually due to infection.

118
Q

What should you never use to section roots before extraction and why?

A

a high speed handpiece - causes surgical emphysema and introduces air into tissue and can lead to cellulitis

119
Q

Name six forms of odontogenic infection

A

1) Periodontitis
2) caries
3) periapical periodontitis
4) pericoronitis
5) osteomyelitis
6) maxillary sinusitis

120
Q

What is the sequelae of infection dependent on?

A

1) virulence of organism
2) host resistance
3) local anatomy
4) treatment of infection

121
Q

Why are antibiotics not helpful for targeting infections of the non-vital tooth?

A

non-vital teeth do not have a vascular supply, therefore the antibiotics cannot reach the site where the vast majority of the bacteria are

122
Q

What will antibiotics do for a non-vital tooth?

A

kill bacteria in PDL and surrounding tissues so may relieve symptoms but will not kill the source of infection

123
Q

What is cellulitis?

A

diffuse inflammation of the soft tissues which is not circumscribed or confined to one area but tends to spread through tissue spaces along fascial planes

124
Q

How does vasodilation assist spread of cellulitis?

A

opens up tissue spaces/fascial planes, aiding potential spread of infection

125
Q

What is Ludwig’s angina?

A

rare but serious bacterial skin infection that affects mouth, neck and jaw. Considered type of cellulitis which spreads quickly to infect soft tissues under tongue

126
Q

Where are the cavernous sinuses?

A

located under the brain behind each eye socket

127
Q

Which major blood vessel passes through the cavernous sinuses taking blood away from the brain?

A

Jugular vein

128
Q

What is a cavernous sinus thrombosis?

A

a blood clot in the cavernous sinuses. Forms when there is infection in the face or skull which spreads to the sinus to prevent further spread, however, the clot also restricts blood flow from brain possibly damaging brain, eyes and nerves.

129
Q

What is sepsis?

A

life-threatening organ dysfunction caused by a dysregulated host response to infection

130
Q

What are some signs of sepsis?

A

slurred speech
extreme shivering
passed no urine in a day
severe breathlessness
illness so bad feel as if they are dying
skin mottled/discoloured/ashen
rash does not blanch with pressure
cyanosis of lips/tongue/skin

131
Q

What is cyanosis?

A

Blue skin or lips (cyanosis) happens when there’s not enough oxygen in your blood, or you have poor blood circulation

132
Q

What body temperature can be indicative of sepsis?

A

above 38 or below 36 degrees

133
Q

What heart rate can be indicative of sepsis?

A

above 90 bpm, high risk over 130bpm

134
Q

What respiratory rate can be indicative of sepsis?

A

more than 20 breaths/min, high risk over 25

135
Q

What white cell count can be indicative of sepsis?

A

more than 12 or less than 4

136
Q

What systolic blood pressure can be indicative of sepsis?

A

less than 100mmHg, high risk less than 90mmHg

137
Q

What is the spread of odontogenic infection dependent on?

A

positioning of apex in relation to buccal, palatal or lingual shelf and also in relation to the muscle attachment

138
Q

What is mediastinitis?

A

inflammation of the chest area between the lungs (mediastinum).

139
Q

In the mandible, spread of infection into which area can cause asphyxia?

A

laryngeal inlet

140
Q

From the spread of odontogenic infection to the laryngeal inlet, where can the infection continue to and what can it cause?

A

potential spread to pre-tracheal fascia or pre-vertebral fascia or the retropharyngeal space which lead to the chest/mediastinum, causing mediastinitis which can be fatal

141
Q

Which tissue spaces are involved in Ludwig’s angina?

A

bilateral involvement of submandibular, submental, sublingual and parapharyngeal and retropharyngeal spaces such that glottal oedema forms

142
Q

What is glottal oedema and what can it lead to?

A

abnormal accumulation of fluid in tissues involving the supraglottic and subglottic region where laryngeal mucosa is loose. Can lead to asphyxiation

143
Q

What is asphyxiation?

A

the state or process of being deprived of oxygen, which can result in unconsciousness or death; suffocation

144
Q

How does cavernous sinus thrombosis manifest? (symptoms)

A

difficulty moving the eyes, build up of pressure behind the eye, proptosis of eye, eyeball pushed forward

145
Q

Cavernous sinus thrombosis has a potentially fatal outcome in how many patients?

A

2/3

146
Q

How is sepsis managed?

A

Blood cultures taken ideally before ABX
serum lactate level taken - over 2 in sepsis
give oxygen
give empirical IV ABX
give IV fluids
monitor urine output

147
Q

What are the four main principles of management of odontogenic infection?

A

1) eliminate cause of infection ASAP
2) Provide a path of least resistance
3) Symptomatic management
4) Review

148
Q

After a sepsis diagnosis and management, how soon after should a patient be reviewed?

A

48-72hrs later

149
Q

What does the presence of a sinus indicate?

A

The presence of chronic, long standing infection

150
Q

Where are sinuses often found intra-orally?

A

at the junction between attached gingivae and reflective mucosa

151
Q

How are sinuses formed in the mouth and where do they come from and go to?

A

pus is allowed to tract through alveolus and erupt through overlying mucosa creating a communication between apex of tooth and oral cavity for pus to discharge.

152
Q

What is a sinus tract lined with?

A

granulation tissue

153
Q

What is a fistula?

A

epithelial lined tract connecting two body cavities

154
Q

When does a sinus become a fistula?

A

When the granulation tissue of a sinus (non-epithelialised), becomes epithelialised

155
Q

What is an orocutaneous fistula?

A

when puss tracts extra-orally through the skin

156
Q

What is the treatment of an orocutaneous fistula?

A

extirpation of pulp or extraction of tooth as well as excising fistula. As it is epithelialised it will not spontaneously close on removal of infection source

157
Q

How does a buccal space infection occur?

A

erosion of bone caused by build up of pus above muscle attachment to buccinator

158
Q

Which teeth are most commonly associated with a buccal space infection?

A

Maxillary molars

159
Q

Clinically, how will a buccal space infection present?

A

a swelling of cheek below the zygomatic arch

160
Q

Why is a peri-orbital swelling particularly concerning?

A

proximity and potential spread to the cavernous sinus

161
Q

How does an infection of the canine space present clinically?

A

infra-orbital swelling
obliteration of naso-labial fold

162
Q

How does the canine space become infected given the muscle between it and the oral cavity?

A

canine root long enough to pass muscles of facial expression

163
Q

What tooth is normally associated with infection of the infratemporal space?

A

usually upper 8

164
Q

How does infection of the infratemporal space present clinically?

A

severe trismus
bulging of temporalis
cavernous sinus thrombosis

165
Q

Which major vessel passes through the cavernous sinus?

A

internal carotid artery

166
Q

Which cranial nerves pass through the cavernous sinus?

A

abducent nerve
oculomotor nerve
trochlear nerve
trigeminal div I and II

167
Q

Which teeth are usually linked to infection of the submandibular or sublingual space?

A

usually lower molars

168
Q

What determines whether a tooth infects the SM space instead of the SL space?

A

long roots - SM space (under mylohyoid attachment)
short roots - SL space

169
Q

How does an infection of the submandibular space present?

A

firm swelling in the SM region
trismus

170
Q

How does an infection of the sublingual space present?

A

little extra-orally
intra-oral swelling of FOM

171
Q

Which teeth are usually responsible for infection of the submental space?

A

usually lower incisors

172
Q

How does infection of the submental space present clinically?

A

firm swelling under chin
discomfort on swallowing

173
Q

What are the three cervical fascial spaces?

A

1) Retropharyngeal space
2) prevertebral space
3) lateral pharyngeal space

174
Q

What is the prevertebral space in relation to the diaphragm?

A

the inferior border of the diaphragm

175
Q

Why do infected areas often have a poor blood supply?

A

as a collection of pus grows it compresses the adjacent tissues as well as their blood vessels

176
Q

Due to the poor blood supply to abscesses, what is the appropriate treatment for an abscess?

A

Drainage and removal of cause

177
Q

What does drainage through a tooth involve?

A

opening an access cavity to provide a path of least resistance then placing a temp filling following drainage

178
Q

When there is pus present in soft tissues, can you just carry out RCT or extraction alone?

A

No

179
Q

When excising an abscess, where should it be done and what steps follow?

A

find most gravitationally dependent point of access
incise through mucosa and periosteum using No. 11 blade
avoid vital structures
blunt dissection to remove locules of pus

180
Q

What results in more scarring - extra-oral excision or pus tract?

A

Pus tract

181
Q

What instrument is used for blunt dissection and how is it used?

A

Spencer-wells artery forcep or Mackindoe scissors
Open and close instrument to crush locules and break fibrous strands supporting them to release and drain the pus

182
Q

What is routinely done with discharging pus?

A

undertake culture and sensitivity using microbiology swab or syringe. (syringe exposes to air which can kill anaerobic bacteria)

183
Q

Which analgesics can be prescribed following drainage and excision and what are their functions?

A

Paracetamol - lowers temperature
ibuprofen - anti-inflammatory
co-codamol - pain relief
dihydrocodeine - not as effective for dental pain

184
Q

When would an antibiotic be indicated when there is an abscess?

A

systemic involvement
significant cellulitis
compromised host defences
involvement of fascial planes

185
Q

What is the antibiotic of choice for abscesses and why?

A

most abscesses are anaerobic - metronidazole drug of choice

186
Q

In severe infections, which two antibiotics can be combined?

A

Metronidazole and Penicillin V

187
Q

When should an abscess patient be referred? 8 reasons

A

rapidly progressing infection
difficulty swallowing
temp over 39
compromised host defences
difficulty breathing
involvement of fascial spaces
severe trismus
infection not responding to treatment

188
Q

Which three sites of drainage can be anaesthetised using LA?

A

Buccal/labial sulcus
palate - parallel to vessels
SL space - buccal and parallel to sublingual fold

189
Q

Which six sites of drainage should general anaesthetic be used with?

A

1) submasseteric
2) pterygomandibular
3) infratemporal
4) parapharyngeal
5) submental
6) submandibular

190
Q

How does Ludwig’s angina present?

A

rapid, board-like swelling of FOM, elevation of tongue, dysphagia, dysarthia, trismus
glottal oedema - suffocation
mediastinitus

191
Q

What is dysphagia?

A

difficulty swallowing

192
Q

What is dysarthia?

A

difficulty speaking

193
Q

What is the priority when managing a patient with Ludwig’s angina?

A

stabilising airway

194
Q

What are the symptoms of CNS LA toxicity at a low dose?

A

excitatory at low doses - agitation, confusion, dizziness, dysphoria, auditory changes, tinnitus, perioral numbness, metallic taste, and dysarthria

195
Q

What are the symptoms of CNS LA toxicity at higher doses?

A

depressant - Perioral tingling, drowsiness, unconsciousness, respiratory arrest

196
Q

Name the two phases of CNS LA toxicity

A

excitation and depression

197
Q

Which system is most resistant to LA toxicity - CNS or CVS?

A

CVS more resistant

198
Q

Explain the biphasic presentation of CVS LA toxicity

A

Early cardio-excitatory effects such as tachycardia and increasing blood pressure are followed quickly by hypotension that is unresponsive to resuscitation leading to cardiovascular collapse and death

199
Q

Is LA cardiac arrest responsive to resuscitation?

A

No

200
Q

What can we do to avoid LA toxicity?

A

slow injection
aspirate
limit dose

201
Q

What is the treatment for LA toxicity?

A

STOP
BLS
call for help
monitor patient
Treatment is lipid emulsion therapy

202
Q

When assessing the degree of difficulty of extraction, which of the following clinical features is not considered a feature that increases the degree difficulty?
a. crowding
b. a lone standing maxillary molar in occlusion
c. a partially erupted impacted third molar
d. erosion/abrasion cavities
e. furcation involvement

A

E

203
Q

When assessing the degree of difficulty of extraction, which of the following radiographic features is not considered a feature that increases the degree difficulty?
a. bulbous roots
b. divergent roots on a multi-rooted tooth
c. hypercementosis
d. root resorption
e. a dilacerated root

A

D

204
Q

Which teeth can be extracted using upper straight forceps?
a. only maxillary incisors
b. maxillary incisors and canines
c. all single rooted maxillary teeth
d. from the second maxillary premolar forward
e. all maxillary teeth

A

B

205
Q

Which mandibular teeth can be extracted using a rotatory rather than a buccal and back movement?
a. lower first premolar
b. lower first and second premolars
c. lower incisors
d. lower canines
e. lower first molars

A

B

206
Q

Which one of the following drugs does not affect bone remodelling?
a. alendronate
b. prednisolone
d. demosumab
d. diclofenac
e. amoxicillin

A

E

207
Q

Which of the following statements is not true of bisphosphonates?
a. they are non-metabolised analogues of pyrophosphate that are capable of localizing to bone and inhibiting osteoclastic function
b. bind avidly to exposed bone mineral around osteoblasts
c. are not metabolised therefore these high concentrations are maintained within bone for long periods of time
d. are anti-angiogenic
e. there are 2 classes nitrogen and non-nitrogen containing

A

B

208
Q

Which of the following is classified as a high-risk patient for developing MRONJ according to SDCEP guidelines?
a. a patient with a previous diagnosis of MRONJ
b. a patient taking subcutaneous bisphosphates once per year
c. a patient taking demosumab injections
d. a patient who has been taking oral bisphosphonates for 2 years
e. a patient who takes oral bisphosphonates and used a steroid based cream as required for eczema

A

A

209
Q

Which of the following is an indicator of sepsis?
a. a respiratory rate of 12 breaths per minutes
b. a systolic BP of 120 mmHg
c. a temperature of > 38oC or < 36oC
d. white blood cell count (WBC) 4.0 - 11.0 x 10*9/L
e. a heart rate of 72 bpm

A

C

210
Q

How would you manage an odontogenic infection with abscess formation as demonstrated by a large swelling in the buccal sulcus with from a lower first molar?
a. prescribe amoxicillin
b. prescribe amoxicillin and metronidazole
c. extraction the lower first molar
d. extripate the pulp for the lower first molar and put in a sedative dressing and incise and drain the buccal swelling
e. incise and drain the buccal swelling

A

D

3rd Year - Module 5 (12 decks)

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