Oral Surgery Flashcards
Indications for tooth extraction?
Caries
Endo:
Perio:
Ortho:
Cracked Teeth
Impacted Teeth
Supernumerary
Pathology:
Questionable Teeth BEFORE Radiation
Contraindications for Tooth Extraction
Poorly Controlled Diabetes
Unstable Angia
ESRD: End Stage Renal Disease
Leukemia
Lymphoma
Hemophelia or Platelet disorder
Hx of Head & Neck Radiation
* HYPERBARIC OXYGEN BEFORE & AFTER EXO
IV Bisphosphonatees
Pericornitis:
* treat infection first
Impacted teeth
Do not erupt when expected
* primary reason=inadequate arch length
What are the most common teeth likely to be impacted?
- Mandibular 3rd Molars
- Maxillary 3rd Molars
- Maxillary Canines
Congenitally missing teeth
- Teeth that don’t form
What are the teeth that are most likely to be congenitally missing?
- 3rd molars
- Mandibular 2nd premolar
- Maxillary Laterals
- Maxillary 2nd premolars
What are the different classification systems for impacted teeth?
- Nature of overlying tissue
- Winter’s Classification
- Pell & Gregory Classification
Nature of Overlying tissue Classification
Soft tissue Impaction:
* HOC above bone level
* gingiva is completely or partially covering tooth
* Easiest
Hard tissue impaction:
1. Partial bony: HOC below bone level
2. Complete Bony: Tooth entirely surrounded by bone. Most DIFFICULT
Impacted Teeth Classification: Winter’s Classification
3rd molars ONLY
* compare long axis of 3rd molar to 2nd molar
Mandibular: (Mama Has Violet Daises):
Mesioangular: Easiest
Horizontal: 2nd easiest
Vertical: 2nd Hardest
Diatoangular: Most Difficult
Pell and Gregory Classification
lower 3rd molars ONLY
Class A: same plane as other molars
Class B: Halfway down other molars
Class C: Below cervical line (CEJ) of 2nd molar
* MOST DIFFICULT
Class I: crown anterior to ramus
Class II: 1/2 crown in ramus
Class III: Entire crown in ramus
* MOST DIFFICULT
Subperiosteal Abscess
Extraction Complication
* infection under periosteum layer
* small pieces of bone or tooth left under a flap
* irrigate thoroughly to avoid
Can happen whenever you elevate a flap
Oro-Antral Communication (OAC)
Aka Sinus Exposure
* communication b/w oral cavity & antrum (Sinus)
What tooth is most commonly associated with an Oro-antral Communication?
Maxillary 1st molar (palatal root)
Oro-Antral Communication: Tx
< 2mm : Do nothing, Sinus Precautions
2-6 mm: 4A’s and Figure 8 suture
* Antibiotics
* Analgesics
* Antihistamines
* Afrin Nasal Spray 2x per day
> 6 mm: Flap Surgery
How do you prevent an Oroantral Communication (OAC)
Good pre-op radiograph: shows level of sinus
* Avoid excessive apical pressure
Alveolar Osteoitis
AKA Dry Socket
* blood clot dislodges or dissolves before wound heals after extraction
* NOT AN INFECTION, NO ANTIBIOTICS REQUIRED
Alveolar Osteitis: Tx
Irrigate & Local pain control
* PACK ALVEOGEL
* EUGENOL HELPS W/PAIN
Nerve Injury
Most common w/Lower 3rd Molars
* close to IAN Nerve
Tx:
*Medrol Dosepak=Steroid to decrease inflammation
* numbness > 4 weeks, refer for microneurosurgeon eval
Tooth Displacement
- maxillary 1st/2nd molar: Maxillary Sinus
- Maxillary 3rd molar: Infratemporal fossa
- Mandibular 3rd molar: Submandibular space
- Oropharynx=Send to ER for chest & abdominal x-ray
Complications of tooth extraction
- Subperiosteal abscess
- Oro-antral communication
- Alveolar Osteitis
- Nerve Injury
- Tooth Displacement
Bite Block
Better visualization
Stabilizes mandible (good for TMJ)
Suction Tips
Yankaur Suction: soft tissue
Frazier Suction: hard and soft tissue
* Cover hole=hard tissue, more suction
* Uncover: Soft tissue, weaker suction
Towel Clip
holds drapes placed around patient
* Locking handle w/finger & thumb rings
* be careful not to pinch patient’s skin
Austin Tissue Retractor
Austin:
* Right angle
* small flaps
Weider Tissue Retractor
AKa Sweet Heart
Broad heart shaped
* protect and retract tongue
Mandibular lingual surgery
Minnesota Tissue Retractor
offset curved and broad
* Cheek/flap reflection
Seldin Tissue Retractor
Long and flat
elevate down to floor of mouth
* mandibular tori removal
Periosteal Elevators
Woodson periosteal: Small & Delicate
#9 Molt periosteal: Larger elevator
Straight Elevator
aka #301
* most commonly used
Lever
Blade: concave surface towrads tooth to be elevated
Triangular Elevator
aka Cryer
* second most common
Wheel and Axle
Remove broken root left in socket
Pick Elevator
remove retained or broken root
Wedge
Crane Pick
* heavy version
Root Tip Pick
* delicate version
150 Forceps
Upper universal
* A=premolars
* S=primary teeth
151 Forceps
Lower universal
A=premolar
S=primary
23 Forceps
Cowhorn
* lower molars
* beak engages bifurcation
88R/L Forceps
Upper Cowhorn
* 2 beaks: palatal root
* 1 beak: buccal bifurcation
74 Forceps
Ash
* mandibular premolars
65 Forceps
Upper Root forceps
15 blade
most common for intraoral sx
11 Blade
Stab Incisions
10 Blade
Large Skin incisions
12 Blade
Mucogingival surgery
* curved shape: improved access to sulcus
Curved shape
* easier to access sulcus
Irrigation
steady stream of sterile water/water during bone removal
* prevents heat generation (May devitalize bone)
* increases bur efficiency
Curettes
Spoon shaped end-scrape away soft tissue
always curette a socket
Rongeurs
double spring pliers
Trim interradicular bone
Curuttes promote better
Promotes better:
* clotting
* healing
* bony infill of socket
Osteotome
Aka Bone Chisel
Flat End
* tapped w/surgical mallet
Monobevel: Remove torus
Bibevel: Section teeth
Bone File
Final Smoothing before suturing
Pull stroke
Surgical Handpieces
Do NOT use air-driven handpiece
* leads to air emphysema
Straight fissure burs:
* section teeth
Round Burs:
* Remove bone
Hemostat
Hemostasis
* clamp blood vessels closed before suturing or cauterizing
Useful for blunt dissection of soft tissue
* I&D
Curved or straight beaks
Serrated End=Grasp Tissue
Needle Holder
Short Stout Beak: (compared to hemostat)
* Face of beak=crosshatched-better grasp of needle
Suture
Primary purpose: Immobilize flap
Place from movable tissue (Flap) to non-movable tissue
Adson tissue forceps
Toothed:
* periosteum
* muscle
* aponeurosis
Non-Toothed:
* fascia
* mucosa
* pathological tissue for biopsy
Utility forceps
Pick up items from tray or prepare packing materials
* NOT for soft tissue handling
Dean Scissors
Cut Sutures
Blade angles up: easier access to suture thread
Mayo Scissors
cut fascia & dissecting soft tissue
What are the preparatory steps for extraction?
- Remove entire correct tooth
- Check tooth condition
- Check Radiograph (PAN or PA)
- Informed Consent
- Comfortable positioning
- Profound anesthesia
- Throat Screen
Simple vs Surgical Extraction
Simple:
* no incisions or sutures
Surgical:
* surgical access w/ mucoperiosteal flap
* use Surgical handpiece
* suture needed
Steps involved in Simple extractioin
- Sever soft tissue attachment
- Luxate tooth with elevator
- Deliver tooth w/forceps
- Post ext:
Simple Extraction: Sever Soft Tissue Attachment
Use periostea Elevator:
* loosen gingival fibers & PDL attached to tooth
* confirms good anesthesia
allows apical placement of forceps
Simple Extraction: Luxate tooth with elevator
Face of blade:
* against tooth your extracting
Back of Blade:
* against alveolar crest
Find a purchase point
Lever
* fulcrum=alveolar bone
* not 100% on adjacent tooth
* = EXPANSION OF BONE & TEAR PDL
Simple Extractoin: Deliver Tooth with Forceps
Slow and deliberate force
* tooth should first be moved then removed
Motions:
Outward (Buccal/Labial):
* initial movement for most permanent teeth
Inward (Lingual/palatal):
* initial movement of most primary teeth
Rotary:
* initial movement in conical-rooted teeth
Apical:
* Always used
* avoid excessive pressure in maxillary molars
UPPER 1st Premolar
CAUTION W?DEEP BIFURCATION
NO Rotation
UPPER Molars:
* Favor buccal pressure (palatal may push palatal root into sinus)
Simple Extraction: Post-Ext
Bend B-L Plates back in place
* unless ortho and implants are planned in future
CSI:
* Curettage
* Smooth bone w/bone file or rongeur
* Irrigate w/syringe
General Rules for Flap Design
Wider base
Incisions over intact bone
* NOT bony defects or eminences
Rounded Corners
Vertical Releases at Line angles
Avoid vital structures
Post-op plaque control=most important procedure after perio sx
Types of Full Thickness Flaps
aka Mucoperiosteal Flaps
envelope:
* 0 vertical releases
* 2 teeth Anterior, 1 Posterior
3-cornered:
* 1 vertical release
* 1 tooth anterior, 1 tooth posterior
Trapezoidal:
* 2 vertical releases
* 1 tooth anterior, 1 tooth Posterior
Semilunar Incision
Type of flap
Apical to mucogingival junction
* apicoectomy (endo sx)
* NOT on maxilla palate
Double Y Incision
Type of Flap
Incision down Palatal midline
* 2 vertical releases at each end (Double Y)
* palatal torus removal
Factors for Prediciting Difficult Extractions
- Divergent Roots
- Root Dilacerations
- Endo treated tooth
- Root Resorption
- Long Roots
- Dense Bone
- Root Fracture
- Proximity to floor of sinus/IAN
- Limited opening
- Bruxism
- Exostoses or tori
- Gross caries
- Severe crowding
What can surgical handpieces be used for?
remove buccal bone
* create ditch/trough=purchase point & path for delivery
* Careful if implant is planned
remove interradicular bone
* moves center of resistance apically
* careful if implant is planned
section tooth
1&2 create space for a purchase point
Single Interuppted suture
Aka simple loop
* easiest
* most common technique
Silk Sutures
- wicking property- allows bacteria to invade
- multifilament
Mandibular Fractures
Best Eval with PANs
Condylar Fractures> Angle>Symphysis> Body>Alveolus>Ramus>Coronoid
Condylar Fracture: contralateral side of blow
Angle/gonial fracture: Ipsilateral side of blow
Ideal Tx: Open Reduction & Internal Fixation (ORIF)
Types of Mandibular Fractures
Greenstick: not all the way throgh
Comminuted: Crushed into multiple fragments
Simple: Closed to oral cavity
Compound: Open to oral cavity, bone exposed through mucosa
Midface Fractures
Best Eval with CBCT
LeFort I: Horizontal across maxilla
LeFort II: Pyramidal
* involves medial Orvit & Nasal Bone
LeFort III: Copmlete cranial fracture dysfunction
Zygomaticomaxillary complex fracture
* caused by direct blow to malar eminence (Cheekbone)
* Bleeding under conjuctiva (eye)
Trauma Surgery
Reduction: Fracture fragments returned to normal position
* Open Reduction: Dissect tissue to Surgically expose fragments
* Closed Reduction: Manipulate fragments w/o surgical exposure
Fixation: Hold bone together for healing
* Internal Fixatoin: use titanium plates & screws to hold bone together
* Intermaxillary Fixation (IMF): wire the jaws closed; arch bars and elastics
How are mandibular fractures ideally treated?
Open Reduction and interal fixation (ORIF)
* use occlusion to hold the jaw in place
* occlusal splints: 4-6 weeks
Retrognathic Mandible
Class II
Orthognathic Surgery
Correct Severe Skeletal Discrepancies
* require Lateral Cephs
* CBCT is becoming more common
Use: Acrylic Splint intraoperatively
* Occlusion guides surgical outcome
Le Fort I Surgery/osteotomoy
Move Maxilla
Used for:
* retrusive maxilla
* vertical maxillary excess
BSSO
Bisagittal Split Osteotomy
Move Mandible
Used for:
* retrusive mandible
* protrusive mandible
Most common post-op complication=nerve damage
Distraction Osteogenesis
2 bone surfaces are gradually separated by traction
* then deposit bone b/w them
* Bone Lengthening (not width)
Phase 1: osteotomy
* Split bone in 2 pieces
Phase 2: Latency period
* appliance is mounted to bone
* not activated for 1 week
Phase 3: distraction phase
* activate appliance
* gradually separate the 2 pieces as bone fills in gap
Biopsychosocial Model of Pain
Axis I: Bio
* nociceptive input from somatic tissue
* acute
Axis II: Psychosocial
* influence interaction b/w thalamus, cortex, and limbic
* Chronic (>6 months)
Its not just about the tooth (axis I), but also the person w/the tooth (axis II)
Pain Pathway
1.Transduction: Pain info tavels from PNS to CNS
2.Transmission: Pain info travels from CNS to thalamus and higher cortical centers
3.Modulation: limit flow of pain info
4.Perception: human experience of pain= 1+ 2 + 3+ psychological factors of higher thought and emotion
Somatic Pain
Increased Stimulus=Increased Pain
* typical dental pain
* Depends on Magnitude of stimulus
Musculoskeletal:
* TMJ
* Periodontal
* Muscles (Myofascial)
Visceral:
* Salivary glands
* pulpal
Neuropathic Pain
Pain independent of stimulus intensity
Damaged pain pathway:
* Trigeminal Neuralgia (TN)
* trauma
* stroke
Trigeminal Neuralgia
Aka Tic Douloureux
Postmenopause women (>50)
Symptoms:
* Trigger Point at specific location
* Electrical, sharp, shooting, and episodic, followed by refractory periods
* Unilateral, affects any of the 3 branches
Tx:
* anticonvulsants (Carbamazepine)
* surgery
Atypical Odontalgia (AO)
Secondary to deafferentation (remove part of nerve pathway)
* result of endo therapy or ext
Localized Phantom Toothache
Postherpectic Neuralgia (PHN)
Sequela of herpes zoster infection
Symptoms:
Burning, aching, shock-like
Tx:
* anticonvulsants
* antidepressants
* sympathetic blocks
Burning Mouth Syndrome
Postmenopause women
associated with:
* type 2 diabetes
* malnutrition
* xerostomia
Characteristics:
* Burning pain
* dryness
* altered taste (maybe)
Chronic Headache
aka neurovascular pain
Migraine:
* unilateral
* pulsating
* nausea and vomitting
* photophobia and phonophobia (Decreased ability to withstand sound and light)
* Tx: Tripan (Selective Serotonini Receptor agonist)
Tension Type:
* bilateral
* non-puslating
* not aggravated by routine activity
Cluster:
* intense pain near one eye
Psychogenic Pain
Intrapsychic disturbance
* conversion reaction
* psychotic delusion
* malingering
Atypical Pain
Facial Pain of unknown cause/diagnosis is pending
Indications for tooth extraction?
Caries (Severe)
Endo:
* major trauma–> severe internal root resorption
Perio:
* Severe CAL
* questionable perio prognosis
Ortho:
* severe crowding
Cracked Teeth
* can’t be saved by a crown
Impacted Teeth
Supernumerary
Pathology:
* significant pathology related to tooth
* odontogenic cysts or infections
Radiation Therapy
* Extract all Questionable BEFORE
* avoid risk of ORNJ (Osteoradionecrosis of the Jaw)
Root tip removal options
Root tip pick: Gouge into adjacent bone
Remove facial bone & elevate facially
Make bone windy at apex & push root out
Prognathic Mandible
Class III
Apertognathic
Anterior open bite
Vertical Maxillary Excess
Maxilla too long
* gummy smile
Horizontal Transverse Discrepancy
Posterior Crossbite
Macrogenia
chin too big
Microgenia
chin too small
Orthognathic Surgery
correct severe skeletal discrepancies
Genioplasty
Move Chin
TMJ Anatomy
Conylar Head
Mandibular (Glenoid) Fossa
Articular Eminence
Articular Disc
Lower Joint space (inferior to disc): Rotational Movement
Upper Joint space (Superior to disc): Translation
TMJ Muscles:
fxn: Move the mandible
Opening:
* Lateral Pterygoid
Closing:
* Masseter
* Temporalis
* Medial Pterygoid
TMJ Ligaments
fxn: lmit movement of mandible from overextending
Capsular Ligament: Completely covers the TMJ
Discal/Collateral Ligament: Attaches to medial and lateral poles of condyle
* keeps disc attached during movement
Posterior Ligament:
* articular disc to back of condyle
* Prevents anterior disc displacement
Lateral Ligament:
* Disc–>wraps around condyle
* prevents posterior displacement
TMJ: Blood Supply
MADS
Maxillary Artery
Ascending Pharyngeal
Deep Auricular
Superficial Temporal
TMJ: Disc Displacement
Aka Internal Derangement
With Reduction:
* Clicking
W/o Reduction:
* Locked
* Condyle stuck behind the disk=decreased ROM w/ipsilateral deviation on opening
TMJ Opening Patterns:
Deflection:
* Deflects towards the side that is stuck at max opening
* **Condyle only rotates, No translation
Deviation
* Deviates toward 1 side & returns back to midline at max opening
Recurrent Dislocation
Move Jaw Down and Back to get over the hump of the eminence
Tx: Botox Injection of lateral pterygoid
* If chronic=surgery
TMJ Ankylosis
Fusion b/w condyle & skull
* severely restricted ROM
Most common cause= TRAUMA
Myofascial Pain Syndrome (MPS)
Chronic Muscular Pain Disorder:
* Somatic pain
* Diffuse pain in pre auricular area
* most common cause of masticatory pain
* Trigger points in muscles of mastication
Tx: Physical Therapy
* Stress management
* Splint therapy
* Medications
TMJ: Non-surgical Tx Options
Counseling:
* Address parafunctional habits
Medical Therapy:
* NSAIDs, Steroids, Analgesics, Antidepressants, Muscle relaxants
Physical Therapy:
* Transcutaneous electrical nerve stims, massage, thermal tx, exercise
Occlusion:
* Splint therapy to Decrease intra-articular pressure
Arthocentesis:
* 2 needles flush out superior joint space
TMJ: Surgical Tx Options
Arthroscopy:
* 2 cannulas + instrumentation w/in superior joint space
Arthroplasty:
* Disc surgically repositioned
* indicated if persistent painful clicking or closed lock
Discectomy:
* Disc/removal if it is severely damaged
Condylotomy:
* Vertical ramus osteotomy: Bone is not fixated
* allows soft tissue to reposition the condyle where they are happiest
Total Joint Replacement:
* only for severe pathologic joints
* Osteoporosis or Rheumatoid Arthritis
Be careful of Facial Nerve For any of these surgeries
When is a biopsy indicated?
after 2 weeks observation of Red or White Lesion
Biopsy Types
- Cytology (Brush Biopsy)
- Fine Needle Aspiration
- Incisional
- Excisional
Cytology
Aka Brush Biopsy
Scrape the lesion w/kit brush or tongue depressor
* smear cells on glass slide
* immediately fixed
Cytology: Indications
Monitoring large tissue areas for dysplastic changes
Cytology: Pros vs Cons
Many false positives
Fine Needle Aspiration
Use needle + Syringe to suck up lesion contents
* fluid expelled onto slide & fixed
Fine Needle Aspiration: Indications
Fluid Filled Lesion
Find out type of fluid
*rule out vascular lesions before cutting into them
Explore intraosseous lesions
Fine Need Aspiration: Pros vs Cons
Pros:
* Good at differentiating Benign vs Malignant
Incisional Biopsy
Deep Narrow Wedge Cut
Incisional Biopsy: Indications
Large Lesions (>1 cm diameter)
Malignant Suspicion
Excisional Biopsy
Complete excision of lesion
* 2-3 mm margin
* Elliptical incision used (Easier to close)
Excisional Biopsy: Indications
Small Lesions (**<1 cm diameter)
Benign Suspicion
Biopsy Techniques
- Form a Ddx List: Help determine type of biopsy indicated
- Identify lesion margin w/indelible ink marker
- use Block Anesthesia when you can– Local Infiltration can distort lesion architecture
- Dont handle tissue directly (Crush the cells)– USE TISSUE FORCEPS
- Sample stored in 10% Formalin (H&E Staining) or Michaels Medium (direct immunofluorescence if pemphigoid/Pemphigus is suspected)
What biopsy technique would you use for:
Large white patch on buccal mucosa that wipes off w/guaze and presumed to be candidiasis.
Cytology brush biopsy
What biopsy technique would you use for:
Firm rough 2x3 cm whtie lesion on lateral tongue that does not wipe off with glaze.
Incisional Biopsy
What biopsy technique would you use for:
Denture wearer presents w/red swelling in the buccal vestibule.
No Biopsy
* adjust the denture and f/u in 2 weeks
Surgical Management of Cysts vs Tumors
Cysts:
* Enucleation
* Curettage
* Marsupialization
Tumors:
* Enucleation
* Curettage
* Resection
Enucleation
Surgical Removal of mass w/o cutting into it or rupturing it
Marsupialization:
Cut slit into abscess or cyst
* suture Slit edges- keep it open
* drains freely
Used for:
* cyst close to vital structures
* I&D
Curettage
Removal of tissue by scraping or scooping
* remove granulation/infectious tissue
Resection
Surgical removal of cyst or tumor + Normal tissue around it
Medical Emergencies:
SPORT
Stop treatment
Position Patient
Oxygen*
Reassure (Staff and patient)
Take Vitals
Syncope
Most common emergency in dental chair
Vasovagal syncope:
* Most common form
* related to needle anxiety
Orthostatic hypotension:
* 2nd most common
* BP drops when standing suddenly
Tx: Place in Tredelenburg position (Supine)
* If pregnant: Left lateral decubitus to relieve inferior vena cava
Epinephrine Overdose
=Rapid intravascular injection
* Always aspirate
Signs & Symptoms:
* Increased BP & HR
* Thumping heart palpations
Angina
=Chest pain from coronary arteries
* Not enough blood to heart
* ischemia w/o necrosis
Stable:
* Predictable w/activity and stress
Unstable:
* Spontaneous
* no precipitating factors, at rest
Tx: ONA
* Oxygen
* Nitroglycerin (0.4mg)-> 5 mins-> NTG-> 5 mins-> NTG
* Aspirin (w/3rd dose of NTG + Call 911)
Myocardial Infarction
Aka Heart Attack
=Angina caused by ischemia w/necrosis
* sudden occlusion of major coronary vessel (Offend L Anterior Descending Artery, LAD)
Tx: MONA
* Morphine
* Oxygen
* Nitroglycerin(0.4mg)-> 5 mins-> NTG-> 5 mins-> NTG
* Aspirin (w/3rd dose of NTG + call 911)
Hypoglycemic Emergency
Ensure patient has eaten, and has had adequate insulin
Tx:
* IF conscious: Glucose tab or orange juice
* If Unconscious: IV Dextrose or IM Glucagon
Hyperventilation
Increase O2 Decrease CO2 in blood
Do NOT give O2, it will make it worse
Tx:
* Position patient upright
* Get them to create into a paper bag (They rebreathe their CO2)
Asthma
=Constriction + Inflammation of bronchioles
* wheezing= high pitch on exhale (Cardinal Sign)
* Avoid NSAIDs and Narcotics
Tx:
* 2 puffs of Albutterol:
* relaxes smooth muscle in bronchioles
Airway Obstruction
Tx:
1. Clear the pharynx of any food, vomit, or foreign object
2. Check for breathing (rise and fall of chest, sounds in mouth/nose)
3. Chin tilt –>protrudes tongue and mandible forward
Seizure/Convulsions
Do not restrain, just clear hazards to protect from injury
Tx:
* IV/IM Benzos (Diazepam)
* Grand Mal Seizure: Dilantin/Phenytoin
* Status Epilepticus (>5 mins): Valium/Diazepam
Stroke
TIA: Transient Ischemic Attack
* Mini stroke
* Blood to brain blocked for few mins
CVA: Cerebrovascular accident
* either Thrombotic (Blockage) or Hemorrhagic (Rupture)
Causes:
* Hypoatremia
Signs:
* Facial droop
* arm lift
* slur
Tx: O2 + Call 911 immediately
Anaphylactic Shock
=Severe Allergic Run
Tx: AEIOU
* Albuterol
* Epinephrine (0.3mg 1:1000)
* IM antihistamine
* Oxygen
* U call 911
Anticoagulation: Blood Tests
Check Blood Tests:
CBC: Anemia, Leukopenia, Thrombocytopenia
Bleeding Time: Platelet Fxn
PT:
* Anticoagulants, liver damage, Vit K-> Extrinsic Clotting Pathway
* INR->Warfarin/Coumadin, INR=2-3 Ideally
PTT: Heparin, Renal Dialysis, Hemophilia->Intrinsic Clotting Pathway
What medication can predispose someone to alveolar osteitis?
ORAL CONTRACEPTIVES
Supraperiosteal Flap
Incision in Buccal mucosa from premolar to premolar
* does not include periostium=partial thickness flap
* Vestibuloplasty
Herbal Anticoagulants
- Garlic, Ginger, Ginko, Ginseng
