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BDS Exam style questions > Oral Surgery > Flashcards

Oral Surgery Flashcards

1
Q

What are the signs and symptoms of mandibular fracture?

A

Nerve damage- numbness in lower lip

Step deformity

Bleeding

Asymmetry

Mobile teeth

Lack of function

AOB

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2
Q

What are 2 radiographic views for mandibular fracture?

A

PA mandible

OPT

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3
Q

What factors could cause a fracture to be displaced?

A

ST damage

Force

Opposing occlusion

Direction of fracture line

Presence of other fractures

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4
Q

How are mandibular fractures managed?

A

Undisplaced- Do nothing

Displaced:
Open reduction and internal fixation

Closed reduction with inter maxillary fixation

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5
Q

What are the signs and symptoms of TMD?

A
  • Limited opening
  • Clicking
  • Crepitus
  • Headache
  • Earache
  • Locking of jaw- fixed or patient may be able to manipulate back in (subluxation)
  • Wear facets/micro-cracks
  • Lost fillings
  • Linea Alba on buccal surface- keratin layer (protective)
  • Radiographically Flattening of bones in joint, Widened PDLs (also seen in high fillings)
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6
Q

What muscles do you palpate in a TMD exam?

A

Masseter

Temporalis

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7
Q

What advice can you give for conservative management of TMD?

A

Soft diet

Masticate bilaterally

No wide opening

No chewing gum

Don’t incise foods

Cut food into small pieces

Stop parafunctional habits e.g. nail biting, grinding

Support mouth on opening e.g. yawning

BRAs

Meds- NSAIDs, muscle relaxants, TCAs

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8
Q

How does a bite splint work?

A

Stabilise the occlusion

Improve the function of the masticatory muscles,
-> Decrease abnormal activity

Protect the teeth in cases of tooth grinding

Reduced loading on TMJ

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9
Q

What is athrocentesis?

A

Injecting medicaments (steroids, hyaluronic acid, ringer lactate solution) into joint to improve lubrication and reduce inflammation (flushing effect)

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10
Q

How do you manage bleeding after an extraction that won’t stop?

A

Oxidised cellulose

LA with vasoconstrictor

Suture

Diathermy

Pressure with damp gauze

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11
Q

What are the causes of delayed onset bleeding?

A

Restarting blood thinners

Infection

LA with vasoconstrictor wears off

Loosening of suture

Patient traumatises region with finger, tongue, food

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12
Q

What are conditions associated with congenital bleeding?

A

VWD

Haemophilia A

Haemophilia B

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13
Q

What are the acquired causes of bleeding disorder?

A

Anticoagulants- warfarin

Antiplatelets- aspirin

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14
Q

Patient is on a NOAC when should you check INR?

A
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15
Q

What are 4 criteria for SIRS (systemic inflammatory response syndrome)?

A

Temperature- >38/<36

Raised HR- >90bpm

Raised respiratory rate- >20 breaths per min

WCC- >12000 per ml/ <4000 per ml

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16
Q

How many signs need to be positive to make diagnosis of SIRS?

A

2

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17
Q

Why is written consent gained prior to third molar extraction prior to sedation process?

A

As patient cannot consent while sedated

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18
Q

What drug is most commonly used for IV sedation in the UK? What is the preparation?

A

Midazolam- 5mg/5ml

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19
Q

What are 3 vital signs you monitor- before, during and after sedation?

A

HR

Blood pressure

Oxygen saturation

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20
Q

What drug is used to reverse effect of midazolam?

A

Flumazenil

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21
Q

What advice should you give to patient after IV sedation?

A

Do not drive that day

No signing of legal documents

Don’t go back to work

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22
Q

What are the indication for inhalation sedation?

A

Gagging issues

Mild to moderate anxiety

Needle phobia

Unaccompanied adult

Unpleasant/traumatic procedure

Medical conditions aggravated by stress like asthma

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23
Q

What are the advantages of IS over IV?

A

Rapid onset

Rapid recovery

Flexible duration

No cannulation

Less side effects

No chaperone needed for adults

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24
Q

What are the contraindications for IS?

A

Cold/blocked nose

First trimester of pregnancy

Patients under 7

Severe COPD

Tonsillar enlargement

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25
Q

What are the safety features of the quantiflex machine?

A

Pin index system- prevents wrong cylinder being attached

Diameter index system- prevents cross connection of piping

Min oxygen delivery of 30%

Oxygen fail safe

Oxygen monitor

Oxygen flush

Reservoir bag

Colour coding- Black O2, Blue NO

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26
Q

When may referral for treatment under GA be made?

A

Medical conditions that make sedation unsafe

Uncooperative children

Severe anxiety

Long/complex procedures

Procedure requires complete stillness

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27
Q

What are the stages of General Anaesthesia?

A
  1. Induction
  2. Excitement
  3. Surgical anaesthesia
  4. Overdoses
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28
Q

What must be included in referral letter for GA?

A

Patient name
Patient address
Patient/ Parent contact numbers- landline and mobile
Patient medical history
Patient GP details
Parental responsibility
Justification for GA
Proposed treatment plan
Previous treatment details

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29
Q

What the definition of conscious sedation?

A

Use of drug or drugs which produce state of depression within the CNS enabling treatment to be carried out but communication can be maintained, patient can respond to command and retain protective reflexes
-> involves a margin of safety wide enough to make unintended loss of consciousness unlikely

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30
Q

What is GABA and its function?

A

Gamma-aminobutryic acid

Inhibitory neurotransmitter in cerebral cortex and motor circuits
-> prolongs time for receptor repolarisation

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31
Q

What is the half life of midazolam?

A

90-150 mins

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32
Q

What are the contraindications for IV sedation?

A

Obesity

Allergy

No chaperone

Pregnancy/lactation

COPD

Severe systemic diseases

Severe special needs

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33
Q

What should you assess before carrying out IV sedation?

A

ASA class

Weight

Vitals- HR, BP, SaO2

MH- drugs

Cooperation level

Level of anxiety

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34
Q

What are the different ASA classes? American Society of Anaesthetist

A

ASA I: Normal healthy patient-non-smoker, minimal alcohol

ASA II: Mild systemic disease

ASA III: Severe systemic disease; limits activity (but not incapacitating)

ASA IV: Severe systemic disease (constant threat to life)

ASA V: Moribund; not expected to live > 24 hrs.

ASA VI: Patient who is brain dead for organ donation

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35
Q

A patient attends with pain on biting, 9mm suppurating pocket with vertical bony defect. What are the possible diagnoses?

A

Symptomatic peri-apical periodontitis

Periodontal abscess

Periapical abscess

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36
Q

What special investigation would help you ascertain whether it was SPP, PerioA or PA abscess?

A

Check if TTP

Use EPT

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37
Q

What initial treatment would you carry out for a tooth

A

Drainage of Pus

RCT or extraction

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38
Q

What are the ways an extracted tooth can be replaced?

A

Implant

Bridge

Partial denture

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39
Q

What local factors must be checked when determining suitability of a patient for an implant?

A

Bone levels- 10mm

Space between teeth- 7mm

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40
Q

What are the generalised factors you would check when determining suitability of patient for an implant?

A

Smoking status

MH- bisphosphonates

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41
Q

How would you investigate and manage an OAC?

A

Investigate:
-> Look for blood bubbling
-> nose holding test
-> radiographs

Manage:
-> Encourage clot, suture margins, give AB, no nose blowing, encourage steam inhalation
-> If large close with BAF

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42
Q

How would you investigate and manage root in the antrum?

A

Investigate- take PA/occlusal radiograph OR OPT

Manage:
Use suction, curettage, irrigation, ribbon gauze, close as for OAC

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43
Q

How would you investigate and manage tuberosity fracture?

A

Investigate:
Look for signs- noise, tear on palate, mobility of more than one tooth

Manage:
-> Dissect out and close wound
-> Reduce and stabilise with wire/splint
-> Remove or treat pulp
-> Give AB
-> remove tooth 8 weeks later

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44
Q

When are impacted 3rd molars not advisable to be removed?

A

Caries free/no pathology associated

Predicted to erupt naturally

Medical History precludes XLA

Risk of mandibular fracture

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45
Q

When should impacted 3rd molars be removed?

A

Unrestorable caries

Non-treatable pulpal/PA pathology

If cyst present

If fractured

If abscess

Osteomyelitis

Recurrent pericoronitis

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46
Q

What are the therapeutic indications for 8 removal?

A

Infection (caries, pericoronitis, periodontal disease or local bone infection) – most common

Cysts

Tumours

External resorption of 7 or 8

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47
Q

What are the surgical indications for 8 removal?

A

Within surgical field (orthognathic, fractured mandible, in resection of diseased tissue)

High risk of disease

Medical indications eg awaiting cardiac surgery, immunosuppressed or to prevent osteonecrosis

Accessibility- limited access

Patient age- complications and recovery time increase with age

Autotransplantation- to position of 6

General Anaesthetic for other treatment

48
Q

What flap is used for removal of impacted 8?

A

3 sided buccal mucoperiosteal flap starting around gingival margin of 7 (mesial and distal relieving incisions)

49
Q

What flap is used for surgical removal of lower 5?

A

2 sided with distal relieving incision

50
Q

What are the principles of flap design?

A

Wide based incision

Reflect down to bone

Cut in one continuous stroke

Avoid ID papilla

No sharp angles

Keep tissues moist

Do not close under tension

Margins of flap should lie on sound bone

51
Q

What should be checked on radiograph before removing an 8?

A

Presence or absence of disease

Anatomy- size, shape, root formation

Depth of impaction

Orientation of impaction

Follicular width

Periodontal Status

Proximity to antrum or IDC

52
Q

Describe the removal of an impacted lower 8?

A

Anaesthesia (LA used even if patient sedated)

Access- flap

Bone removal as necessary

Tooth division as necessary

Debridement

Suture

Achieve haemostasis

Post-operative instructions

53
Q

What is the use of iodine in extraction of lower 8

A
54
Q

What are 3 types of nerve damage that can occur?

A

Neuropraxia- contusion but no damage to sheath/axon

Axonotmesis- damage to axon but not sheath

Neurotmesis- transection

55
Q

What is the risks of temporary and permanent nerve damage?

A

Temporary- 10-20%

Permanent- <1%

56
Q

What is the clinical term for when a patient has dripping from the nose following upper molar extraction?

A

Oro-antral communication

57
Q

What are presenting symptoms of an OAC?

A

Salty metallic taste

Sinusitis

Pain in teeth in both sides

Difficulty creating oral seal

58
Q

What are the signs of an OAC?

A

Splayed roots and trifurcations

Bubbling of blood from socket

Black hole on direct vision

Echo on suction

Prolapsed lining coming through socket

Felt on nose holding test

59
Q

How are OAC closed?

A

If smaller than 2mm
-> encourage clot and suture margins

If larger
-> Buccal advancement flap

Give POI and AB

60
Q

What are the radiographic signs that indicate roots of 8s are close to Inferior dental canal?

A

Interruption of tramlines by tooth

Diversion and deflection of canal

Deflection of root

Narrowing of canal- goes back to normal width

Narrowing of root as it crosses canal

Dark bifid root

Juxta-apical area

61
Q

What is an alternative treatment to extraction of an 8 which may avoid interference with the canal?

A

Coronectomy

62
Q

What images can be used to look at relationship of 8 and IDC?

A

OPT- half?

CBCT

63
Q

What aspects of history would you want to know when a patient has swelling around lower 8, feels unwell and has facial swelling?

A

Pain history

Temperature

Breathing rate

HR

How long has swelling been present

64
Q

What nerves are at risk of damage in XLA of an 8, what do they supply?

A

Lingual nerve- sensation to tongue, lingual gingivae

IAN- sensation to chin, lip and gingivae on that side

Nerve to mylohyoid

Long buccal

65
Q

What may a patient complain of if they have a sialolith?

A

Bad taste

Thick saliva

Dry mouth

Prandial pain and swelling

66
Q

Which gland and duct is most commonly affected by salivary stones and why?

A

Submandibular gland- duct goes up the way to reach oriface (also has long and curved course)

67
Q

What investigations can be done for salivary gland stones?

A

Ultrasound

Sialography

Plain radiographs- lower occlusal

68
Q

How are sialoliths managed?

A

Removal via surgery

69
Q

What is dry socket if it is not an infection?

A

Alveolar osteitis- exposed and inflamed lamina dura due to loss of clot

70
Q

What are the risk factors for dry socket?

A

Extraction of molars

Extraction in mandible

Smoking

Female

OCP

Previous dry socket

LA w ADR

71
Q

How is dry socket treated?

A

Analgesia

LA w ADR

Irrigate w saline

Antiseptic packs- BIP/alvogyl

Curettage and debridement

72
Q

What are the risk factors for an OAC?

A

Lone standing molars

Extraction of maxillary molar

Splayed roots

Large maxillary antrum

Close proximity of apex and antrum

Ankylosis

73
Q

What are the post-op complications that can occur on extraction of impacted 3rd molar

A

Jaw fracture

Pain

Bleeding

Swelling

Stiffness

Infection

Damage to adjacent teeth

74
Q

What guidelines exist for removal of impacted 3rd molars?

A

NICE

SIGN

FDS

75
Q

How are risks related to extractions managed?

A

Pain- analgesia as for headache (pre-emptive), do not exceed dose

Swelling- cold compresses

Bleeding- haemostat agents, bite on damp gauze, avoid increases in BP, avoid exploring clot

Dry socket- avoid smoking

Infection- keep area clean, salty mouth rinses

76
Q

What is a juxta-apical area

A

Well defined and corticated radiolucent area lateral to root rather than apex

77
Q

What are the potential outcomes of nerve damage?

A

Anaesthesia- numbness
Paraestheisa- tingling
Dysaethesia- painful sensation
Hypo/hyper

78
Q

What is warfarin and how does it work?

A

Coumarin based anticoagulant
-> inhibits vitamin K dependent clotting factors 2, 7, 9, 10 and protein C/S

79
Q

What would you need to check before completing an extraction with a patient on warfarin?

A

Check INR- should be less than 4
-> INR must be from last 48 hours ideally last 24
-> 72 hours if well controlled

80
Q

Do you manage extraction differently for patients on warfarin?

A

Try to make extraction as atraumatic as possible

Use enhanced haemostatic aids
-> WHVP
-> Oxidised cellulose
-> Sutures
-> Oral transexamic acid

Extract no more than 3 roots

81
Q

What are bisphosphinates and what conditions are they used for?

A

Inhibit osteoclasts and bone resorption (and bone renewal)

Used for- Paget’s, OP, osteogenesis imperfecta, metastatic cancers, multiple myeloma

82
Q

How is MRONJ diagnosed?

A

Ascertain if patient on bisphosponates (or RANKL inhibitors/anti-angiogenics)

Ask about history of head and neck cancer

Look for areas of exposed bone (may have pus, pain, dehiscence)

83
Q

What is considered low risk for MRONJ?

A

Patient has taken densomumab in last 9 months

Patient has taken or took bisphosponate for less than 5 years

84
Q

What is considered high risk for MRONJ?

A

Patients on anti-resorptive/angiogenic drugs for cancer

Patient who has taken or took bisphospohantes for more than 5 years
-> or less than 5 years with systemic glucocorticoid

85
Q

How would you manage a patient who required extraction and was at risk of MRONJ due to medical history?

A

Advise patient of the risks

Encourage good OH

Avoid extraction if possible

Atraumatic XLA technique

Primary closure

Extensive POI

Review- in 8 weeks

*seek advice from OS/special care team

86
Q

What is pericoronitis? What teeth are usually affected?

A

Inflammation around the crown of a partially erupted tooth- there may be formation of an operculum (flap of gingivae sitting over tooth)

-> usually occurs impacted lower 8s

87
Q

What are the signs and symptoms of pericoronitis?

A

Pain

Swelling

Bad taste

Pus discharge

Ulceration of operculum

Cheek biting

Pyrexia/malaise

Limited opening

88
Q

How do you manage an acute episode of pericoronitis?

A

Incision of localised pericoronal abscess under LA

Irrigation with Saline/CHX
-> under operculum with blunt needle

Analgesia

AB if systemic symptoms or immunocompromised

89
Q

How is pericoronitis managed long term?

A

Extract opposing 8 if traumatising operculum

Extract tooth- once it has resolved

90
Q

What POI are given following extraction?

A

Pre-emptive analgesia- paracetamol and ibuprofen

No rinsing for 24 hours- then regular salty mouthrinses

Bleeding prevention
- Avoid overly hard or hot foods
- Avoid increases in BP for 24 hours- limit exercise/no drinking
- Avoid exploring clot
- Be careful around area when cleaning

Do not smoke- dry socket risk (hold off for as long as possible)

Bleeding- bite on damp gauze for 30 mins, try twice, if not contact GDP/NHS24

91
Q

What procedure may be performed for partial erupted tooth that is not an extraction?

A

Coronectomy

92
Q

What are the potential complications of extracting a lone standing upper molar?

A

Jaw fracture

OAC

Fractured tuberosity

Root in antrum

93
Q

What are the means for achieving haemostasis?

A

Pressure with damp gauze

LA w ADR

Diathermy

Ligatures

Haemostatic forceps

Surgical

WHVP

94
Q

What tissues may be responsible for prolonged bleeding?

A

Soft tissue

Bone

BV- veins, arteries, arterioles

95
Q

What are the risk factors for prolonged bleeding?

A

NSAIDs- anti-platelets

Anticoagulants- warfarin

Liverdisease

Alcoholism

Haemophilia

Fracture

Mucoperiosteal tear

96
Q

What would you want to consider if a patient presented with facial swelling?

A

Size

Presence of pus

Rate of progression

Colour

Airway- is it compromised

97
Q

If you suspect sepsis, what should you do?

A

Urgently refer for treatment in hospital environment
-> likely given IV AB

98
Q

What is Ludwig’s angina?

A

Bilateral swelling of submandibular, submental and sublingual spaces
-> medical emergency
-> requires intubation and EO drains

99
Q

Name the maxillary spaces?

A

Buccal space

Palatal space

Infraorbital space

Infratemporal space

100
Q

Name the mandibular spaces?

A

Sub-lingual space

Submandibular space

Lateral pharyngeal space

Retropharyngeal space

Submental space

101
Q

What is osteoradionecrosis?

A

Bone in head and neck within the radiotherapy beam becomes non-vital (endarteritis)
-> results in slower bone turnover and lack of self repair

102
Q

What are the risk factors for ORN?

A

Radiotherapy

Extraction in mandible

103
Q

How can ORN be prevented?

A

Scaling and CHX in lead up to extraction

Careful extraction technique

Extract teeth at least 10 days before start of radiotherapy

AB and CHX given after

Hyperbaric oxygen before and after

Vit E- 1000IU per day

Pentoxyfilline- 800mg per day

104
Q

How is ORN managed?

A

Irrigate necrotic debris

Sequestrae removal

Resection of exposed bone

Hyperbaric oxygen

105
Q

What vital structure may cause need for altered flap design when removing a lower premolar?

A

Mental foramen housing the mental nerve

106
Q

What is the function of the mental nerve?

A

Supplies sensation to lower lip, skin on chin and gingivae

107
Q

What are some examples of peri-operative complications of extraction?

A

Limited opening- trismus

Swelling

Jaw fracture

Extracting wrong tooth

OAC

Root in antrum

Fracture tuberosity

Bleeding

Nerve damage

108
Q

What are the aims of suturing?

A

Cover bone

Aid haemostasis

Compression of BVs

Reposition tissues

Healing by primary intention

Protection of clot

109
Q

What are the different types of sutures, give examples?

A

NA:
Monofilament- Prolene
Polyfilament- Silk

A:
Monofilament- monocryl
Poly- Vicryl

110
Q

What are examples of different forceps and their uses?

A

Upper straight- extract 3-3
Upper universal- extraction of 3, 4, 5
Upper molar L/R- extract maxillary molars
Upper/lower roots- extract roots
Lower universal- 5-5
Cowhorns- lower 6s
Lower molars- mandibular molars

111
Q

Name 3 types of elevator?

A

Couplands

Warwick James

Cryer’s

112
Q

What are the different techniques for elevation?

A

Lever

Wheel and axle

Wedge

113
Q

What is the use of a luxator?

A

Sever PDL

114
Q

What is osteomyelitis?

A

Bacterial infection of bone:
Invasion of bacteria into the cancellous bone causing inflammation and oedema in marrow spaces
-> blood supply becomes compromised and ischaemia and necrosis occur
-> Due to lack of blood supply bacteria proliferate and spread

115
Q

What are the risk factors for OM?

A

Poor blood supply in mandible

Fracture of mandible

Odontogenic infection

Immunocompromised

Alcoholism

Diabetes

IV drug use

Myeloproliferative diseases- leukaemia, sickle cell

116
Q

How is OM managed?

A

Long course AB- clindamycin and penicillin

Drain pus

Remove non-vital teeth in area of infection

Remove loose bone

Excision of necrotic bone until healthy bleeding bone tissue is reached

117
Q

What treatment can GDPs carry out in bleeding disorder patient?

A

LA

BPE

Supragingival PMPR

Restorations with supra gingival margins

Endo

Pros/impressions

Ortho?

BDS Exam style questions (15 decks)

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