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BDS3 CDS > oral surgery > Flashcards

oral surgery Flashcards

1
Q

how do you control pain during and after dental treatment?

A

local anaesthetic during procedure
systemic analgesic drugs post-op

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2
Q

name 3 NSAIDS?

A

aspirin
ibuprofen
diclofenac

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3
Q

what type of drugs are aspirin, diclofenac and ibuprofen?

A

NSAID

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4
Q

what type of drug is dihydrocodeine?

A

opiod used for analgesia

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5
Q

paracetamol, carbamazepine and dihydrocodiene are all used for what in dentistry?

A

analgesia

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6
Q

what must you know about a drug to prescribe it?

A

mechanism of action
doses
side effects
interactions
groups of patients to avoid

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7
Q

what are the four properties of aspirin?

A

1 analgesic
2 antipyretic (reduces fever)
3 anti inflammatory
4 metabolic

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8
Q

what is acetylsalicylic acid commonly known as?

A

aspirin

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9
Q

how are prostaglandins produced?

A

trauma and infection leads to phospholipid membrane breakdown producing arachidonic acid
arachidonic acid can be broken down to form prostaglandins

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10
Q

what is the function of prostaglandins?

A

they sensitise the tissues to other inflammatory products resulting in pain

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11
Q

do prostaglandins cause pain directly?

A

no they sensitise the tissues to other inflammatory products such as leukotrienes

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12
Q

true or false
increasing prostaglandin production will moderate the pain

A

false
correct answer - decreasing prostaglandin production will moderate pain

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13
Q

describe how the arachidonic acid pathway causes pain and inflammation

A

tissue injury causes injury to phospholipid cell membrane leading to release of arachidonic acid
arachidonic acid then follows the cyclooxygenase pathway to be broken down into prostaglandin which sensitises the tissues to pain and inflammation

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14
Q

what is the function of thromboxane?

A

platelet aggregation

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15
Q

what are the 4 products of the arachidonic acid pathway?

A

from the cyclooxgenase pathway -
prostacyclin
prostaglandin
thromboxane

from the 5 - lipoxygenase pathway
leukotrienes

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16
Q

what is the effect of leukotrienes?

A

broncho constriction
asthma attacks
smooth muscle contraction

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17
Q

arachidonic acid can be broken down into 4 products, what are they?

A

prostacyclin
prostaglandin
thromboxane
leukotrienes

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18
Q

how does aspirin reduce the production of prostaglandins?

A

inhibiting cyclo-oxygenases COX1 and COX2

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19
Q

which cyclooxygenase is aspirin more effective in inhibiting ?

A

COX1

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20
Q

how does analgesic action of aspirin result (refer to arachidonic acid pathway)?

A

inhibition of prostaglandin synthesis in inflamed tissues by cyclooxygenase inhibition

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21
Q

what effect does interleukin 1 have on the body?

A

temperature raising

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22
Q

how does aspirin affect interleukin 1?

A

prevents the temperature raising effects
reduces temperature in fever

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23
Q

does aspirin reduce normal temperature?

A

no

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24
Q

how does aspirin display antipyretic (anti fever) properties?

A

prevents temperature raising effects of interleukin 1

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25
Q

how does aspirin display anti inflammatory properties?

A

reduces redness and swelling and pain at site of injury

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26
Q

what are the adverse effects of aspirin?

A

GIT problems
hypersensitivity
overdose - tetanus, metabolic acidosis
aspirin burns - mucosal

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27
Q

how do you avoid mucosal burns by aspirin?

A

ensure it is swallowed with water

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28
Q

what component in aspirin causes mucosal burns and how?

A

salicylic acid - if applied locally to oral mucosa will chemically burn

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29
Q

how do prostaglandins affect the GIT?

A

inhibit gastric acid
increase blood flow
production of mucin

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30
Q

most patients will experience blood loss from GIT when taking what drug?

A

aspirin

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31
Q

how do hypersensitivity reactions present?

A

acute bronchospasm/asthma type attacks - be careful prescribing to asthmatics
skin rashes - angiodema, urticaria

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32
Q

a patient overdoses on aspirin, what are the adverse effects?

A

tinnitus/deafness
vasodilation and sweating
metabolic acidosis - life threatening

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33
Q

why should a patient with peptic ulceration avoid aspirin?

A

gastric ulcer could perforate

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34
Q

what analgesic should a patient with epigastric pain avoid?

A

aspirin

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35
Q

what analgesic should a patient with bleeding abnormalities avoid?

A

aspirin

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36
Q

why should aspirin be avoided in warfarin patients

A

enhances anticoagulant effect of warfarin and bleeding tendency

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37
Q

how does aspirin affect warfarin

A

increases free (active) warfarin by displacing warfarin from binding sites (inactive) on plasma proteins

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38
Q

which trimester of pregnancy should aspirin be especially avoided?

A

3rd

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39
Q

why should breastfeeding women avoid aspirin?

A

Reyes syndrome risk

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40
Q

why should patients on steroids avoid aspirin?

A

risk of a peptic ulcer with steroids and aspirin may perforate the ulcer

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41
Q

where is aspirin metabolised?

A

liver

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42
Q

where is aspirin excreted?

A

kidney

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43
Q

why should patients with renal/hepatic impairment be cautious taking aspirin?

A

aspirin is metabolised in liver and excreted in kidneys
if renal impairment - excretion reduced

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44
Q

what age group should aspirin be avoided?

A

under 16

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45
Q

why should under 16 avoid aspirin completely?

A

risk of Reyes syndrome

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46
Q

when is aspirin completely contraindicated?

A

under 16
breast feeding
patients with history of hypersensitivity to NSAIDS
haemophilia
previous or active peptic ulceration

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47
Q

give the two key symptoms of Reyes syndrome?

A

encephalopathy
liver damage

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48
Q

why is it important to be cautious prescribing aspirin to patients taking other NSAIDS?

A

combinations of NSAIDS will increase risk of side effects

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49
Q

why must care be taken prescribing aspirin to patients with Glucose 6-Phosphate Dehydrogenase (G6-PD) deficiency?

A

risk of acute haemolytic anaemia on taking a number of common drugs

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50
Q

which patients are susceptible to developing acute haemolytic anaemia when taking a number of common drugs?

A

patients with G6PD deficiency
glucose 6-phosphate dehydrogenase

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51
Q

for mild to moderate odontogenic pain, what dose and regimen of aspirin should be prescribed?

A

under 16 - do not use - Reyes risk

600mg tablets 4 x daily for 5 days

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52
Q

groups to avoid/take caution when prescribing aspirin? 5

A

asthma
pregnant
breast feeding
anticoagulants
under 16

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53
Q

what should be prescribed to patients with previous or active peptic ulcer disease and odontogenic pain?

A

omeprazole or lansoprazole (proton pump inhibitors)
prevent gastric problems

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54
Q

when is ibuprofen commonly used in dentistry?

A

post op analgesia

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55
Q

for mild to moderate odontogenic pain, what dose and regimen of ibuprofen should be prescribed?

A

1 400mg tablet 4x daily for 5 days

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56
Q

what is the maximum daily dose of ibuprofen for an adult?

A

2.4g

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57
Q

take caution when prescribing ibuprofen to…

A

elderly
pregnancy or breast feeding
asthma
taking other NSAIDS
patients on long term systemic steroids

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58
Q

what are the side effects of ibuprofen?

A

GIT discomfort (bleeding, ulceration)
hypersensitivity reactions
headaches… see BNF

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59
Q

ibuprofen has many drug interactions, name some

A

ABCD - remember these interact with ibuprofen.
ace inhibitors
beta blockers
calcium channel blockers
diuretics
anticoagulants

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60
Q

what are the symptoms of ibuprofen overdose?

A

nausea
vomiting
tinnitus

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61
Q

how do you treat ibuprofen overdose?

A

treat with activated charcoal followed by symptomatic measures if more than 400mg/kg ingested in preceding hour

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62
Q

management of paracetamol overdose patient

A

transfer to hospital IMMEDIATELY

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63
Q

what is acetaminophen?

A

paracetamol

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64
Q

true or false
paracetamol does not have anti-inflammatory activity

A

true

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65
Q

what are the properties and benefits of paracetamol?

A

analgesic
antipyretic
no effects on bleeding time
does not interact with warfarin
less irritant to GI
suitable for children

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66
Q

describe the mode of action of paracetamol

A

tissue injury leads to injury to phospholipid cell membrane and production of arachidonic acid

hydroperoxides are generated from the cyclooxygenase pathway and exert a positive feedback to stimulate COX activity

paracetamol blocks this feedback and therefore inhibits COX

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67
Q

when paracetamol blocks the positive feedback of hydroperoxides, what is the effect on the body?

A

analgesia
antipyretic

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68
Q

which patients should you be cautious prescribing paracetamol to?

A

alcohol dependent
hepatic impairment
renal impairment

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69
Q

what are the side effects of paracetamol?

A

rare
rashes
blood disorders
hypotension
liver damage following overdose

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70
Q

what is the effect of paracetamol on anticoagulants?

A

enhances the anticoagulant effects of coumarins - warfarin

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71
Q

for mild to moderate odontogenic pain, what dose and regimen of paracetamol should be prescribed?

A

adults
2x 500mg tablets 4x daily
maximum dose 4g daily
children see BNF as depends on weight/age

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72
Q

what is the weakest opioid?

A

codeine

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73
Q

where in the body do opioid analgesics act?

A

act in the spinal cord - dorsal horn pathways

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74
Q

what quantity of paracetamol can cause overdose?

A

150 mg/kg within 24 hrs

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75
Q

what medication is used to treat neuropathic and functional pain such as trigeminal neuralgia, post-hepatic neuralgia or TMJ pain?

A

carbamazepine

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76
Q

what is carbamazepine used for?

A

trigeminal neuralgia control

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77
Q

what type of medication is carbamazepine?

A

anti-convulsant

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78
Q

what are the clinical features of trigeminal neuralgia?

A

severe spasms of pain/electric shock lasts seconds
usually unilateral
older age
females more affected
periods of remission
recurrences often greater severity

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79
Q

where is the main site of action for paracetamol ?

A

thalamus

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80
Q

what is the function of prostaglandins in the kidneys?

A

PGE2 and PGI2 are powerful vasodilators synthesised in the renal medulla and glomeruli and are imnvolved in control of renal blood flow and excretion of salt and water

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81
Q

where is PGE2 synthesised?

A

renal medulla

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82
Q

where is PGI2 synthesised?

A

glomeruli

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83
Q

how do NSAIDS have nephrotoxic effects?

A

inhibition of renal prostaglandin may result in sodium retention, reduced renal blood flow and renal failure

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84
Q

what analgesics can cause nephritis and hyperkalaemia?

A

NSAIDS

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85
Q

how do opioid analgesics prevent pain?

A

they bind to specific receptors which are associated with neuronal pathways transmitting pain to CNS

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86
Q

what are 3 major problems with opioids ?

A

dependence, tolerance and smooth muscle effects

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87
Q

opioids can cause psychological and physical dependence, what does this mean?

A

withdrawal of the drug will lead to psychological cravings and patient will be physically ill

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88
Q

what does opioid tolerance mean ?

A

to achieve the same therapeutic effects the dose of the drug needs to be progressively increased

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89
Q

what are the resultant effects of opioid action on smooth muscle?

A

constipation
urinary and bile retention

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90
Q

what are the effects of opioids of the CNS?

A

depresses CNS
pain centre - alters perception of pain

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91
Q

what are the side effects of opioids?

A

nausea
vomitting
dry mouth
sweating
bradycardia/tachycardia

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92
Q

what enhances the effects of opioids?

A

alcohol

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93
Q

which groups of patients should you be cautious prescribing opioids to?

A

hypotension
asthma
pregnant or breast feeding
hepatic/renal impairment
dependence

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94
Q

what conditions contraindicate opioid prescription?

A

acute respiratory depression
acute alcoholism
raised inter cranial pressure/head injury

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95
Q

what is the common side effect of codeine?

A

constipation

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96
Q

what are some benefits of codeine?

A

low dependence
effective orally
effective cough suppressant

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97
Q

which codeine combination is found on the dental list?

A

dihydrocodeine

98
Q

what are some side effects of dihydrocodeine?

A

nausea
vomitting
constipation
drowsiness
respiratory depression and hypotension

99
Q

what are serious drug interactions associated with dihydrocodeine?

A

antidepressants
dopaminergic

100
Q

who should you never prescribe an opioid to?

A

patients with raised inter cranial pressure/suspected head injury

101
Q

what are the groups to be cautious prescribing dihyrocodeine to?

A

hypotension
asthma
pregnancy/breastfeeding
renal/hepatic disease
elderly/children

102
Q

what is the antidote for opioid overdose?

A

naloxone

103
Q

when is naloxone indicated?

A

coma or bradypoenea

104
Q

what are the signs and symptoms of opioid overdose?

A

coma
respiratory depression
pinpoint pupils

105
Q

give examples of unrestorable teeth?

A

gross caries
tooth/root fracture
severe tooth surface loss
pulpal necrosis
apical infection

106
Q

what are some indications for tooth extraction?

A

unrestorable teeth
symptomatic PE teeth
traumatic position
ortho indications
interference with denture construction

107
Q

where should you stand for lower molar extraction if right handed?

A

left lower molars - infront
right lower molars - behind

108
Q

when is the only time right handed stands behind a patient to extract tooth?

A

lower right molar/premolar

109
Q

what are the three modes of action for tooth elevation?

A

wheel and axle (rotation)
lever
wedge

110
Q

what are the four applications points for an elevator?

A

buccal - into furcation
medial
distal
superior - upper teeth
inferior - lower teeth

111
Q

what are the post operative complications of MOS a patient should be warned of?

A

pain
swelling
bruising
bleeding
infection
Nerva damage risk - permanent, temporary or altered
jaw stiffness
dry socket

112
Q

why should soft tissues be retracted?

A

improves access to operative field
protection

113
Q

what are the general principles of oral surgery?

A

maximal access, minimal trauma
wide based incision
minimise trauma to dental papillae
no crushing
keep tissues moist
ensure flap margins and sutures will lie on sound bone
make sure wounds are not closed under tension
aseptic technique

114
Q

why should you use a wide based incision?

A

circulation

115
Q

true or false
bigger flaps heal just as quickly as small ones

A

true

116
Q

what are the three stages of debridement?

A

physical - bone file/hand piece to remove sharp edges
irrigation - sterile saline/water into socket and under flap
suction - aspirate under flap to remove debris and check socket for retained apices etc

117
Q

what are the aims of suturing?

A

compress BV
reposition tissue and cover bone
prevent wound breakdown
haemostasis
encourage healing by primary intention

118
Q

what are the two categories of sutures?

A

resorbable
non-resorbable

119
Q

give an example of a monofilament resorbable suture

A

monocryl

120
Q

give an example of a multifilament resorbable suture

A

vicryl rapide

121
Q

give an example of a non-resorbable multifilament and monofilament suture

A

multi - mersilk
mono - prolene

122
Q

how is haemostasis achieved during operation?

A

LA with vasoconstrictor
artery forceps
diathermy
bone wax

123
Q

how is haemostasis achieved post operation?

A

pressure
LA with vasoconstrictor
diathemy
sutures
packing agent

124
Q

what are the stages of surgery?

A

anaesthesia
access
bone removal and tooth division as necessary
debridement
suture
achieve haemostasis
post op instructions and medication

125
Q

what will healing by primary intention minimise?

A

scarring

126
Q

what instrument can be used to retract soft tissues?

A

Howarth’s periosteal elevator

127
Q

why are electrical handpicks used in OS and not air driven?

A

air driven may lead to surgical emphysema

128
Q

what should you use to remove bone in OS?

A

electrical straight hand piece with saline cooled round or fissure tungsten carbide bur

129
Q

what are the uses of elevators?

A

provide application point for forceps
loosen teeth
extract teeth
remove root stumps, apices and retained roots

130
Q

what instruments can you use for debridement?

A

bone file
hand piece
Mitchell’s trimmer
Victoria curette

131
Q

when would you use a non-resorbable suture?

A

if extended retention periods are required
closure of OAF pr exposure of canine

132
Q

when would you use an absorbable suture?

A

if removal of suture not desirable and tissue edges just need held together temporarily

133
Q

compare bacterial colonisation on mono and multi filament sutures

A

monofilament are single strand and resistant to bacterial colonisation
multifilament allow oral fluids and bacteria to move along length and in-between several filaments and can result in infection

134
Q

what are the 4 nerves that can be damaged in extraction of lower third molars?

A

inferior alveolar nerve
lingual nerve
mylohyoid and buccal - less common

135
Q

what analgesia will you prescribe after third molar extraction?

A

ibuprofen
paracetamol
cocodamol

136
Q

what are the complications of lower third molar extractions?

A

pain
swelling
bruising
bleeding
infection
trismus
paraesthesia/anaesthesia of lip and tongue

137
Q

what is the aim of peri-radicular surgery?

A

establish root seal at apex of tooth/point of perforation
remove existing infection

138
Q

what is the review schedule for periradicular surgery?

A

review at one week
post of radiographs 1-6 weeks
further review 3-6 months

139
Q

what are the top reasons periraduicular surgery fails?

A

inadequate seal e.g. too little apex removed
inadequate support e.g. perio pockets
split roots
soft tissue defect over apex post-op

140
Q

how much of the apex should be removed in periradicular surgery?

A

3mm

141
Q

list 10 peri-operative extraction complications

A

difficult access
abnormal resistance
fracture of tooth/root
alveolar bone fracture
jaw fracture
maxillary sinus involvement
fracture of tuberosity
soft tissue damage
nerve damage
haemorrhage
adjacent teeth damage
wrong tooth

142
Q

what might cause difficult access?

A

trismus
reduced aperture of mouth - congenital/syndrome
crowder/malpositioned teeth

143
Q

what causes abnormal resistance during extraction?

A

thick cortical bone
shape/form of roots - hooked/divergent
number of roots
ankylosis
hypercementosis

144
Q

what are risk factors of tooth/root fracture during extraction?

A

caries
alignment
size
root morphology

145
Q

which teeth usually are involved in fracture of alveolar bone?

A

usually buccal plate and canines or molars

146
Q

how do you manage a tuberosity fracture?

A

reduce wound and stabilise
remove or treat pulp, ensure occlusion free
antibiotics and antibiotics
remove tooth 8 weeks later

147
Q

what are the causes of tuberosity fracture?

A

single standing molar

extracting wrong order
inadequate alveolar support

148
Q

how do you diagnose an alveolar fracture?

A

noise
movement noted visibly or with supporting fingers
more than one tooth moving
tear on plate

149
Q

how do you confirm root proximity to sinus?

A

radiograph
OPT periodical or occlusal

150
Q

how do you manage maxillary sinus involvement?

A

inform patient
if small or sinus intact encourage clot, suture and prescribe antibiotic and post op instructions

if large close with buccal advancement flap
antibiotics and nose blowing instructions

151
Q

what are the risk factors for involvement of the maxillary sinus?

A

extraction of upper molars and pre molars
close relationship of roots on radiograph
last standing molars
large bulbous roots
older pt
previous OAC
recurrent sinusitis

152
Q

what are the complications of involvement of maxillary sinus?

A

OAC/OAF
loss of root into antrum
fractured tuberosity

153
Q

how do you diagnose a maxillary sinus involvement?

A

size of tooth
radiographic position
bone at trifurcation of roots
bubbling of blood
nose holding test
direct vision
good light and suction
blunt probe

154
Q

which jaw is more commonly fractured?

A

mandible

155
Q

how do you manage a jaw fracture during extraction?

A

inform patient
post op radiograph
refer
ensure analgesia
stabilise
antibiotic if delay

156
Q

what do you do when you lose a tooth during extraction?

A

stop
locate
suction and radiograph

157
Q

how do you avoid soft tissue damage?

A

pay attention
correct placement of correct instrument
application point
controlled pressure
sufficient not excessive force

158
Q

define neurapraxia

A

contusion of nerve/continuity of epieneural sheath - axons maintained

159
Q

define axonotmesis

A

continuity of axons disrupted - epieneural sheath maintained

160
Q

define neurotmesis

A

complete loss of nerve continuity/nerve transected

161
Q

what are the different ways a nerve can be injured?

A

crushing
transection
damage from LA or surgery
cutting/shredding injuries

162
Q

what will paraesthesia feel like

A

tingling

163
Q

what will anaesthesia feel like

A

numbness

164
Q

what will dysaesthesia feel like

A

unpleasant sensation/pain

165
Q

define hypoaesthesia

A

reduced sensation

166
Q

define hyperaesthesia

A

increased/heightened sensation

167
Q

you have damaged a vessel during surgery nd blood is spurting/haemorrhaging, what vessel have you cut?

A

artery

168
Q

during surgery you cut a vessel and there is a lot of bleeding flowing steadily what vessel have you cut?

A

vein

169
Q

a spurting pulsating bleed is associated with which vessel?

A

arteriole

170
Q

what causes haemorrhage during extraction?

A

local factors - mucoperiosteal tears or fractures of alveolar bone
undiagnosed clotting abnormality - willebrands
liver disease
medication - warfarin/antiplatelets

171
Q

how to you manage soft tissue haemorrhage?

A

pressure - bite on damp gauze
sutures
LA with adrenaline
diathermy
ligatures on larger vessels

172
Q

how do you manage haemorrhage in bone?

A

pressure via swab
LA on swab or injected into socket
haemostat agents
bone wax
pack

173
Q

how do you manage TMJ dislocation?

A

relocate immediately - down and fwd
if unable to relocate - LA into masseter intraorally
refer if unable still

174
Q

how do you manage damage to adjacent teeth during extraction?

A

temporary dressing/restoration
arrange definitive restoration
warn pt of risk

175
Q

what do you do when an instrument breaks during OS?

A

radiograph and retrieve
if unable refer

176
Q

how do you avoid removing wrong tooth?

A

concentrate
check clinical situation against notes/radiographs
safety checks
count teeth
verify with someone else

177
Q

5 post extraction complications

A

pain/swelling
trismus
haemorrhage
dry socket
prolonged nerve damage

178
Q

what is ecchymosis

A

bruising

179
Q

what is most common complication of extraction

A

pain - warn and advise analgesia

180
Q

how to limit post extraction pain

A

gentle handling of tissues
don’t leave exposed bone
complete tooth extraction

181
Q

what may increase bruising and swelling

A

poor surgical technique
rough handling of tissues

182
Q

what is truisms

A

inability to open mouth fully/jaw stiffness

183
Q

what causes truisms - 4

A

surgery - oedema
giving LA - medial pterygoid
damage to TMJ
haematoma - MP or masseter

184
Q

treatment for trismus

A

monitor
gentle mouth opening exercises - trismus screw

185
Q

procedures with high risk bleeding complications

A

complex extraction
extraction of more than 3 teeth
flap raising procedures
biopsy
gingival re-contouring

everything else is low risk or unlikely risk

186
Q

what causes immediate post op bleeding within 48hrs

A

LA wears off and vasoconstrictor
sutures loose
pt traumatises area with tongue or food
reactionary bleeding

187
Q

what causes secondary bleeding and how long after extraction

A

usually infection - 3-7 days

188
Q

treatment of soft tissue post op bleeding

A

pressure - damp gauze
suture
LA with adrenaline
diathermy

189
Q

treatment of bone post op haemorrhage

A

pressure
LA on swab with vasoconstrictor
bone wax
pack and suture

190
Q

3 haemostatic agents

A

adrenaline in LA
oxidised regenerated cellulose
thrombin liquid and powder

191
Q

where to take caution using oxidised regenerated cellulose and why

A

lower 8s - acidic can damage IAN

192
Q

3 systemic haemostatic aids

A

vitamin K
tranexamic acid
missing clotting factors

193
Q

which suture is suitable when managing bleeding

A

interrupted or horizontal mattress

194
Q

where to refer if can’t stop bleeding

A

weekdays - maxillofacial or dental hospital
weekends and evening - maxillofacial on call or A and E

195
Q

how can you prevent intra operative and post operative extraction haemorrhage - 4

A

thorough medical history
atraumatic extraction technique
check good haemostasis at end if surgery
good post op instruction

196
Q

post extraction instructions - 5

A

don’t rinse for several hours - avoid vigorous
avoid trauma - hard foods or touching with tongue
avoid hot food
avoid excessive exercise and alcohol
bleeding control info

197
Q

why do you avoid exercise and alcohol after OS

A

increases blood pressure and decreases clot quality

198
Q

after how many months is there little chance that nerve damage will improve

A

18

199
Q

what are the three types of sensory change after nerve damage

A

anaesthesia
paraesthesia
dysaesthesia

200
Q

what is hypoaesthesia

A

reduced sensation

201
Q

what is hyperaesthesia

A

increased sensation

202
Q

what percentage of all extraction is affected by dry socket

A

2-3%

203
Q

what percentage of lower 8 is affected by dry socket

A

20-35%

204
Q

signs and symptoms of dry socket

A

normal clot gone - empty socket - bare bone
intense pain - kept up at night, throbs, dull ache
sensitive
bad smell
bad taste
3-4 days after extraction

205
Q

predisposing factors of dry socket - 5

A

molars
female
mandible
smoker - low blood supply
oral contraception

206
Q

management of dry socket

A

reassure
systemic analgesia
LA
irrigate with warm saline
curettage and debridement
antiseptic pack alvogyl

207
Q

2 things that delay healing

A

infection
sequestrum

208
Q

what is sequestrum

A

bits of dead bone
tooth or amalgam fragments

209
Q

how to diagnose OAC

A

radiographic position of roots in relation to antrum
bone at trifurcation on roots
bubbling of blood
direct vision

210
Q

why cautious for nose holding test or blunt probe test when assessing for OAC

A

can create OAF

211
Q

management of small OAC

A

encourage clot
suture
post op instruction

212
Q

management if large OAC

A

buccal advancement flap
bone graft
antibiotics
nose blowing instruction

213
Q

what is osteomyelitis

A

inflammation of bone marrow
implies bone infection

214
Q

describe spread of osteomyelitis

A

bacteria in cancellous bone
inflammation and oedema
compromises blood supply and leads to tissue necrosis
will spread until arrested by antibiotics or surgery

215
Q

why is osteomyelitis less common in maxilla

A

rich blood supply - several arteries

216
Q

why is osteomyelitis more common in mandible

A

IAA is primary blood supply

dense cortical bone limits penetration of periosteal blood vessels

poorer blood supply means more likely to become ischaemic and infected

217
Q

risk factors of osteomyelitis

A

odontogenic infection
compromised host defence e.g. diabetes

218
Q

radiographic radiolucency with moth eaten appearance - diagnosis ?

A

osteomyelitis

219
Q

what is an involucrum

A

increased radio density surrounding radiolucency

220
Q

bacteria associated with mandibular osteomyelitis

A

anaerobic bacteria

221
Q

effect of radiotherapy on bone

A

bone becomes non-vital
turnover is slow
self repair ineffective
reduced blood supply

222
Q

why is mandible more affected by ORN

A

poor blood supply

223
Q

prevention of ORN

A

chlorhexadine mouthwash
antibiotics

224
Q

what are bisphosphonates used to treat

A

osteoporosis
pagets disease
malignant bone metastases

225
Q

example of bisphosphonate

A

end in onate
alendronate

226
Q

drugs involved in MRONJ

A

antiresorptive
antiangiogenic

227
Q

when can MRONJ occur

A

post extraction
following denture trauma
spontaneous

228
Q

increased dose and increased duration of bisphosphonates increases the risk of what

A

MRONJ

229
Q

using anti resorptive drugs concurrently with which 2 drugs increases MRONJ risk

A

steroids
or
antiangiogenic drugs

230
Q

treatment of MRONJ

A

manage symptoms - remove sharp bone
chlorhexadine mouthwash

231
Q

what is actinomyetosis

A

rare bacterial infection caused by actinomycetes israelii (there’s more)

232
Q

signs of actinomycosis

A

skin sinuses and swelling
lumpy pus

233
Q

actinomycosis treatment

A

high dose antibiotics

234
Q

antibiotic prophylaxis dose and time

A

amoxicillin 3g 60mins before procedure

235
Q

basic principles of surgery

A

risk assess
aseptic technique
radiological assessment
minimal trauma to hard and soft tissues

236
Q

what kind of flap is used in OS in regards to what tissues are lifted

A

mucoperiosteal flap - lift mucosa and periosteum

237
Q

3 principles of lifting flap

A

maximal access minimal trauma
preserve adjacent soft tissues and papillae
wide base incision for circulation and perfusion

238
Q

what is a mucocele

A

blocked minor salivary gland - saliva build up

239
Q

what hand piece is used for bone removal and why

A

electric straight handpiece with saline or sterile water cooled bur
air driven - surgical emphysema

240
Q

why are air driven handpicks not used in surgery

A

surgical emphysema risk - air between soft tissues and bone and can cause sepsis

BDS3 CDS (11 decks)

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