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Oral Surgery Flashcards

1
Q

indications of XLA

A

gross caries
advanced periodontal disease
tooth/root fracture
severe tooth surface loss
pulpal necrosis
apical infection
symptomatic partially erupted teeth
traumatic position
orthodontic indications
interference with denture construction

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2
Q

operator position for XLA

A

behind ptx for lower RHS molars
in front of ptx for everything else

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3
Q

teeth to rotate

A

lower 5, 4, 3, 2, 1, maybe 7 & 8 if fused
upper 1, 2, 3 maybe 4 if only 1 root

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4
Q

uses of elevators (6)

A
  1. provide a point of application for forceps
  2. loosen teeth prior to using forceps
  3. XLA tooth without use of forceps
  4. removal of multiple root stumps
  5. removal of retained roots
  6. removal of root apices
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5
Q

3 methods for using elevators

A
  1. lever
  2. wedge
  3. wheel and axle
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6
Q

lever technique

A

uses a fulcrum & force to push tooth out

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7
Q

wedge technique

A

used to wedge the tooth out of the socket; usually with a Warwick James

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8
Q

wheel and axle technique

A

generally the safest option
turning the elevator when it is in a socket to try and elevate the tooth; usually with Cryer’s

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9
Q

luxators

A

used for cutting the PDL & loosen tooth in socket, a peritome may also be used but these will not lift tooth from socket and should not be used for elevating

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10
Q

post op instruction (9)

A
  1. be careful not to bite lip, cheek, tongue soon after XLA as they will still be numb
  2. do not rinse vigorously for several hrs after XLA as this can disturb clot - leave to next day
  3. avoid hot drinks / alcohol - raises BP
  4. use hot salt water mouthwash 3/4 times a day to keep area clean starting day after XLA
  5. socket will heal quicker if you avoid smoking for the next week
  6. east soft foods on opposite side of mouth for a few days
  7. may be pain after XLA, analgesia will help
  8. if pain gets worse after 2-3 days get in contact
  9. avoid exercise for a few days as this will raise BP
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11
Q

5 peri operative complications

A
  1. difficulty of access
  2. fracture of tooth/root/jaw/tuberosity
  3. involvement of maxillary antrum
  4. damage to adjacent tooth/restoration
  5. wrong tooth
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12
Q

5 post op complications

A
  1. pain /swelling / ecchymosis
  2. trismus
  3. haemorrhage
  4. prolonged effects of nerve damage
  5. dry socket
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13
Q

examples of abnormal resistance to XLA (4)

A
  1. ptx has cortical bone with divergent or hooked roots
  2. abnormal number of roots
  3. teeth have hypercementosis (too much cementum) as in Paget’s disease
  4. ankylosed teeth i.e. no PDL
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14
Q

4 causes of jaw fracture

A
  1. impacted 3rd molar
  2. large cyst
  3. atrophic mandible
  4. too much force put through mandible
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15
Q

oro-antral communication

A

when tooth is XLA and there is a hole between tooth socket and maxillary sinus - diagnosed by size of tooth, radiographic position of roots, bubbling of blood in tooth socket, direct vision with good lighting & suction (which sounds like a echo), ask ptx to squeeze nose & hold mouth open then breathe out and a hissing sound indicates communication - but this may create one if not already there

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16
Q

what happens if a communication is not treated

A

the walls will become epithelialised becoming an oro-antral fistula which is a chronic condition
ptx will complain of bad taste & pain in maxilla, fluid coming out of nose, nasal obstruction, change in voice

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17
Q

post op instruction for a communication

A
  • refrain from forcibly blowing nose or stifling sneeze by pinching nose
  • steam / menthol inhalations
  • avoid use of straw
  • refrain from smoking
  • use hot towel on face to clear sinuses
  • warm salt bath or chlorhexidine mouthwash after 24hrs
  • avoid wind instruments
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18
Q

tx of communication

A

<2mm - clot encouraged & margins sutured
>2mm & lining of sinus torn - closed with buccal advancement flap, antibiotics given, should be done there & then

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19
Q

root in the antrum

A

confirm this radiographically
to remove cut buccal advancement flap, fenestration (window) opened with care and small curettes used to remove

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20
Q

fractured maxillary tuberosity

A

can happen if single standing molar or unknown unerupted wisdom tooth
must XLA from posterior -> anterior i.e. 8, 7, 6 while ensuring alveolar support

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21
Q

management of fractured maxillary tuberosity

A
  1. dissecting out and closing wound
  2. reducing - putting into position with fingers / forceps and stabilising - with orthodontic buccal arch wire spot welded by composite
    tooth then XLA with a surgical 8wks later to make sure this doesn’t recur
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22
Q

lost tooth

A

swallowed, aspirated, suctioned or down ptx top but it must be found & this can include radiographs

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23
Q

neurapraxia

A

contusion of nerve / continuity of epineural sheath & axons maintained

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24
Q

axonotmesis

A

continuity of axons but not epineural sheath which is disrupted

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25
Q

neurotmesis

A

complete loss of nerve continuity / nerve transected

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26
Q

nerve damage can cause (5)

A
  1. anaesthesia - numbness
  2. paraesthesia - tingling
  3. dysaesthesia - unpleasant sensation /pain
  4. hypoaesthesia - reduced sensation
  5. hyperaesthesia - increased / heightened sensation
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27
Q

management of dislocation of TMJ

A

jaw should be relocated immediately
if unable, try adding LA into masseter intraorally
once in place give analgesia & advice on yawning
if it cannot be relocated refer immediately

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28
Q

causes of trismus / jaw stiffness post op (4)

A
  1. related to surgery - oedema / muscle spasm
  2. related to IDB - medial pterygoid haematomy / spasm
  3. haematoma into medial pterygoid or masseter - clot organises & fibroses
  4. damage to TMJ - oedema or joint effusion
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29
Q

causes of haemorrhage

A

can occur in immediate post op i.e. within 48hrs of XLA
caused by: vasoconstricting effects of LA wearing off, sutures becoming loose or being lost or ptx traumatising area

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30
Q

local haemostatic agents that can be used in dental setting (5)

A
  • adrenaline containing LA
  • surgicel; oxidised regenerated cellulose to form framework for clot formation (be careful in lower 8 region as the acidity can damage the IAN)
  • gelatin sponge as an absorbable meshwork for clot formation
  • thrombin liquid & powder
  • fibrin foam
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31
Q

systemic haemostatic aids for when clot is not forming

A
  • vitamin K needed for formation of clotting factors
  • anti-fibrinolytics e.g. tranexamic acid to prevent clot breakdown
  • giving clotting factors to ptx
  • transfusing plasma or whole blood
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32
Q

dry socket (localised osteitis)

A

normal clot will disappear and socket will be straight to bone
intense pain that affects sleep & may radiate to ear, bad smell or taste coming from socket
starts 3-4 days post XLA & will take 7-14 days to resolve
inflammation affecting the lamina dura
ensure no tooth fragments or bony sequestra remain

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33
Q

risk factors for dry socket (8)

A
  • risk increases from anterior to posterior
  • mandible more common
  • smoking reduces blood supply so increases risk
  • female
  • OCP
  • LA with vasoconstrictor
  • excessive trauma during XLA
  • family history or previous dry socket
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34
Q

management of dry socket

A

reassurance
irrigated with warm chlorhexidine / saline then filled with whiteshead varnish pack (must be sutured in and removed at end) or alvogyl (LA+antiseptic)
advise analgesia with hot salty or chlorhexidine mouthwashes
no antibiotics as it is not an infection

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35
Q

sequestrum

A

dead bits of bone, amalgam or tooth are left in socket preventing healing - should be removed

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36
Q

osteomyelitis

A

infection in bone - rare
invasion of bacteria into cancellous bone causing soft tissue inflammation & oedema in closed bone marrow spaces thus increasing tissue hydrostatic pressure & compromising blood supply leading to ischaemia & necrosis even of soft tissue

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37
Q

is osteomyelitis more common in maxilla or mandible

A

maxilla has rich blood supply but mandible has 1 primary blood supply with dense overlying cortical bone limiting perfusion of periosteal blood vessels so there is a poorer blood supply that is more likely to become ischaemic & infected

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38
Q

management of osteomyelitis

A

difficult to distinguish from dry socket / localised infection of socket
will take 10-12 days to be detectable radiographically
refer for tx
clindamycin & penicillin often effective against odontogenic infections as they have good bone penetration

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39
Q

osteoradionecrosis (ORN)

A

seen in patients who have received radiotherapy to head & neck to treat cancer
all bone within radiation beam is pretty much non-vital, reduced bloody supply and slow turnover of any remaining viable bone means self-repair is ineffective
mandible mainly affected

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40
Q

prevention of ORN

A

excellent OH with use of scaling & chlorhexidine to help limit slowing of bone repair due to infection
XLA carefully to avoid damage to socket
hyperbaric O2 before and after XLA to increase local soft tissue oxygenation & increase vascular ingrowth can be useful

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41
Q

bisphosphonates

A

inhibit osteoclast activity and will inhibit bone resorption and therefore bone renewal too
used to treat osteoporosis, paget’s disease and malignant bone metastases
e.g. alendronate, zoledronate

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42
Q

MRONJ

A

medicine related osteonecrosis of jaw
want to avoid XLA by good OH etc but if required it should be done carefully & ptx monitored
tx of MRONJ is not very successful as regeneration of bone is not to be expected

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43
Q

infective endocarditis

A

antibiotic prophylaxis can be given but is undertaken following consultation with GP & team on individual case by case basis - risk factors inc rheumatic fever, prosthetic heart valves

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44
Q

3 sided flap

A

favoured in GDHS
distal relieving incision should not be straight back but angled buccally to avoid lingual nerve and along external oblique ridge

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45
Q

envelope flap

A

with the papilla either include it or don’t, don’t cut halfway through as it heals better when it is all or nothing
this may rip the mucosa due to increased tension so might be better to just cut a mesial relieving incision giving more room

46
Q

surgical access

A

a full thickness buccal mucoperiosteal flap is necessary
some may also raise a lingual flap to minimise damage to lingual nerve
large flap will heal at same rate as a smaller one so sometimes better to have a large flap so soft tissues are not stretched more than necessary

47
Q

how to cut flap

A

should be cut in 1 continuous firm stroke with no sharp angles - firm to cut through periosteum
retract down to bone & done cleanly
trauma to dental papillae should be as minimal as possible
flap design should aid retraction which should be done with a howarth’s periosteal elevator or rake elevator
once retracted tissue should not be crushed and should be kept moist
close tissue with no tension onto sound bone
this will all increase chance of healing by primary intention & minimalisation of scarring

48
Q

how to remove bone

A

bone should be removed using an electrical straight handpiece with a saline cooled bur
if bur is air driven it could lead to surgical emphysema as air is trapped in tissues; this can become infected & antibiotics are necessary
bur itself should be round or fissure tungsten carbide as cut much better

49
Q

gutter of bone

A

this should be cut around the tooth and as close as possible to tooth
should be deep and narrow
should be removed to cancellous bone - this will be bleeding
most necessary to allow for elevator application on distal & mesial aspects of the tooth

50
Q

if a distally impacted molar

A

should cut bone distally being careful not to cut through lingual plate
here a lingual flap is necessary to protect soft tissues from bur
bone should be cut from lingual aspect forwards to protect lingual plate
care should be taken mesially to not cut the 7

51
Q

tooth division

A

can be vertical or horizontal
most commonly section crown of tooth from the roots first
vertical sectioning can help when roots of tooth are diverging

52
Q

debridement of tooth socket

A

to remove sharp bony ridges - bone file & handpiece and to remove soft tissue debris - mitchell’s trimmer or victoria curette
sterile saline irrigation should be used in socket and under flap and there must eb aspiration under flap to remove debris

53
Q

when to use non resorbable sutures (4)

A
  • extended retention
  • incentive for ptx to return
  • oral antral fistula
  • exposure of a canine tooth with associated packing (Whitehead’s varnish pack or CoePack)
54
Q

monofilament v polyfilament

A

single strand which will pass easily through tissue, will also not wick so will be resistant to bacterial colonisation
polyfilament will be easier to handle despite their wicking effects

55
Q

surgical post op instruction

A

Good post-op instructions will prevent patients returning with many common minor problems. Tell them to:
* Take analgesia before the local wears off and expect pain
* Don’t rinse for several hours post-op, it may wash away the clot or encourage bleeding
* Eat softer colder foods for the rest of the day and softer foods for the next week
◦ Hard foods will traumatise the socket
◦ Very warm foods can cause post-op bleeding and burn the lip while still numb
* Do not explore the socket with your fingers or tongue – will remove the clot and cause bleeding
* Do not bite or burn your lip while still numb
* If post-op bleeding occurs, roll up damp gauze and bite down on it for up to 20-30 minutes
◦ If bleeding persists return here or A&E if out of hours
* You may experience swelling, it will peak in 48 hours and resolve in 10 days
◦ Use ice packs wrapped in a tea towel for 5 minutes at a time, 5 on 5 off
◦ These should be used for an hour or so
* Some people bruise, this is variable and don’t be alarmed if you do
* Some experience jaw stiffness or limitation of opening
◦ This usually settles in 1-2 weeks but can be longer
◦ Keep eating and drinking even if it is difficult
* Eat on the other side of your mouth and try not to chew food into the socket
* Keep the area clean!
◦ Brush everywhere else as normal but take care around the sutures
◦ Use hot salty mouthrinses especially after eating
◦ Can use CHX twice a day
▪ Not after brushing! It interacts with toothpaste and washes it away
▪ Not before or after eating, as it can cause staining especially if food is on the teeth
▪ The staining can however be polished off
* You may have resorbable or non-resorbable sutures
◦ Resorbable Vicryl sutures may be lost in days or up to two weeks
* Come back if there are major problems or minor problems don’t settle
25
Oral Surgery
* Avoid smoking for as long as possible
◦ However just being a smoker increases the risk of dry socket no matter what
* Avoid alcohol and exercise today
◦ These increase the blood pressure leading to bleeding
* Reassure we are here if you need any advice

56
Q

common analgesia post op (3)

A
  1. ibuprofen - 200/400mg, 6 hourly or 3x daily, avoid in asthmatics, bleeding disorders, warfarin & other NSAIDs
  2. paracetamol - 500mg, 2 tablets 4-6hrly, no more than 8 a day
  3. cocodamol - 8mg codeine/500mg paracetamol, stronger is 30/500mg, 2 tablets 4-6 hourly, no more than 8 a day
57
Q

nerves at risk on surgical removal of impacted 3rd molars (4)

A
  1. long buccal nerve
  2. mylohyoid nerve
  3. inferior alveolar nerve
  4. lingual nerve - especially on a distal relief incision on surgical XLA so should angle distal relief towards the cheek
58
Q

when it is not advisable to remove 8s (4)

A
  1. ptx whose medial history contraindicated removal & risk outweighs benefit
  2. deeply impacted 3rd molars with no history or evidence of local / systemic pathology
  3. where there is an unacceptably high risk of surgical complications or fracture of an atrophic mandible may occur
  4. where 1 tooth is removed under LA but the contralateral 3rd molar is asymptomatic
59
Q

clinical assessment before removal of 3rd molars

A
  • eruption status of 3rd molar
  • presence of local infection
  • caries in or resorption of 3rd molar and adjacent tooth
  • periodontal status
  • orientation & relationship to inferior alveolar canal
  • occlusal relationship
  • TMJD
  • regional lymphadenopathy
60
Q

what to look for in radiograph pre XLA

A
  • type & orientation or impaction & access to tooth
  • crown size & condition e.g. caries / size / shape
  • root no & morphology e.g. apical hooks or abnormal roots
  • alveolar bone level inc point of elevation, depth & density
  • follicular width - if enlarged likely forming a cyst
  • perio status in comparison to adjacent teeth
  • relationship between upper molars & maxillary antrum // lower molars & inferior alveolar canal
  • any associated pathology i.e. cyst, loss of bone to pericoronal infection etc
61
Q

radiographically what suggests a close relationship between 3rd molars & IAN canal (3)

A

if there is diversion of the canal, if there is darkening of the root where crossed by the canal or if there is interruption of the white lines of the canal

62
Q

angulation / orientation of impacted 3rd molars

A

angulation done against curve of spee, most will be vertically / mesially angled
vertical 30-38%
mesial 40%
distal 6-15%
horizontal 3-15%
transverse (sideways) / aberrant (ridonk position) less common

63
Q

what is a cyst

A

a fluid filled epithelial lined sac

64
Q

what is pericoronitis

A

inflammation of soft tissues around crown of wisdom tooth
it will only occur when there is a communication between the tooth and the oral cavity
no communication = no pericoronitis
communication means where it can be probed, even through the PDL
inflammation caused by food & debris getting trapped under the operculum (flap of gum tissue that can form over a PE wisdom tooth)

65
Q

signs and symptoms of pericoronitis

A

pain - described as throbbing pain
swelling - IO/EO
bad taste
pus discharge - especially on pressing the operculum
occlusal trauma to operculum
limited mouth opening
dysphagia - difficult to eat
pyrexia - temperature
malaise
regional lymphadenopathy

66
Q

tx for periocoronitis

A

any periocoronal abscess should be incised & drained
irrigate with warm chlorhexidine mouthwash 10-20ml with blunt needle under operculum

67
Q

consent for wisdom tooth XLA

A
  • if under GA / IV sedation; consent must be written
  • if under LA; can be written or verbal
68
Q

warnings of complications

A

potential fracture of adjacent restorations
risk of jaw fracture
expect pain, may be bruising, swelling, jaw stiffness - use analgesics
risk of numbness (anaesthesia) or tingling (paraesthesia) caused by nerve damage
lingual nerve damage - numbness to 1 side of tongue, may alter taste due to parasympathetic innervation from chorda tympani of CN VII
prolonged bleeding
dry socket - especially in ptx taking OCP, smokers, those with a history of it

69
Q

aim of a coronectomy

A

to reduce risk of IAN damage by removal of crown of a tooth leaving the root adjacent to the IAN
explain to ptx if root is mobilised during crown removal then the entire tooth must be removed

70
Q

aim of periradicular surgery

A

to remove any existing infection via excision of the apical 3mm portion & curettage
apical 3mm removed as this will remove any lateral canals and allow for curettage of the apex
main indication is when there is failure of endodontics

71
Q

blood & nerve supply of MoM

A

blood supply - deep auricular artery which is a branch of the 1st branch of the maxillary artery
nerve supply -
masseter = nerve to masseter
temporalis = 2 deep temporal nerves
lateral & medial pterygoid = nerve to lateral / medial pterygoid
all of these arise from mandibular branch of trigeminal

72
Q

pain in TMJ can be referred along what nerve

A

auriculotemporal nerve

73
Q

suprahyoid muscles that help with mastication

A

anterior belly of digastric; nerve to mylohyoid
mylohyoid; nerve to mylohyoid
geniohyoid; C1
stylohyoid; facial nerve
(genioglossus also helps; CN XII)

74
Q

TMJ opening & closing

A

opening - rotational movement, translates forwards in joint by sliding down articular tubercle from mandibular fossa, lateral pterygoid aids this
closing - mandible moves up & backwards when sat up right and you use your mouth

75
Q

in some forms of TMD the articular disc can be anteriorly displaced:

A

this means posterior band of disc is much further anterior than it should be stretching bilaminar zone of disc; in some people this can:
1. on opening the disc will pop back into place which is known as anterior displacement with reduction - produces a clicking sound
2. if it does not it is anterior displacement without reduction as disc stays in front of condyle - produces a grating sound

76
Q

parafunction

A

habitual exercise of a body part in a way that is other than the most common use of the body part

77
Q

causes of TMD

A

bruxism
lack of posterior support
trauma (rare)
degenerative disease e.g. localised osteoarthritis or generalised disease such as rheumatoid arthritis

78
Q

2 types of derangement of articular disc

A

closed lock - limited mouth opening as disc is ‘dislocated’ forwards int he way of the condyle
open lock - disc is dislocated back in the glenoid fossa so disc is in the way leading to an anterior open bite

79
Q

click v crepitus

A

click not an issue unless causing ptx pain but crepitus makes more of a crunching sound & can be indicative of degenerative change to joint, could also be due to torn / perforated meniscus
jaw should usually open 30-50mm, slightly wider in males, measure using willis bite gauge

80
Q

IO indications of parafunctional habit

A

cheek biting
linea alba - linear buccal keratosis
tongue scalloping - tongue thrust forwards during clenching
occlusal NCTSL

81
Q

to differentiate TMD from sinusitis

A

differential diagnosis by getting ptx to bend forwards & back up
if it feels like all the upper teeth are in pain it is probably sinusitis because there is usually pain in sinusitis on movement

82
Q

conservative TMD advice

A

soft diet, masticate bilaterally, avoid wide opening / chewing gum / incising food, stop nail biting / grinding, hot & cold on face, put head on chest to stop yawning, reduce stress, analgesia if really bad i.e. ibuprofen

83
Q

more extreme TMD management

A

only in bad cases
muscle relaxants i.e. valium ( diazepam ) can be used
tricyclic antidepressants & steroids along with botox to paralyse masseter

84
Q

TMD & splints

A

bite raising appliances hep stabilise occlusion and improve function of masticatory muscles thus decreasing abnormal activity while protecting teeth from grinding

85
Q

most common cause of TMJ clicking

A

anterior disc displacement with reduction is most common cause of TMJ clicking

clicking due to lack of coordination between condyle & articular disc

86
Q

signs & symptoms of mandibular fracture

A
  • pain, swelling, bruising, limitation of function
  • occlusal derangement
  • numbness of lower lip
  • looseness / mobile teeth often in a segment
  • bleeding
  • anterior OB implies a subcondylar fracture
  • deviation of mandible to opposite side
  • trismus
87
Q

surrounding tissue classification of mandibular fracture

A
  1. simple - will not involve surrounding tissue
  2. compound - involves surrounding tissue; in mouth it is always a compound fracture
  3. comminuted - fracture turns the bone into many pieces usually only in a GSW
88
Q

describing fracture

A

no of fractures
side i.e. uni / bilateral
site i.e. angle, body, ramus
direction of fracture line i.e. favourable / unfavourable

89
Q

direction of fracture line

A

the fracture will be favourable if it is broken, however the line of fracture prevents displacement. this form of fracture will not need splinting just a soft diet for healing process
an unfavourable fracture line will encourage displacement and will require splinting

90
Q

what causes fracture displacement (5)

A
  • direction of fracture line i.e. unfavourable
  • opposing occlusion
  • magnitude of force
  • mechanism of injury
  • intact soft tissue i.e. attached muscle pull, integrity of periosteum
91
Q

management of mandibular fracture

A

clinical assessment -> radiographic assessment -> tx
tx inc: antibiotics (necessary for any compound fracture in body esp in mouth where it is exposed to saliva), fracture then reduced to bring it into place and fixated to keep it in place

92
Q

2 main methods for radiographically assessing a mandibular fracture

A
  1. CBCT
  2. 2 radiographs at right angles to each other i.e. OPT with a PA mandible
93
Q

symptoms of maxillary fracture

A

malocclusion
altered sensation
diplopia (double vision)
decreased air entry
change in facial appearance
nose bleed

94
Q

signs of maxillary fracture

A

swelling bruising paraesthesia pain nose bleed AOB / deviation trismus diplopia altered eye movements change in pupillary level, enophthalmos - posterior displacement of eyeball epiphora - overflow of tears to face due to insufficient drainage, facial flattening

95
Q

tx of maxillary fracture

A

again reduction & fixation but most often open reduction with internal fixation

96
Q

epithelium of sinuses

A

pseudostratified ciliated columnar epithelium with goblet cells

97
Q

purpose of cilia in sinuses

A

will mobilise trapped particulate matter & foreign material within sinus and move it to the semilunar hiatus (just below middle concha) for elimination into the nasal cavity

98
Q

why can sinusitis present as tooth pain

A

in maxillary sinus the alveolar canals that transport the posterior superior alveolar vessels & nerves to maxillary posterior teeth are generally found on posterior wall of the sinus cavity

99
Q

OAC v OAF

A

communication is fresh but a fistula is an epithelial lined tract

100
Q

aetiology of sinusitis

A

effects of a viral infection causing inflammation & oedema, obstruction of hiatus semilunaris & trapping of debris in sinus cavity which is further enhanced by damage to cilia so sinus can no longer evacuate contents efficiently causing a build up of pressure allowing for bacterial overgrowth of the normal flora

101
Q

traumatic causes of sinusitis

A

sinus wall fracture
RCT - initiating a periapical inflammation at floor of sinus / introducing bacteria into sinus
XLA - OAC / roots in antrum
implants
nasal packing

102
Q

signs & symptoms of sinusitis

A

facial pain, pressure, congestion, nasal obstruction, paranasal drainage, hyposmia (reduced smell), fever, headache, dental pain
must rule out - periapical abscess, periodontal infection, deep caries, XLA socket problems, TMD, neuralgia / atypical facial pain

103
Q

tx of sinusitis

A

decongestants to reduce oedema i.e. pseudoephidrine, oxymetazoline (nasal spray), humidified air
antibiotics only used if the above not effective or symptoms worsen - give amoxicillin for 10-14 days (same regime as OAC) can also give clindamycin / doxycycline

104
Q

explain combination syndrome

A

where lower anteriors are retained but uppers are all extracted so biting of lower teeth into upper ridge induces bone destruction causing flabby ridge formation

105
Q

why take an aspiration & what for

A
  • can be from a blood sample of venous blood taken for a FBC, U&E (urea & electrolytes), haematinics or glucose
  • can be taken from lesion i.e. abscess or cyst
    by taking an aspirate it avoids contamination by oral commensals & protects anaerobic species
106
Q

types of surgical biopsy

A
  1. excisional biopsy - removes all clinically abnormal tissue; usually for benign lesions i.e. fibrous overgrowths, denture hyperplasia, mucoceles
  2. incisional biopsy - removes part of the abnormal tissue; do this when lesion is larger or if unsure of diagnosis e.g. lichen planus, SCC
    type of incision biopsy is a punch biopsy
    remember area must be large enough and representative
107
Q

what is osseointegration

A

when implant has osseointegrated there is direct interface between bone & implant surface with no fibrous attachment
it allows for occlusal forces to be transmitted directly onto bone
effectively are ankylosed
requires initial primary stability followed by secondary stability
these plants should have:
- no mobility when tested manually
- proven ability to function for yrs
- limited morbidity on failure

108
Q

what is the material of choice for implants

A

titanium as it is bioinert

109
Q

primary stability in osseointegration

A

good quality bone required to ensure implant is held in place whilst new bone grows around & onto it
if mobility at this stage then osseointegration is unlikely

110
Q

secondary stability in osseointegration

A

when osseointegration actually occurs & produces stability
if mobility at this stage then implant will need replaced as it has failed

Exam (14 decks)

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