Oral Surgery Flashcards
What is an OAC
Communication between the maxillary sinus and the oral cavity
What are the predisposing factors for an OAC
-Close to antrum
-Large antrum
-Submerged teeth
-Hypercementosis
-Excessive force
-Periodontal disease and bone loss
What is the treatment for an OAC
-If small, simple horizontal mattress suture
-If large, buccal advancement flap
-Antral regime
What is the antral regime
-Antibiotics
-Steam inhalation (Karvol)
-Nose drops (ephedrine)
-No nose blowing, wind instruments
What are the clinical findings for an OAC
-Hollow sound in the socket with the sucker
-Bubbling in the socket
-Regurgitation of fluid
-Antral lining between the roots of the tooth
-Radiographic defect in the antral floor
What is an OAF
-Occurs when the OAC becomes epithelialise
What are the signs and symptoms of an OAF
-Chronic sinusitis
-Regurgitation of fluids
-Nose bleeds
-Fluid in sinus on radiograph
-Antral mucosa prolapse in the mouth
What is the treatment for OAF
-Antibiotics before the surgery
-Excision of the fistula tract
-Buccal advancement flap
What are the risk factors for a fractured tuberosity
-Lone standing molars
-Hypercementosis
-Excessive force
-Bulbous roots
-Large antrum
What is the treatment for a fractured tuberosity
-If small, dissect the fragments out and close, antral regime
-if large, allow to heal for 8 weeks and splint, then surgical removal, antibiotics
How to treat displaced roots
-2 radiographs
-Removal under GA
-Cadwell Luc procedure
-Antral regime
Causes of acute sinusitis
-Decreased drainage
-Infection
-Deviated septum
-Debilitated patient
Signs and symptoms of acute sinusitis
-TTP but vital teeth
-Pain over the mid face
-Pain on bending down
-Facial swelling
-Purulent discharge
-Pyrexia
-What is the treatment for acute sinusitis
-Antral regime
-Analgesics
-Bed rest
What are the signs and symptoms of chronic sinusitis
-Mucopurulent discharge
-Nasal obstruction
-Thickened antral mucosa
When to refer infection to hospital
-Rapidly spreading infection
-Immunocompromised
-Pyrexia
-Raised floor of mouth
-Difficulty breathing/swallowing
-Deviated uvula
-Trismus
What special tests to do for referring infection to hospital
-Temperature
-Pulse and blood pressure
-Radiographs
-Blood glucose
-CRP
What is Ludwig’s angina
-Bilateral swelling of the submandibular, sublingual and submental spaces
What are the factors that can affect spread of infection
-Number of virulence factors
-Host immune response
-Natural barriers (e.g. muscles)
-Site of source of infection
What are the treatment options for spreading infection
-Identify the source of infection first
-Extraction
-Draining through root canal
-Incision and drainage
What are the indications for extractions of wisdom teeth
-Unrestorable caries in 7
-Non-treatable periapical pathology
-Resorption of adjacent teeth
-Cysts/tumours
-Preventing jaw surgery
What is pericoronitis and what type of bacteria is involved
-Inflammation of the soft tissue overlying a partial erupted tooth
-Streptococci, anaerobic bacteria
Early symptoms of pericoronitis
-Pain
-Swelling
-Halitosis
-Trismus
-Lymphadenopathy
Initial management of pericoronitis
-Good OHI
-Irrigate with CHX/saline
-Debridement of operculum under LA
-Analgesics
-CHX mouthwash
-Grind opposing cusps
Describe tooth and local factors to consider before extraction
-Crown to root ratio
-Bone density
-Adjacent teeth
-Anatomical structures
-Mouth opening
Main signs of proximity to iD canal on radiograph
-Darkening of roots
-Interruption of tramline
-Diversion of canal
Describe a coronectomy
-Section the crown off the tooth
-Remove all enamel
-Ensure roots are 2-4mm below crestal bone level
Contraindications for coronectomy
-Caries
-Apical pathology
-Root mobility
Principles of flap design
-Suture over sound bone
-Preservation of interdental papilla
-Ability to extend or close
-Wider at the base to maintain good blood supply
-Avoids vital structures
What are the contra-indications for NSAIDs
-Pregnancy
-Asthmatic
-GI bleeds
What is the analgesic ladder
-Non-opiods (paracetamol, ibuprofen)
-Weak opioids (codeine)
-Strong opioids (morphine)
What are the complications of LA
-Injection into parotid gland causes facial palsy
-Injection into muscle causes trismus
-Haematoma if laceration of vein
-Intravascular injections can cause tachycardia, blindness
