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Oral Surgery Flashcards

1
Q

What type of complication occurs during an operation?

A

Peri-operative complications

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2
Q

What are the peri-operative complications of an extraction?

A

GENERAL (2)
1. Difficult access
2. Abnormal resistance

TOOTH (4)
3. fracture of root / crown
4. fractures of alveolar bone
5. fracture of jaw
6. fracture of tuberosity

COMMUNICATION (2)
7. OAC
8. Root in antrum

SOFT TISSUE (4)
9. Soft tissue damage
10. Nerve damage
11. Haemorrhage
12. TMJ dislocation

SURROUNDING STRUCTURES (5)
13. Wrong tooth
14. Damage adjacent teeth/rests.
15. Extract tooth germ
16. Broken instruments
17. Loose tooth

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3
Q

Extraction Peri-operative complication information on: Access

(Why difficulty)

A
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4
Q

Extraction Peri-operative complication information on: Abnormal resistance

A
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5
Q

Extraction Peri-operative complication information on: Fractured tooth/root

anatomical and disease Causes:

A

.

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6
Q

Extraction Peri-operative complication information on: fractured alveolar bone

Cause
Most common area
Treatment

A
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7
Q

Extraction Peri-operative complication information on: fractured mandible

Common causes
Prevention
Symptoms
Response /treatment

A
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8
Q

Extraction Peri-operative complication information on: fractured tuberosity

Most common area
cause (increasing risk)
diagnosis
management
process for tooth if remains

A
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9
Q

Extraction Peri-operative complication: OAC

  • what?
  • diagnosed by?
  • risk factors?
  • Management
A

.

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10
Q

Extraction Peri-operative complication information on: Root in antrum management

A
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11
Q

Extraction Peri-operative complication information on: soft tissue damage prevention

A

Prevention
- correct placement of instrument
- controlled pressure

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12
Q

Extraction Peri-operative complication information on: haemorrhaging

types
cause / increased risk factors
treatment (hard and soft tissue)

A
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13
Q

Extraction Peri-operative complication information on: nerve damage

(causes, types, symptom types)

A

Chemical injury

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14
Q

Extraction Peri-operative complication information on: TMJ dislocation management

A
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15
Q

Extraction Peri-operative complication information on: wrong tooth prevention

A
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16
Q

Extraction Peri-operative complication information on: Lost tooth and where

A

inhalation most likely in right bronchi

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17
Q

Extraction Peri-operative complication information on: Extract tooth germ

(where common?)

A

Rare, molars

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18
Q

Extraction Peri-operative complication information on: damage to adjacent teeth / restorations

(how, management)

A
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19
Q

Extraction Peri-operative complication information on: broken instrument

A
  • Tips of elevators/luxators/burs
  • Radiograph and retrieve/refer if cant
  • Contact defence union
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20
Q

Post extraction instructions

A
  • no smoking for 24hrs
  • explain LA wearing off etc (3-4hrs)
  • swelling normal, worst 2-3 days after
  • sudden pain increase after few days = infection so contact us
  • bruising normal - lasts two weeks
  • mouth opening can be restricted for about a week
  • if stitches, should fall out and disappear after 7-10 days (unless told otherwise)
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21
Q

Extraction Immediate / short - Post-operative complications

A

soft tissue (4)
1. pain / swelling / bruising (Ecchymosis)
2. trismus
3. nerve damage
4. haemorrhaging

Hard tissue (3)
5. dry socket
6. sequestrum
7. infected socket

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22
Q

Extraction long term post-operative complications

A
  1. OAF (chronic)
  2. MRONJ
  3. ORN
  4. Osteomyelitis
  5. Infective endocarditis
  6. Actinomycosis

*2-6 much rarer

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23
Q

Extraction immediate post operative complications: pain / swelling / ecchymosis

(what makes worse)

A

Pain
- exposed bone
- rough handling soft tissue
- incomplete extraction

Rest:
- Rough handling of soft tissue
- Pulling flaps
- Tearing periosteum

24
Q

Extraction immediate post operative complications: trismus

(cause, treatment)

25
Q

Extraction immediate post operative complications: haemorrhaging

  • short term and long term causes
  • treatment
26
Q

Extraction immediate post operative complications: nerve damage

(types and symptoms)

27
Q

Extraction immediate post operative complications: dry socket

  • how occurs?
  • predisposing factors?
  • symptoms? (3)
  • when happens and how long lasts?
  • how manage?
A

Predisposing factors - vasoconstrictor (smoking), the pill, mandible

28
Q

Extraction immediate post operative complications: infected socket

  • effects
A

Rare
Effects
- pus
- bleeding
- delayed healing

29
Q

Extraction Long term post operative complications: OAF chronic

Diagnosis methods
Treatment (small and large)

30
Q

Extraction immediate post operative complications: sequestrum - effect

A
  • delays healing
  • quite common
31
Q

Extraction Long term post operative complications: MRONJ

  • cause (2)
  • where occurs and how bad?
  • management
  • prevention
A

summary
- bisphosphonates (zalondonic acid / alendronic acid), angiogenic, antiresorptive drugs
- both jaws, extreme or mild
- antibiotics if pus, chlorohexidine mouth wash, debridement, sequestrectomy
- AVOID extractions if medications, extractions in primary care setting

32
Q

Extraction Long term post operative complications: ORN

(cause, prevention and treatment)

33
Q

Extraction Long term post operative complications: Osteomyelitis

  • what is it, what it causes and how it causes this
  • predisposing factors
  • what is typical of this and allows for diagnosis
  • treatment
    (What, risk, diagnosing, treatment)
A

summary
- infection of cancellous bone causing increased hyrostatic pressure = lower blood flow = necrosis of hard and soft tissues
- predisposing factors = immune issue / mandible fracture
- typical - moth eaten appearance radiographically and involucrum
treatment - penicillins and debridement of necrotic tissue

34
Q

Extraction Long term post operative complications: IE

(Risks and why)

A

predisposing risk factors
- past rheumatic fever (= heart vegetations/scarring)
- Prosthetic valves
- Previous IE

  • as bacteria can colonise when bacteraemia
35
Q

Extraction Long term post operative complications: actinomycosis

(what and treatment)

36
Q

Aspirin
1. What
2. Effect (3)
3. How analgesic
4. Contraindications (7)
5. overdose effects

extra - disease caused when underage

37
Q

Ibuprofen
1. what
2. effect
3. possible contraindications
4. side effects
5. overdose effects

38
Q

paracetamol
1. what
2. effect
3. side effect
4. possible contraindications
5. overdose

A

NOT AN NSAID

39
Q

Opioids
1. action
2. effects
3. issues (2) and side effects (3)
4. contraindications

40
Q

Codeine
1. what
2. effect on oral pain
3. overdose symptoms
4. dentally relevant info
5. contraindications

41
Q

General description of pain pathway

A

damage to tissue = prostaglandin production = higher sensitised tissue to pain and inflammation

42
Q

what drug is an anticonvulsant that can also be used as an analgesic? and for what type of pain?

A

Carbamazepine
- neuropathic / functional pain
i.e. trigeminal neuralgia

43
Q

Basic principles of Surgical access for extracting a tooth (mucoperiosteal Flap design etc.)

A

-Max access / min trauma
-Big and small heal at same rate
-Wide based incision for circulation
-No sharp angles and continuous cut
-Flap retraction down to bone
-KEEP MOIST
-Minimise trauma to dental papillae
-Suture over sound bone

44
Q

Oral surgery: purpose of tissue retraction and types of retractors

A

purpose
- best access
- soft tissue protection

retractors
- howarths periosteal elevator and rake retractors

45
Q

Oral Surgery: types of access flaps

A
  1. envelope flap
    - 2 sided (no third mesial relieving flap)
  2. 3 sided flap
    - mesial and distal relieving flaps
46
Q

Oral surgery: principles of bone drill

A
  • electrical straight handpiece
  • saline water cooled
  • tungsten carbide bur
  • NOT air as = emphysema
    - deadly
    - air blown into subcutaneous tissue and can spread = infection
47
Q

types of debridement in oral surgery

A
  1. physical
    - HARD - bone file / handpiece to smooth bone
    - SOFT - mitchells trimmer / victoria curette to remove soft tissue debris
  2. irrigation
    - sterile saline into socket / under flap
  3. suction
    - aspirate under flap
48
Q

aims of suturing (3)

A
  • reposition tissues, covering bone
  • haemostasis (compress BV)
  • encourage healing
49
Q

suture types / filament types

A
  1. non absorbable
    - if extended retention needed (OAF)
  2. polyfillament
    - filaments twisted together
    - easier to handle
    - prone to wicking (infection spreads along)
  3. absorbable
    - if removal not possible / desierable
    - vicryl breakdown via water absorption = polymer breakdown

filament types (absorbable / non absorbable)
- mono (resistant to wicking, less scarring)
- poly

50
Q

suture needle properties

A
  • curved
  • triangular cross section
51
Q

lower 8 extraction, nerves in close proximity

A

Lingual
Inferior alveolar
Long buccal
Mylohyoid

52
Q

when is a 3 sided flap access for an extraction not possible?

A

when the mesial relieving flap could damage the mental nerve

53
Q

Anti-fibrinolytic haemostatic agent

And other haemostatic agent

A

Tranexamic acid - prevents blood clot breaking down

Desmopressin (von williebrand factor and 8)

54
Q

What are each for and what are the movements for each:

  1. Luxator
  2. Elevators
A
    • for tearing periodontal ligament
    • forced down long axis of tooth and slight rocking motion (NOT palatally)
    • used medically, midbuccally and distaly
    • for tooth removal / lifting teeth out socket / listening tooth for forceps use
    • 3 actions = wheel and axil, wedge, lever (risk bone break)
55
Q

3 methods of bone debridement

A
  1. Physical
    - bone file / hand piece - mitchels trimmer or Victoria curette
  2. Irrigation
    - sterile saline
  3. Suction
    - under flap / in socket
56
Q

What is the function of ferric sulphate

A

Haemostatic agent to put on pulp

BDS3 (14 decks)

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