oral surgery Flashcards
what vasoconstrictors can be used in LA?
- adrenaline
-felypressin
-none
what is the purpose of vasconstrictors in LA?
to increase the amount of time absorption occurs in the bloodstream
what vasconstrictor would you not give to a pregnant woman and why?
felypressin- induces labour
give two factors which affect which LA technique you would use
- the nerve you are anaesthetising
- the bone density
what is the difference between an infiltration and a block?
infiltration- LA deposited around terminal branches of the nerve
block- deposited beside nerve trunk
what is the bevel of the needle?
the point/tip of the needle
what is the gauge of the needle?
the diameter of the lumen
30-gauge has a smaller internal diameter than a 25-gauge needle
what is the length of a short needle?
25mm
what is the length of a long needle?
35mm
how much solution in a a typical LA cartridge?
2.2ml
describe lidocaine
HCl 2%
1:80,000 adrenaline
metabolised in liver and excreted in the kidney
rapid onset: 2-3 mins
describe Prilocaine
HCl 3%
contains felypressin
describe articaine
metabolised in liver and excreted in kidney
1:200,000 adrenaline
how long will anaesthesia last after a block with lidocaine HCl 2%?
pulp- 90 minutes
soft tissue- 3-5 hours
what is the max dose (mg/kg) of lidocaine?
5mg/kg
how many mg are in one cartridge of lidocaine?
44
what is the max dose (mg/kg) of articane?
7mg/kg
how many mg are in one cartridge of articane?
88
what is the max dose (mg/kg) of prilocaine?
8mg/kg
how many mg are in one cartridge of prilocaine?
66
what patients would u limit the use of adrenaline in?
- cardiovascular disease
- hyperthyroidism
- hypertension
- B-blockers
- Tricyclic antidepressants
what tissues does a lingual nerve block anaesthetise?
- lingual gingiva
- mucosa of anterior 2/3rds of the tongue
- floor of the mouth
what tissues does an inferior alveolar nerve block anaesthetise?
the mandibular teeth
what post operative instructions would you give to a patient after an extraction? (in depth)
- pain is normal; try and start analgesics before LA wears off
- take pain killers you would normally use for headache
- use regular analgesia for 1-3 days then as required
- warn not to go over dose on packet
- bleeding unlikely but is a possibility
- don’t touch the socket with finger/toothbrush/tongue as it can disturb the clot
- no exercise/ anything that will increase blood pressure rest of the day
- avoid hot food/drinks until LA completely worn off
- no hard food- can traumatise the socket
- eat on opposite side of the mouth for a few days
-no alcohol for 24 hours and no smoking for as long as possible - don’t rinse until the next day
- start rinsing with warm salty water 4x daily
- advise on bleeding
- adjacent teeth may be sensitive
- jaw might be sore for a few days- if it prevents eating call back
- may be some facial swelling- if concerned, call back
- can bruise
what advice would you give a patient to prepare them for bleeding at home?
- bite down on damp gauze for 20-30 mins
- ensure it is damp but not soaking to stop it sticking
- if not stopped, repeat for up to an hour
- contact dentist/ out of hours if still not stopped
- make sure you give a contact number
- if cannot get to any dentist, go to A&E
what advice would you give to a patient after an extraction? (basic)
- painkillers
- bleeding
-no exercise, hot/hard food, alcohol, smoking - eat on opposite side of the mouth
- rinsing instructions
- sensitivity, bruising, swelling, jaw stiffness
what advice would you give to a patient after a surgical extraction?
- same as simple extraction but with additional info.
- don’t touch sutures
- if sutures fall out with no pain/bleeding, just leave them
- if sutures become uncomfortable, come back to have them removed
- tell patient if sutures are resorbable or not
- advice on chlorhexidine- capful 2/3x daily
- dilute with water if it causes discomfort
- do not use just before/after eating or just after brushing
- bruising and swelling common
- use ice pack for swelling
what is a periotome used for?
to remove a tooth or retained roots without damaging the alveolar plates or traumatising the soft tissue
what is the difference between elevators and luxators?
elevators- less sharp, more curved blades that fit the shape of the tooth
luxators- sharp, flat-tipped blades that can penetrate into periodontal space
name 3 types of elevator
- couplands
- cryer’s
- warwick james
name uses of elevators
- to provide a point of application for forceps
- to loosen teeth prior to using forceps
- removal of retained roots
what are the 3 basic actions of elevators?
wheel and axle
wedge
lever
what are couplands elevators used for
Extracting retained roots
what are cryer elevators used for
used in furcation area of molar teeth
What are the Warwick James elevators used for
good to use for extracting wisdom teeth
where would you stand to extract the lower right molar teeth
Behind the patient
where would you stand to extract upper teeth
Infront of the patient
Where would you stand to extract the lower left molar teeth
Infront of the patient
what teeth would you extract using cowhorn forceps?
lower molars, especially broken down ones
what teeth would you extract using bayonet forceps?
upper wisdom teeth
