oral surgery

Question 1

what vasoconstrictors can be used in LA?

Answer 1

• adrenaline
  -felypressin
  -none

Question 2

what is the purpose of vasconstrictors in LA?

Answer 2

to increase the amount of time absorption occurs in the bloodstream

Question 3

what vasconstrictor would you not give to a pregnant woman and why?

Answer 3

felypressin- induces labour

Question 4

give two factors which affect which LA technique you would use

Answer 4

• the nerve you are anaesthetising
• the bone density

Question 5

what is the difference between an infiltration and a block?

Answer 5

infiltration- LA deposited around terminal branches of the nerve
block- deposited beside nerve trunk

Question 6

what is the bevel of the needle?

Answer 6

the point/tip of the needle

Question 7

what is the gauge of the needle?

Answer 7

the diameter of the lumen
30-gauge has a smaller internal diameter than a 25-gauge needle

Question 8

what is the length of a short needle?

Answer 8

25mm

Question 9

what is the length of a long needle?

Answer 9

35mm

Question 10

how much solution in a a typical LA cartridge?

Answer 10

2.2ml

Question 11

describe lidocaine

Answer 11

HCl 2%
1:80,000 adrenaline
metabolised in liver and excreted in the kidney
rapid onset: 2-3 mins

Question 12

describe Prilocaine

Answer 12

HCl 3%
contains felypressin

Question 13

describe articaine

Answer 13

metabolised in liver and excreted in kidney
1:200,000 adrenaline

Question 14

how long will anaesthesia last after a block with lidocaine HCl 2%?

Answer 14

pulp- 90 minutes
soft tissue- 3-5 hours

Question 15

what is the max dose (mg/kg) of lidocaine?

Answer 15

5mg/kg

Question 16

how many mg are in one cartridge of lidocaine?

Answer 16

44

Question 17

what is the max dose (mg/kg) of articane?

Answer 17

7mg/kg

Question 18

how many mg are in one cartridge of articane?

Answer 18

88

Question 19

what is the max dose (mg/kg) of prilocaine?

Answer 19

8mg/kg

Question 20

how many mg are in one cartridge of prilocaine?

Answer 20

66

Question 21

what patients would u limit the use of adrenaline in?

Answer 21

• cardiovascular disease
• hyperthyroidism
• hypertension
• B-blockers
• Tricyclic antidepressants

Question 22

what tissues does a lingual nerve block anaesthetise?

Answer 22

• lingual gingiva
• mucosa of anterior 2/3rds of the tongue
• floor of the mouth

Question 23

what tissues does an inferior alveolar nerve block anaesthetise?

Answer 23

the mandibular teeth

Question 24

what post operative instructions would you give to a patient after an extraction? (in depth)

Answer 24

• 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

Question 25

what advice would you give a patient to prepare them for bleeding at home?

Answer 25

- 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

Question 26

what advice would you give to a patient after an extraction? (basic)

Answer 26

- painkillers - bleeding -no exercise, hot/hard food, alcohol, smoking - eat on opposite side of the mouth - rinsing instructions - sensitivity, bruising, swelling, jaw stiffness

Question 27

what advice would you give to a patient after a surgical extraction?

Answer 27

- 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

Question 28

what is a periotome used for?

Answer 28

to remove a tooth or retained roots without damaging the alveolar plates or traumatising the soft tissue

Question 29

what is the difference between elevators and luxators?

Answer 29

elevators- less sharp, more curved blades that fit the shape of the tooth luxators- sharp, flat-tipped blades that can penetrate into periodontal space

Question 30

name 3 types of elevator

Answer 30

- couplands - cryer's - warwick james

Question 31

name uses of elevators

Answer 31

- to provide a point of application for forceps - to loosen teeth prior to using forceps - removal of retained roots

Question 32

what are the 3 basic actions of elevators?

Answer 32

wheel and axle wedge lever

Question 33

what are couplands elevators used for

Answer 33

Extracting retained roots

Question 34

what are cryer elevators used for

Answer 34

used in furcation area of molar teeth

Question 35

What are the Warwick James elevators used for

Answer 35

good to use for extracting wisdom teeth

Question 36

where would you stand to extract the lower right molar teeth

Answer 36

Behind the patient

Question 37

where would you stand to extract upper teeth

Answer 37

Infront of the patient

Question 38

Where would you stand to extract the lower left molar teeth

Answer 38

Infront of the patient

Question 39

what teeth would you extract using cowhorn forceps?

Answer 39

lower molars, especially broken down ones

Question 40

what teeth would you extract using bayonet forceps?

Answer 40

upper wisdom teeth