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BDS Finals > Oral Surgery > Flashcards

Oral Surgery Flashcards

1
Q

Indications for Extractions (5)

A
  1. Unrestorable teeth
  2. Traumatic position
  3. Symptomatic partially erupted teeth
  4. Orthodontic indications
  5. Interference with construction of dentures
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2
Q

Percentage of dry sockets/osteonecrosis (3)

A

2-3%
20-30% lower 8s
1/1000 w/bisphosphonates

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3
Q

Spread of infection from upper anteriors (3)

A

Lip
Nasolabial region
Lower eyelid

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4
Q

Spread of infection from upper laterals

A

Palate
Uncommon

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5
Q

Spread of infection from upper premolars and molars (4)

A

Cheek
Infra-temporal region
Maxillary antrum (rare)
Palate (less common)

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6
Q

Spread of infection from lower anteriors (2)

A

Mental space
Submental space

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7
Q

Spread of infection from lower premolars and molars (5)

A

Buccal space
Submasseteric space
Sublingual space
Submandibular space
Lateral pharyngeal space

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8
Q

Surgical Management of Infection (3)

A

Drainage
Removal of source of infection
Antibiotics

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9
Q

When are antibiotics not needed for an infection (3)

A

Drainage achieved
Source of infection removed
Patient not systemically unwell

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10
Q

NEWS

A

National Early Warning Score

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11
Q

Hilton technique

A

Item with two ends inserted into incision and opened to allow drainage

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12
Q

Why is a drain inserted after an incision for infection

A

To allow complete drainage

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13
Q

Ludwigs Angina (2)

A

Bilateral cellulitis of the sublingual and submandibular spaces
SIRS most likely

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14
Q

SIRS

A

Systemic Inflammatory Response Syndrome

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15
Q

Why might pain be worse at night (2)

A

Prone position
No distraction

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16
Q

Why should you ask how a patient feels when they present with infection

A

To check for systemic symptoms

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17
Q

Where could there be swelling that is not visible (2)

A

Submasseteric Space
Common from lower 8s

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18
Q

Causes of mobile teeth (2)

A

Periodontal disease
Infection for a very very long time

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19
Q

Infection in immunocompromised patients (2)

A
  1. May have less severe response but may be very unwell due to medication
  2. Methotrexate, Steroids
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20
Q

Will you see a radiolucency for an acute dentoalveolar abscess (3)

A

Probably not
Acute - Fast
Bone not had time to resorb

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21
Q

When should you sensibility test for an abscess

A

If you are unsure which tooth is causing the infection

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22
Q

Why should you palpate an abscess

A

To feel where is the most fluctuant

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23
Q

Can an abscess be diagnosed from a radiograph

A

No, it must be diagnosed clinically

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24
Q

Options for draining an abscess (2)

A

Incision
Extraction

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25
Q

Post incision instructions for patient

A

Rinse mouth out every so often with salt water

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26
Q

When should follow-up be arranged post abscess drainage

A

2-3 days

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27
Q

What measures can be used to determine whether a patient has systemic symptoms (4)

A
  1. HR
  2. Temperature
  3. Resp rate
  4. B.P - Likely raised in dental chair anyway
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28
Q

How to refer patient to hospital (3)

A
  1. Gather information first
  2. Phone max fax
  3. Explain symptoms of SIRS
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29
Q

Cardinal signs of inflammation (5)

A
  1. Heat
  2. Redness
  3. Swelling
  4. Pain
  5. Loss of function
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30
Q

Epulis Fissuratum

A

Denture induced hyperplasia

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31
Q

Purpose of vestibuloplasty

A

Deepen the sulcus

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32
Q

Papillary hyperplasia

A

Overgrowth of soft tissue on palate

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33
Q

When are tori an issue

A

For denture design
Not an issue for fully dentate patients

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34
Q

Autografts (3)

A

Bone taken from patient
Lilac crest bone
Rib

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35
Q

Allografts

A

Bone taken from other humans

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36
Q

Xenografts (2)

A

Bone taken from animals
Bio-Oss

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37
Q

Synthetic Grafts (2)

A

Customisable size and shape
Beta Tricalcium Phosphate

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38
Q

When does root calcification of third molars occur

A

Ages 18-25

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39
Q

Agenesis

A

Failure of a structure to develop

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40
Q

Where is agenesis more common (3)

A

Maxilla
Females
Mexican population

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41
Q

Main risks for all extractions (10)

A
  1. Pain
  2. Swelling
  3. Bruising
  4. Bleeding
  5. Infection
  6. Damage to adjacent tooth
  7. Tooth/root fracture
  8. Jaw stiffness
  9. Dry socket
  10. Nerve damage
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42
Q

Risks for maxillary extractions (3)

A
  1. Loss of tooth into maxillary antrum
  2. Creation of OAC/OAF
  3. Fracture of maxillary tuberosity
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43
Q

Risks for mandibular extractions (4)

A
  1. Mandibular fracture
  2. TMJ dislocation
  3. Nerve damage - 8s
  4. Higher risk of dry socket than for maxillary teeth
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44
Q

Unrestorable teeth (6)

A
  1. Gross caries
  2. Advanced periodontal disease
  3. Tooth/root fracture
  4. Severe tooth surface loss
  5. Pulpal necrosis
  6. Apical infection
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45
Q

Elevators which look similar to luxators

A

Couplands

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46
Q

Elevators which look like triangles

A

Cryers

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47
Q

Elevators which come in a set of 3

A

Warwick James

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48
Q

Contraindications to coronectomy (5)

A
  1. Immunosuppressed
  2. Poorly controlled diabetes
  3. About to have surgery/chemo/bisphosphonates
  4. Gross caries
  5. Low risk to nerve
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49
Q

Reasons a coronectomy would be deemed a failure (4)

A
  1. Enamel leftover
  2. Infection
  3. Wound dehiscence
  4. Pt symptomatic
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50
Q

Types of impaction for 8s (5)

A
  1. Mesio
  2. Disto
  3. Horizontal
  4. Vertical
  5. Transverse
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51
Q

Most common causes of TMD (3)

A
  1. Myofascial pain
  2. Disc displacement
  3. Degenerative disease
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52
Q

Less common causes of TMD (5)

A
  1. Chronic recurrent dislocation
  2. Ankylosis
  3. Hyperplasia
  4. Tumours
  5. Infection
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53
Q

Special investigations for TMD (7)

A
  1. OPT
  2. CBCT
  3. MRI
  4. Transcranial view (TMJ)
  5. Nuclear imaging
  6. Orthography
  7. Ultrasound
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54
Q

Treatment options for TMD (7)

A
  1. Pt education
  2. Splints
  3. Physical therapy
  4. Medication
  5. Acupuncture
  6. Botox
  7. TMJ surgery
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55
Q

Types of disc displacement

A

With or without reduction

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56
Q

If a pt has a painful clicking jaw, what part of the joint is feeling pain

A

Ligament attached to disc is stretched as disc slips forward

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57
Q

Reduction

A

Returning to original place

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58
Q

Normal mouth opening (2)

A

35-45mm
3 fingers

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59
Q

Exercised for TMD (3)

A
  1. Curl tongue back and open with tongue still on palate
  2. Open against resistance
  3. Open while looking in mirror (for deviation)
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60
Q

Reasons for conservative management of TMD (3)

A
  1. Surgery high risk
  2. Medications have side effects
  3. 50% of TMD cases improve with conservative management
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61
Q

Why would diazepam be prescribed for TMD (3)

A
  1. Only in severe circumstances
  2. While pt waits for referral
  3. Short term - addiction issues
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62
Q

What can be prescribed for TMD by a GP (3)

A
  1. Gabapentin
  2. Nortriptylene
  3. Amitriptylene
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63
Q

TMD Reasons for referral (4)

A
  1. Red flags
  2. Trauma
  3. Closed lock
  4. CN deficiencies - urgent
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64
Q

Main nerves at risk during M3M surgery (2)

A
  1. Inferior alveolar
  2. Lingual
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65
Q

Nerves less likely to be damaged during M3M surgery but still possible (2)

A
  1. Nerve to mylohyoid
  2. Long buccal
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66
Q

Location of lingual nerve (2)

A
  1. Close relationship to lingual plate in mandibular region
  2. 0-3.5mm medial to mandible
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67
Q

Guidelines for extraction of wisdom teeth (2)

A
  1. NICE
  2. SIGN
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68
Q

What type of microbes are involved in pericoronitis

A

Anaerobic microbes

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69
Q

Give some examples of microbes involved in pericoronitis (3)

A
  1. Staph
  2. Strep
  3. Actimyces
70
Q

Pericoronitis treatment

A

Irrigation with saline or CHXD under operculum

71
Q

When would antibiotics be given for pericoronitis (3)

A
  1. If pt systemically unwell
  2. Pt immunocompromised
  3. E/O swelling
72
Q

Superficial impaction

A

Crown of 8 related to crown of 7

73
Q

Moderate impaction

A

Crown of 8 in-between crown and root of 7

74
Q

Deep impaction

A

Crown of 8 related to roots of 7

75
Q

Signs of proximity to canal (5)

A
  1. Interruption of lamina dura
  2. Darkening of root crossed by canal
  3. Diversion of root/canal
  4. Narrowing of root/canal
  5. Dark and bifid root
76
Q

Most common impaction angulation of M3Ms (2)

A
  1. Vertical 30%
  2. Mesial 40%
77
Q

Common treatment options for impacted M3Ms (4)

A
  1. Extraction
  2. Coronectomy
  3. Clinical review
  4. Referral
78
Q

Less common treatment options for impacted M3Ms (4)

A
  1. Operculectomy
  2. Surgical exposure
  3. Pre-surgical orthodontics
  4. Autotransplantation
79
Q

What is more likely is there is a large cystic lesion associated with a M3M during extraction

A

Mandibular fracture

80
Q

How likely is temporary numbness of IDN

A

10-20%

81
Q

How likely is permanent numbness of IDN

A

<1%

82
Q

How long do nerves take to recover from temporary symptoms

A

18-24 months
After this, not much chance of recovery

83
Q

SBAR

A

Situation
Background
Assessment
Recommendation

84
Q

Cyst definition

A

A pathological cavity having fluid, semi-fluid or gaseous contents which is not created by the accumulation of pus

85
Q

Most common odontogenic cysts (5)

A

Radicular cyst
Residual cyst
Dentigerous cyst
Eruption cyst
OKC

86
Q

Periapical granuloma vs radicular cyst

A

Radicular cyst > 1cm

87
Q

Radicular cyst variants (2)

A
  1. Residual cyst
  2. Lateral radicular cyst
88
Q

Paradental cyst typical location

A

Distal aspect of PE M3M

89
Q

Buccal bifurcation cyst typical location

A

Buccal aspect of M1M

90
Q

Dentigerous cyst (3)

A
  1. Associated with crown of UE and usually impacted tooth
  2. Cystic change of dental follicle
  3. Reduced Enamel Epithelium
91
Q

Where is dentigerous cysts more common (2)

A
  1. Males
  2. Mandible
92
Q

Where is OKC more common (3)

A
  1. Males
  2. Mandible
  3. Posterior
93
Q

Odontogenic Keratocyst (3)

A
  1. Developmental odontogenic cyst
  2. No specific relationship to teeth
  3. Rests of Serres
94
Q

Why do OKC have a high chance of recurrence (2)

A
  1. Thin friable lining
  2. Daughter cysts
95
Q

Basal cell naevus syndrome (3)

A

Multiple OKCs
Multiple basal cell carcinomas
Calcification of intracranial dura mater

96
Q

Non-epithelial cysts (3)

A
  1. Stafnes bone cavity
  2. Solitary bone cyst
  3. Aneurysmal bone cyst
97
Q

Nasopalatine duct cyst signs (2)

A

Salty discharge
Radiolucency midline

98
Q

Where are solitary bone cysts more common (4)

A
  1. Scalloping on radiograph
  2. Male
  3. Mandible
  4. Can occur in association with other bone pathology
99
Q

Stafne cavity typical presentation (5)

A
  1. Concavity
  2. Inferior to canal
  3. Asymptomatic
  4. Well defined
  5. Rarely displaces structures
100
Q

Types of biopsy (3)

A
  1. Aspiration
  2. Incisional
  3. Excisional
101
Q

How is an aspiration biopsy carried out (3)

A
  1. Wide bore needle
  2. 5-10ml syringe
  3. May be unable to withdraw plunger
102
Q

Enucleation

A

All of cystic lesion removed

103
Q

Marsupialisation

A
  1. Surgical window in cyst to remove contents
  2. Encourages cyst to shrink so enucleation can follow
104
Q

Enucleation advantages (3)

A
  1. Whole lining can be examined
  2. Primary closure
  3. Little aftercare needed
105
Q

Masupialisation indications (3)

A
  1. If enucleation would damage surrounding structures
  2. Very large cysts
  3. Pt unable to withstand extensive surgery
106
Q

Disadvantages to marsupialisation (4)

A
  1. Opening may close and cyst may reform
  2. Complete lining not available for histology
  3. Difficult to keep clean and lots of aftercare needed
  4. Long time to fill in
107
Q

When would an upper 8 be extracted for pericoronitis on the lower

A

If it occludes with the operculum

108
Q

Risk Factors for OAC (7)

A
  1. Upper molar and premolar xla
  2. Close relationship of roots to sinus
  3. Last standing molars
  4. Large bulbous tooth
  5. Older pt
  6. Previous OAC
  7. Recurrent sinusitis
109
Q

Peri operative signs of OAC (3)

A
  1. Bone removed at trifurcation
  2. Bubbling at socket
  3. Change in suction sound
110
Q

Post operative signs of OAC (3)

A
  1. Non-healing socket
  2. Salty discharge
  3. Fluid from nose when drinking
111
Q

Management of OAC (5)

A
  1. Inform pt and gain consent to monitor, close or refer
  2. If small (<2mm) may close spontaneously
  3. Close (or refer) with a buccal advancement flap
  4. Conservative advice
  5. Antibiotics - Pen V 500mg 4x/day 5 days
112
Q

Conservative advice for management of OAC (6)

A
  1. No nose blowing
  2. Don’t stifle sneezes
  3. Avoid straws
  4. Smoking cessation
  5. Avoid steam inhalation
  6. HSMW or CHXD
113
Q

Other than antibiotics what could be prescribed for OAC (5)

A

Nasal drops/decongestant
Ephedrine nasal drops
0.5% 10ml
1-2 drops 4x a day
Max 7 days

114
Q

Drug choice for sinusitis

A

Phenoxymethylpenicillin

115
Q

What is likely if OAC is not closed (3)

A
  1. Sinusitis
  2. Infection
  3. Impaired healing
116
Q

Management of root lost into sinus (6)

A
  1. If small consider monitoring but advise pt on risk of infection
  2. Refer or raise buccal advancement flap
  3. Saline and suction to see if root can be removed
  4. Widen socket with water cooled bur
  5. Ribbon gauze
  6. Consider endoscopic or caldwell luc procedure
117
Q

Why do teeth fracture (6)

A
  1. Thick cortical bone
  2. Root shape and number
  3. Ankylosis
  4. Caries
  5. RCT
  6. Alignment
118
Q

Soft tissue retractors (3)

A
  1. Howarths periosteal elevator
  2. Rake retractor
  3. Minnesota retractor
119
Q

Aims of suturing (5)

A
  1. Reposition tissues
  2. Cover bone
  3. Prevent wound breakdown
  4. Achieve haemostasis
  5. Encourage primary healing
120
Q

Peri-operative haemostasis (4)

A
  1. LA with vasoconstrictor
  2. Artery forceps
  3. Diathermy
  4. Bone wax
121
Q

Post operative haemostasis (5)

A
  1. Pressure
  2. LA with vasoconstrictor
  3. Diathermy
  4. Surgicel
  5. Sutures
122
Q

Lidocaine max dose

A

4.4mg/kg
1/10 of cartridge per kg

123
Q

How much active agent is in 1 cartridge of lidocaine

A

44mg

124
Q

Prilocaine max dose

A

6mg/kg
1/10 of cartridge per kg

125
Q

Which cysts are formed from Rests of Serres (4)

A
  1. OKC
  2. Orthokeratinised odontogenic
  3. Gingival
  4. Lateral periodontal
126
Q

Non-odontogenic epithelial cysts (4)

A
  1. Nasiolabial
  2. Nasopalatine
  3. Globulomaxillary
  4. Median
127
Q

‘Attention seeking’ cyst

A

Solitary bone cyst

128
Q

Mesh bag stress ball cyst

A

Aneurysmal bone cyst

129
Q

Valsalva Test

A

Hold nose and GENTLY blow

130
Q

Recommended time for closure of OAC

A

48 hours

131
Q

Flap options for closure of OAC (2)

A
  1. Buccal advancement flap
  2. Buccal fat pad (BCP) flap
132
Q

Ecchymosis

A

Bruising

133
Q

Reasons for abnormal resistance on XLA (5)

A

Thick cortical bone
Shape of roots
Number of roots
Hypercementosis (x-ray)
Ankylosis

134
Q

Order for tooth extraction

A

Back to front

135
Q

Reasons for increased bleeding (2)

A
  1. Liver disease/alcoholism
  2. Anticoagulants/antiplatelets
136
Q

Give 3 anticoagulants/antiplatelet examples

A

Warfarin
Aspirin
Clopidogrel

137
Q

Dislocation of TMJ on xls (4)

A
  1. Relocate
  2. If unable - LA into masseter
  3. If unable - immediate referral
  4. Support pts head
138
Q

What is surgicel

A

Oxidised cellulose which acts as a framework for clot formation

139
Q

Haemostatic agents (5)

A
  1. LA containing adrenaline
  2. Surgicel
  3. Gelatin sponge
  4. Thrombin liquid/powder
  5. Fibrin foam
140
Q

Systemic haemostatic aids (3)

A
  1. Vitamin K
  2. Anti-fibrinolytics (transexamic acid)
  3. Plasma or whole blood
141
Q

How does dry socket occur

A

Normal clot not formed/disappears
Bare socket - exposed bone

142
Q

Timeline of dry socket (2)

A

Starts after 3-4 days
7-14 days to resolve

143
Q

Risk factors for MRONJ (7)

A
  1. Extremes of age
  2. Corticosteroid use
  3. Bone turnover conditions
  4. Malignancy
  5. Chemo/radiotherapy
  6. Duration of therapy
  7. Previous MRONJ
144
Q

Dry Socket Management (5)

A
  1. Reassurance
  2. Analgesia
  3. Irrigate socket
  4. Curettage/debridement to encourage new clot?
  5. Antiseptic pack - BIP
145
Q

What should you initially check if you suspect dry socket

A

That no remnant of tooth or bony sequestra has been left behind

146
Q

OAF additional management

A

Excise sinus tract

147
Q

Osteomyelitis

A

Inflammation of bone marrow

148
Q

Where is osteomyelitis more common

A

Mandible
Maxilla has excellent blood supply

149
Q

Osteomyelitis surgical tx (not carried out by GDP) (6)

A
  1. Drain pus
  2. Remove any non-vital teeth in area
  3. Remove loose pieces of bone
  4. Removal of bone cortex
  5. Perforation of bony cortex
  6. Excision of necrotic bone
150
Q

Osteomyelitis tx (3)

A
  1. Investigate host defences
  2. Antibiotics - pen V (longer course)
  3. Severe - hospital admission
151
Q

Osteoradionecrosis (3)

A
  1. Bone within radiation beam becomes virtually non-vital
  2. Turnover of any viable bone slow
  3. Reduced blood supply
152
Q

Prevention of Osteaoradionecrosis (5)

A
  1. Scaling/CHXD pre XLA
  2. Careful technique
  3. Antibiotics, CHXD, review
  4. Hyperbaric oxygen
  5. Get advice/refer pt for XLA
153
Q

Risk factors for MRONJ (4)

A
  1. Smoking/Alcohol
  2. Diabetes
  3. Thin mucosal coverage
  4. Poor OH
154
Q

MRONJ Tx (4)

A
  1. Manage symptoms
  2. Remove sharp edges of bone
  3. CHXD
  4. Antibiotics if suppuration
155
Q

IV Bisphosphonate examples (2)

A

Clodronate
Pamidronate

156
Q

Actinomycosis (2)

A
  1. Rare bacterial infection
  2. Multiple skin sinuses and swelling
  3. Recurrence common
157
Q

Actinomycosis Tx (3)

A
  1. Drainage of pus
  2. Excision of necrotic bone and chronic sinus tract
  3. High dose antibiotics
158
Q

Why is rheumatic fever a risk factor for infective endocarditis

A

Scarring on heart valves

159
Q

Antibiotics for IE (3)

A
  1. Amoxicillin - 3g powder sachet, 60mins before
  2. Clindamycin - 2x 300mg capsules, 60 mins before
  3. Azithromycin - 500mg (12.5ml) 60 mins before
160
Q

When should antibiotics be prescribed to prevent IE (2)

A

Consult cardiologist if they have risk factors
Discuss risks and benefits with pt, do they want antibiotics

161
Q

Clinical features of salivary gland tumour (5)

A
  1. Lump
  2. Asymmetry
  3. Obstruction
  4. Pain
  5. Facial palsy - late sign
162
Q

Radiographic Features to Describe (7)

A

Location
Shape
Margins
Multiplicity
Locularity
Effect on surrounding anatomy
Inclusion of UE/PE teeth

163
Q

Causes of most cysts growing

A

Hydrostatic pressure

164
Q

Secondary infections of cysts (2)

A

May lose margins
If no other signs of infection - malignancy?

165
Q

Inflammatory Collateral Cysts (2)

A

Paradental cysts
Buccal bifurcation cyst

166
Q

Characteristic Symptoms of most cysts (4)

A

Mobility
Numbness
Slow growing
Egg shell crackling

167
Q

Classification of cysts (3)

A

Structure
Origin
Pathogenesis

168
Q

How may radicular cysts form (2)

A

Proliferating epithelium with central necrosis
OR
Epithelium surrounds fluid area

169
Q

How does OKC tend to grow

A

Along bone

170
Q

Pre operative diagnostic test for OKC (4)

A
  1. Cyst aspiration
  2. Contains squames
  3. Low soluble proteins (<4mg)
171
Q
A

BDS Finals (23 decks)

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