Oral Surgery Flashcards
1
Q
Indications for Extractions (5)
A
- Unrestorable teeth
- Traumatic position
- Symptomatic partially erupted teeth
- Orthodontic indications
- Interference with construction of dentures
2
Q
Percentage of dry sockets/osteonecrosis (3)
A
2-3%
20-30% lower 8s
1/1000 w/bisphosphonates
3
Q
Spread of infection from upper anteriors (3)
A
Lip
Nasolabial region
Lower eyelid
4
Q
Spread of infection from upper laterals
A
Palate
Uncommon
5
Q
Spread of infection from upper premolars and molars (4)
A
Cheek
Infra-temporal region
Maxillary antrum (rare)
Palate (less common)
6
Q
Spread of infection from lower anteriors (2)
A
Mental space
Submental space
7
Q
Spread of infection from lower premolars and molars (5)
A
Buccal space
Submasseteric space
Sublingual space
Submandibular space
Lateral pharyngeal space
8
Q
Surgical Management of Infection (3)
A
Drainage
Removal of source of infection
Antibiotics
9
Q
When are antibiotics not needed for an infection (3)
A
Drainage achieved
Source of infection removed
Patient not systemically unwell
10
Q
NEWS
A
National Early Warning Score
11
Q
Hilton technique
A
Item with two ends inserted into incision and opened to allow drainage
12
Q
Why is a drain inserted after an incision for infection
A
To allow complete drainage
13
Q
Ludwigs Angina (2)
A
Bilateral cellulitis of the sublingual and submandibular spaces
SIRS most likely
14
Q
SIRS
A
Systemic Inflammatory Response Syndrome
15
Q
Why might pain be worse at night (2)
A
Prone position
No distraction
16
Q
Why should you ask how a patient feels when they present with infection
A
To check for systemic symptoms
17
Q
Where could there be swelling that is not visible (2)
A
Submasseteric Space
Common from lower 8s
18
Q
Causes of mobile teeth (2)
A
Periodontal disease
Infection for a very very long time
19
Q
Infection in immunocompromised patients (2)
A
- May have less severe response but may be very unwell due to medication
- Methotrexate, Steroids
20
Q
Will you see a radiolucency for an acute dentoalveolar abscess (3)
A
Probably not
Acute - Fast
Bone not had time to resorb
21
Q
When should you sensibility test for an abscess
A
If you are unsure which tooth is causing the infection
22
Q
Why should you palpate an abscess
A
To feel where is the most fluctuant
23
Q
Can an abscess be diagnosed from a radiograph
A
No, it must be diagnosed clinically
24
Q
Options for draining an abscess (2)
A
Incision
Extraction
25
Post incision instructions for patient
Rinse mouth out every so often with salt water
26
When should follow-up be arranged post abscess drainage
2-3 days
27
What measures can be used to determine whether a patient has systemic symptoms (4)
1. HR
2. Temperature
3. Resp rate
4. B.P - Likely raised in dental chair anyway
28
How to refer patient to hospital (3)
1. Gather information first
2. Phone max fax
3. Explain symptoms of SIRS
29
Cardinal signs of inflammation (5)
1. Heat
2. Redness
3. Swelling
4. Pain
5. Loss of function
30
Epulis Fissuratum
Denture induced hyperplasia
31
Purpose of vestibuloplasty
Deepen the sulcus
32
Papillary hyperplasia
Overgrowth of soft tissue on palate
33
When are tori an issue
For denture design
Not an issue for fully dentate patients
34
Autografts (3)
Bone taken from patient
Lilac crest bone
Rib
35
Allografts
Bone taken from other humans
36
Xenografts (2)
Bone taken from animals
Bio-Oss
37
Synthetic Grafts (2)
Customisable size and shape
Beta Tricalcium Phosphate
38
When does root calcification of third molars occur
Ages 18-25
39
Agenesis
Failure of a structure to develop
40
Where is agenesis more common (3)
Maxilla
Females
Mexican population
41
Main risks for all extractions (10)
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
42
Risks for maxillary extractions (3)
1. Loss of tooth into maxillary antrum
2. Creation of OAC/OAF
3. Fracture of maxillary tuberosity
43
Risks for mandibular extractions (4)
1. Mandibular fracture
2. TMJ dislocation
3. Nerve damage - 8s
4. Higher risk of dry socket than for maxillary teeth
44
Unrestorable teeth (6)
1. Gross caries
2. Advanced periodontal disease
3. Tooth/root fracture
4. Severe tooth surface loss
5. Pulpal necrosis
6. Apical infection
45
Elevators which look similar to luxators
Couplands
46
Elevators which look like triangles
Cryers
47
Elevators which come in a set of 3
Warwick James
48
Contraindications to coronectomy (5)
1. Immunosuppressed
2. Poorly controlled diabetes
3. About to have surgery/chemo/bisphosphonates
4. Gross caries
5. Low risk to nerve
49
Reasons a coronectomy would be deemed a failure (4)
1. Enamel leftover
2. Infection
3. Wound dehiscence
4. Pt symptomatic
50
Types of impaction for 8s (5)
1. Mesio
2. Disto
3. Horizontal
4. Vertical
5. Transverse
51
Most common causes of TMD (3)
1. Myofascial pain
2. Disc displacement
3. Degenerative disease
52
Less common causes of TMD (5)
1. Chronic recurrent dislocation
2. Ankylosis
3. Hyperplasia
4. Tumours
5. Infection
53
Special investigations for TMD (7)
1. OPT
2. CBCT
3. MRI
4. Transcranial view (TMJ)
5. Nuclear imaging
6. Orthography
7. Ultrasound
54
Treatment options for TMD (7)
1. Pt education
2. Splints
3. Physical therapy
4. Medication
5. Acupuncture
6. Botox
7. TMJ surgery
55
Types of disc displacement
With or without reduction
56
If a pt has a painful clicking jaw, what part of the joint is feeling pain
Ligament attached to disc is stretched as disc slips forward
57
Reduction
Returning to original place
58
Normal mouth opening (2)
35-45mm
3 fingers
59
Exercised for TMD (3)
1. Curl tongue back and open with tongue still on palate
2. Open against resistance
3. Open while looking in mirror (for deviation)
60
Reasons for conservative management of TMD (3)
1. Surgery high risk
2. Medications have side effects
3. 50% of TMD cases improve with conservative management
61
Why would diazepam be prescribed for TMD (3)
1. Only in severe circumstances
2. While pt waits for referral
3. Short term - addiction issues
62
What can be prescribed for TMD by a GP (3)
1. Gabapentin
2. Nortriptylene
3. Amitriptylene
63
TMD Reasons for referral (4)
1. Red flags
2. Trauma
3. Closed lock
4. CN deficiencies - urgent
64
Main nerves at risk during M3M surgery (2)
1. Inferior alveolar
2. Lingual
65
Nerves less likely to be damaged during M3M surgery but still possible (2)
1. Nerve to mylohyoid
2. Long buccal
66
Location of lingual nerve (2)
1. Close relationship to lingual plate in mandibular region
2. 0-3.5mm medial to mandible
67
Guidelines for extraction of wisdom teeth (2)
1. NICE
2. SIGN
68
What type of microbes are involved in pericoronitis
Anaerobic microbes
69
Give some examples of microbes involved in pericoronitis (3)
1. Staph
2. Strep
3. Actimyces
70
Pericoronitis treatment
Irrigation with saline or CHXD under operculum
71
When would antibiotics be given for pericoronitis (3)
1. If pt systemically unwell
2. Pt immunocompromised
3. E/O swelling
72
Superficial impaction
Crown of 8 related to crown of 7
73
Moderate impaction
Crown of 8 in-between crown and root of 7
74
Deep impaction
Crown of 8 related to roots of 7
75
Signs of proximity to canal (5)
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
Most common impaction angulation of M3Ms (2)
1. Vertical 30%
2. Mesial 40%
77
Common treatment options for impacted M3Ms (4)
1. Extraction
2. Coronectomy
3. Clinical review
4. Referral
78
Less common treatment options for impacted M3Ms (4)
1. Operculectomy
2. Surgical exposure
3. Pre-surgical orthodontics
4. Autotransplantation
79
What is more likely is there is a large cystic lesion associated with a M3M during extraction
Mandibular fracture
80
How likely is temporary numbness of IDN
10-20%
81
How likely is permanent numbness of IDN
<1%
82
How long do nerves take to recover from temporary symptoms
18-24 months
After this, not much chance of recovery
83
SBAR
Situation
Background
Assessment
Recommendation
84
Cyst definition
A pathological cavity having fluid, semi-fluid or gaseous contents which is not created by the accumulation of pus
85
Most common odontogenic cysts (5)
Radicular cyst
Residual cyst
Dentigerous cyst
Eruption cyst
OKC
86
Periapical granuloma vs radicular cyst
Radicular cyst > 1cm
87
Radicular cyst variants (2)
1. Residual cyst
2. Lateral radicular cyst
88
Paradental cyst typical location
Distal aspect of PE M3M
89
Buccal bifurcation cyst typical location
Buccal aspect of M1M
90
Dentigerous cyst (3)
1. Associated with crown of UE and usually impacted tooth
2. Cystic change of dental follicle
3. Reduced Enamel Epithelium
91
Where is dentigerous cysts more common (2)
1. Males
2. Mandible
92
Where is OKC more common (3)
1. Males
2. Mandible
3. Posterior
93
Odontogenic Keratocyst (3)
1. Developmental odontogenic cyst
2. No specific relationship to teeth
3. Rests of Serres
94
Why do OKC have a high chance of recurrence (2)
1. Thin friable lining
2. Daughter cysts
95
Basal cell naevus syndrome (3)
Multiple OKCs
Multiple basal cell carcinomas
Calcification of intracranial dura mater
96
Non-epithelial cysts (3)
1. Stafnes bone cavity
2. Solitary bone cyst
3. Aneurysmal bone cyst
97
Nasopalatine duct cyst signs (2)
Salty discharge
Radiolucency midline
98
Where are solitary bone cysts more common (4)
1. Scalloping on radiograph
2. Male
3. Mandible
4. Can occur in association with other bone pathology
99
Stafne cavity typical presentation (5)
1. Concavity
2. Inferior to canal
3. Asymptomatic
4. Well defined
5. Rarely displaces structures
100
Types of biopsy (3)
1. Aspiration
2. Incisional
3. Excisional
101
How is an aspiration biopsy carried out (3)
1. Wide bore needle
2. 5-10ml syringe
3. May be unable to withdraw plunger
102
Enucleation
All of cystic lesion removed
103
Marsupialisation
1. Surgical window in cyst to remove contents
2. Encourages cyst to shrink so enucleation can follow
104
Enucleation advantages (3)
1. Whole lining can be examined
2. Primary closure
3. Little aftercare needed
105
Masupialisation indications (3)
1. If enucleation would damage surrounding structures
2. Very large cysts
3. Pt unable to withstand extensive surgery
106
Disadvantages to marsupialisation (4)
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
When would an upper 8 be extracted for pericoronitis on the lower
If it occludes with the operculum
108
Risk Factors for OAC (7)
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
6. Recurrent sinusitis
109
Peri operative signs of OAC (3)
1. Bone removed at trifurcation
2. Bubbling at socket
3. Change in suction sound
110
Post operative signs of OAC (3)
1. Non-healing socket
2. Salty discharge
3. Fluid from nose when drinking
111
Management of OAC (5)
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
Conservative advice for management of OAC (6)
1. No nose blowing
2. Don't stifle sneezes
3. Avoid straws
4. Smoking cessation
5. Avoid steam inhalation
6. HSMW or CHXD
113
Other than antibiotics what could be prescribed for OAC (5)
Nasal drops/decongestant
Ephedrine nasal drops
0.5% 10ml
1-2 drops 4x a day
Max 7 days
114
Drug choice for sinusitis
Phenoxymethylpenicillin
115
What is likely if OAC is not closed (3)
1. Sinusitis
2. Infection
3. Impaired healing
116
Management of root lost into sinus (6)
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
Why do teeth fracture (6)
1. Thick cortical bone
2. Root shape and number
3. Ankylosis
4. Caries
5. RCT
6. Alignment
118
Soft tissue retractors (3)
1. Howarths periosteal elevator
2. Rake retractor
3. Minnesota retractor
119
Aims of suturing (5)
1. Reposition tissues
2. Cover bone
3. Prevent wound breakdown
4. Achieve haemostasis
5. Encourage primary healing
120
Peri-operative haemostasis (4)
1. LA with vasoconstrictor
2. Artery forceps
3. Diathermy
4. Bone wax
121
Post operative haemostasis (5)
1. Pressure
2. LA with vasoconstrictor
3. Diathermy
4. Surgicel
5. Sutures
122
Lidocaine max dose
4.4mg/kg
1/10 of cartridge per kg
123
How much active agent is in 1 cartridge of lidocaine
44mg
124
Prilocaine max dose
6mg/kg
1/10 of cartridge per kg
125
Which cysts are formed from Rests of Serres (4)
1. OKC
2. Orthokeratinised odontogenic
3. Gingival
4. Lateral periodontal
126
Non-odontogenic epithelial cysts (4)
1. Nasiolabial
2. Nasopalatine
3. Globulomaxillary
4. Median
127
'Attention seeking' cyst
Solitary bone cyst
128
Mesh bag stress ball cyst
Aneurysmal bone cyst
129
Valsalva Test
Hold nose and GENTLY blow
130
Recommended time for closure of OAC
48 hours
131
Flap options for closure of OAC (2)
1. Buccal advancement flap
2. Buccal fat pad (BCP) flap
132
Ecchymosis
Bruising
133
Reasons for abnormal resistance on XLA (5)
Thick cortical bone
Shape of roots
Number of roots
Hypercementosis (x-ray)
Ankylosis
134
Order for tooth extraction
Back to front
135
Reasons for increased bleeding (2)
1. Liver disease/alcoholism
2. Anticoagulants/antiplatelets
136
Give 3 anticoagulants/antiplatelet examples
Warfarin
Aspirin
Clopidogrel
137
Dislocation of TMJ on xls (4)
1. Relocate
2. If unable - LA into masseter
3. If unable - immediate referral
4. Support pts head
138
What is surgicel
Oxidised cellulose which acts as a framework for clot formation
139
Haemostatic agents (5)
1. LA containing adrenaline
2. Surgicel
3. Gelatin sponge
4. Thrombin liquid/powder
5. Fibrin foam
140
Systemic haemostatic aids (3)
1. Vitamin K
2. Anti-fibrinolytics (transexamic acid)
3. Plasma or whole blood
141
How does dry socket occur
Normal clot not formed/disappears
Bare socket - exposed bone
142
Timeline of dry socket (2)
Starts after 3-4 days
7-14 days to resolve
143
Risk factors for MRONJ (7)
1. Extremes of age
2. Corticosteroid use
3. Bone turnover conditions
4. Malignancy
5. Chemo/radiotherapy
6. Duration of therapy
7. Previous MRONJ
144
Dry Socket Management (5)
1. Reassurance
2. Analgesia
3. Irrigate socket
4. Curettage/debridement to encourage new clot?
5. Antiseptic pack - BIP
145
What should you initially check if you suspect dry socket
That no remnant of tooth or bony sequestra has been left behind
146
OAF additional management
Excise sinus tract
147
Osteomyelitis
Inflammation of bone marrow
148
Where is osteomyelitis more common
Mandible
Maxilla has excellent blood supply
149
Osteomyelitis surgical tx (not carried out by GDP) (6)
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
Osteomyelitis tx (3)
1. Investigate host defences
2. Antibiotics - pen V (longer course)
3. Severe - hospital admission
151
Osteoradionecrosis (3)
1. Bone within radiation beam becomes virtually non-vital
2. Turnover of any viable bone slow
3. Reduced blood supply
152
Prevention of Osteaoradionecrosis (5)
1. Scaling/CHXD pre XLA
2. Careful technique
3. Antibiotics, CHXD, review
4. Hyperbaric oxygen
5. Get advice/refer pt for XLA
153
Risk factors for MRONJ (4)
1. Smoking/Alcohol
2. Diabetes
3. Thin mucosal coverage
4. Poor OH
154
MRONJ Tx (4)
1. Manage symptoms
2. Remove sharp edges of bone
3. CHXD
4. Antibiotics if suppuration
155
IV Bisphosphonate examples (2)
Clodronate
Pamidronate
156
Actinomycosis (2)
1. Rare bacterial infection
2. Multiple skin sinuses and swelling
3. Recurrence common
157
Actinomycosis Tx (3)
1. Drainage of pus
2. Excision of necrotic bone and chronic sinus tract
3. High dose antibiotics
158
Why is rheumatic fever a risk factor for infective endocarditis
Scarring on heart valves
159
Antibiotics for IE (3)
1. Amoxicillin - 3g powder sachet, 60mins before
2. Clindamycin - 2x 300mg capsules, 60 mins before
3. Azithromycin - 500mg (12.5ml) 60 mins before
160
When should antibiotics be prescribed to prevent IE (2)
Consult cardiologist if they have risk factors
Discuss risks and benefits with pt, do they want antibiotics
161
Clinical features of salivary gland tumour (5)
1. Lump
2. Asymmetry
3. Obstruction
4. Pain
5. Facial palsy - late sign
162
Radiographic Features to Describe (7)
Location
Shape
Margins
Multiplicity
Locularity
Effect on surrounding anatomy
Inclusion of UE/PE teeth
163
Causes of most cysts growing
Hydrostatic pressure
164
Secondary infections of cysts (2)
May lose margins
If no other signs of infection - malignancy?
165
Inflammatory Collateral Cysts (2)
Paradental cysts
Buccal bifurcation cyst
166
Characteristic Symptoms of most cysts (4)
Mobility
Numbness
Slow growing
Egg shell crackling
167
Classification of cysts (3)
Structure
Origin
Pathogenesis
168
How may radicular cysts form (2)
Proliferating epithelium with central necrosis
OR
Epithelium surrounds fluid area
169
How does OKC tend to grow
Along bone
170
Pre operative diagnostic test for OKC (4)
1. Cyst aspiration
2. Contains squames
3. Low soluble proteins (<4mg)
171
