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BDS4 > Oral Surgery > Flashcards

Oral Surgery Flashcards

1
Q

What are some routes of spread of odontogenic infections?

A

Maxillary abscesses
Mandibular abscesses

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2
Q

What is the line on the left showing?

A

Buccal space

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3
Q

What are the lines showing?

A

Sublingual abscess
Mylohyoid muscle

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4
Q

What are the lines showing?

A

Submandibular gland
Mylohyoid muscle
Submandibular abscess
Platysma muscle

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5
Q

Where does the infection spread for upper anterior teeth?

A

Lip
Nasiolabial region
Lower eyelid

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6
Q

Where does infection spread for upper lateral incisor?

A

Palate

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7
Q

Where does infection spread for upper premolars and molars?

A

Cheek
Infratemporal region
Maxillary antrum
Palate

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8
Q

What does this photo show?

A

Palatal abscess

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9
Q

What does this photo show?

A

Intraoral (labial) abscess

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10
Q

What does this photo show?

A

Buccal/infraorbital spread

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11
Q

What does this show?

A

Infraorbital spread

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12
Q

What does this show?

A

Buccal space spread

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13
Q

What does this show?

A

Buccal space/infraorbital space spread

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14
Q

Where does infection spread for lower anteriors?

A

Mental and submental space

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15
Q

Where does infection spread for lower premolars and molars?

A

Buccal space
Submasseteric space
Sublingual space
Submandibular space
Lateral pharyngeal space

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16
Q

What does this show?

A

Submental spread

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17
Q

What does this show?

A

Submental sinus tract to skin

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18
Q

What is this?

A

Submandibular spread

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19
Q

What is this?

A

Buccal/submandibular spread

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20
Q

What does this lateral oblique radiograph show?

A

Buccal/submandibular spread

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21
Q

What does this show?

A

Submandibular sinus tract to skin

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22
Q

How to manage abscess?

A

Establishment of drainage: extraoral, intraoral
Removal of source of infection: immediate, delayed
Antibiotic therapy: toxicity, durability, MH

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23
Q

What does this show?

A

Submandibular space spread

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24
Q

What does this show?

A

Extraoral incision and drainage

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25
Q

What does this show?

A

Hilton technique

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26
Q

What does this show?

A

Placement of extraoral drain

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27
Q

What does this show?

A

Extraoral sinus

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28
Q

What does this show?

A

Buccal space spread

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29
Q

What does this show?

A

Submandibular space spread

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30
Q

What is Ludwig’s angina?

A

Bilateral cellulitis of sublingual and submandibular spaces

31
Q

IO features of ludwigs angina?

A

Raised tongue
Difficulty breathing/swallowing
Drooling

32
Q

EO features of ludwigs angina?

A

Diffuse redness and swelling bilaterally in submandibular region

33
Q

Systemic features of ludwigs angina?

A

Increased HR, RR, temp, WCC

34
Q

What does NEWS stand for?

A

National early warning score

35
Q

What are some of the physiological parameters of NEWS?

A

RR, O2 saturation, any supplemental oxygen, temp, systolic BP, HR, level of consciousness

36
Q

Complete this?

A
37
Q

Clinical features of pulp hyperaemia?

A

Pain lasts seconds
Pain stimulated by hot/cold/sweet food
Pain resolved after stimulus
Caries approaching pulp but tooth can still be restored without treating pulp

38
Q

Clinical features of acute pulpitis?

A

Constant severe pain
Reacts to thermal stimuli
Poorly localised pain
Referral of pain
No response to analgesics
Open symptoms less severe

39
Q

How to diagnose acute pulpitis?

A

History
Visual examination
Negative TTP
Pulp testing equivocal
Radiographs
Diagnostic LA
Removal of restorations

40
Q

How to diagnose acute periodontitis?

A

TTP
Non vital tooth
Slight increase in mobility
Radiographs

41
Q

What is shown on radiographs for acute periodontitis?

A

Loss of clarity of lamina dura
Radiolucent shadow
Widening of apical periodontal space

42
Q

Cause of traumatic periodontitis?

A

Parafunction (clenching/grinding)

43
Q

How to diagnose traumatic periodontitis?

A

Clinical examination of occlusion
TTP
Normal vitality
Radiographs

44
Q

Tx for traumatic periodontitis?

A

Occlusal adjustment
Parafunction therapy

45
Q

What is the commonest pus producing infection?

A

Acute apical abscess

46
Q

What are the initial symptoms of acute apical abscess?

A

Severe unremitting pain
Acute tenderness in function
Acute tenderness on percussion

47
Q

What are symptoms of acute apical abscess once abscess perforates through bone?

A

Pain often remits
Swelling, redness, heat
As swelling increases pain returns
Initial reduction in TTP as pus escapes into soft tissues

48
Q

Where does site of swelling of acute apical abscess depend upon?

A

Position of tooth in arch
Root length
Muscle attachments
Potential spaces in proximity to lesion e.g. submental/ sublingual spaces

49
Q

Example of gram positive and gram negative cocci?

A

S.anginosus
Veillonella species

50
Q

Example of gram positive and gram negative bacilli?

A

Actinomyces israelii
Prevotella intermedia

51
Q

What is capnophilic?

A

Require carbon dioxide

52
Q

What is facultative?

A

With and without oxygen

53
Q

What is antimicrobial resistance?

A

Microorganisms change in ways that render medications used to cure the infections they cause ineffective

54
Q

2 types of resistance of bacteria?

A

Intrinsic resistance
Acquired resistance

55
Q

How can genes acquire resistance?

A

Mutation
Acquisition of new genes

56
Q

How do viridans group streptococci e.g. S.mitte resist antibiotics?

A

Alter target site e.g. change from circular to square shape- if u change shape then penicillins can no longer stick to exert their actions

57
Q

Label the pathways of periapical infection?

A

Infected or necrotic pulp
PDL
Alveolar bone
Apical foramen
Periapical infection

58
Q

Key microbiological features of dental abscesses?

A

Endogenous infection
Often mixed infections
Strict anaerobes important
E.g. S.anginosus, P.intermedia

59
Q

Bacteria in periodontal abscess?

A

Anaerobic streptococci
P.intermedia

60
Q

Microbiology and treatment for salivary gland infection?

A

S.aureus
Mixed anaerobes
Drainage
Flucloxacillin and metronidazole

61
Q

5 cardinal signs of inflammation?

A

Heat
Redness
Swelling
Pain
Loss of function

62
Q

Microbiology for osteomyelitis of jaw

A

Anaerobic gram negative rods
Anaerobic streptococci
Streptococcus anginosus
Staphylococcus aureus

63
Q

Acute apical abscess treatment?

A
  1. Provide drainage
    Soft tissue incision intraorally
    Soft tissue incision extraorally
    Extract tooth
    Pulp extirpation
    Periradicular surgery
  2. Need for antibiotics determined by severity, absence of adequate drainage, MH
64
Q

Local factors affecting assessment of need for antibiotics

A

Toxicity
Airway compromisation
Dysphagia
Trismus
Lymphadenitis
Location (e.g. FOM)

65
Q

Systemic factors affecting assessment of need for antibiotics- acute apical abscess

A
  • Immunocompromised pt- HIV, drug induced (steroids), blood disorders (leukaemia)
  • Diabetes
  • elderly
66
Q

What is reversible pulpitis

A

Level of inflammation in which returning to normal state is possible if noxious stimuli is removed.

Mild/moderate tooth pain when stimulated, no pain without stimulus, subsides within seconds, no mobility, no pain on percussion

67
Q

What is irreversible pulpitis

A

Higher level of inflammation in which dental pulp has been damaged beyond point of recovery

Sharp, throbbing, severe pain upon stimulation and pain may be spontaneous or occur without stimulation, pain persists after stimulating removed, can’t sleep

68
Q

Etiology of periapical (radicular) cyst

A

Caries, trauma, periodontal disease
Death of dental pulp
Apical bone inflammation
Dental granuloma
Stimulation of epithelial rests of Malassez
Epithelial proliferation
Periapical cyst formation

69
Q

What is sepsis

A

Life threatening organ dysfunction caused by dysregulated host response to infection.
Sepsis=SIRS+suspected infection

SIRS- systemic inflammation response syndrome
Temp <36 or 38C
Pulse >90/min
Resp rate >20/min
WCC <4 or >12

70
Q

Primary care treatment for sepsis and ludwigs angina

A

Diagnosis
Seek advice/help

71
Q

Secondary care treatment for sepsis and ludwigs angina

A

Sepsis 6:
1. Give high flow O2
2. Take blood cultures
3. Give IV antibiotics
4. Give fluid challenge
5. Measure lactate
6. Measure urine output

72
Q

What does S, I and R mean for a choice of antibiotic?

A

S= susceptible at standard dose
I= susceptible at increased dose
R= resistant even with increased exposure/dose

73
Q

What is antimicrobial stewardship?

A

Coherent set of actions which promote using antimicrobials responsibly

BDS4 (50 decks)

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