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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
What does this show?
Hilton technique
26
What does this show?
Placement of extraoral drain
27
What does this show?
Extraoral sinus
28
What does this show?
Buccal space spread
29
What does this show?
Submandibular space spread
30
What is Ludwig’s angina?
Bilateral cellulitis of sublingual and submandibular spaces
31
IO features of ludwigs angina?
Raised tongue Difficulty breathing/swallowing Drooling
32
EO features of ludwigs angina?
Diffuse redness and swelling bilaterally in submandibular region
33
Systemic features of ludwigs angina?
Increased HR, RR, temp, WCC
34
What does NEWS stand for?
National early warning score
35
What are some of the physiological parameters of NEWS?
RR, O2 saturation, any supplemental oxygen, temp, systolic BP, HR, level of consciousness
36
Complete this?
37
Clinical features of pulp hyperaemia?
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
Clinical features of acute pulpitis?
Constant severe pain Reacts to thermal stimuli Poorly localised pain Referral of pain No response to analgesics Open symptoms less severe
39
How to diagnose acute pulpitis?
History Visual examination Negative TTP Pulp testing equivocal Radiographs Diagnostic LA Removal of restorations
40
How to diagnose acute periodontitis?
TTP Non vital tooth Slight increase in mobility Radiographs
41
What is shown on radiographs for acute periodontitis?
Loss of clarity of lamina dura Radiolucent shadow Widening of apical periodontal space
42
Cause of traumatic periodontitis?
Parafunction (clenching/grinding)
43
How to diagnose traumatic periodontitis?
Clinical examination of occlusion TTP Normal vitality Radiographs
44
Tx for traumatic periodontitis?
Occlusal adjustment Parafunction therapy
45
What is the commonest pus producing infection?
Acute apical abscess
46
What are the initial symptoms of acute apical abscess?
Severe unremitting pain Acute tenderness in function Acute tenderness on percussion
47
What are symptoms of acute apical abscess once abscess perforates through bone?
Pain often remits Swelling, redness, heat As swelling increases pain returns Initial reduction in TTP as pus escapes into soft tissues
48
Where does site of swelling of acute apical abscess depend upon?
Position of tooth in arch Root length Muscle attachments Potential spaces in proximity to lesion e.g. submental/ sublingual spaces
49
Example of gram positive and gram negative cocci?
S.anginosus Veillonella species
50
Example of gram positive and gram negative bacilli?
Actinomyces israelii Prevotella intermedia
51
What is capnophilic?
Require carbon dioxide
52
What is facultative?
With and without oxygen
53
What is antimicrobial resistance?
Microorganisms change in ways that render medications used to cure the infections they cause ineffective
54
2 types of resistance of bacteria?
Intrinsic resistance Acquired resistance
55
How can genes acquire resistance?
Mutation Acquisition of new genes
56
How do viridans group streptococci e.g. S.mitte resist antibiotics?
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
Label the pathways of periapical infection?
Infected or necrotic pulp PDL Alveolar bone Apical foramen Periapical infection
58
Key microbiological features of dental abscesses?
Endogenous infection Often mixed infections Strict anaerobes important E.g. S.anginosus, P.intermedia
59
Bacteria in periodontal abscess?
Anaerobic streptococci P.intermedia
60
Microbiology and treatment for salivary gland infection?
S.aureus Mixed anaerobes Drainage Flucloxacillin and metronidazole
61
5 cardinal signs of inflammation?
Heat Redness Swelling Pain Loss of function
62
Microbiology for osteomyelitis of jaw
Anaerobic gram negative rods Anaerobic streptococci Streptococcus anginosus Staphylococcus aureus
63
Acute apical abscess treatment?
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
Local factors affecting assessment of need for antibiotics
Toxicity Airway compromisation Dysphagia Trismus Lymphadenitis Location (e.g. FOM)
65
Systemic factors affecting assessment of need for antibiotics- acute apical abscess
- Immunocompromised pt- HIV, drug induced (steroids), blood disorders (leukaemia) - Diabetes - elderly
66
What is reversible pulpitis
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
What is irreversible pulpitis
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
Etiology of periapical (radicular) cyst
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
What is sepsis
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
Primary care treatment for sepsis and ludwigs angina
Diagnosis Seek advice/help
71
Secondary care treatment for sepsis and ludwigs angina
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
What does S, I and R mean for a choice of antibiotic?
S= susceptible at standard dose I= susceptible at increased dose R= resistant even with increased exposure/dose
73
What is antimicrobial stewardship?
Coherent set of actions which promote using antimicrobials responsibly

BDS4 (50 decks)

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