Oral surgery Flashcards
A fit and healthy patient presents to the surgery to have the surgical removal of the lower right third permeant molar (48).
- Anatomically, which nerves must be anaesthetised to remove this tooth safely? (3 marks)
1) Right inferior alveolar nerve
2) Right lingual nerve
3) Right long buccal nerve
A fit and healthy patient presents to the surgery to have the surgical removal of the lower right third permeant molar (48).
List TWO different ways you could assess that anaesthesia has been achieved? (1 mark)
ASK the patient if the right half of their tongue/lip/chin is numb
CHECK by probing adjacent to the 48 buccal/lingual
After a 48 extraction the patient presents one week later with neuro-sensory deficit affecting the right chin and lip region. Using the descriptions below provide the dental terminology. (3 marks)
i) pins and needles feeling, or partial loss of sensation:
ii) painful, unpleasant or neuralgic sensation that lasts for a fraction of a second:
iii) total loss of sensation
i) Paresthesia
ii) Dysesthesia
iii) Anesthesia
Give THREE clinical reasons that could account for neuro-sensory deficit during a 48 extraction (3 marks)
Crushing (1 mark)
Cutting (1 mark)
Damage to the nerve from the local anesthetic (1 mark)
A patient returns to the clinic with symptoms and signs of a dry socket.
What is the correct terminology for this? (1 mark)
Alveolar osteitis
List THREE predisposing factors that could contribute to dry socket? (3 marks)
Smoking (1 mark)
Sex: Female (1 mark)
More common to occur in molar extractions and more likely to occur in the mandible (1 mark)
How would you manage dry socket (3 marks)
Supportive: reassurance and analgesics (1 mark)
LA, irrigate socket with warm saline, curettage and debridement (1 mark)
Antiseptic pack with Alvogyl (1 mark)
Following clinical investigation, the coronal tooth structure of all the remaining teeth is found to be extensively decayed and therefore deemed unrestorable.
How would you manage these teeth given that that Mr Clarke is at an increased risk of osteoradionecrosis? (1 mark)
Provide primary orthograde endodontics and decoronate (1 mark)
List ONE management strategy for established osteoradionecrosis of the jaw? (1 mark)
HBOT: hyperbaric oxygen therapy
What type of handpiece is used for bone removal? (1 mark)
Electrical straight handpiece with saline cooled bur (1 mark)
What are TWO aims for raising a flap in oral surgery? (2 marks)
To gain maximal access to underlying structures and tissues (1 mark)
To protect the surrounding soft tissues by reducing trauma to them (1 mark)
What are 4 factors that influence flap design in oral surgery?
Aim of the surgical procedure (1 mark)
Condition of the surrounding tissues (1 mark)
Location of the surgical site (1 mark)
Wound healing (1 mark)
What are 3 methods of achieving hemostatic control (3 marks)
Even and firm pressure (1 mark)
Suturing (1 mark)
LA with adrenaline (1 mark)
List FOUR peri-operative complications (4 marks)
Fracture of tooth/root
Dislocation of TMJ
Damage to soft tissues
Damage to adjacent teeth
A patient has had radiotherapy to the parotid gland. What are complications of extractions for this patient and why? (2 marks)
Increased risk of infection due to compromised immune system (1 mark)
Risk of osteoradionecrosis due to weakened bone tissue and delayed healing (1 mark)
A patient comes in for a surgical extraction of roots 45. What nerves are needed to be anesthetized (2 marks)
Right inferior alveolar nerve (1 mark)
Right lingual nerve (1 mark)
What are THREE possible nerve deficits (3 marks)
Anaesthesia (numbness) (1 mark)
Paraesthesia (tingling) (1 mark)
Dysaesthesia (unpleasant sensation/pain) (1 mark)
Name THREE steps to debride a wound prior to suturing and briefly describe how each is done (3 marks)
Physical
-Bone file or handpiece to remove sharp bony edges
-Trimmer or curette to remove soft tissue debris (1 mark)
Irrigation: Sterile saline into socket and under flap (1 mark)
Suction: Aspirate under flap to remove debris (1 mark)
Name FOUR indication to extract a tooth
Unrestorable teeth
Orthodontic indications
Traumatic position
Symptomatic partially erupted teeth
A patient attends your surgery complaining of persistent bleeding after an extraction that was completed one day ago. Give FOUR treatments
Even and firm pressure with damp gauze
Sutures
LA with vasoconstrictor
Diathermy
You arrange an appointment for treatment and this is carried out uneventfully. They return the next day complaining they have been bleeding all night. Outline options that you could carry out clinically to deal with this post-operative bleeding. (4 marks)
Prolonged pressure with damp gauze
Sutures
LA with adrenaline
Haemostatic agent e.g surgical, equitamp
You arrange an appointment for treatment and this is carried out uneventfully. They return the next day complaining they have been bleeding all night.
If following your interventions, you still could not stop the bleeding - what would you do?
Urgently refer to local OS/OMFS unit or A&E
What are FOUR types of sutures and provibe an example of each
Non resorbable monofilament: prolene
Non resorbable multifilament: mersilk
Resorbable monofilament: monocryl
Resorbable multifilament: vicryl
What are THREE types of flap designs
2 (envelope) sided flap
3 sided flap
semilunar flap
Why do you not use an air driven handpiece for surgical bone removal?
Surgical emphysema risk
A patient has returned to the surgery following an extraction carried out by a colleague earlier in the day complaining of continual bleeding from the socket.
List 3 causes that may be contributing to this post-operative complication (3 marks)
Any 3 of:
Damage to periostium / alveolus / vessel during extraction or other local factor
Medication (must state example of antiplatelet, anticoagulant)
Alcoholism
Liver Disease
Systemic Disease such as Haemophilia
