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BDS5 OSCE > Oral Surgery > Flashcards

Oral Surgery Flashcards

1
Q

Describe pulp hyperaemia

A
  • Reversible pulpits
  • Pain stimulated by hot/cold or sweet and lasts a few seconds
  • Pain resolves after removal of stimulus
  • Sharp pain
    (caries is approaching the pulp but the tooth can still be restored without treating the pulp)
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2
Q

Describe acute pulpitis

A
  • irreversible pulpitis
  • severe constant pain, worsens with thermal stimuli
  • Poorly localised, pain may be referred
  • Poor/minimal response to analgesics
  • Symptoms less severe if there is a release of pressure (crown so carious its broken off)
  • Negative TTP (PDL not inflamed as infection in pulp chamber)
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3
Q

Describe acute apical periodontitis

A
  • Tooth is TTP
  • Pain very well localised
  • Tooth non vital (unless traumatic)
  • Radiograph may show loss of lamina dura
  • May be slightly mobile
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4
Q

Discuss the treatment of an acute apical abscess

A
  1. drain infection via intra or extra oral soft tissue incision
  2. Remove source - RCT (pulp extirpation), extraction or peri-radicular surgery
  3. Prescribe antibiotics if patient is systemically unwell
  4. If infection is causing difficulty with anaesthesia, prescribe antibiotics and get patient back to remove source at future date (5 days time)
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5
Q

what are the 5 cardinal signs of inflammation

A
  • heat
  • redness
  • swelling
  • pain
  • loss of function
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6
Q

Describe upper teeth areas of spread

A
  • Buccally > buccal space
  • Palatally > unlikely due to dense palatal bone
  • Buccally below buccinator > drains into mouth
  • Maxillary sinus > unusual, would develop into sinusitis
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7
Q

Describe lower teeth areas of spread

A
  • lingually above mylohyoid line > sublingual space under tongue
  • lingually below mylohyoid line > submandibular
  • buccally above buccinator > drain into mouth
  • buccally below buccinator > drain into buccal space
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8
Q

whether infection spreads to sublingual or submandibular space depends on what

A

The tooth in relation to the mylohyoid line. Premolars are more likely sublingual, molars more likely submandibular

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9
Q

What are the primary fascial spaces

A
  • vestibular
  • palatal
  • canine
  • buccal
  • submental
  • sublingual
  • submandibular
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10
Q

what are posterior spaces filled with and why does infection spread there

A

connective tissue, because infection follows areas of less resistance

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11
Q

what are the posterior potential spaces

A
  • pterygomandibular space
  • infra-temporal space
  • deep temporal space
  • superficial temporal space
  • masseteric space
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12
Q

what is Ludwig’s angina

A

life threatening cellulitis involving bilateral submental, submandibular and sublingual swelling

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13
Q

What are the features of Ludwig’s angina

A
  • Diffuse redness and swelling bilaterally in submandibular region
  • Raised tongue
  • Difficulty breathing
  • Difficulty swallowing
  • Drooling
  • Systemic - increased heart rate, respiratory rate, temperature and white cell count (SIRS)
  • Compromised airway
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14
Q

What is SIRS

A

Systemic inflammatory response syndrome

Diagnosed when a patient has 2 or more from the following
- temperature <36 or >38
- heart rate >90 beats per minute
- respiratory rate > 20 breaths per minute
- WBC <4000/mm3 or >12,000/mm3

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15
Q

What is sepsis

A

life threatening condition caused by an over-reaction of the body’s immune system response to infection. Diagnosed when SIRS criteria is met and infection is present

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16
Q

What is the sepsis six treatment of sepsis

A
  1. Give high flow oxygen
  2. Take blood cultures
  3. Give IV antibiotics
  4. Give a fluid challenge
  5. Measure lactate
  6. Measure urine output
17
Q

What is the prescription for first line antibiotics for a periapical abscess

A
  • Phenoxymethylpenicillin 250mg (send 40 tablets, 2 tablets 4 times a day for 5 days)
  • Amoxicillin 500mg (send 15 tablets, 1 tablet 3 times a day for 5 days)
  • Metronidazole 400mg (send 15 tablets, 1 tablet 3 times a day for 5 days)
18
Q

why would you prescribe amoxicillin over phenoxymethylpenicillin

A

if you are concerned about someone actually taking the entire prescription/ remembering to take 8 tablets per day (3 tablets per day easier to remember)

19
Q

What nerves are at risk during mandibular third molar surgery

A
  • inferior alveolar nerve
  • lingual nerve
  • long buccal nerve
  • nerve to mylohyoid
20
Q

what are 3 consequences of third molar impaction

A
  • caries
  • pericoronitis
  • cyst formation
21
Q

what is the inferior alveolar nerve and what does it supply

A
  • peripheral sensory nerve arriving from mandibular division of trigeminal nerve
  • supplies all mandibular teeth and mucosa/skin of the lower lip and chin on that side
22
Q

what is the lingual nerve and what does it supply

A
  • branch of mandibular division of trigeminal nerve
  • supplies sensory innervation to anterior 2/3rd of Doral and ventral tongue mucosa
  • gives off branch which supplies lingual gingival and floor of the mouth
23
Q

name three guidelines relating to third molar surgery

A
  1. NICE guidance on extraction of wisdom teeth 2000
  2. SIGN publication 43 management of unerupted and impacted third molar teeth 2000
  3. FDS RCS 2020 parameters of care for patients undergoing mandibular third molar surgery
24
Q

Discuss all the indications for third molar extractions

A
  1. Therapeutic indications - infections (caries, pericoronitis, periodontal disease), periapical abscess, cysts, tumours, external resorption of 7 or 8
  2. Surgical indications - if the M3M is present within perimeter of surgical field, consideration can be taken for removal
  3. High risk of disease - mesioangular or horizontally impacted 8 has high caries risk for the 7 and periodontal detriment for the 7
  4. Medical indications - pt awaiting cardiac surgery, immunosuppressed or to prevent osteonecrosis, MRONJ before starting bisphosphonate medication
  5. Accessibility - limited access to restore
  6. Patient age - complications increase with age
  7. Autotransplantation
  8. Pt undergoing general anaesthetic
25
Q

What is pericoronitis

A

inflammation around the crown of a partially erupted tooth. Food and debris get trapped under operculum resulting in inflammation or infection

26
Q

What type of microbes are present in pericoronotis

A

anaerobic microbes - streptococci and actinomyces

27
Q

what are the signs and symptoms of pericoronitis

A
  • pain (dull ache)
  • swelling (intra or extra oral)
  • bad taste
  • pus discharge
  • occlusal trauma to operculum
  • ulceration of operculum
  • evidence of cheek biting
  • foetor oris (bad breath)
  • limited mouth opening
  • Pyrexia (raised body temperature/fever)
  • Dysphagia (difficulty in swallowing food or liquid)
  • Malaise (systemic illness)
  • Regional lymphadenopathy
28
Q

How do you treat pericoronitis

A
  1. Incise localised pericoronal abscess if required
  2. +/- local anaesthesia depending on patient pain
  3. Irrigate with warm saline or chlorhexidine mouthwash (10-20ml blunt needle under operculum) chlorhexidine in some council areas only
  4. Consider extraction of upper third molar if traumatising operculum
  5. Instruct pt on warm salty mouthrinses/ chlorhexidine rinses and give advice regarding analgesia
  6. Instruct to keep fluids up and soft diet
  7. only prescribe antibiotics if systemically unwell, extra-oral swelling or immunocompromised
29
Q

What is the first line antibiotic treatment for pericoronitis

A

Metronidazole 400mg
Send 9 tablets
Label: 1 tablet 3 times daily
Tell patient to avoid alcohol

30
Q

If a patient is on warfarin, what antibiotics should you prescribe for pericoronitis

A

Amoxicillin

Metronidazole enhances the anticoagulant effect

31
Q

What are the predisposing factors which increase chance of pericoronitis

A
  • Partial eruption
  • vertical or distoangular impaction
  • opposing maxillary M3M or M2M causing mechanical trauma
  • upper respiratory tract infections
  • stress and fatigue
  • poor oral hygiene
  • insufficient space between ascending ramus and distal aspect of M2M
  • white race
  • a full dentition

BDS5 OSCE (4 decks)

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