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Finals > Oral Surgery > Flashcards

Oral Surgery Flashcards

1
Q

What is the flow chart of the end result of caries

A

Caries
—> Pulp Hyperaemia
<-> Chronic Pulpitis or

—> Acute Apical Periodontitis
—> Acute Apical Abscess
(<—> Chronic Sinus)* some cases
<-> Chronic Apical Infection (granuloma)
—> Apical Cyst (Radicular)
<-> Infected Apical Radicular Cyst

Can jump Acute apical periodontitis —> Chronic apical infection (granuloma)

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2
Q

What are the four clinical features of pulp hyperaemia?

A

Pain lasting for seconds
Pain stimulated by hot/cold or sweet foods
Pain resolves after stimulus
Caries approaching pulp, but tooth can still be restored without treating pulp

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3
Q

What are the clinical features of acute pulpitis?

A

Constant severe pain
Reacts to thermal stimulus
Poorly localised pain
Referral of pain
No (or minimal) response to analgesics
Open symptoms, less severe

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4
Q

What are the factors that contribute towards the diagnosis of Acute Pulpitis?

A

History
Visual Examination
Negative tenderness to percussion (usuallly)
Pulp testing is equivocal
Radiographs
Diagnostic Local anaesthetic
Removal of restorations

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5
Q

What are the factors of an acute apical periodontitis diagnosis?

A

Tenderness to percussion
Tooth is non-vital (unless traumatic)
Slight increase in mobility
Radiographs

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6
Q

What is the radiographic presentation of acute apical periodontitis?

A

Loss of clarity of lamina dura
Radiolucent shadow
Delay in changes at the apex of the tooth
Widening of apical periodontal space

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7
Q

What are the causes of traumatic periodontitis?

A

Parafunction; tooth clenching or grinding

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8
Q

What are the features of diagnosis of traumatic periodontitis?

A

Clinical examination of the occlusion: functional positioning, posturing
Tender to percussion
Normal vitality
Radiographs; generalised pdl space widening

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9
Q

What are the treatment options for traumatic periodontitis?

A

Occlusal adjustment
Therapy for parafunction

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10
Q

What is the most common pus producing infection?

A

Acute apical abscess

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11
Q

What are the four pus producing infections?

A

Acute apical abscess
Periodontal abscess
Pericoronitis
Sialadenitis

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12
Q

What are two examples of organisms associated with dental abscesses?

A

Polymicrobial
Anaerobes

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13
Q

What are two unusual infections associated with dental abscesses?

A

Staphylococcal lymphadenitis of childhood
Cervico-facial actinomycosis

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14
Q

What are the symptoms of acute apical abscess?

A

Severe unremitting pain
Acute tenderness in function
Acute tenderness on percussion
No swelling, redness or heat

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15
Q

What are the five cardinal signs of inflammation?

A

Heat
Redness
Swelling
Pain
Loss of function

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16
Q

What are the symptoms of an abscess that has perforated bone?

A

Pain often remits
Swelling, redness and heat in the soft tissues
As swelling increases, pain returns
Initial reduction in tenderness to percussion of the tooth as pus escapes into soft tissues

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17
Q

What does the site of swelling of an acute apical abscess depend on?

A

The position of the tooth in the arch
Root length
Muscle attachments
Potential spaces in proximity to lesion

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18
Q

What are some examples of potential spaces in proximity to an acute apical abscess lesion?

A

Submental space
Sublingual space
Submandibular space
Buccal space
Infraortbital space
Lateral pharyngeal space
Palate

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19
Q

What are the treatment options for an acute apical abscess?

A

Provide drainage
Provide antibiotics

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20
Q

What are the methods used to provide drainage of an acute apical abscess?

A

Soft tissue incision intraorally
Soft tissue incision extraorally
Remove source/cause; extract tooth, pulp extirpation, Periradicular surgery

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21
Q

What is the need for antibiotics determined by?

A

Severity
Absence of adequate drainage
Patient’s medical condition

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22
Q

What are the local factors considered in the assessment of antibiotic need?

A

Toxicity
Airway compression
Dysphagia
Trismus
Lymphadenitis
Location

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23
Q

What are the systemic factors in assessment for need of antibiotics?

A

Immunocompromised (acquired, drug induced, blood disorders)
Diabetes
Extremes of age

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24
Q

What is an example of acquired immunocompromisation?

A

HIV

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25
Q

What are causes of drug induced immunocompromisation?

A

Steroids
Cytostatics

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26
Q

What are the causes of blood disorder associated immunocompromisation?

A

Leukaemia

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27
Q

How would you describe a periapical granuloma (chronic apical periodontitis)

A

Mass of chronically inflamed granulation tissue at apex of tooth

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28
Q

Which cells are in a periapical granuloma/ chronic apical periodontitis?

A

plasma cells, lymphocytes, histiocytes, fibroblasts and capillaries)

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29
Q

Why is a periapical granuloma not a true granuloma?

A

It is not granulomatous inflammation

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30
Q

What type of cells are present in granulomatous inflammation?

A

Epithelloid histocytes
Lymphocytes
Giant cells

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31
Q

What is the aetiology of an apical (radicular) cyst?

A

Caries
Trauma
Periodontal disease
Pulp necrosis
Apical bone inflammation
Dental granuloma
Stimulation of epithelial rests of malassez
Epithelial proliferation
Periapical cyst formation

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32
Q

Why is a maxillary abscess more likely to spread buccally opposed to palatally?

A

The palate is more dense

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33
Q

What happens when a sublingual abscess travels above the mylohyoid muscle?

A

It will become a sublingual abscess

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34
Q

What happens if a mandibular abscess travels below the mylohyoid muscle?

A

It will become a submandibular abscess

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35
Q

Where can an infection in the upper anterior teeth spread to?

A

Lip
Nasolabial region
Lower eyelid

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36
Q

From which tooth can infection spread to the palate?

A

Upper lateral incisor

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37
Q

Where can infection in upper premolars and molars spread to?

A

Cheek
Infra-temporal region
Maxillary antrum
Palate

38
Q

Where can infection in lower anterior spread to?

A

Mental and submental space

39
Q

Where can infection in lower premolars and molars spread to?

A

Buccal space
Submasseteric space
Sublingual space
Submandibular space
Lateral pterygoid space

40
Q

What are the three management options for infections?

A

Establishment of drainage
Removal of source of infection
Antibiotic therapy

41
Q

What is Ludwigs Angina?

A

Bilateral cellulitis of the sublingual and submandibular spaces

42
Q

What are the intraoral features of Ludwig’s Angina?

A

Raised tongue
Difficulty breathing
Difficulty swallowing
Drooling

43
Q

What are the extra oral features of Ludwigs Angina?

A

Diffuse redness and swelling bilaterally in the submandibular region

44
Q

What are the systemic features of ludwigs angina?

A

Increased heart rate
Increased respiratory rate
Increased temperature
Increased white cell count

45
Q

What techniques can be used to stop a bleeding socket?

A

Direct pressure
Vasoconstrictor (LA)
Diathermy
Surgicel
Bone wax

46
Q

What techniques can be used to stop bleeding soft tissue?

A

Suturing
Cauterising
Direct pressure
Haemostatic clips
Ligatures

47
Q

What are the 5 types of sensory changes?

A

Anaesthesisa
Paraesthesia
Dysaesthesia
Hypoaesthesia
Hyperaesthesia

48
Q

What are the four causes of nerve damage?

A

LA damage
Transection
Crush injuries
Cutting/shredding injuries

49
Q

What are the three types of nerve damage?

A

Neurapraxia
Axonotmesis
Neurotmesis

50
Q

What is neurapraxia?

A

Contusion
Epineural sheath intact
Axons intact

51
Q

What is axonotmesis?

A

Epineural sheath not intact
Axons intact

52
Q

What is neurotmesis?

A

Nerve transected

53
Q
A
53
Q
A
54
Q

What are 4 causes of abnormal resistance?

A

Hypercementosis
Ankylosis
Long/divergent/increased number of roots
Thick cortical bone

55
Q

What are post extraction complications?

A

Dry socket
Prolonged bleeding
Infection
OAF
Bruising
Swelling
Pain
Trismus
ORN
MRONJ

56
Q

How is OAC diagnosed?

A

Visual
Air bubbling
Blunt probe

57
Q

How is a small OAC managed?

A

Bone cutterage
Encourage new clot
Alvogyl

58
Q

How is a large OAC managed?

A

Buccal advancement flap

59
Q

What are the causes of post extraction pain/swelling/bruising?

A

Poor technique
Rough tissue handling
Torn periosteum

60
Q

What are the two types of post Xla haemorrhage?

A

Immediate
Secondary

61
Q

What does an immediate post Xla haemorrhage consist of?

A

Reactionary and rebound bleeding within 48 hours post op

62
Q

What is immediate post Xla haemorrhage associated with?

A

Vessels opening up as the vasoconstrictive effect of local anaesthetic wears off
Sutures become loose
Socket is traumatised

63
Q

What is secondary post Xla haemorrhage associated with?

A

Infection
Occurs 3-7 days after Xla

64
Q

What are examples of haemostatic agents?

A

Surgical oxidised cellulose
Gelation sponges
WHVP
Bone wax
Thrombin liquid/powder
Fibrin foam

65
Q

What does Whitehead’s Varnish Pack (WHVP) consist of?

A

Iodoform
Gum benzoin
Storax
Balsam tolu
Ethyl ester

66
Q

What are the surgical aids for haemostasis?

A

Suturing the socket
Ligation of vessels
Diathermy

67
Q
A
68
Q

What are the aims of suturing?

A

To approximate and reposition tissues
To compress the blood vessels
To cover the bone
To achieve haemostasis
To encourage healing by primary intention

69
Q

What are the two types of suture?

A

Resorbable
Non-resorbable

70
Q

What are examples of resorbable monofilament sutures?

A

Monocryl: poliglecaprone 25

71
Q

What are examples of multifilament/polyfilament sutures?

A

Vicryl rapide: polyglactin 910

72
Q

What are the features of vicryl rapide?

A

Holds tissue edges together temporarily
Vicryl breaks down via water absorption

73
Q

What are examples of non-resorbable monofilament sutures?

A

Prolene: polypropylene

74
Q

What are examples of non-resorbable multifilament/polyfilament sutures?

A

Mersilk: black silk

75
Q

What are the features of mersilk sutures?

A

Used when extensive periods of retention are required
Must be removed post-op
Used for closure of the OAF/exposure of a canine

76
Q

What are the ten principles of flap design?

A

Maximal access, minimal trauma
Wide based incision for circulation
Scalpel used in one firm motion
No sharp angles
Minimise trauma to dental papilla
Flap resection down to bone
No crushing of tissues
Keep tissues moist
Ensure flap margins lie on sound bone
Aim for healing by primary intention to minimise scarring

77
Q

What hand piece is used during surgical extractions?

A

Straight electric with saline cooled round or tissue tungsten carbide bur

78
Q

Why should air turbine handpieces be avoided in oral surgery?

A

Risk of surgical emphysema

79
Q

Why should air turbine handpieces be avoided in oral surgery?

A

Risk of surgical emphysema

80
Q

What is flap design influenced by?

A

The procedure
Surrounding nerves
Required access
Personal preference

81
Q

What are the methods for debridement?

A

Physical
Aspiration
Irrigation

82
Q

What is the official name for dry socket?

A

Localised osteitis

83
Q

What are the predisposing factors for dry socket?

A

Female
Contraceptive
Mandible
Previous experience
Smoking
Family history
Excessive trauma
Excessive rinsing

84
Q

What are the treatment options for dry socket?

A

Irrigate with warm saline
Currette or debridement to encourage bleeding
Use an antiseptic pack

85
Q

What instructions should be given to a DOAC patient before a single tooth extraction?

A

Miss morning dose: apixaban, dabigatran
Delay morning dose: rivaroxiban

86
Q

What are reasons for fractures?

A

Thick cortical bone
Root shape
Root number
Hypercementosis
Ankylosis
Caries
Alignment

87
Q

What are post-op complications of extractions?

A

Pain
Stiffness
Swelling
Bleeding
Bruising
Dry socket
Infection
Nerve damage

88
Q

How are large OACs managed?

A

Buccal advancement flap
Antibiotics
Nose blowing instructions

89
Q

How are small OACs managed?

A

Encourage clot
Suture margins
Antibiotics
Post op instructions

90
Q

How is a tuberosity fracture diagnosed?

A

Noise
Movement noted- visually or with fingers
Tear on palate

Finals (20 decks)

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