Oral Surgery Flashcards
Where do you stand for XLA of lower RHS?
Stand behind
Where do you stand for XLA of lower LHS and all uppers?
Stand in front
What are the 3 techniques for using an elevator or luxator?
Lever
Wedge
Wheel & axle
What are the risks you would explain to a patient before performing an XLA?
Pain
Bleeding
Bruising
Swelling
Infection
Damage to adjacent teeth/restorations
Unable to XLA
Root fracture and possible roots left in situ
Dry socket
Temporary permanent number or altered sensation to the IAN
OAC/root in sinus
How would you describe TMD to a patient?
Condition where the movement of the jaw joint, ligaments and muscles have been affected and can be painful. Typically associated with a clenching and/or grinding habit and can be worse on wide opening or chewing
It is not usually seriously and generally gets better on it’s own or with minimal lifestyle changes.
What are the signs and symptoms of TMD?
Limited opening
Clicking
Crepitus
Headache
Earache
Locking of jaw
Attritive wear
Wear facets
Lost fillings
Linea alba
What is the treatment for TMD?
Soft diet
No wide opening
No chewing gym
Cut food into smaller pieces
Support mouth on opening
Try to stop parafunctional habit
Relaxation techniques
Massage/heat packs
Initially soft splint worn at times of clenching and grinding
What are the care instructions to give to a new splint wearer?
Wear at time of parafunction - evens out bite and relieves pressure on muscles
Demonstrate insertion and removal and get patient to show taking it in and out
Teeth must be cleaned properly before wearing splint
Avoid consuming anything other than water while splint is in place
Clean splint with cold water and soap
Place in sterilising solution 1x a week
What are the risk factors for a tuberosity fracture?
Single standing molar
Unknown erupted molar wisdom tooth
Pathological gemination
Extracting in wrong order
Inadequate alveolar support
What are the signs of a tuberosity fracture?
Noise
Movement notes both visually or with supporting fingers
More than 1 tooth movement
Tear on palate
What is the treatment for a tuberosity fracture?
Dissect out and close if possible
Reduce with fingers and fix with splint
Treat/remove pump
Remove tooth 8 weeks later
What is the other name for a dry socket?
Alveolar osteitis
How would you describe dry socket to a patient?
Normal clot fails to form properly or gets dislodged leaving exposed bone which can lead to intense pain. Takes upto 2 weeks to resolve completely. Not usually associated with infection.
What are the risk factors for a dry socket?
Molars more common
Mandible more common
Female
Smoking
Oral contraceptive pill
LA
Excessive trauma
Excessive rinsing
Previous dry socket
What are the symptoms of dry socket?
Pain- dull ache/throbbing
Ear pain
Kept up all night
Poor smell
Bad taste
What is the treatment for dry socket?
Reassurance
Recommend analgesia
LA
Irrigate with warm saline
Currettage and debridement - remove any sequestrum
Alveogyl pack
What is SIRS?
Systemic Inflammatory Response Syndrome
What criteria indicates a diagnosis of SIRS?
Fever >38 or <36
Tachycardia >90 bpm/minute
Breathing rate >20 breaths/minute
What is Ludwig’s Angina?
Bilateral cellulitis of submandibular and sublingual space
What are the signs of Ludwig’s Angina?
E/O-redness and swelling in submandibular region
I/O-raised tongue, breathing/swallowing difficulty, drooling
Systemic- inc. HR, inc Temp, Inc breath rate
What are the aims of suturing?
Compress blood vessels
Approximate tissues
Prevent wound breakdown
Encourage healing by primary intention
What type of filament is preferred in sutures?
Monofilament
Less likely to facilitate an infection
What are the principles of cutting a flap in a surgical XLA?
Big flaps heal as well as small ones
Maximum access with minimal trauma
Wide base incisions
Aim for healing by primary intention
Cut flap down to bone in a continuous stroke
Be aware of adjacent anatomical structures
Keep papilla intact
No sharp angles
No crushing
Don’t close wound under tension (affects the blood supply)
Causes of TMD
macro trauma - punch
Micro trauma - para function
Occlusal features - high restorations, lack of posterior support, deep bite
Stress
Class 2 div 2
