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BDS4 > Oral surgery - 3rd molars > Flashcards

Oral surgery - 3rd molars Flashcards

1
Q

What guidance can you follow for removal of lower 8’s?

A

NICE
Royal college of surgeons
SIGN

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2
Q

According to the NICE and SIGN guidance what are some Strong indications in the removal of lower wisdom teeth?

A
  • Recurring infection (more than one episode)
  • Caries in the tooth or the adjacent
  • PAP
  • Cysts
  • Perioddontal disease
  • External resorption
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3
Q

What are some advisible indications of lower 8’s?

A
  • To get patient dentally fit
  • Significant infection
  • Orthagnathic surgery
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4
Q

What are the contraindications of removal of lower 8’s?

A
  • third molar is likely to erupt successfully and become functional
  • High risk of surgical complications
  • High risk of jaw fracture
  • Medically contraindicated
  • No local or systemic pathology or symptoms
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5
Q

What could be a possible cause of the operculum being repeatedly inflammed and causing the patient bother?

A

The upper 8 is biting on the operculum and traumatising it.

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6
Q

What type of flap would you use for extracting a lower 8?

A

3 sided flap

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7
Q

Loss of what between a 7 and a 8 on an OPT will usually signify the differncence between vertical and distal angular impaction?

A

The black triangle between 7 and 8

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8
Q

What is a good acroynm for looking at lower 8’s on OPT’s?

Which includes everything?

A
  • MOLARS
  • M(measure follicluar width, is it a cyst)
  • O(Orientation, is the tooth impacted)
  • L(Loss of bone and recurring infection)
  • A(Adjacent tooth and position of the sinus +alveolar bone levels)
  • R(Roots and their relation ot anatomical structures)
  • S(size of the crown)
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9
Q

What are the 6 indications on a OPT which suggesst a close relationship with the roots and the IAN?

A
  • Juxta-apical area (which is a radiolucency area around the apex of the tooth which isnt caused by caries or pathology)
  • Loss of canals tram lines
  • Darkening of the roots
  • Bending of the roots or canal
  • Narrowing of the roots or the canal
  • Bifid root
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10
Q

What are the 4 main treatment options for XLA of a M3M?

A
  • Do nothing (local measures may be necessary like CHX rinise)
  • XLA
  • surgical removal with CBCT taken
  • Coronectomy
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11
Q

In order to obtain valid consent. What are the main risks of XLA of a M3M?

A
  • Pain
  • Swelling
  • brusisng
  • Bleeding
  • Infection
  • Jaw stiffness
  • Jaw fracture
  • Damage to adajcent teeth
  • Need for further treatment
  • Potential damage to nerve be specific 5% temp and <1% permenant if nerve not crossed.
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12
Q

What are the main principles of flap design if you are raising a flap

A
  • Maximium access with minimal trauma
  • Use a sharp scalpel and cut all the way down to bone
  • Ensure these margins are on sound bone
  • Cut with one continuous motion
  • Wide base
  • Keep tissues moist
  • Minimise trauma to papilla
  • Wounds closed by approximating the margins
  • Heal by primary intention
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13
Q

Outline procedure of XLA of M3M?

A
  1. Lift a flap
  2. Bone removal
    * Two different types of bur used- fissure and round head bur- with electrical handpiece (avoiding air handpieces removes the risk of surgical emphysema)
     Round head bur used initially to create a buccal gutter
    - Always start distally and come round towards the mesial aspect
    - Cut down to the ACJ
     Then consider if tooth needs sectioned
    - Mesially impacted teeth usually need decoronated
    - Start with round bur and make a divet at the ACJ
    - Switch to the fissure bur to cut the tooth
    - Extend cut ¾ round the tooth so you can easily flick off the crown and avoid damage to the Lingual nerves in the mesial aspect
    - An elevator can be used to remove the crown
    - Consider need to dissect roots for removal
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14
Q

What is post-operative advice following removal of M3M?

A
  • Pain analgesics before the LA wears off
  • Swelling ice pack
  • Bleeding, pressure damp gauze 30mins then call NHS24 or us
  • Keep clean with warm salty water wait 4-6hrs then do after every meal
  • Eating and drinking avoid hot foods and drinks
  • Avoid smoking drinking and strenuous excercise
  • Dont explore the socket
  • Sutures are resorbable so will dissappear in 2 weeks
  • Emergency contact A&E
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15
Q

When would you consider extraction of upper molars as well as lowers?

A
  • If the upper molars were biting on the operculum
  • Patient getting GA
  • Causing bother too
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16
Q

What risks with a coronecetomy must be explained to the patient to obtain consent?

A
  1. Remain asymptomatic
  2. Roots may migrate towards mouth
    - If need removed at later date this could eb considered staged effect as the risk to the IAN will be decreased
  3. Roots may remain symptomatic or become infected and symptomatic at a later date requiring removal
    * If the root are mobile after crown removal they must be removed
    - Must always consent for full extraction when consenting for coronectomy
    * The rate of dry socket is the same for a coronectomy as for a surgical removal
17
Q
  1. Which nerve can potentially be damaged during extraction of a lower third molar?

2

A
  • Inferior alveolar nerve & nerve to mylohyoid
18
Q
  1. Which of the following would be considered and indication for removal of a lower third molar?
A
  • Third molar is carious or recurrent infection requiring Iv antibiotics
19
Q
  1. Which warning would you give to a patient consenting for removal of lower third molars?
A

Pain, swelling, bleeding, brusing, infection (dry socket), mandiblar fracture, jaw stiffness, need for further treatment, damage to adjacent tooth, loss of taste, damage to nerves temp and permenant which will cause numbness, tingling or pain of the lower lip, skin on the chin, lateral border of the tongue.

20
Q
  1. What figure would you quote as the national statistic for patient who will sustain temporary nerve damage following a lower third molar extraction?
A

20% if crosses the IANC on OPT
5% if doesn’t and is low risk

21
Q
  1. What should you document in the notes following clinical assessment of a lower third molar?

Things you can see in the mouth

A
  • Degree and type of impaction
  • Systemic symptoms like lymphadenopathy
22
Q
  1. What is routinely prescribed postoperatively for patient undergoing third molar extractions?
A

Nothing

23
Q
  1. A coronectomy is indicated when?
A
  • The roots of the tooth are in close proximity to the ID canal
  • The tooth isnt carious
  • Patient isnt immuno-comprimised or medically comprimised

BDS4 (24 decks)

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