Oral Surgery Flashcards
True or false.. pts with diabetes type 2 and liver cirrhosis are more prone to undergo postoperative bleeding
True . In diabetes type 2, less platelet aggregation and impaired wound healing result in prolonged bleeding after multiple extractions
Impairment of vitamin-K-dependent clotting factors and prolonged prothrombin time occur in liver cirrhosis
Vitamin K-dependent clotting factors __, __, ___, and ___ are stored in the liver
2, 7, 9, 10
___ pupils [with/without] light reflex suggests the patient is suffering from oxygen deprivation. Why?
Dilated
Without
The brain stem that controls pupillary response lacks oxygen, causing the cells to die or become damaged.
___ poisoning can be treated by administration of ethanol because ethanol… (3 things)
Has a higher affinity for alcohol dehydrogenase
Inhibits metabolism of methanol into formaldehyde
Prevents injury to the cranial nerve 2 (optic nerve) by methanol metabolites
What is the most common post-extraction complication seen following the extraction of the lower molars in a 3-year old?
Postoperative lip-biting
Administration of 100% oxygen to patients with ___ is contraindicated because the risk of losing the hypoxia drive is greater because their chemoreceptors have “adjusted” to the below-normal O2 level and above-normal CO2 level. CO2 levels should be set at ___ rather than ___ as the baseline.
COPD
60
40
What is the first thing that should be done when it appears that a person has collapsed and is unconscious?
Establish if they are truly unconscious by tapping not their shoulder and asking questions.
After establishing unconsciousness, assess the person’s airway, breathing, and pulse before providing first aid.
In what order should an airway obstruction be managed in an unconscious patient?
Clear the pharynx
Check breathing
Extend the patient’s neck
Protrude the tongue and mandible
True or false… NO produces vasoconstriction
False. It produces vasodilation
What medication should be administered to treat a patient suffering from xerostomia, tachycardia, gastrointestinal activity, and suspected atropine poisoning?
Physotigmine
Phystotigmine is an agent that can reverse atropine overdose. It inhibits acteylcholinesterase enzyme from braking down acetylcholine in the neuromuscular junction allowing acetylcholine to function properly
Atropine is a competitive inhibitor of muscarinic receptors M1-M5
Patients with hyperventilation syndrome may present with ___ and ___. They have roughly the same ___ in the arterial blood and insufficient ___ in their blood and other tissues
Chest pain and tingling sensation in the fingertips and around the mouth and may accompany a panic attack
Osygenation
CO2
Hyperventilation syndrome is a condition of insufficient ___, not ___, so additional ___ is contraindicated.
CO2
O2
Oxygen
Fabrication of an emergency occlusal separator device is indicated for patients with ____
Hemarthrosis
Further damage and bleeding of the joint is avoided through the use of an occlusal separator to relive the injured TMJ disorder from contact
What is hemarthrosis? What is the most common cause?
A condition wherein bleeding occurs in the joint or joint space
Injuries to joints are the most usual cause of hemarthrosis, which result in joint pain and inflammation
When a person suddenly loses consciousness it is important to assess the ABCDs which are…
A - Airway (check for obstruction)
B - Breathing (check for rise and fall of chest)
C - Circulation (check pulse)
D - Diabetes (check for blood sugar is pt is diabetic)
When administering intravenous diazepam, the Verrill sign is best described as ___
Ptosis of the eyelid (drooping of the upper or lower eyelid)
The level of sedation can be evaluated by checking several parameters including the verrill sign, which signifies the effect of anesthesia to the muscles that controls the eyelid
How should you manage a generalized tonic-clonic epileptic seizure?
Roll the person on their side to prevent fluid ingestion into the lungs which if not prevented could cause airway blockage and death
The person should be moved away from sharp edges with their head supported with a soft cushion or pillow if possible
Emergency services should be contacted immediately if the seizure lasts for more than 5 minutes, or if it occurred more than once without regaining consciousness
Emergency services should be contacted immediately if a seizure lasts for more than __ minutes or if…
5
It occurred more than once without regaining consciousness
Excisional biopsies are indicated over incisional if…
The lesion is < 1cm
The lesion is pedunculated
The marginal mandibular branch of the facial nerve that is in the ___ aspect of the face and neck. It supplies the ___ and ___. Specifically, which muscles?
Anterior
Lower lip muscles and chin
Mentalis, depressor annuli Otis, and depressor labii inferioris
Name 4 nerves that innervate the TMJ
Masseteric
Auriculotemporal
Deep temporal
V3
Bleeding under the conjunctiva may indicate a fracture of the ___
Zygomaticomaxillary complex (which involves fracture of the maxillary sinus, walls, and orbital floor; the zygomatic arch, and the lateral orbital rim and wall.
Why is a “tripod” fracture of the zygomaticomaxillary complex an inaccurate term?
Because a fourth suture could be involved between the zygomatic and sphenoid bones
Which muscle is attached to the condylar head and causes forward displacement of the mandible? It originates in the ___ and attaches to the ___ and the ___
Lateral pterygoid
Infratemporal fossa
TMJ disk (superior head) and the neck of the mandible (inferior head)
In a right excursive movement, the ___ lateral pterygoid contracts and pushes the mandible __ and __. Meanwhile, the __ lateral pterygoid is relaxed to prevent an antagonizing force. If both muscles contract, ___ results.
Left
Downward and forward
Right
Protrusion
A ___ spectrum antibiotic can disturb the oral microflora balance and cause fungal invasions such as Candida albicans to thrive. ___ is an effective treatment for candida applications.
Broad
Clotrimazole
Which structure functions by pulling the articular discs posteriorly against the lateral pterygoid that pulls it forward?
Superior retrodiscal lamina
During mouth opening the ___ is extended, preventing overextension and anterior dislocation of the articular disc.
Retrodiscal lamina
The incidence of root fracture is greatest during extraction of which teeth?
Maxillary first premolars
Lorazepam has all six intrinsic benzodiazepine effects, which are…
Anxiolysis
Anterograde amnesia
Sedation/hypnosis
Anticonvulsion
Antiemesis
Muscle relaxation
What is haloperidol?
An older antipsychotic used in the treatment of schizophrenia, acute psychotic states, and delirium
What is methohexital?
A short-acting barbiturate with a rapid onset of action
What is pentazocine?
An opioid analgesic used to treat moderate to moderately severe pain
What is zaleplon?
A nonbenzodiazepine sedative and hypnotic that is used for the management and treatment of insomnia
Patients receiving nitrous oxide typically experience __ before the onset of sedation.
Tingling in the extremities and near the lips. They may also experience warming up of the body, a sedated and drowsy condition, and a temporary state of euphoria
Excessive nitrous oxide sedation may elicit what kinds of symptoms?
Unawareness o surroundings
Incoherence
Hallucinations
Feeling of floating
Inability to keep an open mouth
After administering an IA block, the pt experiences paralysis of the muscles of the forehead, eyelid, and the upper and lower lip on the same side of injection. Anesthetic was most likely deposited into ___
The capsule of the parotid gland (this is where the facial nerve passes through to innervate the muscles of facial expression)
What is the purpose of biofeedback?
Enable the patient to gain control of certain physiological functions
Biofeedback is a type of therapy in which patients are taught ways to achieve better health through controlling certain regulatory and involuntary processes that occur within their body
Biofeedback is conducted in what 3 ways?
Electromyography functions by measuring the tension within a muscle
Thermal biofeedback focuses on the skins temperature
Neurofeedback promotes a deeper understanding of how the brain waves of the patient function
What are three different ways to modify pain sensation?
Inhibition pain signals from reaching the brain by blocking the nociceptive pathways
Raising the pain threshold of patients through medications like analgesics and sedatives
Psychosomatic hypnosis
Cortical depression
What is the principal benefit of intravenous sedation?
The ability to titrate doses to control the flow of medication for safe levels, preventing an unnecessary overdose
IV sedation is fast-acting and is directed to the bloodstream, which reduces the required drug dose needed to provide an effect, as compared to other routes of administration
IV sedation also allows the patient to recover faster after the drug is titrate down and slowly removed from the blood stream
True or false.. a direct interviewing style helps patients relax through a controlled conversation regarding their dental condition. Direct interviews give patients a sense of comfort, knowing that the dentist is focusing attention toward them. They also decrease the time spent answering unnecessary questions from patients.
True
What is the most common side effect of nitrous oxide or oxygen? ___% of the patients who undergo nitrous oxide sedation experience side effects like nausea and vomiting. ___ nitrous release is more likely to cause patients to experience disorientation, headaches, and nausea.
Nausea
0.5%
Rapid
Incisions made closest to the ____ will create a better esthetic appearance after wound healing
Relaxed skin tension line
When treating actinomycosis of the jaw, which of the following is the most accepted dosage schedule for the administration of penicillin?
10 million units IV per day for 10-14 days followed by a long-term oral antibiotic
Actinomycosis requires long-term antibiotic treatment in oral doses that may last 6-12 months depending on the disease severity
Actinomycosis infection elicits suppurations and inflammation
Swellings caused by actinomycosis drain pus containing sulfur granules
What is the correct total flow of nitrous oxide and oxygen?
The amount necessary to keep the reservoir bag 1/3 to 2/3 full
Advanced cases of osteoarthritis of the TMJ may exhibit what 5 things?
Crepitus
Flattening of the articular surface of the condyle
Limited jaw movement
Pain on mouth opening
Antagonial notching (only in some cases)
Advanced osteoarthritis may cause ___gnathia (AKA ____).
Aperto-gnathia (anterior open bite)
The decrease in condylar height experienced by patients with severe osteoarthritis may make the posterior teeth occlude prematurely, resulting in an anterior open bite.
