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.
True or false… advanced osteoarthritis can result in a true prognathia
False.
It can result in a pseudoprognathic-appearing mandible and cause deviation of jaw movement, further aggravating the condition, but this is not considered a true prognathia
The capsular ligament completely encircles the TMJ and prevents ___ movements that may cause…
Overextensive
The TMJ to dislocate
The capsular ligament must be cut in order to access the superior joint space.
What happens when midazolam is injected intra-arterially?
Some patients experience moderate-severe pain within the extremity where it was administered
True or false… nitrous oxide takes a long time for the body to metabolize
False. Its effects in the body are immediately removed once the nitrous oxide gas is completely expired by the patient, making anesthetic recovery time faster.
Ventricular arrhythmias can be treated by an IV injection of ___
Lidocaine
What is the main cause of failure of autogenous third molar transplants?
Traumatic occlusion because they cannot withstand the heavy occlusal forces in the posterior during mastication
What is autogenous tooth transplantation?
Involves taking a freshly extracted tooth (either impacted or erupted) from its original position in the arch and transferring it to a recipient site in the same person
What are some of the causes of failure of ATTs?
Chronic root resorption
Inflammatory resorption
Marginal and apical periodontitis
Dental careis
Occlusal trauma
Which is more rigid, internal or external splints? What is one of the major disadvantages of internal splints?
Internal splints are more rigid and display more retention. One of the major disadvantages of internal splints is that less tooth structure is conserved
What is the most probable reason for a patient to experience trismus following an IA block?
Piercing the medial pterygoid muscle
A normal mouth opening ranges from ___-___mm (males have slightly greater openings than females (males = ~___, females = ~___) the normal lateral movement is ___-___mm
35-45
50mm
35mm
8-12mm
What are the three classifications of trismus of incisal opening?
Mild: 20-30mm
Moderate: 10-20mm
Severe: < 10mm
If a patient sedated with nitrous becomes suddenly irrationally excited, what is the likely explanation?
The patient is entering stage 2 anesthesia
Describe stage 2 anesthesia
Excitatory stage
Patient exhibits uncontrolled movements, excited actions, and possibly delirium
Irregular respiratory patterns and heart rate
Pupillary dilation
Uncontrolled body movements
Because this stage of anesthesia is dangerous and potentially life-threatening, fast-acting drugs are utilized to pass this stage and attain the third stage of anesthesia as quickly as possible.
Name three procedures that can be completed via arthroscopy
Lavage of the TMJ
Removing adhesions
Disk manipulations
Note that repairing disk perforations requires making a flap incision to access the temporomandibular disk
Diagnosis of disk perforations is best completed using ____ imaging
T2-weighted magnetic resonance
What is the greatest disadvantage of oral sedation?
Differences in the rate of gastrointestinal drug absorption among patients
Administration of a schedule 2 narcotic with an anti-psychotic drug creates ____
Neuroleptic analgesia
Patients under neuroleptic analgesia show some degree of quietness, alteration of awareness, and some analgesia
What is the best way to access a fractured palatal root that has been displaced into the maxillary antrum area during extraction of a maxillary first molar?
Through the canine fossa above the level of the premolar roots
An opening or window is made in the anterior wall of the maxillary sinus. The root is retrieved through this opening and the opening is sutured
What is the Caldwell-luc operation? What is it indicated for?
An opening is made in the anterior wall of the maxillary sinus (area of the canine fossa).
Indicated for the retrieval of a broken tooth root from maxillary sinus
Removal of abnormal tissue growths
Treatment of maxillary infections
A patient suffering from chronic recurrent TMJ dislocation would have the greatest success in resolving their condition by….
Corrective orthognathic surgery or articular eminectomy usually combined with capsular plication
Surgical procedures for the treatment of chronic TMJ dislocation can be divided into two subgroups. What are they?
1) those that limit the range of movement
2) those that remove the blocking factor that prevents the condyle form returning to its normal position
What is an Eminectomy?
A technique that removes the articular eminence, leaving a flat smoot surface for the condyle to slide over without interference.
What is capsular plication?
Tightens the TMJ capsule, and limits translatory movement
What is interpositional arthroplasty?
A treatment for severe degenerative joint disease and ankylosis. This procedure separate the non-mobile portion and mobile portion of the TMJ to ensur that the condyle and the temporal bone do not directly contact each other
Recontours the bones within the TMJ and uses fascia, cartilage, or any suitable substance in between the two bones to correct the damaging and painful friction between them.
Reduces painful movements and re-establishes motion within the TMJ. In some cases, coronoidecomy procedures are also performed to manage trismus and pseudoankylosis
Which weight loss supplement is considered dangerous due to reported cases of sudden cardiac death?
Ephedra
Which component in dentrifices should be limited in order to prevent inactivation of fluoride ions?
Dicalcium phosphate
The interaction of fluoride ions and dicalcium phosphate dehydrate results in the formation of insoluble fluoride compounds that reduce the amount of free and available fluoride ions.
A split-thickness or mucosal skin graft used in a vestibuloplasty receives its nourishment and oxygenation primarily from…
The exposed periosteum that forms the graft bed
Mucosal Grafts are initially adapted and attached to the recipient site through ____ layer formation. Nutrients for the graft are taken from the recipient bed through a process known as ____
Fibrin
Plasmatic imbibition
Seizures induced by a lidocaine overdose can be treated by ___
Diazepam
____ is a rapid-acting and highly efficacious anticonvulsant drug indicated to treat anxiety, panic, and acute seizure atttacks such as those induced by ____
Diazepam
Lidocaine
What functions do skin grafts provide after a vestibuloplasty procedure is completed?
Prevents reattachment of muscle to periosteum
Describe a vestibuloplasty
The surgeon displaces the muscle attachments in the periosteum of the jaw to deepen the vestibule and expose more alveolar bone needed to create a residual ridge that will provide more denture support
In detaching a portion of these muscles, more residual ridge becomes exposed and a new vestibular depth is established
The muscles that were detached have a tendency to readapt to the previous location within the periosteum. In order to maintain the new positioning and prevent the muscular re-attachment at the previous spot, a skin graft is placed that attaches to the periosteum of the exposed alveolar bone
What may happen if 100% oxygen is not provided to a patient soon after nitrous oxide sedation?
Diffusion hypoxia
What is diffusion hypoxia?
Diffusion hypoxia may occur when a patient is rocovering from N2O anesthesia. Large quantities of this gas cross from the blood into the alveolus (down its concentration gradient), so for a short period of time, the O2 and CO2 in the alveolus are diluted by the gas. Diluting the O2 and CO2 can cause the partial pressure of oxygen to decrease, temporarily inducing hypoxia. The decrease in CO2 could also potentiates this effect, as ventilation would be suppressed, leading to potential hypoxemia
During ___ sedation, patients are awake but feel lightly drowsy. Patients retain the ability to move and to maintain a patent airway independently
Conscious
____ sedation is characterized by a depressed conscious such that the patient is unable to continuously and independently maintain a patent airway and experiences a partial loss of protective reflexes and of the ability to respond to verbal commands or physical stimulation
Deep
General anesthesia is a medically induced ___ leading to a loss of protective reflexes, resulting from the administration of one or more general anesthetic agents.
Coma
True or false… no autonomic nerves are involved in pain perception
True. They are related to muscular or motor reflexive functions such as peristalsis, breathing, and heartbeat
What portion of forceps is most likely to accidentally crush the lip of a patient?
The hinge
It lies nearest to the lips during the extraction procedure, especially during the extraction of posterior teeth
A patient with ___ one week postsurgery suggests infection. After one week, the surgical wound should have a large decrease in redness and reduced or no swelling. Patients with ____ and ____ that does not subside three or four days postsurgery should seek care.
Fever
Swelling and fever
Name four endogenous opioid peptides
Endorphin
Enkephalins
Dynorphin
Endomorphine
Bradykinin is a ___ that is created in the ___. It is a mediator of ___ that can also induce ____ and increase ___.
Kinin
Blood
Inflammation
Vasodilation
Vascular permeability
A patient who suffered a midface trauma presents with paresthesia of the left upper lip, cheek, and left side of the nose. What structure was most likely fractured?
Intfraorbital rim
The infraorbital nerve exits the ___ foramen and branches out to innervate the __, ___, and ___ up to the ___.
Infraorbital
Upper lips
Cheeks
Nose up to the nasal vestibule
Trochlear nerve dysfunction presents as….
What muscle does the nerve innervate?
Failure of eyes to move down and out.
The trochlear nerve (CN 4) is a motor nerve that innervates the superior oblique muscle. This muscle allows rotation of the eyes within the vertical plane and rotational movement of the eye toward and away from the medial plane (down and out)
What is the mnemonic for extrensic eye muscle innervation?
LR6, SO4, AO3
Lateral rectus - CN6 (abducens)
Superior oblique - CN4 (trochlear)
All others - CN3 (oculomotor)
True or false… N2O is contraindicated in patients with type 2 diabetes
False. It is contraindicated in patients who are undergoing psychotic care
Name some contraindications of nitrous oxide sedation.
Severe emotional disturbances
Severe drug-related dependence
COPD/bronchitis/emphysema/URI
Otitis media
Clautrophobia or irrational fear of “gas”
Maxillofacial deformities/ nasal obstructions
Pregnant patients (especially those in 1st trimester)
Sickle cell disease
Pts being treated with bleomycin sulfate
Methylenetetrahydrofolate reductase deficiency
What is the graft material that provides vital osteoblasts for the formation of new bone?
Hemopoietic marrow
Freeze-dried allografts and xenografts are both osteoinductive but DO NOT contain cells that can form bone
Define osteo inductive
Ability to form new bone through the stimulation of the stem cells in the body
Why is inferior movement of the maxilla the least stable orthognathic surgery?
Because the vertical occlusal forces of the masticatory muscles often cause it to relapse
Also, maxillary bone is thinner and less solid than mandibular bone
What is the verrill sign? What is it used for?
Similar to ptosis, a condition in which there is drooping of the upper or lower eyelid
The presence of the verrill sign during IV sedation helps the anesthesiologist determine the depth and adequacy of sedation. The verrill sign helps in determining a safe limit in administering the IV conscious sedation drug such as diazepam. The presence of the sign tells that the anesthesia needed for the procedure is already adequate and that the safe limit has already been reached.
____ is an IV drug that is used to control seizures and convulsions and also shortens the time in passing through stage 2 of general anesthesia. This drug is the barbiturate with longest duration and is the most widely used anticonvolusant drug in the world. It is used in general anesthesia to limit stage 2 anesthesia
Phenobarbital
Describe stage 2 anesthesia
Pts may exhibit involuntary excitement, delirium, apnea, and exaggerated reflex responses, leading to possible vomiting
Long term exposure to N2O can cause what three things?
Peripheral neuropathy
Vitamin B12 deficiency
Reproductive side effects (in pregnant females)
When performing a PSA block, the anesthetic should be injected in what location?
Pterygoidpalatine space
What type of flap should be laid for lingual mandibular tori removal?
Full-thickness envelop flaps with proper extension to provide adequate access
Note that vertical incisions are contraindicated in these cases
When administering N20, the reservoir bag serves what purpose?
It makes up for the difference between the constant gas flow from the machine and the cyclic breathing pattern of the patient.
What type of flap is indicated (most commonly) for the removal of a mesiodens?
Full thickness palatal
Mesiodens are usually found palatal to the area between the maxillary central incisors and can be extracted with a full thickness palatal flap.
Full thickness palatal flaps not only allow for adequate visualization, it allows for better blood supply than partial thickness flaps, rendering the procedure less traumatic and reducing bleeding
What is the difference between cryer elevators and crane picks?
Cryers should be used for larger root segments (often removes the interradicular bone)
Crane picks are used for the delicate removal os smaller root fragments.
After a mandibular first molar is extracted, when is a patient most likely to experience postextraction alveolar osteitis (Dry socket)?
Three days after
How do you determine the percentage of oxygen use in nitrous oxide administration?
Divide the liters per minute of the gas desired by the total amount of gas being delivered per minute
Why isn’t lorazepam used in the dental setting?
It lasts too long.
What is the mnemonic for benzodiazepines that undergoes extrahepatic metabolism?
Outside The Liver (OTL)
Oxazepam
Temazepam
Lorazepam
These undergo extrahepatix metabolism and do not form active metabolites
When is it acceptable to reposition bone that has broken off during an extraction?
When they can be properly repositioned within the fracture site with evidence of an intact blood supply
The beaks of a needle holder compared to the beaks of a hemostat are ___ and ___. What are hemostats designed to do?
Shorter and thicker
Hold tissues together to control bleeding. They are made thinner to ensure that it can engage issues and severed vessels even when theya re small and hard to reach
In trauma cases ____ fractures are diagnosed by deviation of the mandible to the same side
Subcondylar
After an IA block, which anatomical space is most likely to be involved in a needle tract infection?
Pterygomandibular
True or false… acute osteomyelitis involves suppurative drainage and loosening of teeth.
False. This is a sign of periodontitis. Not acute osteomyelitis
Acute osteomyelitis mostly affects ____ and is usually correlated with a _____ infection. It may occur in adults with…
Children
Staphylococcus aureus
Immunosuppression
What are pedicle flaps?
They are indicated in cases where mucosal coverage is insuffienct to cover the wound.
They are created with a portion of the base still attached to the original site so blood supply is still present.
They are the best option for wound coverage and have high success rates
_____ skin graft technique for vestibuloplasty increases the length of the overlap ridge that may be used for denture fabrication. Vestibuloplasty accomplish what goal?
Split-thickness
Vestibuloplasty in general helps to create a longer residual ridge and a deeper flange area to improve the resistance of fabricated dentures for displacement
It also increases the available stable soft tissue that can support a denture while also increasing its retention
The duration of action for a single IV bolus dose of diazepam relics on ____
Hepatic biotransformation
Diazepam undergoes oxidative metabolism by demethylation, hydroxylation, and glucoronidation in the liver as part of the cytochrome P450 system. It has several pharmacologically active metabolites chiefly desmethyldiazepam. The metabolites are conjugated with glucronide and are excreted in urine. Diazepam is highly lipid soluble and is widely distributed throughout the body after administration. The drug primarily distributes to muscles and adipose tissues.
