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BDS3 > Oral Surgery > Flashcards

Oral Surgery Flashcards

1
Q

Extractions

  1. 4 indications for extractions
  2. 4 reasons a tooth may be considered unrestorable
  3. 4 pre-extraction complications
A
  1. Traumatic tooth position, unrestorable tooth, symptomatic partially erupted tooth, orthodontic considerations
  2. Gross caries, advanced periodontal disease, tooth/crown/root #, pulp necrosis
  3. Medical history precludes extraction (uncontrolled bleeding condition, unsuitable blood results), pre-operative radiograph shows tooth is ankylosed to bone, patient refuses to consent/is unable to consent, proximity to important anatomical structures, tooth position inadequate for access/limited mouth opening
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2
Q

List 4 types of peri-operative complications

A

Bleeding/haemorrhage, nerve damage, OAC, damage to adjacent tooth/restoration, lost tooth, tooth #

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3
Q

List 3 causes of access/vision difficulties

A

Limited mouth opening (reduced aperture), trismus, crowded/malpositioned teeth

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4
Q

List 3 causes of abnormal resistance

A

Hypercementosis, ankylosis, long/divergent/increased number of roots, thick cortical bone

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5
Q

List 3 causes of tooth #

A

Caries, alignment, root, size, misdirection of force

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6
Q

Jaw #

  1. 3 causes
  2. 3 signs/symptoms
  3. Management
  4. Alveolar # management
A
  1. Misdirection of force, atrophic mandible, cyst in bone, impacted 8
  2. Crack, step (visual/palpable), tear in gingiva at # line, abnormal disclusion
  3. Immediate analgesia (LA block), radiograph (OPT/occlusal), refer, provide analgesia and antibiotics. If required, stabilise (tie free end of bone to teeth opposite # line and teeth together)
  4. Suture, dissect free smooth edges
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7
Q

How would you treat a TMJ dislocation

A

Relocate (condyles down and back)

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8
Q

OAC

  1. 3 diagnosis tools
  2. Management
  3. PoI
A
  1. Direct vision (aspiration, good lighting - blood bubble at base of socket), nose blow test (hold nose, gently blow - bubbling at base of socket), blunt probe, radiograph
  2. If small/lining intact - encourage clot, suture margins
    If large/lining torn - buccal advancement flap
  3. Don’t dislodge clot, no straws, avoid wind instruments for 2 weeks, don’t rinse today, WSWM from tomorrow, avoid nose blowing, steam inhalation, closed sneezing/stifle sneezes
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9
Q

Maxillary tuberosity #

  1. 3 causes
  2. 3 signs/symptoms
  3. Management
  4. How would you retrieve a root in the antrum?
A
  1. Extraction in wrong order (front to back), last standing molar, unknown unerupted 8
  2. Loose/mobile tuberosity/tooth, crack, tear in palate, noise
  3. If small - remove and close. If large - (reduce and stabilise) replace, RCT tooth and ensure occlusion-free, then surgically remove 8wks later
  4. Suction (narrow-bore), small curette, irrigation, ribbon gauze
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10
Q

How do you manage a lost tooth

A

Stop and search for it. If possible inhalation, send to A&E for CXR

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11
Q

Damage to adjacent tooth/restoration

  1. 3 causes
  2. Management
A
  1. Using tooth to lean on with elevator, forceps slip and hit opposing tooth, restoration overhang in contact with tooth to be extracted
  2. Temporary restoration, arrange definitive
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12
Q

Broken instrument

  1. 2 causes
  2. Management
A
  1. Instrument fatigue, incorrect use (using luxator as an elevator, etc.)
  2. Retrieve, radiograph to confirm, refer if unable to retrieve
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13
Q

Nerve injuries

  1. 3 types
  2. 5 effects of nerve damage
  3. 3 types/names of nerve injuries and define
A
  1. Crush injuries, cutting/shredding injuries, transection injuries
  2. Anaesthesia, dysaesthesia, paraesthesia, hyperaesthesia, hypoaesthesia
  3. Neurapraxia - temporary loss of function due to blockage of nerve conduction. Bruise/contusion. Epineural sheath and axons maintained
    Axonotmesis - gradual loss of function distal to injury site. More severe contusion/crush. Epineural sheath disrupted, axons maintained
    Neurotmesis - most severe type. Transection. Complete loss of nerve continuity. Epineural sheath and axons disrupted
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14
Q

Bleeding/haemorrhage

  1. 4 reasons
  2. Soft tissue management
  3. Bone management
  4. 3 types of haemostatic agents
A
  1. Medication side effects, undiagnosed/unmanaged clotting abnormality, liver disease/dysfunction, local factors (mucoperiosteal tear, etc.)
  2. Bite on damp gauze, introduce haemostatic agents, suture, diathermy, haemostatic forceps/artery clips
  3. Bite on damp gauze, introduce haemostatic agents, bone wax, pack, suture
  4. Oxidised regenerated cellulose (surgicel), adrenaline-containing LA (on pledget/gauze/into socket), fibrin foam, thrombin liquid
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15
Q

Surgery

  1. 4 principles of surgery
  2. 4 features of flap design
  3. 2 methods of soft tissue retraction
  4. 2 reasons for soft tissue retraction
  5. 2 elevator functions (3 methods of use)
  6. What handpiece and why
  7. 3 methods of debridement
  8. 4 aims of suturing
  9. 4 types of sutures
  10. 4 types of flap (draw)
  11. Nerves damaged when extracting L8
A
  1. Maximal access with minimal trauma, clean flap reflection down to bone, keep tissues moist, no crushing of tissues, aim for healing by primary intention to minimise scarring, re-approximate tissues,
  2. Use scalpel in one, continuous motion, no sharp angles, ensure tension-free closure (relieving incisions), consider aesthetics, achieve haemostasis, aim for healing by primary intention to minimise scarring
  3. Rake retractor, Howarth’s periosteal elevator
  4. Improve/gain access to field, protect soft tissues
  5. Loosen/remove teeth, remove retained roots
  6. Electric straight handpiece with saline-called straight/fissure tungsten carbide bur. Air-driven handpieces can cause surgical emphysema
  7. Handpiece, bone file, Mitchell’s trimmer, Victoria curette, irrigation, aspiration
  8. Achieve haemostasis, prevent wound breakdown, re-approximate tissues, aim for healing by primary intention to minimise scarring, cover bone, ensure margins and sutures lie on sound bone
  9. Envelope (with/out relieving incision), 3-sided (mesial and distal relieving incisions), semi-lunar (periradicular), triangular
  10. Envelope (with/out relieving incision), 3-sided (mesial and distal relieving incisions), semi-lunar (periradicular), triangular
  11. Inferior alveolar, lingual, buccal, nerve to mylohyoid
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16
Q

Analgesia

  1. Pain pathway
  2. Aspirin analgesic, antipyretic, anti-inflammatory, metabolic features
  3. 3 side effects and 4 contraindications
  4. Ibuprofen - why better than aspirin, 3 side effects, 4 contraindications
  5. Paracetamol - action, 2 contraindications
  6. Opioids - one in dentistry, 2 contraindications, 2 problems
A
  1. Trauma causes release of arachidonic acid from cell membranes, interacts with COX to activate PGG2 and PGH2 (activates PGE2), causing release of leukotrienes and influx of inflammatory products (pain, swelling, red)
  2. Analgesic - COX inhibitor
    Antipyretic - reduces raised temperature in fever
    Anti-inflammatory - reduces production of PGs
    Metabolic - reduces platelet aggregation, raises BMR
  3. Mucosal burns, antiplatelets/thins blood, GI upset. Not for other NSAID, antiplatelet/anticoagulant, peptic ulcer, pregnant/<16 (Reye’s)
  4. Less effect on platelets and gastric mucosa (COX2 inhibitor). Dizzy/headache, tired, GI upset. Not for renal/hepatic impairment, other NSAID, LT steroids, peptic ulcer
  5. Indirectly inhibits COX by reducing PGs in CNS pathway. Not for renal/hepatic impairment, alcoholics
  6. Dihydrocodeine. Not for raised ICP (head injury), acute alcoholism. Tolerance, dependence
17
Q

List 4 types of post-extraction complications

A

Bruising, swelling, pain, bleeding, dry socket, OAF, trismus, infected socket, ORN, MRONJ

18
Q

List 3 causes of post-extraction pain/swelling/bruising

A

Poor technique (traumatic), rough tissue handling, tear in gingival/mucoperiosteum

19
Q

Trismus

  1. Definition
  2. 3 reasons that it occurs
  3. Management
A
  1. Limited mouth opening due to muscle spasm
  2. Surgical reasons (open too long, muscle spasm), LA into muscle (masseter), haematoma in muscle
  3. Soft diet, CHX MW, gentle opening techniques (wooden spatulas, trismus screw)
20
Q

OAF

  1. Define
  2. Treatment
A
  1. Occurs secondary to OAC. Occurs if OAC heals incorrectly/doesn’t heal. Formation of epithelial-lined tract between the antrum and mouth.
  2. Remove tract, suture closed
21
Q

Post-op bleed

  1. 2 types (differences)
  2. Management
  3. PoI
A
  1. Immediate - reactionary/rebound (vessels not being compressed anymore). Within 48hrs, usually ooze
    Delayed - usually 3-7days post-extraction. Often due to infection
  2. Rapid history, remove clot, identify source, same as peri-operative bleed - bite on damp gauze, introduce haemostatic agents, suture, diathermy, haemostatic forceps/artery clips
  3. Don’t rinse today, don’t smoke, no excess alcohol/exercise, bleeding management advice
22
Q

Dry socket

  1. 2 other names
  2. 4 predisposing factors
  3. 4 signs/symptoms
  4. Management
A
  1. Localised osteitis/alveolar osteitis
  2. Posterior tooth, mandibular tooth, smoking, excessive pre- and post-extraction rinsing, female, some oral contraceptive pills, previous dry socket, FH of dry socket
  3. Continuous intense throbbing pain (dull throb - kept awake at night), may radiate to ear/jaw, malodour/halitosis, no signs of infection, exposed sensitive bone
  4. Ensure no remaining tooth/sequestrum, analgesia (LA), irrigate to remove food trapped, debride, encourage clot formation, suture, PoI (WSMW, no excessive rinsing, don’t dislodge clot)
23
Q

Sequestrum

  1. Define
  2. Management
A
  1. Piece of dead bone formed within diseased/injured bone

2. Remove

24
Q

Infected socket

  1. Define
  2. Management
A
  1. Rare bacterial infection with pus discharge causing delayed healing
  2. Clean socket/drain pus, irrigate, radiograph, debride, suture
25
Q

Osteomyelitis

  1. Define
  2. Progression
  3. 3 predisposing factors
  4. 3 types
  5. Management
  6. Radiographic appearance
A
  1. Inflammation of bone marrow
  2. Medullary cavity to cancellous bone to cortical bone to periosteum. Bacteria invade bone, cause local soft tissue necrosis and ischaemia
  3. Odontogenic infection, # mandible, immunocompromised, comorbidities
  4. Early, acute suppurative, chronic (± pus)
  5. Refer, blood tests, surgery
  6. Mottled bone, sequestrum, involucrum
26
Q

ORN

  1. How it occurs
  2. What jaw more likely to be affected and why
  3. 3 prevention/treatment methods
A
  1. High-dose radiation induces local enarteritis obliterates which leads to progressive fibrosis and capillary loss, leaving bone susceptible to avascular necrosis.
  2. Mandible as thicker bone/poorer blood supply
  3. Hyperbaric oxygen chamber, pre-operative scaling, CHX MW use, good OH, atraumatic technique, suture (primary healing), resect necrotic bone, antibiotics
27
Q

MRONJ

  1. Define
  2. Stages
  3. High risk category
A
  1. Medicated-induced osteonecrosis of the jaw. Reduced bone turnover (inhibition of osteoclastogenesis). New bone formed faster than old bone lost
  2. Stage 0 - symptomatic, no necrotic/exposed bone
    Stage 1 - asymptomatic, necrotic bone/fistula that probes to bone
    Stage 2 - symptomatic, infection, necrotic bone/fistula that probes to bone
    Stage 3 - necrotic bone/fistula that probes to bone with one/more of: EO fistula, OAC, necrosis extends beyond alveolus, osteolysis extending to border of mandible/sinus
  3. Oral/IV bisphosphonates (or RANKL inhibitors) for non-malignant bone conditions for >5yrs
    Oral/IV bisphosphonates (or RANKL inhibitors) for any length of time in combination with systemic glucocorticoids
    Anti-angiogenic/anti-resorptive drugs involved in cancer treatment/management
    Previous MRONJ
28
Q

Actinomycosis

  1. Bacteria involved
  2. What is unique
  3. Management
A
  1. A. israelli/viscosus
  2. Erodes through tissue, doesn’t follow fascial planes
  3. Refer, antibiotics, LT antibiotics to prevent
29
Q

IE

  1. Define
  2. High risk category
  3. Management
A
  1. Bacterial inflammation of endocardium, particularly affecting CMP heart valves
  2. Previous IE, cyanotic CHD, prosthetic valve (replacement surgery)
  3. Consult with cardiologist, consider antibiotic prophylaxis

BDS3 (16 decks)

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