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4th Year Revision > Oral Surgery > Flashcards

Oral Surgery Flashcards

1
Q

What are the reasons for failure of conventional RCT? (4)

A
  • anatomical
  • root obturation error/problem
  • root perforation/fracture
  • pathology
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2
Q

What are the pathological indications for periradicular surgery? (4)

A
  • chronic persistent periapical granuloma
  • radicular cyst
  • cementoma
  • external root resorption
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3
Q

What are the contraindications for periradicular surgery? (4)

A
  • anatomical factors e.g proximity to neuromuscular bundles
  • periodontal considerations e.g presence of defects
  • medical factors e.g leukaemia, neutropenia
  • skill and ability of surgeon
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4
Q

What are the stages of periradicular surgery? (7)

A
  • LA
  • flap design
  • bone removal
  • curettage
  • apicectomy
  • retrograde preparation and filling
  • closure
  • POI
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5
Q

What are the types of full mucoperiosteal flaps? (3)

A
  • 2 sided
  • 3 sided
  • horizontal/envelope
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6
Q

What is a full flap? (3)

A
  • incisions through gingival margin
  • papillae mesial and distal included
  • relieving incision at 90* to tooth
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7
Q

What is a mucogingival flap? (3)

A
  • crowned anterior teeth
  • scalloped incision in middle of attached gingiva at 45*
  • vertical relieving incisions straight up and down
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8
Q

Give an advantage of a submarginal flap

A

Avoids recession

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9
Q

Give 2 disadvantages of a submarginal flap

A

Scarring

Painful post op

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10
Q

How do you do a root end resection? (5)

A
  • remove the apical 3mm to remove the apical delta
  • slight bevel improves vision
  • use fissure bur
  • if post present do not section it
  • all granulation tissue must be removed
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11
Q

What is guided tissue regeneration?

A

When a barrier membrane is used to treat teeth with large periapical lesions in conjunction with periodontal defects or without cortical bone

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12
Q

How do you do wound closure? (4)

A
  • thorough irrigation before closure
  • compression of flap to eliminate haematoma
  • reapproximation of flap (suture papillae first)
  • apply pressure +/- ice pack
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13
Q

What are the success rates of non surgical re treatment?

A

56-98%

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14
Q

What are the success rates of surgical treatment?

A

37-95%

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15
Q

What are the properties of root end filling materials? (4)

A
  • well tolerated by apical tissues
  • bactericidal or bacteriostatic
  • adhere to tooth
  • dimensionally stable
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16
Q

What are the disadvantages of amalgam? (4)

A
  • sets slowly
  • dimensionally unstable
  • scatters
  • leaks
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17
Q

What are the contents of MTA? (5)

A
  • tricalcium silicate
  • tricalcium aluminate
  • tricalcium oxide
  • silicate oxide
  • bismuth oxide
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18
Q

What are the properties of MTA? (6)

A
  • high pH
  • good sealing ability
  • hydrophilic
  • radiopaque
  • excellent biocompatibility
  • regeneration of cementum
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19
Q

What procedures are performed using a microscope? (7)

A
  • osteotomy
  • curettage
  • root end resection
  • inspection of resected root surface
  • root end preparation
  • root end filling
  • examination of surgical site
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20
Q

What are the valid causes of surgical failure? (4)

A
  • failure to clean root canal throughly
  • failure to seal root end
  • tissue irritation
  • failure to manage materials properly
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21
Q

What are the uncertain causes for surgical failure? (4)

A
  • infected dentinal tubules
  • infected periradicular lesion
  • accessory or lateral canals
  • loss of alveolar bone
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22
Q

What are the symptoms of sepsis in adults? (6)

A
  • slurred speech
  • extreme shivering
  • passed no urine in a day
  • severe breathlessness
  • illness so bad they feel they’re dying
  • skin mottled/discoloured/ashen
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23
Q

What are the symptoms of sepsis in children? (4)

A
  • no urine >12 hours
  • skin abnormally cold
  • rash not fade with pressed glass
  • fever
  • skin colour change
  • difficulty walking
  • vomiting
  • fast breathing
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24
Q

What are the clinical features of sepsis? (5)

A
  • temp >38C or <36C
  • heart rate >90
  • respiratory rate >20
  • WCC >12 or <4
  • BP systolic <100
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25
Q

What bloods should you take for a patient with sepsis? (6)

A
  • FBC
  • U+E
  • glucose
  • CRP
  • lactate
  • cultures
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26
Q

What is the treatment of sepsis? (6)

A
  • take blood cultures ideally before antibiotics
  • take serum lactate
  • give oxygen
  • give empirical intravenous antibiotics
  • give IV fluids
  • monitor urine output
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27
Q

What are the synonyms for TMJ disorders? (4)

A
  • TMJ pain dysfunction syndrome
  • myofascial pain dysfunction
  • facial arthomyalgia
  • mandibular dysfunction
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28
Q

What are the types of TMJ classification? (3)

A
  • no meniscal displacement
  • anterior displacement of meniscus with reduction e.g clicks
  • anterior displacement without reduction e.g locks
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29
Q

What is the management of TMJ disorders?(5)

A
  • take time to explain and reassure patient
  • remove the dental cause e.g traumatic occlusion
  • advise soft diet/analgesics
  • jaw exercises/physiotherapy/ice packs
  • review 6 weeks
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30
Q

What could be the causes of TMJ pain? (6)

A
  • arthritis
  • pain of dental origin
  • other systemic arthropathies
  • atypical facial pain
  • giant cell arteritis
  • intracranial neoplasm
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31
Q

What are the classifications of oral ulceration? (6)

A
  • traumatic
  • iatrogenic
  • idiopathic
  • infective
  • autoimmune
  • neoplastic
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32
Q

What drugs can induce oral ulceration? (3)

A
  • NSAIDs
  • methotrexate
  • nicorandil
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33
Q

What is methotrexate used for?

A

In the management of rheumatoid arthritis, lichen planus and skin conditions

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34
Q

Who is more likely to get RAs? (5)

A
  • F>M
  • childhood to 40 years
  • white
  • non smokers
  • high socio economic status
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35
Q

What are the causes of recurrent apthous stomatitis? (4)

A
  • stress
  • menstrual cycle
  • hypersensitivity to foods
  • GI tract disease
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36
Q

Why does anaemia/haematinic deficiency predispose to mucosal disease? (3)

A
  • epithelial atrophy
  • compromised cell mediated immunity
  • cytotoxity of leucocytes reduced
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37
Q

What investigations should you do for recurrent oral ulcerations? (3)

A
  • full blood count
  • haematinics
  • immunology for coeliac disease
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38
Q

What is the oral presentation of crohns disease? (4)

A
  • mucosal tags
  • lip swelling
  • full width gingival inflammation
  • cobblestone mucosa
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39
Q

Why do you get recurrent oral ulceration in GIT disease in the stomach/small intestine? (2)

A
  • chronic blood loss secondary to gastric/peptic ulceration

- failure to absorb vitamin B12

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40
Q

What are the signs and symptoms of coeliac disease?(4)

A
  • severe or persistent mouth ulcers
  • unexplained iron, vitamin B12 or folate deficiency
  • irritable bowel syndrome
  • first degree relative of people with coeliac disease
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41
Q

What is the result of coeliac disease in infants 4-24 months? (3)

A
  • reduced growth
  • diarrhoea
  • abdominal distension
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42
Q

What is the result of coeliac disease in adults? (4)

A
  • abdominal discomfort
  • bloating
  • diarrhoea
  • weight loss
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43
Q

What is the sequelae of coeliac disease? (5)

A
  • anaemia secondary to iron deficiency and folate deficiency
  • calcium deficiency
  • vit D deficiency
  • vit K deficiency
  • GIT lymphoma
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44
Q

What is the treatment for coeliac disease?

A

Gluten free diet

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45
Q

How do you control ulceration in recurrent apthous stomatitis? (4)

A
  • SLS free toothpaste
  • chlorohexidine gluconate mouthwash
  • hydrocortisone mucoadhesive buccal tablets 2.5mg
  • doxycycline dispensable tablets as mouthwash
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46
Q

What are the investigations for cysts? (4)

A
  • vitality test
  • radiology
  • aspiration of cyst contents
  • biopsy
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47
Q

What are the contraindications for enucleation? (4)

A
  • cyst is large
  • involves a number of vital teeth
  • difficult anatomical site
  • involving a potentially useful unerupted tooth
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48
Q

Why do you need to eliminate dead space? (2)

A
  • to reduce reactionary haemorrhage

- to reduce post operative infection

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49
Q

How do you eliminate dead space? (4)

A
  • drain placement
  • procedures to collapse the walls of the cavity
  • use of biological and other materials to fill the space
  • use layered soft tissue closure or secondary intention
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50
Q

What are the disadvantages of enucleation? (4)

A
  • infection
  • incomplete removal of lining
  • damages to adjacent teeth or antrum
  • weakening of bone
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51
Q

What are the advantages of marsupialisation? (4)

A
  • avoids pathological fracture
  • treatment for medically compromised patients
  • avoids damage to adjacent structures
  • allows potentially useful teeth to erupt
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52
Q

What are the disadvantages of marsupialisation? (4)

A
  • orifice closes and cyst reforms
  • repeat visits
  • manual dexterity and compliances
  • complete lining not available for histology
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53
Q

Name 5 developmental epithelial odontogenic cysts

A
  • dentigerous cyst
  • eruption
  • odontogenic keratocyst
  • lateral periodontal
  • gingival
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54
Q

What is the treatment for keratocysts? (4)

A
  • enucleation
  • curettage of cavity
  • long term radiographic follow up
  • en bloc resection
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55
Q

Name 2 epithelial non odontogenic cysts

A
  • nasopalatine duct cyst

- nasolabial cysts

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56
Q

What is the histopathology of aneurysmal bone cysts?

A

Consists of mass of blood filled spaces with scattered giant cells

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57
Q

What is an ameloblastoma?

A

Odontogeni tumour arising from a tooth forming structure. Essentially benign but can be locally aggressive and invasive

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58
Q

When would you do an excisional biopsy? (2)

A
  • when there is small benign lesions

- malignancies where primary repair is possible

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59
Q

What are the problems with biopsies? (4)

A
  • inappropriate specimen
  • specimen too small
  • can’t orientate specimen
  • lab not informed for need for frozen section
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60
Q

What do frozen sections do?

A

Allow rapid diagnosis of malignancy within 1 hour

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61
Q

What is exfoliative cytology?

A

Removal of surface cells by scraping with a spatula or cytobrush

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62
Q

When would you do a labial gland biopsy?

A

Diagnosis of sjogrens syndrome

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63
Q

What is toluidine blue?

A

A cationic metachromatic dye that selectively binds in vivo to acidic tissue components of DNA and RNA

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64
Q

What is the vizilite system used for?

A

The vizilite system is used to detect the mucosal tissue undergoing metabolic or structural changes that by their nature have different absorbance and reluctance profiles when exposed to various forms of light sources

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65
Q

What concerns you about a lesion? (4)

A
  • site
  • size
  • colour
  • risk factors
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66
Q

Name 4 intra oral detection methods

A
  • toluidine blue
  • exfoliative cytology
  • biopsy
  • PDD
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67
Q

What are the changes in exfoliative cytology for oral cancer? (2)

A
  • decreased CA

- increased proliferation markers

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68
Q

What is the p53 wild type gene? (5)

A
  • normal tumour suppressor gene
  • half life 20 mins
  • 393 amino acids
  • cell cycle arrest
  • repair or apoptosis
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69
Q

What is the p53 codon 72 gene? (3)

A
  • loss of control
  • no repair
  • most common gene affected in cancer
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70
Q

How do you do a sentinel lymph node biopsy? (3)

A
  • inject radioactive dye into cancer
  • use device to identify radioactivity
  • incise down onto node and remove for biopsy
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71
Q

What are synchronous 2nd primary tumours?

A

Within 6/12 index tumour

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72
Q

What are metachronous 2nd primary tumours?

A

More primary tumours >6/12

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73
Q

Name 4 potentially malignant lesions

A
  • erythroplakia
  • erythroleukoplakia
  • leukoplakia
  • erosive lichen planus
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74
Q

What is dyskeratosis congenital? (3)

A
  • leukoplakia
  • nail dystrophy
  • increased skin pigmentation
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75
Q

What common pathology affect the salivary glands? (4)

A
  • inflammatory disorders
  • obstruction/trauma
  • neoplasms
  • autoimmune/degenerative
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76
Q

What are the systemic causes of bacterial sialadenitis? (4)

A
  • immunosuppression
  • medication
  • dehydration
  • irradiation
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77
Q

What is the acute management of sialadenitis? (4)

A
  • antibiotics
  • fluids
  • sialogogues
  • analgesics
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78
Q

What are the causes of sialolithiasis? (3)

A
  • stasis of saliva
  • mucous plug
  • duct stricture
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79
Q

What are the symptoms of obstructive sialadenitis? (4)

A
  • recurrent episodes of transient prandial salivary gland swelling
  • no symptoms between attacks as saliva escapes from the gland
  • the bigger the stone becomes the more severe the symptoms
  • complete obstruction causes stasis of saliva and allows commensals from the oral cavity to enter the gland
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80
Q

What is the presentation of acute sialadenitis secondary to obstruction? (4)

A
  • stasis allows ascending infection
  • increasing painful swelling of 24-72 hours duration
  • oral discharge of pus
  • systemic manifestation
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81
Q

What are the investigations for salivary gland tumours? (4)

A
  • radiographs
  • FNA
  • ultrasound
  • CT/MRI
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82
Q

What are the indications for salivary gland surgery? (3)

A
  • chronic pain
  • repeated acute or chronic sialadenitis
  • benign/malignant tumours +/- nerve reconstruction
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83
Q

What will the patient experience post removal of the submandibular gland? (4)

A
  • pain, swelling, brusing
  • scar
  • numbness of tongue
  • weakness of lower lip
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84
Q

What are the types of parotid surgery? (4)

A
  • extra capsular dissection
  • lobar resection
  • superficial parotidectomy
  • total parotidectomy
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85
Q

What are the post operative complications of salivary gland surgery? (4)

A
  • facial nerve injury
  • gustatory sweating
  • numbness around ear lobe
  • salivary fistula
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86
Q

How long does radiotherapy for oral cancer last?

A

Extends over 3-7 weeks with daily or week ends off

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87
Q

What are the side effects of chemotherapy?

A
  • low rbc +/- abc +/- platelets
  • mucositis
  • impaired wound healing, bleeding, infection
  • change in taste, tricky to swallow, halitosis
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88
Q

What are the side effects of radiotherapy? (4)

A
  • osteoradionecrosis
  • altered taste
  • infection
  • dental caries
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89
Q

What are the management strategies for oral mucositis? (4)

A
  • bland rinses
  • topical anaesthetics
  • analgesics
  • low level laser treatment
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90
Q

What are the management strategies for a sore mouth? (4)

A
  • avoid strong foods
  • eat bland, soft diet
  • avoid alcohol MWs
  • topical lignocaine, benzydamine HCL
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91
Q

What is the treatment for sialadenitis? (4)

A
  • flucloxacillin or augmentin
  • drain pus
  • keep well hydrated
  • encourage saliva flow
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92
Q

How does amifostine treat a painful mouth? (3)

A
  • protects damage to salivary glands by radiotherapy
  • promotes repair of damaged tissue
  • bind to harmful free radicals
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93
Q

How does sucralfate treat a painful mouth?

A

Sucralfate treats a painful mouth as it is a sucrose sulphate aluminium complex that binds to the ulcer creating a physical barrier that protects the gastrointestinal tract and prevents the degradation of mucus

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94
Q

What does denosumab do?

A

Inhibits osteoclast function and bone resorption

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95
Q

What is osteoradionecrosis?

A

exposed irradiated bone that fails to heal over 3/12 without residual or recurrent cancer

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96
Q

What is the medical management of osteoradionecrosis? (4)

A
  • 250mg tetracycline x4 day for 14 days
  • then 250mg x2 for several months
  • if severe infection add flagyl 200mg x3
  • pentoxyfylline +tocopherol for 6/12
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97
Q

What does pentoxifylline do? (5)

A
  • increases intracellular cAMP
  • activates PKA
  • inhibits TNF alpha and leukotriene synthesis
  • reduces inflammation and innate immunity
  • decreases blood viscosity and decreases potential for platelet aggregation and thrombus formation
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98
Q

What biological therapies can be used to treat oral cancer? (4)

A
  • vaccines e.g perception
  • anti angiogenic therapy
  • anti p53 antibodies
  • nivolumab immunotherapy
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99
Q

What does the biological therapy cetuximab do?

A

Blocks the surface of cancer cells that can trigger growth

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100
Q

How do biological therapies work? (3)

A
  • stop cancer cells dividing
  • seek out cancer cells and kill them
  • get the immune system to attack the cancer cells
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101
Q

What are the indications for the use of foscan PDT? (4)

A
  • licensed for palliative therapy
  • failed or unsuitable for surgery
  • failed or refused radiotherapy
  • curative therapy
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102
Q

What are the potential problems of foscan PDT? (4)

A
  • extravascular injection
  • light deprivation
  • immediate post operative pain
  • depth of tumour necrosis limited
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103
Q

What are the potential benefits of foscan PDT? (4)

A
  • possible under LA
  • quick
  • repeatable
  • preserves aesthetics/function
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104
Q

In PDT how much foscan is given?

A

0.15mg/kg

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105
Q

What are the clinical effects of fiscal PDT? (4)

A
  • impressive tumour reduction and necrosis
  • marked reduction in trismus
  • arrest of bleeding
  • marked halitosis
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106
Q

What are the classifications of zygoma fractures? (7)

A
  • type 1 undisplaced
  • type 2 arch fracture only
  • type 3 tripod fracture f-z suture intact
  • type 4 tripod fracture f-z suture distracted
  • type 5 blow out fracture only
  • type 6 orbital rim fracture
  • type 7 comminuted and other fractures
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107
Q

What are the symptoms of zygoma fractures? (4)

A
  • pain
  • numb cheek
  • double vision
  • restricted jaw movement
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108
Q

What are the signs of zygoma fractures? (5)

A
  • swelling
  • depressed cheek bone
  • periorbital bruising
  • surgical emphysema
  • palpable deformity
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109
Q

What are the investigations for zygoma fractures? (5)

A
  • radiographs 10 and 30 degrees
  • CT
  • ultrasound
  • ophthalmology
  • HESS chart
110
Q

What are the advantages of CT scans over plain radiograms and tomograms? (4)

A
  • no difficult positioning of patient
  • no movement of cervical spine
  • high quality images unaffected by soft tissue oedema and haemorrhage
  • better definition of difficult to image areas
111
Q

How do you tell if there is a blow out fracture of the orbital floor?

A
  • diplopia test in 9 fields of gaze
  • diplopia on upward gaze
  • up gaze limitation on affected side
  • pain on upward gaze
112
Q

What is the classic presentation of orbital fractures in children?

A

Absence of subconjunctival haemorrhage with up gaze diplopia and general malaise

113
Q

What are the radiographic features of a blow out fracture of the orbital floor? (4)

A
  • step at infra orbital margin
  • separation at f-z suture
  • fracture at arch
  • fracture at buttress
114
Q

When do we do no treatment for fractures of the zygomatic complex? (4)

A
  • no visual disturbance
  • no restricted jaw movement
  • no cosmetic problem
  • patient refusal
115
Q

When do we do treatment for fractures of the zygomatic complex? (4)

A
  • displaced fracture
  • trismus
  • infra orbital nerve damage
  • other injuries
116
Q

Where is the location of open reduction and internal fixation? (5)

A
  • fronto zygomatic suture
  • infra orbital region
  • zygomatic arch
  • plates or wires
  • antral pack
117
Q

What post op instructions do you give for fractures of the zygomatic complex? (4)

A
  • antibiotics
  • avoid pressure to the face
  • avoid contact sports
  • avoid blowing nose
118
Q

What are the complications of fractures of the zygomatic complex? (5)

A
  • mal reduction or mal union
  • asymmetry
  • retrobulbar haemorrhage
  • blindness
  • infra orbital nerve damage
119
Q

What is a le fort I classification?

A

Horizontal fracture of the maxilla immediately above the teeth and palate. It extends posteriorly to the pterygoid plate. It separates the dento alveolar complex from the nose and antrum

120
Q

What is a le fort II classification?

A

Pyramidal fracture that passes across the bridge of the nose, through the infra orbital margin, around the zygomatic buttress to the pterygoid plate

121
Q

What is a le fort III classification?

A

Separation of the entire mid face from the bones of the cranium. Extends from the nasal bone, through the bones of the orbit to the f-z suture. The zygoma also fractures. Fracture of the pterygoid plate

122
Q

What are the clinical features of le fort I? (5)

A
  • mobility of tooth bearing segment of the upper jaw
  • crepitus in buccal sulcus
  • palatal haematoma
  • fractured teeth cusps
  • bruising of upper lip and lower mid face
123
Q

What are the clinical features of le fort II and III? (4)

A
  • bilateral peri orbital bruising
  • subconjunctival haemorrhage
  • lengthening of face
  • anterior open bite
124
Q

What structures is the antrum of high more related to? (7)

A
  • orbit
  • infra orbital nerve
  • nasolacrimal duct
  • posterior teeth
  • lateral wall of nose
  • pterygopalatine fossa
  • maxillary artery
125
Q

What is the common pathology of the maxillary sinuses? (4)

A
  • infective sinusitis
  • non infective sinusitis
  • fractures
  • tumours/cysts
126
Q

What is the presentation of acute infective sinusitis? (4)

A
  • pain
  • tenderness across area worsens on bending over
  • posterior teeth TTP
  • history of coloured discharge
127
Q

What % of sinusitis is caused by a bacterial infection?

128
Q

What are the SDCEP guidelines for the management of sinusitis? (4)

A
  • inhalations
  • epinephrine nasal drops 0.5% tds for 1 week
  • amoxicillin 250mg ads for 7 days
  • doxycycline 100mg for 1 week (200mg on first day)
129
Q

What are the causes of sinusitis? (2)

A
  • mechanical obstruction of osmium

- impaired mucous clearance

130
Q

What is the treatment of chronic sinusitis? (2)

A
  • drainage

- metronidazole with amoxicillin/erythromycin

131
Q

What are the complications of sinusitis? (3)

A
  • brain abscesses
  • orbital cellulitis
  • cavernous sinus thrombosis
132
Q

What are the causes of oro antral communication? (4)

A
  • extraction of posterior teeth
  • tuberosity fracture
  • middle third fracture
  • malignancy/pathology
133
Q

What happens if oro antral communication is untreated?

A

A fistula develops which can cause persistent sinusitis, unilateral nasal discharge, intra oral antral polyp, caogausia and facial pain

134
Q

What do you do if you create an oro antral communication? (5)

A
  • close with a buccal advancement flap
  • plate or modified denture
  • antibiotics, ephedrine drops, mucolytic inhalations
  • avoid nose blowing
  • if communication of treated than 5mm spontaneous closure unlikely
135
Q

What is non infective sinusitis?

A

Mucosal inflammation due to atopy, upper airway obstruction, undiagnosed foreign bodies, syndromes

136
Q

Name 3 cell wall synthesis inhibitors

A
  • cephalosporins
  • carbapenums
  • monobactums
137
Q

What are the features of penicillins time dependant killing? (3)

A
  • prefer dividing bacteria
  • take time for the inhibition process and eventually microorganisms rupture
  • high blood levels
138
Q

What are the indications for penicillin? (4)

A
  • spreading infection/cellulitis/lymphadenopathy/fever/malaise
  • pen G reserved for severe infection
  • oral route compromise
  • beware beta lactamase producing
139
Q

What are the immediate reactions to penicillin? (4)

A
  • nausea/vomiting
  • erythema
  • wheeze
  • hypotension
140
Q

What are the delayed reactions to penicillin? (4)

A
  • blood dycrasias
  • haemolytic anaemia
  • leukopenia
  • thrombocytopenia
141
Q

What are the autoimmune reactions to penicillin? (4)

A
  • eosinophilia
  • stevens johnson syndrome
  • exfoliative dermatitis
  • toxic epidermal necrolysis
142
Q

What are the risk factors for a penicillin reaction? (3)

A
  • multiple drug reactions
  • atopic disease
  • skin testing
143
Q

Why is recurrent allergy for penicillin higher in those with repeated exposure short term or long IgE expression??

A

Because serum IgE antibodies are often retained for 10-1000 days

144
Q

What is the dose of penicillin G?

145
Q

What is the resistance of penicillin? (3)

A

Reduced PBP- altered configuration
Beta lactamase- hydrolysis
Tolerance- disable autolysis mechanism

146
Q

What are the common effects of penicillin? (3)

A
  • diarrhoea
  • nausea
  • skin rash
147
Q

What are the uncommon effects of penicillin? (2)

A
  • vomiting

- urticaria and pruritus

148
Q

What are the very rare effects of penicillin? (4)

A
  • diarrhoea
  • black hairy tongue
  • neutro/leuco/thrombocytopenia
  • increased PT/INR/bleeding
149
Q

What are the alternatives to penicillin? (4)

A
  • metronidazole
  • clarithromycin
  • erythromycin
  • clinamycin
150
Q

What is amoxicillin associated with?

A

Diarrhoea and C diff associated colitis

151
Q

What is the mechanism of action of metronidazole? (4)

A
  • inhibits DNA replication
  • fragment existing DNA
  • penetrate cells equally
  • enzymatic reduction
152
Q

What is the spectrum activity of metronidazole? (3)

A
  • obligate anaerobes
  • gram -ve pathogens
  • bactericides
153
Q

What are the types of bacteria metronidazole has activity on? (4)

A
  • clostridium
  • fusobacterium
  • prevotella
  • peptostreptococcus
154
Q

What is the distribution of metronidazole? (4)

A
  • wide volume distribution
  • penetrates saliva
  • CNS penetration
  • foetal circulation
155
Q

What are the dental indications for metronidazole? (3)

A
  • acute necrotising forms of gingivitis
  • pericoronitis
  • dental abscess
156
Q

What are the interactions of metronidazole? (6)

A
  • disulfiram
  • phenytoin
  • phenobarbital
  • cimetidine
  • lithium
  • warfarin
157
Q

What are the main adverse effects of metronidazole? (4)

A
  • compulsive seizure
  • nausea, vomiting, anorexia, diarrhoea
  • peripheral neuropathy
  • thrombocytopenia
158
Q

What are the oral effects of metronidazole? (5)

A
  • unpleasant taste
  • furred tongue
  • glossitis
  • stomatitis
  • candida
159
Q

What is the half life of metronidazole?

160
Q

What things does the outcome of infection depend on? (4)

A
  • virulence of organism involved
  • host resistance to infection
  • local anatomy
  • treatment of infection
161
Q

What local factors does host resistance depend on? (3)

A
  • anatomical site
  • mucosal barriers
  • local immune response
162
Q

What systemic factors does host resistance depend on? (6)

A
  • age
  • stress
  • pregnancy
  • underlying host pathology
  • nutritional state of host
  • type of drug therapy
163
Q

What are the indications for antibiotics to be used with abscesses? (4)

A
  • systemic involvement
  • significant cellulitis
  • compromised host defences
  • involvement of fascial spaces
164
Q

When should you refer an odontogenic infection? (6)

A
  • rapidly progressing infection
  • difficulty in breathing
  • difficulty in swallowing
  • involvement of fascial tissue spaces
  • temp >39*C
  • severe trismus
165
Q

What are the symptoms of infection in the infra temporal space? (3)

A
  • severe trismus
  • bulging of the temporalis
  • cavernous sinus thrombosis
166
Q

What are the sites of drainage we would use local anaesthetic as opposed to general anaesthetic? (3)

A
  • palate
  • sublingual space
  • buccal/labial sulcus
167
Q

What is the result of ludwigs angina? (6)

A
  • board like swelling floor of mouth
  • elevation of tongue
  • dysphagia
  • dysarthria
  • trismus
  • glottal oedema
168
Q

What nerves/arteries does an infected cavernous sinus affect? (5)

A
  • internal carotid artery
  • abducent nerve
  • oculomotor nerve
  • trochlear nerve
  • trigeminal div I and II
169
Q

What types of swelling can an upper 6 have? (4)

A
  • palatal swelling
  • maxillary sinusitis
  • intra oral swelling
  • facial swelling
170
Q

How is pain detected? (4)

A
  • nociceptors
  • a delta and c fibres
  • modulated a beta
  • modulated spinal mechanisms
171
Q

What is the definition of analgesia?

A

An insensibility to pain without loss of consciousness. A state in which painful stimuli are to perceived or interpreted as pain

172
Q

What are the classifications of analgesics? (5)

A
  • specific
  • conventional analgesic
  • unconventional analgesic
  • analgesic adjuncts
  • non pharmacological
173
Q

Name 2 specific analgesics

A
  • antacids

- vasodilators

174
Q

What should you consider when you prescribe? (5)

A
  • diagnosis
  • potency
  • onset and duration
  • patient and drug factors
  • route of administration
175
Q

What are the enteral routes of administration? (3)

A
  • oral
  • buccal/sublingual
  • rectal
176
Q

Name 4 topical routes of administration

A
  • mucosal
  • cutaneous
  • nasal
  • conjunctival
177
Q

What is aspirins therapeutic activity? (4)

A
  • anti pyrexic
  • anti platelet
  • anti inflammatory
  • analgesic mild/moderate
178
Q

What are the indications for aspirin? (4)

A
  • acute pain
  • dental pain
  • rheumatic fever
  • rheumatoid arthritis
179
Q

What are the side effects of aspirin? (5)

A
  • ulcerogenesis
  • prostaglandin inhibition
  • decreased mucous production
  • decreased acid production
  • influence cell permeability H+
180
Q

What drugs do aspirin interact with? (7)

A
  • anticoagulants
  • antihypertensive
  • antidepressants
  • anti epileptics
  • NSAIDs
  • thrombocytes
  • steroids
181
Q

What is the standard adult dose of aspirin?

A

300-900mg 4-6 hourly with a max of 4g daily

182
Q

What is the half life of paracetamol?

183
Q

What is the standard adult dose for paracetamol?

A

10/15mg/kg every 4-6 hours

184
Q

What drugs can interact with paracetamol? (7)

A
  • st johns wort
  • carbamazepine
  • rifampicin
  • alcohol
  • phenobarbital
  • phenytoin
  • primidone
185
Q

How much paracetamol is needed to be fatal?

186
Q

What are the side effects of a paracetamol overdose? (4)

A
  • nausea and vomiting
  • haemorrhage
  • hypoglycaemia
  • cerebral oedema
  • death
187
Q

What are the indications for morphine use? (3)

A
  • acute severe pain
  • cough suppression
  • touch, pressure, vision
188
Q

What are the unwanted effects of morphine? (4)

A
  • nausea
  • respiratory depression
  • constipation
  • confusion in the elderly
189
Q

What is the maximum daily dose of morphine?

190
Q

What are the contraindications for prescribing morphime? (5)

A
  • suspected head injury
  • acute alcoholism
  • reduced respiratory
  • overdose
  • hypersensitivity
191
Q

What is the therapeutic activity of codeine?

A

agonist at opiod receptors

192
Q

What is the standard adult dose for codeine?

A

30-60mg 4-6 hourly (max of 240mg in 24h)

193
Q

How does codeine produce an analgesia effect?

A

By being metabolised in the liver to form morphine

194
Q

What are the contraindications of codeine use?

195
Q

What is the half life of codeine?

196
Q

What are the side effects of codeine? (3)

A
  • nausea
  • hypotension
  • urticaria
197
Q

What are the interactions of codeine? (4)

A
  • alcohol
  • antihistamines
  • anxiolytics and hypnotics
  • antipsychotics
198
Q

Deficiency in bleeding is due to what? (4)

A
  • coagulation factor
  • platelets
  • vascular
  • drug therapy
199
Q

If bleeding continues when should you refer? (2)

A
  • blood pressure decreases less than 100/60

- heart rate >100bpm

200
Q

What post op advice can you give in the 1st 24hours after extraction? (4)

A
  • dont rinse
  • start HSMW 24hrs later
  • if bleeds put pressure with clean cloth
  • avoid alcohol, strenuous exercise and smoking
201
Q

What should you do if the tuberosity fractures? (3)

A
  • if fragment is small, remove it
  • if there is a pulpal infection, remove tooth and check for OAC
  • if the tooth is not carious, splint and surgically remove
202
Q

What are the risk factors for a dry socket? (6)

A
  • the pill
  • radiotherapy
  • previous dry socket
  • Md extractions
  • smokers
  • females
203
Q

What can happen if a retained root is pushed into the Mx antrum? (4)

A
  • may resorb
  • may fibrose
  • may cause infection
  • may become and antrolith
204
Q

Why would you get a false -ve to no response in pulp sensibility testing? (3)

A
  • calcified canal
  • immature apex
  • recent trauma
205
Q

What are the types of cold test? (3)

A
  • ethyl chloride
  • dichlorafluoromethane
  • ice sticks
206
Q

What are the types of heat test? (3)

A
  • hot water
  • gutta percha heated in flame
  • rotation of rubber trophy cup
207
Q

Why would you get a false positive to an electric pulp test? (4)

A
  • electrode makes contact with gingiva or large amalgam restoration
  • patient is anxious
  • tooth is not dry or isolated well
  • liquefaction necrosis
208
Q

Why would you get false negatives to an electric pulp test?

A
  • patient is premeditated
  • inadequate contact with enamel
  • trauma
  • canal is calcified
  • apex is immature
  • partial necrosis
209
Q

What is laser doppler flowmetry?

A

An objective test of the presence of mixing red blood cells within a tissue

210
Q

What is the procedure for laser doppler flowmetry?

A

Laser light transmitted to the dental pulp by fibre optic against tooth structure

211
Q

What are the uses of laser doppler flowmetry? (4)

A
  • traumatic teeth
  • pulp tyrosine on children
  • revascularisation of replanted teeth
  • differential diagnosis of periapical radiolucencies
212
Q

Why is pulp capping less successful in older patients?

A

Because pulpal blood supply decreases reducing the regenerative capacity and response to pulp capping

213
Q

What is condensing osteitis?

A

The tooth will have an etiological factor for low grade, chronic inflammation such as necrotic pulp, extensive restoration or crack

214
Q

Give 5 indications for peri-radicular surgery

A

Under obturated canal, over obturated canal so excess material in the peri-apical tissues, fracture instruments in the canal, peri-apical pathology for biopsy, anatomically difficult root canals to obturate, correct procedural errors, exploratory surgery

215
Q

Give 2 factors that have a direct effect on the success of peri-radicular surgery.

A

Quality of endodontic treatment and coronal seal

216
Q

Why is the apical tissue removed in periradicular surgery?

A

Removes the apical delta area that harbours bacteria causing the infection

217
Q

What effect does lateral canals have on the outcome of surgery?

A

Can have a detrimental effect if these are lower than the apical 3mm as bacteria can survive and cause persistent infection

218
Q

Give 5 ideal properties of retrograde root filling materials

A

a. Well tolerated by apical tissues
b. Bactericidal or bacteriostatic
c. Adhere to tooth
d. Dimensionally stable
e. Easy to handle
f. Do not stain
g. Noncorrosive
h. Do not dissolve
i. Promote cementogenesis
j. Radiopaque

219
Q

What type of flap is preferred for the best aesthetic outcomes in periradicular surgery?

A

Papilla sparing or Levart Flap

220
Q

What kind of suture material is used for periradicular surgery?

A

Non-resorpable monofilaments like 4/0 or 5/0 prolene or ethilon

221
Q

What should you warn your patient about when doing periradicular surgery around a crowned tooth?

A

Gingival recession and exposed roots – poor aesthetics

222
Q

How successful is repeat peri-radicular surgery?

A

Not very about 33%

223
Q

What is the commonest cause of osteomyelitis?

A

Spread of infection from an odontogenic focus

224
Q

Other than odontogenic sources of infection how else could osteomyelitis develop?

A

Penetrating injuries, fractures of the mandible including pathological, anything that affects the blood supply like radiotherapy or metabolic bone diseases like Paget’s, MRONJ any immunocompromised condition e.g renal transplant case

225
Q

What is a sequestrum?

A

A section of dead bone

226
Q

What is an involucrum?

A

a layer of newbonegrowth outside existingbone

227
Q

What is meant by a pathological facture?

A

A fracture in an area of diseased bone or in the presence of pathology that has weakened the architecture of the bone rendering more prone to fracture

228
Q

What is the difference between acute purulent osteomyelitis and acute osteomyelitis?

A

The purulent form produces pus

229
Q

How does chronic osteomyelitis differ from acute osteomyelitis?

A

Chronic OM has low grade symptoms of long duration with attempts being made at bone healing whereas the acute from present like an odontogenic abscess with significant pain and swelling and lack of mandibular function

230
Q

How does radiotherapy cause necrosis of the jaw bone?

A

Damages the blood supply to the bone (endarteritis obliterans) and also suppression of osteoclasts and reduced ability of fibroblasts to produce collagen

231
Q

How long after radiotherapy is complete does the risk of necrosis disappear?

A

it does not reduce over time or disappear

232
Q

What 2 treatments can be offered to a patient who has had head and neck radiotherapy who needs a tooth extracted to try to reduce the risk of necrosis?

A

Medication – pentoxyphylline + tocopherol (+clodronate) or hyperbaric oxygen therapy

233
Q

What is meant by a drug holiday?

A

When the patient stops taking the drug for a period of 3 months before the dental treatment

234
Q

What epithelial remnants do cysts of the jaws develop from?

A

Remnants of the root sheath of Hertwig, the dental lamina and the reduced enamel epithelium

235
Q

What 2 cysts are associated with vital teeth?

A

Periodontal cyst, paradental cyst, dentigerous cyst

236
Q

On a radiograph what size does an apical area represent a cyst?

A

More than 6mm

237
Q

Name 3 cyst like radiolucency’s commonly found at the angle of the mandible.

A

Dentigerous
Keratocyst
Ameloblastoma

238
Q

What cyst has a potential for recurrence and why?

A

Keratocyst due to friable cyst lining, growth in an AP direction between the bone trabeculae making it difficult to remove, friable lining and the presence of daughters cysts in the lining

239
Q

How does a keratocyst behave differently to a dentigerous cyst?

A

Keratocysts grow much faster with a high proliferative rate, generally grow in an AP direction with a thin friable membrane that is difficult to enucleate intact and may or may not involve a tooth. Dentigerous cysts always involve a tooth are attached at the ACJ and are slow growing in 3D and are easy to enucleate as the membrane is thick.

240
Q

What area on a lesion would you take an incisional biopsy?

A

The worse looking part that is representative of the lesion

241
Q

What lesions are treated by an excisional biopsy?

A

Simple small benign lesions like polyps

242
Q

What is meant by mapping biopsies?

A

Taking multiple biopsies for the same lesion as the lesion is heterogeneous in appearance e.g speckled so one area does not represent the whole lesion

243
Q

What is a punch biopsy?

A

An incisional biopsy taken using a circulate blade that punches out a circle of mucosa

244
Q

When might a frozen section be required?

A

During surgery to establish if all of the tumour is removed and for immunofluorescence for vesiculo-bullous conditions

245
Q

What is meant by the terms sessile and pedunculated?

A

Sessile means the lesion has a flat base whereas pedunculated means it has a small stalk at the base

246
Q

What is meant by sensitivity and specificity of diagnostic tests?

A

sensitivityis the ability of a test to correctly identify those with the disease (true positive rate), whereas testspecificityis the ability of the test to correctly identify those without the disease (true negative rate)

247
Q

What suture material would you use to close a biopsy wound?

A

4/0 vicryl rapide

248
Q

How quickly should a traumatic ulcer heal?

249
Q

When does the maxillary antrum develop in the foetus?

A

3rd month intrauterine life

250
Q

What volume is the average adult maxillary antrum?

A

3.5x2.5x3.2cm

251
Q

What is the 3 dimensional shape of the maxillary antrum?

A

Pyramidal with the base forming the lateral wall of the nose

252
Q

Where is the ostium of the maxillary antrum?

A

2/3rd up the medial wall of the antrum draining to the middle meatus measuring 2.4 mm

253
Q

What type of lining has the maxillary antrum?

A

Respiratory ciliated columnar epithelium

254
Q

What is the commonest infection of the maxillary antrum?

A

Respiratory viral infection

255
Q

What percentage of antral infections are odontogenic in origin?

256
Q

What is the difference between an OAC and an OAF?

A

An AOC is a communication between the maxillary sinus and the mouth usually after the extraction of a molar tooth whereas an OAF is an OAC that has persisted so that there has been epithelial growth along the defect such that there is continuity between the lining of the mouth and the antrum and this is a fistula

257
Q

What is the commonest site of fracture and why?

A

Condyle as it is a point of weakness designed to facture in preference to transmitting the force of the impact to the cranium

258
Q

What factors determine whether a fracture is displaced?

A

Muscle pull and the pattern of fracture if it is favourable the muscles hold the two ends of the fracture together if it is unfavourable the muscle pulls the ends of the bone apart

259
Q

What is a guardsman’s fracture?

A

Bilateral condylar fractures and a symphyseal facture caused by a direct impact on the chin

260
Q

What is a bucket handle fracture?

A

Bilateral parasymphyseal fractures of an edentulous mandible

261
Q

What does a lateral open bite indicate the pattern of fracture might be?

A

Displaced condylar fracture on the contralateral side

262
Q

What does an anterior open bite indicate the pattern of fracture might be?

A

Bilateral displaced condylar fracture or a condyle and a contralateral displaced body or angle fracture

263
Q

What is meant by management using a closed technique?

A

Inter maxillary fixation- wire the jaws together

264
Q

When might you manage a fracture of the condyle with an open technique?

A

Fracture dislocation or a badly displaced condylar neck fracture or a bilateral fractured condyle

265
Q

Who developed the principles that guide the placement of the plates?

266
Q

What are 3 sequelae of delayed presentation of a displaced fractured mandible?

A

Infection, fibrous union, mal-union, non-union, malocclusion

267
Q

What percentage of TMJ disease is treated surgically?

268
Q

What is the sensory innervation of the TMJ?

A

auriculotemporal and masseteric branches of V3or mandibular branch of the trigeminal nerve.

269
Q

Which joint space is accessed for arthrocentesis?

A

The superior joint space

270
Q

What is the difference between arthroscopy and arthrocentesis?

A

Arthroscopy involves using endoscope to access the superior joint space to investigate it but when you wash out the joint to break down any fibrous adhesions this is arthrocentesis

271
Q

List 3 indications for TMJ surgery

A

Degenerative TMJ conditions such as psoriatic arthropathy, recurrent dislocation, internal derangement without reduction, condylar hyperplasia

272
Q

Give 3 signs that would indicate TMJ surgery would be beneficial.

A

Closed lock of the TMJ, chronic unmanageable pain, recurrent uncontrolled dislocation

4th Year Revision (12 decks)

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