Oral Surgery Flashcards
1
Q
What procedures count as oral surgery?
A
- Simple exodontia - extractions
- Complex exodontia - MOS
- Soft tissue surgery - biopsy
- Oral pathology management - tumours
- Anxiety management - sedation
- Medical condition management
2
Q
What PPE is needed for simple exodontia?
A
Level 2 PPE:
- eye
- mask
- apron
- gloves
3
Q
What are the legal considerations needed to allow simple exodontia?
A
- Clear documented treatment plan
- Medical history up to date
- PreOP radiograph
- Patient confirms reason for attendance and the tooth extraction
4
Q
What is the definition of luxation?
A
Displacement or dislocation of an object
5
Q
What is the definition of elevation?
A
The action of moving an object from its original position in a vertical plane
6
Q
What is the definition of extraction?
A
The complete removal of an object from its surroundings
7
Q
What are the 3 forms of techniques for simple exodontia?
A
- Luxation
- Elevation
- Extraction
8
Q
What is the definition of point of application?
A
The point at which an instrument becomes active and applies force to an object or surface
9
Q
What is the point of application for a luxator? and in which area of the tooth?
A
- At the periodontal ligament space
- Used in the long axis of the tooth
10
Q
What is the process of using a luxator?
A
- Gentle apical pressure with lateral cutting action
2. Incise the PDL, wedges between alveolar one and root surface
11
Q
What is the point of application of an elevator? and what orientation and movement is it used?
A
- Interproximal point of application
- With a perpendicular orientation
- Rotational movement (pulley lever)
12
Q
What is needed when using elevators?
A
Fulcrum
13
Q
What is the definition of primary drive?
A
Refers to the action used with a luxating or elevating instrument with utilisation of lever and fulcrum rests
14
Q
What is the definition of primary movement
A
First stages of dental extraction by severing the PDL fibres and encouraging dilatation of alveolar bone
15
Q
What is the definition of secondary movement?
A
Forceps are applied to the coronal section of the tooth to be extracted
16
Q
What is the definition of secondary drive?
A
Forceps are used to grip and apply apical pressure
17
Q
What other movements are used when using a forcep/
A
Rotational movement and 8-figure movements
18
Q
How to use luxators safely?
A
Instrument in heel of hand, index finger guides tip, supporting digits straddle alveolus of quadrant
19
Q
How to use elevators safely?
A
Instrument in heel of and, index finger guides tio, fulcrum on alveolar bone, perpendicular to extracting tooth, supporting digits straddle alveolus of quadrant
20
Q
How to use forceps safely?
A
Operating gand conforms to grip of instrument, supporting hand reciprocates apical pressure and lateral movements
21
Q
What is the order of use when extracting a tooth?
A
- wide narrow luxator
- elevators: starting with smallest
- delivery of tooth with extraction forceps using secondary movements
22
Q
What are the ergonomics when extracting a tooth?
A
- Standing
- Right handers: LRQ standing behind and other quadrants in front
- Upper teeth: patient high ad supie
- Lower teeth: patient low ad upright
- Supporting and reciprocates apical pressure and provides proprioceptive feedback
23
Q
What are some peri-operative complications for simple exodontia?
A
- ineffective La
- excess bleeding
- crown or root fracture
- root displacement
- communication
- adjacent tooth damage
- soft tissue injury
- alveolar fracture
- instrument fracture
- tooth inhalation
24
Q
What are some post-operative complication of simple exodontia?
A
- Pain
- Swelling
- Bruising
- Bleeding
- Dry socket
- Infection
- Trismus
- Difficulty eating
- Prolonged healing
25
What is normal bleeding and how to deal with excessive bleeding?
```
- Haemostasis within 3-5 mins
If continues:
- apply Pa
- place haemostatic agent in socket
- suture socket with resorbable suture
- rest with no mouth rinsing then reapply pressure
```
26
How to deal with crown/root fracture? and what increase the risk?
- Should anticipate from pre-OP radiograph
- Heavily restored, RCT, curved morphology
- Refer to MOS`
27
How a communication forms? and how to deal with a sinus communication?
Loss of alveolar bone leading to communication
| - Refer to MOS
28
How to deal with a dry socket?
- Occurs 3-5 days postOP
- Painkillers ineffective
- Bad taste
- Increased in smokers
- Treatment irrigate with saline and dress with alvogyl
29
What is essential to ask a patient before extracting a tooth, in regards to their wellbeing?
Have they eat?, if not offer a glucose-based supplement
30
What is the relevant previous medical history, when assessing the difficulty of an extraction?
Bleeding disorders
Bisphosphonates
Antibiotic allergy
Anticoagulants and Antiplatelets
```
Refer to the SDCEP guidelines
Radiotherapy
Chemotherapy
Haemophilia
Liver/Kidney failure
```
Essential to liaise with necessary colleagues
31
What are the radiographs of choice for a extraction?
DPT and periapical
32
What consentual aspects must the patient know and understand for you to undertake an extraction?
- The tooth to be extracted
- risk vs benefits
- justification for extraction
- other viable options
33
What medical aspects must you understand before starting an extraction on a patient?
- Changes since last visit
- Changes to bleeding and healing times (anti-coagulants, immunosuppression or bisphosphonates)
- Diabetes control
- Has the patient eaten?
34
What should be included on the surgical safety checklist before a tooth extraction?
- Team awareness
- Patient points to tooth
- Dentist identifies tooth
- X-rays present
- Previous medical history
- Clearly planned and recorded
35
What equipment is essential for an extraction?
```
PPE: level 2
LA: topical, long/short needle, appropriate LA for patient's needs
Extraction instruments
Gause
Post OP instruction leaflet
```
36
What position of the patient is gold standard for a lower tooth?
Low and upright
37
What position of the patient is gold standard for a upper tooth?
Higher and more supine
38
What is the role of the working/dominant hand?
Control the extraction instrument
39
What is the role of the supporting hand?
Protects the patient by the digits straddling the alveolar bone providing proprioceptive feedback
40
What general movement is done with forceps?
Bucco-lingual movement
41
What movement with forceps are specific to single rooted teeth?
Rotational
42
What movement with forceps are specific to lower molars?
Figure of 8
43
What should you tell and give the patient after the extraction?
```
First, stop the bleeding
Give verbal and written instructions
Explain how to control bleeding (provide gause)
Give OHI
Suggest soft diet
No smoking or alcohol
OoH number
Ask if any questions
```
44
What complications can occur during the extraction procedure?
```
Pain, from LA failure
Excessive bleeding
Soft tissue trauma
Adjacent tooth damage
Crown fracture
Root fracture
Need to refer to MOS
```
45
What complication can occur after the extraction procedure?
```
Pain
Swelling
Dry socket
Infection
Post-extraction hemorrhage
Boney sequestration
Medication related osteonecrosis of the jaw (MRONJ)
```
46
What is the definition of a cavity?
A hollow space within within the body or tissues
47
What is the definition of a cyst?
Cavity lined by epithelium
48
What is the definition of a granuloma?
A collection of macrophages that adhere together down the microscope
Nodule of red tissues seen by naked eye (granulation tissue)
49
What is the definition of granulation tissues?
Capillaries and fibroblasts
| Arrive at injured site, capillaries keep area oxygenated and fibroblast makes a scar
50
What cells do chronic inflammation contains?
Lymphocytes, plasma cells, macrophages and some eosinophils
51
What cells do acute inflammation contain?
Neutrophils
52
What is the definition of odontogenic?
Derived from epithelial residues of tooth forming organ
53
What is the definition of non-odontogenic?
Derived from other non-tooth cells
54
Name 2 types of odontogenic cysts?
Inflammatory
| Developmental
55
Name 3 examples of inflammatory odontogenic cysts?
Abscess
Periapical granuloma
Periapical cyst
56
What causes a periapical abscess?
Pulpal death is the cause due to caries, though may be subsequent trauma
Due to microbial infection in the root canal after pulpal death
57
How does an abscess form?
Neutrophils accumulate with bacteria in the centre
| Granulation tissue grown in around central area
58
Is an abscess a cyst?
No
| The abscess forms a cavity filled with pus and is lined by granulation tissue
59
How to treat a abscess?
Incise and drain centre
Pus drains out
Granulation tissue resolves
Small scar forms
60
What happens if the abscess becomes infected or injury persists?
Get cavity lined by granulation tissue that persists
Becomes a periapical granuloma
Can have chronic inflammation (plasma cells)
61
What can a abscess progress to?
Chronic apical periodontitis
62
What can inflammation stimulate in a periapical granuloma?
Stimulate epithelial remnants to proliferate and form a true cyst lining, which will become a periapical cyst or a combined periapical cyst and granuloma (can also become infected again forming another abscess)
63
What is left after the tooth is extracted after periapical cyst?
```
Residual cyst
(radicular or apical periodontal cysts)
```
64
What does a periapical cyst look like under a microscope?
```
Fibroconnective tissue and scarring forming edge of lesion
Granulation tissue
Squamous epithelium
Capillaries
Neutrophils
Plasma cells (if chronic)
```
65
If there is a lateral opening of the root canal, what is a cyst called?
Lateral radicular cyst
66
Name 4 developmental odontogenic cysts?
Odontogenic keratocyst
Dentigerous cyst
GIngival cyst of newborn
Rare cyst
67
What is a odontogenic keratocyst lined by, covered with and associated with?
Squamous epithelium, with a distinct wavy band of thin parakeratin (keratin with nuclei)
Now designated a true tumour as it often recurs
Rarely assoc with Gorlin-Goltz syndrome
68
What are the symptoms of Gorlin-Goltz syndorme?
Multiple keratocysts in mouth and numerous skin tumours
| Caused by mutation in the receptor sonic hedgehog (developmental patterning protein)
69
Where are Dentigerous cysts found?
Cyst around crown
70
What is the pathology of a dentigerous cyst and what is it derived from?
Squamous epithelial lining with occasional mucus secreting cells
From reduced enamel epithelium
Does not recur
71
What are some variants of dentigerous cyst?
An eruption cyst is a dentigerous cysts forming outside the bone
Can also be called follicular cysts
72
Where are gingival cysts of newborn found?
```
In gingiva (Bohn's nodules)
Resolve spontaneously
```
73
What is the pathology for a gingival cysts of newborn?
Lined with squamous epithelium and filled with keratin
74
Where are lateral periodontal cyst located?
Interproximally
| Does not recur after enucleation
75
What is the pathology of an lateral periodontal cyst?
Squamous lined cyst with focal thickened areas of epithelium
76
Name 3 very rare developmental odontogenic cysts?
Glandular odontogenic cyst
Gingival cysts of adults
Botryoid odontogenic cyst
77
Where is the Glandular odontogenic cyst located and do they recur?
Anterior mandible
| Recur
78
Where is the Gingival cysts of adults located and do they recur?
Gingiva
| Not recur after enucleation
79
Where is the Botryoid odontogenic cyst located and do they recur?
Interproximally
| Recur
80
What is the definition of a non-odontogenic cyst?
Derived from other non-tooth cells
81
Name 7 types of non-odontogenic cysts and cyst-like lesions?
```
Salivary mucocoele
Nasopalatine duct cyst
Nasolabial cyst
Tru bone cyst
Dermoid cyst
Epidermoid cyst
Thyroglossal cyst
```
82
Name 2 types of salivary mucocoelecysts?
Extravasation mucocoele Mucous retention cyst
83
What is the pathology and description for an extravasation mucocoele?
Not a true cyst but cyst-like as no epithelial lining
Caused from trauma
Ball of mucin
Spilled mucus from minor salivary gland duct
Granulation tissue walls of area
84
What is the definition of granulation tissue?
Capillaries and fibroblasts
85
What is the pathology and description for a mucous retention cyst?
A true cyst which usually forms when salivary duct is blocked
Lined by epithelium
Dilated salivary duct
86
What occurs if a mucous retention cyst enlarge?
Burst
| Become a combined mucous retention cyst and extravasation mucocoele
87
What is 1 variation of mucosal retention cyst?
A ranula
A mucous retention cyst occurring in a large salivary gland
If it bulges out into neck its is called a plunging ranula
88
Describe the location, origin and the epithelial lining of the nasopalatine duct cyst?
Swelling in midline of anterior palate
Originate from epithelium of nasopalatine duct in incisive canal
Epithelial lining can be stratified squamous, respiratory, cuboidal or columnar cells
89
Describe the location, origin and the epithelial lining of the nasolabial cyst?
Lesion in upper lip below nose, lateral to midline
Derived from remnants of the embryonic nasolacrimal duct
Pseudostratified columnar epithelium lining
90
What is the meaning of 'true' for a true bone cyst?
True relates to the cavity wall is formed by bone forming tissue
91
What is the solitary bone cyst lined by?
Bone cavity lined by CT in mandible of teenager
92
What is a rare bone cyst and give an example?
Aneurysmal bone cyst
| Not true cyst but a cavity in bone lined by CT and blood filled spaces
93
Describe the location, origin and the epithelial lining of the dermoid cyst?
Developmental skin cyst in young children
Embryonic remnants of skin form 'skin' lined cysts
Squamous lining produced by keratin and has skin appendages
Rare in FoM
94
Describe the epithelial lining and aetiology of the epidermoid cyst?
Squamous lined cyst which is thought to be acquired by traumatic implantation of surface epithelium
95
Describe the location, origin and the epithelial lining of the Thyroglossal cyst?
Common in neck but rare in mouth
Embryonic ract runs from midline back of tongue, through hyoid bone to area of thyroid gland
Rarely found at back on tongue
Lined by epithelium, with surrounding thyroid tissue in wall
