Oral surgery and bone biology Flashcards
SOP for preventing WSS
Confirm pt is in for XLA
Tell me which tooth
Point to the tooth
Check with clinical records
Ludwig’s angina
– mandible infection risk…
Bilateral involvement of the submandibular, submental, sublingual and parapharyngeal, retropharyngeal spaces – glottis oedema – AIRWAY CONCERN.
Mediastinitis
Mandibular infections can spread down the retropharyngeal/parapharyngeal space to the mediastinum (chest area), and result in mediastinitis.
Cavernous sinus thrombosis
Can’t move the eye, pressure behind the eye (proptosis)
Signs of sepsis
S - shivering
I - incontinence
G - grey and blue
N - nervous of dying
E - exasperated (breathless)
D - drunk (slurred speech)
“SIGNED”
routes of spread mandibular molar
4
routes of spread maxillary molar
5
Characteristic of canine space infection
Obliteration of nasolabial fold
Management of Submandibular/sublingual space infections
o COULD excise sublingual space infection
o NOT submandibular (as this would be an extra-oral surgery)
Teeth likely to give rise to submental space infections
o Lower incisors with long routes
o Firm swelling under chin
Dental infection antibiotics - first line
- First line for dental infection
Penicillin V: 500mg x 4 (5 day course)
Dental infection antibiotics - Anaerobic conditions (such as periocornitis)
Metronidazole: 400mg x 3 (5 day course)
When would you be concerned with referring pt on to specialist care?
o Sever trismus
o Fever symptoms (>39 degrees)
Pyrexia vs sepsis
o Pyrexia: means elevated body temperature/fever/muscle aches etc.
o Sepsis: infection causing widespread inflammation, rapid HR, breathing, low BP.
Which gland controls bone turnover?
parathyroid gland (controls Ca2+ levels in the blood)
Increases calcium levels in the blood?
Calcitriol (increases calcium levels – “TRI help increase!”)
Calcitonin
Hormone produced from thyroid gland
Decreases calcium levels in the blood – “tone it down a bit!”
Through inhibiting bone resorption (bone remains therefore Ca2+ cannot be released into the bloodstream)
Calcitriol
An active from of vitamin D.
Increases calcium levels in the blood – “TRI help increase!”
Through promotion of Ca2+ uptake into the blood from he intestines.
Bone remodelling after an extraction finishes after ___ months
6
An analogue of pyrophosphate (which stimulates bone growth). Also works by inhibiting osteoclast function.
Bisphosphonates
Non-nitrogen containing bisphosphonates
Clodronate
These resemble pyrophosphate allowing them to be incorporated into the phosphate chain of ADP making it unusable for energy production in osteoclasts.
Nitrogen containing bisphosphonates
Alendronate
These block the enzyme farnesyl diphosphate synthase in the HMG-CoA reductase pathway to prevent the formation of key isoprenoid lipids in osteoclasts which anchor proteins to the cell membrane and without these death occurs.
SDCEP high risk patients for MRONJ
Previous MRONJ
Taking for malignant conditions
For Paget’s disease
Osteogenesis imperfecta
Concurrent use of systemic corticosteroids or other immunosuppresants
Coagulopathy, chemotherapy, radiotherapy.
SDCEP low risk patients for MRONJ
Not yet started taking bisphosphonates
Taking bisphosphonates for the prevention or management of osteoporosis.
Diagnosis criteria for MRONJ (RED)
o R – RADIATION FREE: no history of radiation therapy to the jaws
o E - EIGHT WEEKS: of exposed bone in the maxillofacial region or bone that can be probed that has persisted for more than 8 weeks.
o D - DRUGS: taking, or previously was taking bisphosphonates, antiangiogenic drugs or RANKL inhibitors.
RANKL inhibitor?
Denosumab (Prolia)
What does denosumab do and when’s the best time to do extractions for a patient on this drug?
o Mimics the function of endogenous osteoprotegerin (OPG)
TREATMENT WINDOW – best to do treatment just before theyre due their next injection
What are other drugs that could cause MRONJ?
Steroids
Long-term NSAIDs use
Sharing patients information to the incorrect patients?
Breach of patient confidentiality
General data protection regulation
What should you do if you perform WSS?
- Apologies to the patient
- Incident reporting on DATIX form
- Significant event analysis
How would local anatomy determine whether infection from a lower molar spreads to the sublingual space or the submandibular space?