Oral Surgery, Bitches Flashcards
1
Q
SOAP - expand and define:
A
Subjective: med Hx, CC
Objective: vitals, radiographs, etc. (obtain/organize)
Assessment: analyze and diagnose
Plan: and/or procedure
2
Q
Surgical Wound Classification, Class I
Class II
Class III
Class IV
A
Clean, uninfected
Clean-contaminated (resp, alimentary, genital, urinary entered)
Contaminated - open, fresh, accidental
Dirty-infected - old, traumatic, infected
3
Q
When making incisions, the blade is _______ to the surface
A
Perpendicular
4
Q
3 potential complications of a Flap:
A
Necrosis
Dehiscence (opens up)
Tearing
5
Q
In a Flap, the _____ should be wider than the ______
A
Base wider than Tip
6
Q
T/F
It is almost impossible to make an incision too long
A
True
*avoid tears and nerve damage/pain
7
Q
Important: Incisions heal in what direction?
A
In width (across)
*independent of length, does NOT heal end to end
**longer incision better
8
Q
Make releasing incisions how many teeth away from the extraction site?
A
1 - 1.5 teeth away
9
Q
Irrigate tissue with _______ instead of _______
A
Saline solution
Distilled water
10
Q
If an instrument is used to place tissue in _______ , don’t use it again
A
Formalin
*denatures tissues
11
Q
T/F
Don’t crush, overheat, or dry out tissue
A
True
12
Q
Poorly controlled _______ will lead to increase tension on the wound, decrease vascularity, and provide a culture/medium for infection
A
Hemostasis
13
Q
Dead space (like a socket) will remain empty after closure and will fill up with blood, with leads to what?
A
High potential for infection
14
Q
Eliminate dead spaces by suturing from the bottom or a ______ dressing
A
Pressure
15
Q
4 methods to promote wound Hemostasis:
A
Assist natural (direct pressure)
Thermal coagulation (electrocautery)
Suture ligation
Vasoconstrictors
16
Q
4 methods to eliminate Dead Space:
A
Suture
Pressure dressing
Packing
Drains (suction/nonsuction)
17
Q
In the 1st couple days use _______ to decrease inflammation
After use ______
A
Ice
Heat
18
Q
Decrease infection risk by _________ during surgery
Remove necrotic and foreign ischemic material - known as ________
A
Irrigation
Debridement
19
Q
4 ways to Control Edema during surgery:
A
Careful
Elevation
Systemic steroids
Ice
20
Q
Mucosal edges heal until they meet, known as…
A
Epithelialization
21
Q
When will epithelial healing stop?
A
Once it touches other free edge of epithelium
22
Q
3 stages of wound healing:
A
Inflammatory
Fibroplastic
Remodeling
23
Q
Anything tending to hold wound edges apart:
A
Tension
24
Q
Primary intention:
Secondary intention:
Tertiary intention:
A
Sutured lacerations/incisions
Gap (extraction sockets)
Grafts
25
Primary intention of bone has edges less than _____mm apart
Secondary intention of bone healing has edges more than _____ mm apart
1 mm
1 mm
26
Healing in extraction socket - Whitish yellowish stuff:
Greenish:
Socket looks empty:
Fibrin clot (or fluid if soft, bone/tooth/peanut if hard)
Food
If symptoms, dry - if no pain, not dry
27
Extraction sockets heal by _______ intention
Secondary
28
If the nerve is Contused, you normally get _______ recovery
Spontaneous
29
When there is opening into sinus lining, how to wounds heal?
Proliferate along wound into tract
*creates opening (epithelialized tract between oral cavity and sinus)
30
Inflammatory Stage Phase I:
Phase II:
Vascular (vasoconstriction)
Cellular (Complement cascade)
31
What holds wounds together during the inflammtory stage?
Fibrin
*not strong
32
4 signs of Inflammation:
Rubor (redness)
Calor (heat)
Dolor (pain)
Tumor (swelling)
33
In the Fibroplastic Stage, _______ strands form the latticework in which _______ lay down ground substance and ________
Fibrin
Fibroblasts
Tropocollagen
34
After Tropocollagen is layed down by the Fibroblasts, capillary ingrowth occurs and wounds rapidly gain strength - this phase lasts how long?
These wounds are ______ due to excess/haphazard collagen arrangement
These wounds are _______ b/c lots of vascularization
These wounds are ___% as strong as uninjured tissue
2-3 weeks
Stiff
Erythmatous
70-80%
35
T/F
| You can't wear hand jewelry in surgery
True
36
What stage of wound healing is 70-80% as strong as uninjured tissue?
What stage is 80-85% as strong?
Fibroplastic
Remodeling
37
Wound Maturation, aka...
Remodeling Stage of wound healing
38
In the Remodeling Stage, _____ is removed and the wound softens
Collagen
39
T/F
| Every incision results in a scar
True
40
4 factors that impair wound healing:
Foreign material
Necrotic tissue
Ischemia
Wound tension
41
Foreign material (impairing wound healing) can be bacteria, dirt, or _______
Suture material
42
Flushing a wound with a sterile solution, aka...
Debridement
43
What can prevent the growth of reparative cells?
Necrotic tissue
44
2 factors that impair Wound Healing
Ischemia (leads to further necrosis and decreased nutrients)
Tension (anything tending to hold wound edges apart)
45
What heals better b/c there is less re-epithelialization, collagen deposition, contraction, and remodeling?
Primary Intention Wounds
46
What type of wound contains a Gap between epithelial edges and takes longer to heal?
What is an example?
Secondary Intention
extraction sockets
47
Wound treated by coverage with tissue grafts:
Tertiary Intention
48
Bone Healing has the same 3 stages as Soft Tissue: Inflammation, fibroplasia, and remodeling
In addition, what 2 factors are involved?
Osteoclasts
Osteoblasts
49
Bone
Less than 1 mm apart:
More than 1 mm apart:
Primary Intention
Secondary Intention
50
In Bone healing of Secondary Intention, a ______ formation extends beyond the free edges of the bone and is followed by ossification
Callus
51
Extraction Socket Healing:
| Bleeding, Clot, Platelets adhere to surrounding tissued , then _____ transformed into ______ (thin, whitish)
Fibrinogen
Fibrin
52
T/F
| In wound healing, Fibrinogen turns into Fibrin which trap cellular components
True
53
Extraction Sockets heal by ______ intention
Secondary
54
Week One wound healing:
Week 2 wound healing:
Week 3-4:
Inflammatory Stage
Granulation tissue/osteoid deposition
complete epithelialization
55
4 requirements of Implant Healing (Osseointigration):
Tight Fit
Viable bone
Implant Immobility
Implant surface free of contamination
56
Implant placed, superficial layer on surface of implant dies, scaffold forms, new bone forms, osteocytes secrete _______ at implant surface and secrete osteoid (new bone)
proteoglycans
57
Membrane that allows O2, fluids, nutrients through but not Fibroblasts - can exclude soft tissue and guide bone into the right position
GTR - Guided Tissue Regeneration
58
What type of epithelial junction exists at an implant?
Hemidesmosomal
59
3 most injured nerves:
IAN-Mental Nerve - Mn fractures
Lingual Nerve - 3rd Molars (impacted)
IA Nerve (AMC or orbital blow-out fractures)
60
Neurapraxia (loss of nerve conduction) causes resorption of ______
Recovery usually _______
myelin sheath
spontaneous
61
Resorption of myelin sheath:
Axons/myelin sheath disrupted, recovery 2-6 months
Complete loss of nerve/transection
Neurapraxia
Axonotmesis
Neurotmesis
62
Nerve healing proceeds by _____ followed by _____
Degeneration
Regeneration
63
What instrument is used to reflect mucoperiosteum, loosen soft tissue, or to retract flap after reflection?
Periosteal Elevator
*has that beaver tail
64
T/F
| Mennesota cheek and flap retractor, Weider tongue retractor, seldin flap retractor all retract soft tissues
True
65
Stillies, Adson, and Cotton?
Forceps
66
2 Instruments to remove Bone:
Chisel
Mallet
67
T/F
| You can't use any handpieces that blow air b/c it can cause serious infection/swelling
True
68
What Instrument is Primarily used for cutting/removing bone?
Rongeurs
*spring loaded handle
69
What instrument looks like a spoon and is used to remove soft tissue from bone cavities?
Curette
*periapical or double-ended dental
70
What clamps a vessel?
What sutures?
Hemostats
Needle Holder
71
Bone wax ____ blocks small bone channels
mechanically
72
What's your "go to" hemostatic material?
made of?
Gelfoam
*gelatin sponge
73
Gelfoam, CollaPlug, CollaTapa, and CollaCote all control hemmorrhage
True
74
The better instrument for suturing:
The better needle design:
3/8 circle
reverse cutting
75
Plain gut suture lasts ____ days in oral cavity
Chromic gut lasts ____ days
5 days
10-12 days
*made from sheep intestines serosal lining
76
Suture scissor for removing sutures
What 2 are for dissection/cutting soft tissue?
Iris
Metzenbaum
77
2 Instruments for holding mouth open:
Bite block
Molt Mouth Prop (use w/ caution)
78
What luxates teeth, removes broken/surgically sectioned teeth from sockets?
Dental Elevators
79
3 types of Dental Elevators:
Straight
Triangular
Pick
80
2 Types of Extraction Forceps: (and shape)
Mx - S shaped
Mn - L shaped
81
What is used for All OS procedures?
Pharyngeal Partition
82
T/F
| Making a Flap makes a procedure surgical
False
*must be tissue and bone
83
2 Extraction techniques:
Closed (forceps)
Open (surgical with flaps)
84
In a Closed Extraction, loosen soft tissue with what instrument?
Luxation with what?
Then forceps
periosteal elevator
luxator/elevator
85
T/F
| Usual post-op care of socket involves curette, irrigation, and CHX
True
86
Envelope Flap has how many teeth Anterior and Posterior to tooth of interest?
Releasing Incision?
2 teeth Anterior, 1 tooth Posterior
1 tooth each
87
To close an Antral-Oral Fistula, use what kind of Flap?
Pedicle
88
T/F
| Not seeing the PDL is an indication for extraction
True
89
Where should you never suture after extraction?
Over socket
90
How does suturing usually proceed?
Buccal to Lingual
*Soft to Hard tissue
91
T/F
| There should be no knots placed over the incision line
true
92
3 Cases in which Root Fragments can be left:
If excessive Trauma
Smaller than 4-5mm
Next to vital structures (nerves, vessels, sinus)
93
If there is _____ or _____ at the Apex of a tooth it must come out
infection
radiolucency
94
If multiple extractions, which usually come out first?
Last?
Maxillary
1st Molars, Canines
95
The width of the cuff should be __% greater than the diameter of the extremity
20%
96
In what part of SOAP are diagnoses listed?
A - assessment
97
American Academy of Anesthesiologists I:
ASA II:
ASA III:
normal/healthy
mildly systemic
severe systemic disease
98
T/F
| If Angina is stable, ambulatory OS procedures are usually safe with proper precautions
True
99
With Angina Pectoris, what is the dental management Strategy if Stable
Stress reduction/pain control
100
How much should epi be limited with Angina?
ABx when?
0.04 mg
6-8 weeks post stent placement
101
When should procedures be done if pt has Unstable Angina?
after med consultation to PCP
OMFS if emergency
102
Tx should be deferred how long after MI?
6 months
103
How is Warfarin/Coumadin effect measured?
INR
104
3 types of blood thinners:
Clotting cascade interference
Platelet aggregation inhibitors
Direct Thrombin inhibitors
105
INR (if pt taking Coumadin) must be taken ___ hrs prior to surgery.
If it is less than ____, most minor surgery can be done
24 hours
3
106
Platelet Aggregation Inhibitors: Pts may be on Aspirin, _____, or both
Can be on what for surgery?
Clopidogrel
one, not both
107
Pt taking Aspirin and Clopidogrel must discontinue one ____ days pre-op
5-7 days
108
A Direct Thrombin Inhibitor (Pradaxa) must be discontinued when?
evening before, morning of procedure
*2 doses
109
Defer elective Tx ___ months after CVA (stroke)
Limit epi to ___ mg
6 months
.04
*like MI
110
CV pts should be treated with anxiety reduction, _______ should be available, and minimize epi
Nitroglycerin
111
T/F
| ABx prophylaxis is required for Dysrhythmias
False
112
T/F
| ABx prophylaxis is required for Acquired Valve Disease
True
113
ABx prophylaxis is recommended for what 3 conditions?
Prosthetic cardiac valve
Previous BE (bacterial endocarditis)
Congenital heart disease - various categories
114
Standard AB used for BE pt:
if allergic:
non oral:
allergic/non oral
amoxicillin
clindamycin/arithromycin/clarithromycin
ampicillin
clindamycin/cefazolin
115
HTN emergency:
HTN urgency:
over 200 systolic
over 115 diastolic
116
Pts with HTN should take what prior to Dental surgery?
normal antihypertensives
| just sip of water
117
For mild/moderate HTN, Tx is limited and BP is _____
Severe HTN BP is _____ and electives are deferred
140/90
200/100
118
Bronchial asthma - keep albuterol on hand and use what in case of emergency?
Avoid meds containing ____ and _____
*Demerol (histamine) should be avoided
1:1000 epi
NSAIDS, aspirin
119
No supplemental what if pt has COPD
Oxygen
120
Renal Transplant pts - can have Cyclosporin A induced _____
gingival hyperplasia
121
If Prostate cancer, think what?
bisphosphonates
122
The best metric for Diabetes monitoring (avg over 3 months):
HbA1c
123
HbA1c reflect avg glc levels over previous ___ months
3
124
When should Diabetes pts be scheduled?
Early AM
125
What to do w/ dose if pts taking steroids if Dental Surgery?
Double dose prior, day of, day after
*adrenal suppression pts
126
If Hyperthyroidism avoid _____
*limit epi
Atropine
127
Stop taking Aspirin how long prior to Dental Surgery?
5 days
*restart day after
128
If INR is less than 3, proceed with surgery. If not stop Coumadin __ days prior to surgery (w/ physician approval)
3 days
129
If pt on Heparin, defer surgery ____ hrs after stopped and reverse with Protamine
6 hrs
