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Tim's Cards > Oral Surgery, Bitches > Flashcards

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

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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

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3
Q

When making incisions, the blade is _______ to the surface

A

Perpendicular

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4
Q

3 potential complications of a Flap:

A

Necrosis

Dehiscence (opens up)

Tearing

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5
Q

In a Flap, the _____ should be wider than the ______

A

Base wider than Tip

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6
Q

T/F

It is almost impossible to make an incision too long

A

True

*avoid tears and nerve damage/pain

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7
Q

Important: Incisions heal in what direction?

A

In width (across)

*independent of length, does NOT heal end to end

**longer incision better

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8
Q

Make releasing incisions how many teeth away from the extraction site?

A

1 - 1.5 teeth away

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9
Q

Irrigate tissue with _______ instead of _______

A

Saline solution

Distilled water

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10
Q

If an instrument is used to place tissue in _______ , don’t use it again

A

Formalin

*denatures tissues

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11
Q

T/F

Don’t crush, overheat, or dry out tissue

A

True

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12
Q

Poorly controlled _______ will lead to increase tension on the wound, decrease vascularity, and provide a culture/medium for infection

A

Hemostasis

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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

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14
Q

Eliminate dead spaces by suturing from the bottom or a ______ dressing

A

Pressure

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15
Q

4 methods to promote wound Hemostasis:

A

Assist natural (direct pressure)

Thermal coagulation (electrocautery)

Suture ligation

Vasoconstrictors

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16
Q

4 methods to eliminate Dead Space:

A

Suture

Pressure dressing

Packing

Drains (suction/nonsuction)

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17
Q

In the 1st couple days use _______ to decrease inflammation

After use ______

A

Ice

Heat

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18
Q

Decrease infection risk by _________ during surgery

Remove necrotic and foreign ischemic material - known as ________

A

Irrigation

Debridement

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19
Q

4 ways to Control Edema during surgery:

A

Careful

Elevation

Systemic steroids

Ice

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20
Q

Mucosal edges heal until they meet, known as…

A

Epithelialization

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21
Q

When will epithelial healing stop?

A

Once it touches other free edge of epithelium

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22
Q

3 stages of wound healing:

A

Inflammatory

Fibroplastic

Remodeling

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23
Q

Anything tending to hold wound edges apart:

A

Tension

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24
Q

Primary intention:

Secondary intention:

Tertiary intention:

A

Sutured lacerations/incisions

Gap (extraction sockets)

Grafts

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25
Q

Primary intention of bone has edges less than _____mm apart

Secondary intention of bone healing has edges more than _____ mm apart

A

1 mm

1 mm

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26
Q

Healing in extraction socket - Whitish yellowish stuff:

Greenish:

Socket looks empty:

A

Fibrin clot (or fluid if soft, bone/tooth/peanut if hard)

Food

If symptoms, dry - if no pain, not dry

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27
Q

Extraction sockets heal by _______ intention

A

Secondary

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28
Q

If the nerve is Contused, you normally get _______ recovery

A

Spontaneous

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29
Q

When there is opening into sinus lining, how to wounds heal?

A

Proliferate along wound into tract

*creates opening (epithelialized tract between oral cavity and sinus)

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30
Q

Inflammatory Stage Phase I:

Phase II:

A

Vascular (vasoconstriction)

Cellular (Complement cascade)

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31
Q

What holds wounds together during the inflammtory stage?

A

Fibrin

*not strong

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32
Q

4 signs of Inflammation:

A

Rubor (redness)

Calor (heat)

Dolor (pain)

Tumor (swelling)

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33
Q

In the Fibroplastic Stage, _______ strands form the latticework in which _______ lay down ground substance and ________

A

Fibrin

Fibroblasts

Tropocollagen

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34
Q

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

A

2-3 weeks

Stiff

Erythmatous

70-80%

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35
Q

T/F

You can’t wear hand jewelry in surgery

A

True

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36
Q

What stage of wound healing is 70-80% as strong as uninjured tissue?

What stage is 80-85% as strong?

A

Fibroplastic

Remodeling

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37
Q

Wound Maturation, aka…

A

Remodeling Stage of wound healing

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38
Q

In the Remodeling Stage, _____ is removed and the wound softens

A

Collagen

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39
Q

T/F

Every incision results in a scar

A

True

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40
Q

4 factors that impair wound healing:

A

Foreign material

Necrotic tissue

Ischemia

Wound tension

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41
Q

Foreign material (impairing wound healing) can be bacteria, dirt, or _______

A

Suture material

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42
Q

Flushing a wound with a sterile solution, aka…

A

Debridement

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43
Q

What can prevent the growth of reparative cells?

A

Necrotic tissue

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44
Q

2 factors that impair Wound Healing

A

Ischemia (leads to further necrosis and decreased nutrients)

Tension (anything tending to hold wound edges apart)

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45
Q

What heals better b/c there is less re-epithelialization, collagen deposition, contraction, and remodeling?

A

Primary Intention Wounds

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46
Q

What type of wound contains a Gap between epithelial edges and takes longer to heal?

What is an example?

A

Secondary Intention

extraction sockets

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47
Q

Wound treated by coverage with tissue grafts:

A

Tertiary Intention

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48
Q

Bone Healing has the same 3 stages as Soft Tissue: Inflammation, fibroplasia, and remodeling

In addition, what 2 factors are involved?

A

Osteoclasts

Osteoblasts

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49
Q

Bone
Less than 1 mm apart:

More than 1 mm apart:

A

Primary Intention

Secondary Intention

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50
Q

In Bone healing of Secondary Intention, a ______ formation extends beyond the free edges of the bone and is followed by ossification

A

Callus

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51
Q

Extraction Socket Healing:

Bleeding, Clot, Platelets adhere to surrounding tissued , then _____ transformed into ______ (thin, whitish)

A

Fibrinogen

Fibrin

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52
Q

T/F

In wound healing, Fibrinogen turns into Fibrin which trap cellular components

A

True

53
Q

Extraction Sockets heal by ______ intention

A

Secondary

54
Q

Week One wound healing:

Week 2 wound healing:

Week 3-4:

A

Inflammatory Stage

Granulation tissue/osteoid deposition

complete epithelialization

55
Q

4 requirements of Implant Healing (Osseointigration):

A

Tight Fit

Viable bone

Implant Immobility

Implant surface free of contamination

56
Q

Implant placed, superficial layer on surface of implant dies, scaffold forms, new bone forms, osteocytes secrete _______ at implant surface and secrete osteoid (new bone)

A

proteoglycans

57
Q

Membrane that allows O2, fluids, nutrients through but not Fibroblasts - can exclude soft tissue and guide bone into the right position

A

GTR - Guided Tissue Regeneration

58
Q

What type of epithelial junction exists at an implant?

A

Hemidesmosomal

59
Q

3 most injured nerves:

A

IAN-Mental Nerve - Mn fractures

Lingual Nerve - 3rd Molars (impacted)

IA Nerve (AMC or orbital blow-out fractures)

60
Q

Neurapraxia (loss of nerve conduction) causes resorption of ______

Recovery usually _______

A

myelin sheath

spontaneous

61
Q

Resorption of myelin sheath:

Axons/myelin sheath disrupted, recovery 2-6 months

Complete loss of nerve/transection

A

Neurapraxia

Axonotmesis

Neurotmesis

62
Q

Nerve healing proceeds by _____ followed by _____

A

Degeneration

Regeneration

63
Q

What instrument is used to reflect mucoperiosteum, loosen soft tissue, or to retract flap after reflection?

A

Periosteal Elevator

*has that beaver tail

64
Q

T/F

Mennesota cheek and flap retractor, Weider tongue retractor, seldin flap retractor all retract soft tissues

A

True

65
Q

Stillies, Adson, and Cotton?

A

Forceps

66
Q

2 Instruments to remove Bone:

A

Chisel

Mallet

67
Q

T/F

You can’t use any handpieces that blow air b/c it can cause serious infection/swelling

A

True

68
Q

What Instrument is Primarily used for cutting/removing bone?

A

Rongeurs

*spring loaded handle

69
Q

What instrument looks like a spoon and is used to remove soft tissue from bone cavities?

A

Curette

*periapical or double-ended dental

70
Q

What clamps a vessel?

What sutures?

A

Hemostats

Needle Holder

71
Q

Bone wax ____ blocks small bone channels

A

mechanically

72
Q

What’s your “go to” hemostatic material?

made of?

A

Gelfoam

*gelatin sponge

73
Q

Gelfoam, CollaPlug, CollaTapa, and CollaCote all control hemmorrhage

A

True

74
Q

The better instrument for suturing:

The better needle design:

A

3/8 circle

reverse cutting

75
Q

Plain gut suture lasts ____ days in oral cavity

Chromic gut lasts ____ days

A

5 days

10-12 days

*made from sheep intestines serosal lining

76
Q

Suture scissor for removing sutures

What 2 are for dissection/cutting soft tissue?

A

Iris

Metzenbaum

77
Q

2 Instruments for holding mouth open:

A

Bite block

Molt Mouth Prop (use w/ caution)

78
Q

What luxates teeth, removes broken/surgically sectioned teeth from sockets?

A

Dental Elevators

79
Q

3 types of Dental Elevators:

A

Straight

Triangular

Pick

80
Q

2 Types of Extraction Forceps: (and shape)

A

Mx - S shaped

Mn - L shaped

81
Q

What is used for All OS procedures?

A

Pharyngeal Partition

82
Q

T/F

Making a Flap makes a procedure surgical

A

False

*must be tissue and bone

83
Q

2 Extraction techniques:

A

Closed (forceps)

Open (surgical with flaps)

84
Q

In a Closed Extraction, loosen soft tissue with what instrument?

Luxation with what?

Then forceps

A

periosteal elevator

luxator/elevator

85
Q

T/F

Usual post-op care of socket involves curette, irrigation, and CHX

A

True

86
Q

Envelope Flap has how many teeth Anterior and Posterior to tooth of interest?

Releasing Incision?

A

2 teeth Anterior, 1 tooth Posterior

1 tooth each

87
Q

To close an Antral-Oral Fistula, use what kind of Flap?

A

Pedicle

88
Q

T/F

Not seeing the PDL is an indication for extraction

A

True

89
Q

Where should you never suture after extraction?

A

Over socket

90
Q

How does suturing usually proceed?

A

Buccal to Lingual

*Soft to Hard tissue

91
Q

T/F

There should be no knots placed over the incision line

A

true

92
Q

3 Cases in which Root Fragments can be left:

A

If excessive Trauma

Smaller than 4-5mm

Next to vital structures (nerves, vessels, sinus)

93
Q

If there is _____ or _____ at the Apex of a tooth it must come out

A

infection

radiolucency

94
Q

If multiple extractions, which usually come out first?

Last?

A

Maxillary

1st Molars, Canines

95
Q

The width of the cuff should be __% greater than the diameter of the extremity

A

20%

96
Q

In what part of SOAP are diagnoses listed?

A

A - assessment

97
Q

American Academy of Anesthesiologists I:

ASA II:

ASA III:

A

normal/healthy

mildly systemic

severe systemic disease

98
Q

T/F

If Angina is stable, ambulatory OS procedures are usually safe with proper precautions

A

True

99
Q

With Angina Pectoris, what is the dental management Strategy if Stable

A

Stress reduction/pain control

100
Q

How much should epi be limited with Angina?

ABx when?

A

0.04 mg

6-8 weeks post stent placement

101
Q

When should procedures be done if pt has Unstable Angina?

A

after med consultation to PCP

OMFS if emergency

102
Q

Tx should be deferred how long after MI?

A

6 months

103
Q

How is Warfarin/Coumadin effect measured?

A

INR

104
Q

3 types of blood thinners:

A

Clotting cascade interference

Platelet aggregation inhibitors

Direct Thrombin inhibitors

105
Q

INR (if pt taking Coumadin) must be taken ___ hrs prior to surgery.

If it is less than ____, most minor surgery can be done

A

24 hours

3

106
Q

Platelet Aggregation Inhibitors: Pts may be on Aspirin, _____, or both

Can be on what for surgery?

A

Clopidogrel

one, not both

107
Q

Pt taking Aspirin and Clopidogrel must discontinue one ____ days pre-op

A

5-7 days

108
Q

A Direct Thrombin Inhibitor (Pradaxa) must be discontinued when?

A

evening before, morning of procedure

*2 doses

109
Q

Defer elective Tx ___ months after CVA (stroke)

Limit epi to ___ mg

A

6 months

.04

*like MI

110
Q

CV pts should be treated with anxiety reduction, _______ should be available, and minimize epi

A

Nitroglycerin

111
Q

T/F

ABx prophylaxis is required for Dysrhythmias

A

False

112
Q

T/F

ABx prophylaxis is required for Acquired Valve Disease

A

True

113
Q

ABx prophylaxis is recommended for what 3 conditions?

A

Prosthetic cardiac valve

Previous BE (bacterial endocarditis)

Congenital heart disease - various categories

114
Q

Standard AB used for BE pt:

if allergic:

non oral:

allergic/non oral

A

amoxicillin

clindamycin/arithromycin/clarithromycin

ampicillin

clindamycin/cefazolin

115
Q

HTN emergency:

HTN urgency:

A

over 200 systolic

over 115 diastolic

116
Q

Pts with HTN should take what prior to Dental surgery?

A

normal antihypertensives

just sip of water

117
Q

For mild/moderate HTN, Tx is limited and BP is _____

Severe HTN BP is _____ and electives are deferred

A

140/90

200/100

118
Q

Bronchial asthma - keep albuterol on hand and use what in case of emergency?

Avoid meds containing ____ and _____

*Demerol (histamine) should be avoided

A

1:1000 epi

NSAIDS, aspirin

119
Q

No supplemental what if pt has COPD

A

Oxygen

120
Q

Renal Transplant pts - can have Cyclosporin A induced _____

A

gingival hyperplasia

121
Q

If Prostate cancer, think what?

A

bisphosphonates

122
Q

The best metric for Diabetes monitoring (avg over 3 months):

A

HbA1c

123
Q

HbA1c reflect avg glc levels over previous ___ months

A

3

124
Q

When should Diabetes pts be scheduled?

A

Early AM

125
Q

What to do w/ dose if pts taking steroids if Dental Surgery?

A

Double dose prior, day of, day after

*adrenal suppression pts

126
Q

If Hyperthyroidism avoid _____

*limit epi

A

Atropine

127
Q

Stop taking Aspirin how long prior to Dental Surgery?

A

5 days

*restart day after

128
Q

If INR is less than 3, proceed with surgery. If not stop Coumadin __ days prior to surgery (w/ physician approval)

A

3 days

129
Q

If pt on Heparin, defer surgery ____ hrs after stopped and reverse with Protamine

A

6 hrs

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