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