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Spring 2018 > Oral Surgery Final > Flashcards

Oral Surgery Final Flashcards

1
Q 
Odontogenic infection
% aerobic
% anaerobic
  -Gram positive _
  -Gram negative _
A

25% aerobic
75% anaerobic
Gram positive cocci
Gram negative rods

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2
Q

Typical infections
_ are aerobes only
_ are mixed
_ are anaerobic only

A

7%
60% mixed
33% anaerobic

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3
Q

2 stages of ondontogenic infection

A
  1. Aerobic bacteria initiation
    - spreading factors
    - necrosis and hypoxemia
  2. Anaerobic bacteria
    - toxins
    - wall off infection (abscess)
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4
Q

Course of odontogenic infection (3 stages)

A

Cellulitis
Abscess
Fistula

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5
Q

What causes cellulitis

Early vs. late cellulitis

A

Strep

Early: mild, soft, red, easy to treat

Late: diffuse, hard, life threatening, hard to treat

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6
Q

Abscesses are filled with _

A

Anaerobes

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7
Q

3 things that determine how odontogenic infections spread

A

Muscle attachments
Bone thickness
Root angulation

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8
Q

_ infection occurs in max anterior teeth because the roots are below _

A

Vestibular

Muscles

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9
Q

_ space infection occurs in the max posterior because roots of the teeth are _

A

Buccal

Above buccinator muscle

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10
Q

How to distinguish a buccal space infection

A

Feel inferior border of mandible, all infection is above it

Can drain in mouth

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11
Q

How to determine a submandibular space infection

A

Infection is below inferior border of mandible

Hard to drain into mouth

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12
Q

Ludwig’s angina

A

Bilateral submandibular, sublingual and submental space cellulitis

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13
Q

Primary space infections (6)

A 
Vestibular
Canine
Buccal
Sublingual
Submental
Submandibular
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14
Q

Vestibular space infections are where

A

Max anterior gingiva

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15
Q

6 secondary spaces can be infected

A 
Pterygomandibular
Masseteric
Superficial and deep temporal
Lateral pharyngeal
Retropharyngeal
Pre-vertebral
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16
Q

If infection gets into masticator space, what is hallmark of infection?

A

Can’t open mouth more than 15 mm (trismus)

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17
Q

How can a dentist cause pterygomandibular infection

A

Inject into a real dirty mouth

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18
Q

3 major complications of lateral pharyngeal space infections

A

Airway impingement
Spread to superior mediastinum
Spread into danger space/inferior mediastinum

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19
Q

How do severe fascial space infections happen

Prevent?

A

High speed hand piece, non-sterile air and water vented into space

Back venting air piece

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20
Q

What 5 things need to be considered in determining severity of disease

A 
Rate of progression
Quality and quantity and location of swelling
Trismus
Systemic involvement
Airway
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21
Q

Admission is advised for swelling in _ and _

A

Secondary and neck spaces

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22
Q

Trismus indicates _

A

Secondary space involvement

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23
Q

Temp > _ indicates systemic involvement

A

101

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24
Q 
Who is referred/admitted?
_ onset
_ compliance
Severe swelling
_ involvement
 _
Airway concerns
Immunocompromised
A 
Rapid onset
Poor compliance
Secondary space involvement
<15mm opening
Temp >101
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25
Q

Main surgical goal, 2 others

A

Remove source of infection

Drain pus
Release tension, improve circulation

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26
Q

Mild infection antibiotics:
Moderate infection antibiotics:
PCN allergy

A

Mild: amoxicillin 500 mg
Mod: amox 500 mg and metronidazole 500 mg
PCN allergy: cephalexin (with metro)

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27
Q

For a severe odontogenic infection, do what?
Mild allergy?
Severe allergy?

A

Penicillin G with metronidazole
Cephalexin for mild allergy
Clindamycin for severe allergy

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28
Q

1 reason for treatment failure

A

Inadequate surgery

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29
Q

Least likely reason for treatment failure

A

Antibiotic problems

30
Q

3 types of bony preprosthetic surgery

A

Alveoloplasty
Torus reduction
Tuberosity reduction

31
Q

3 types of soft preprosthetic surgery

A

Inf. Papillary hyperplasia
Inf. Fibrous hyperplasia
Frenal attachments

32
Q

3 systemic and 3 local factors responsible for variation in amount of bone resorption

A

Systemic:
Nutritional abnormalities
Osteoporosis
Endocrine dysfunction

Local:
Alveoloplasty at time of extraction
Dentures
Facial form

33
Q

6 anatomical factors to consider when planning a tissue supported prosthesis

A 
Ridge form
Osseus prominences
Tuberosity form
Vestibular depth
Adjacent vital structures
Inter-arch distance
34
Q

Immediate vs delayed alveoloplasty

A

Immediate: at time of extractions
Delayed: after bony healing of socket, 2 surgeries

35
Q

3 types of alveoloplasty

A

Digital compression
Intraseptal
Surgical

36
Q

Tori vs. exostoses

A

Tori on lingual
Exostoses buccal
Tori harder to remove

37
Q

Max tori consideration

A

Can be pneumatized and communicate with nasal passage

38
Q

What causes inflammatory papillary hyperplasia

Treatment

A

Mechanical irritation
Ill-fitting dentures
Poor oral hygiene
Fungal infections

Non-surgical (denture adjustment, antifungal)
Surgical excision
Abrasion of superficial layer of palatal mucosa

39
Q

What causes inflammatory fibrous hyperplasia

A

Denture irritation from ill fit or allergy

40
Q

Tissue excised from infla. Fibrous hyperplasia should be _

A

Submitted for histological evaluation

41
Q

4 steps to metastatic infection

A

Surgery
Transient bacteremia
Distant susceptible site
Infection

42
Q

How does SBE form

A

Extraction, bacteremia
Agglutination antibodies bind bact.
Bacteria complex circulates
Infect sterile thrombus

43
Q

2 people who need prophylaxis

A

Prosthetic cardiac valve

Previous infective endocarditis

44
Q

_% of SBE comes from dentistry

A

13%

45
Q

Antibiotic prophylaxis regimen

Why?

A

Amoxicillin 2 mg 1 hr preposterous

Predictable blood level from 1 dose

46
Q

If allergy to penicillin

A

Clindamycin 600 mg 1 hr preop

47
Q

What if a patient is already on antibiotics

A

Use different one

48
Q

T/F prophylactic antibiotics are recommended prior to dental procedures to prevent prosthetic joint infections

A

FALSE not recommended anymore

49
Q

Prophylaxis principles

A

Give to those with significant risk (rare in dentistry)
Time it correctly (before treatment)
Correct antibiotic and dose
Stop after surgery

50
Q

T/F treatment for prevention is different than treatment for actual infection

A

TRUE

51
Q

T/F give antibiotics to prevent dry socket

A

FALSE - rinse with chlorhexidine or administer local

52
Q

Indications for prophy for dentoalveolar surgery

A 
Poorly controlled metabolic disease
Immunosuppressed
Surgery longer than 3 hrs
Contaminated wound
Insertion of major foreign body
Surgery adjacent to sinus
Bony impaction
53
Q

4 indications for biopsy

A

Lesions persist 2+ weeks
Persistent changes in epithelial tissue
Lesions that interfere with function
Bone lesions not identifiable by clinical or radiological findings

54
Q

5 things to note about lesions

A 
Size/shape
Single/multiple
Surface texture
Color
Sharpness of bordersa
55
Q

4 types of biopsies

A

Oral cytology
Aspirational biopsy
Incisional
Excisional

56
Q

Cytology biopsy
How
Why

A

Brush smeared over and onto slide

Large areas of mucosal change

57
Q

Aspiration biopsy
What
Why

A

Syringe, take fluid

Lesions suspected to contain fluid or intraosseus lesion

58
Q

Incisional biopsy
What
Why

A

Deep and narrow wedge taken out

Extensive lesion, hazardous location
Suspicion of malignancy

59
Q

Excisional biopsy
What
Why

A

Take whole lesion (all the way around it)

Small, benign appearance

60
Q

Why refer a biopsy

A 
Malignancy suspected
Close to anatomical structure
Sedation
Medically compromised
Further surgery
61
Q

Put biopsied tissue in what

A

10% formalin solution

20 times the volume of the specimen

62
Q

When taking a bone biopsy, how much to take

A

4-5 mm of sound bone around lesion

63
Q

When a biopsy is done, what needs to be documented

A 
Preop counseling
Post op counseling
Date/time
History
Clinical description
Follow up
64
Q

4 things required in a patient provider relationship

A

Chief complaint and diagnostic studies
History of present illness and diagnosis
Med history
Physical exam

65
Q

6 things dentists can prescribe

A 
Analgesics
Antibiotics
Antimicrobials
Anti-inflammatory
Anxiolytics
Muscle relaxants
66
Q

3 things required before a dentist can write a prescription

A

State license
Registration
DEA registration number

67
Q

5 things on a prescription

A 
Patient info
Date issued
Drug info
Refill authorization
Prescriber info
68
Q

Drug info includes

A 
Drug name
Strength
Dosage form
Route
Directions for use
Duration
Quantity
Special instructions
69
Q 
Abbreviations:
a.c.
ad lib
b.i.d
caps
d.a.w
Gtt, gtts
p.r.n
q.d.
q.i.d
t.i.d
A 
Ac=before meal
Ad lib= use freely
Bid = twice daily
Caps=capsules
Daw= dispense as written (brand)
Gtt=drops
Prn= as needed
Qd=once a day
Qid=4 times a day
Tid=3 times a day
70
Q

Max dose per day:
Acetaminophen
Aspirin
Ibuprofen

A

4000mg
4000mg
2400mg/3200mg

Spring 2018 (18 decks)

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