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Need to Know > oral surgery need to know > Flashcards

oral surgery need to know Flashcards

1
Q

what are the uses of elevators?

A
  • to provide a point of application for forceps
  • to loosen teeth prior to using forceps
  • to extract a tooth without the use of forceps
  • removal of multiple root stumps
  • removal of retained roots
  • removal of root apices
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2
Q

what are the main aims of suturing?

A
  • reposition tissues
  • cover bone
  • prevent wound breakdown
  • achieve haemostasis
  • encourage healing by primary intention
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3
Q

what are the different types of sutures?

A
  • non-absorbable
  • absorbable
  • poly-filament
  • monofilament
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4
Q

what nerves are at risk of damge during extraction of a lower third molar?

A
  • inferior alveolar nerve
  • lingual nerve
  • mylohoid nerve
  • buccal nerve
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5
Q

name two different flap designs

A
  • envelope
  • 3-sided
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6
Q

how would you manage an OAF?

A

if communication is small/maxillary sinus is intact;
* encourage clot
* suture margins of communication
* prescribe antibiotics
* give post-op instructions

if communication is large/lining of communication is torn then;
* close hole with buccal advancement flap
* give antibiotics and nose blowing instructions

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7
Q

what are the different types of nerve damage?

A
  • anasthesia- numbness
  • parathesia- tingling
  • dysaesthesia- pain, unpleasant feeling
  • hypoaesthesia- reduced sensation
  • hyperaesthesia- heightened sensation
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8
Q

how do you manage a dry socket?

A
  • support and reassure the patient
  • LA block
  • irrigate with warm saline solution
  • remove the previous blood clot to encourange new clotting
  • advise pt on analgesia and hot salty mouthwashes- should not be swished around
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9
Q

what is a sequestrum?

A

a piece of dead bone that has become separated during the process of necrosis from normal/sound bone

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10
Q

what is osteomyelitis?

A

inflammation of bone marrow

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11
Q

why is the mandible particularly affected by osteomyelitis?

A

primary blood supply is inferior alveolar artery and dense overlying cortical bone limitis penetration of periosteal blood vessels
has a poor blood supply and more likely to become ischaemic and infected

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12
Q

what two types of bleeding can occur post extraction?

A

primary bleeding
* occurs within 48 hours of extraction
* caused by vessels opening up as the vasoconstriction effects of LA wear off /toothbrush/tongue/sutures becoming loose
secondary bleeding
* often due to infections occurring 3-7 days after the extraction
* usually mild but can occasionally cause a major bleed

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13
Q

give methods for achieving haemostasis after extraction

A
  • apply firm pressure with damp gauze
  • surgical oxidised cellulose- surgicel
  • suture the socket
  • bone wax can be placed in the socket
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14
Q

what nerves are infected by an IDB?

A
  • inferior alveolar nerve
  • lingual nerve
  • some fibres of incisive and mental branches may also be anaesthetised
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15
Q

what are the 2 types of resorbable suture?

A
  • monofilament- monocryl
  • polyfilament- vicryl rapide
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16
Q

what are the two types of non-resorbable sutures?

A
  • monofilament- prolene
  • multifilament-black silk
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17
Q

name 5 general oral surgery principles that should be adhered to when carrying out flap surgery

A
  • create maximal access with minimal trauma- bigger flaps heal just as quickly as small ones
  • use the scalpel in one firm continuous stroke
  • minimise trauma to dental papilla
  • keep the tissues mosie
  • aim for healing by primary intention to minimise scarring
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18
Q

what handpiece and bur are used to cut bone?

A
  • straight electrical hand piece with saline cooled bur
  • round of fissure tungsten carbide burs
  • air drive handpieces may lead to surgical emphysema and embolisms to form
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19
Q

describe factors which influence flap design

A
  • the type of surgery being carried out
  • proximity of important structures such as nerves and muscles e.g. lingual nerve can be damaged during surgical removal of lower 3rd molars
  • depending on the area of the mouth e.g. to improve aesthetics
  • ability to access/visualise and ability to suture it back
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20
Q

give methods of debridement prior to suturing

A

mechanical
* bone file/ handpiece to remove any sharp bony edges
* mitchell’s trimmer/victoria currette for soft tissue debris
irrigation
* sterile saline/water put into socket under flap to wash out debris
suction
* aspirate under flap to remove debris

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21
Q

list peri operative complications of extractions

A
  • abnormal resistance e.g. thick cortical bone
  • fracture of tooth or alveolar bone
  • involvement of the maxillary antrum
  • soft tissue damage
  • damge to nerves
  • dislocation of TMJ
  • damage to adjacent teeth and restorations
  • wrong tooth extracted
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22
Q

where is the mental foramen located?

A
  • anterior surface of the mandible
  • transmits the terminal branches of the inferior alveolar nerve and mental artery
  • located roughly between apices of premolars on the mandible
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23
Q

what does the mental nerve give sensation to?

A
  • buccal soft tissue anterior to the mental foramen
  • lip and chin
  • anterior teeth on that side if the arch
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24
Q

describe the use of triangular flaps for extraction

A
  • 3 sided flap
  • used for retained single roots
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25
Q

describe the use of envelope flaps for extraction

A
  • 2 sided flap
  • used for retained two rooted teeth
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26
Q

describe the use of semilunar flaps for extraction

A
  • 1 sided flap
  • used for periapical involvement
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27
Q

name 4 indications to extract a tooth

A
  • symptomatic partially erupted teeth
  • traumatic position
  • orthodontic indications
  • interference with construction of dentures
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28
Q

name 2 drugs in which care must be taken when carrying out an extraction

A
  • warfarin
  • clopidogrel
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29
Q

why must you take care during extraction on a patient who takes warfarin?

A
  • increased risk of bleeding- anticoagulants prevent clots from forming and growing
  • insufficient activation of vitamin K affects clotting factors II, VII, IX, X
  • anti clotting protein C and S are inhibited
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30
Q

why must you take care during extraction on a patient who takes clopidogrel?

A
  • anti-platelet drug
  • platelet inhibition occurs and fibrin clot production is reduced
  • this reduced a clot being produced at the site of extraction
  • there is less chance of a spontaneous bleed on patients on this drug alone compared to patients with dual therapy or warfarin
31
Q

what drug counteracts benzodiazepine sedation?

A

fumazenil

32
Q

what are the 2 types of sedation?

A

inhalation (nitrous oxide)
intravenous (midazolam)

33
Q

give contraindications for inhalation sedation

A
  • pts undergoing bleomycin therapy (high O2)
  • nasal blockages
  • pts with musculoskeletal and neuromuscular diseases/problems
34
Q

what is the clinical name for dry socket?

A

localised alveolar osteitis

35
Q

what is dry socket?

A

occurs when the blood clot at the site of the tooth extraction fails to develop or dislodges/dissolves before the wound has fully healed

36
Q

what are the predisposing factors of dry socket?

A
  • lower molarts
  • smoking
  • more common in females
  • oral contraceptive pill
  • excessive trauma during extraction
  • excessive mouth rinse which washes clot away
  • patients who have had dry socket before
37
Q

what are the symptoms of dry socket?

A
  • moderate to severe dull aching pain
  • pain that keeps pt awake at night
  • paint hat throbs and radiates to the ear
  • exposed bone is sensitive
  • halitosis and bad taste in the mouth
38
Q

how long does dry socket take to resolve?

A

7-14 days

39
Q

what nerves must be anaesthetised to remove tooth 48 safely

A
  • inferior alveolar nerve
  • lingual nerve
  • long buccal nerve
40
Q

what are two different ways to assess anaesthesia has been achieved?

A
  • probe around tooth and ask patient if they feel anything sharp
  • ask if the patients lips and tongue feel numb
41
Q

what are 3 clinical reasons that could account for neurological-sensory deficits?

A
  • crushing injury
  • cutting/shredding injury
  • transection of the nerve
  • damage due to LA
42
Q

what are the aims of raising a flap?

A
  • allows better access to the tooth if finding any difficulty to extract e.g. abnormal resistance, ankylosis etc.
  • helps with closure of an OAF
43
Q

state the aims of retracting a flap

A
  • protection of the soft tissue
  • better access and vision
44
Q

during an extraction, the patient’s root fractures. what radiograph should you take?

A

periapical

45
Q

what analgesix is most appropriate post extraction for a patient who takes warfarin?

A

paracetemol

46
Q

how us facial palsy caused during an IDB?

A

if the clinician doesn’t hit bone and inserts too far back, LA is depositied in the parotid gland
the facial nerve runs through parotid gland and due to dense fascia around the gland, the LA will remain for a long time and cause paralysis of the facial muscles that the nerve innervates

47
Q

Q
how would you initially manage. apatient with facial palsy?

A

reassure- tell patient sensation will return after a few hours
keep eye patch over eye to prevent drying out as pt cannot blink

48
Q

what guidance document would you refer to for advice on dealing with patients on warfarin?

A

SDCEP anticoagulants and antiplatelets document

49
Q

when should INR be tested before an extraction?

A

no longer than 24 hours before the procedure

50
Q

below which INR level would it be safe to carry out an extraction?

A

4

51
Q

if all of your attempts to achieve haemostasis are unsuccessful, what should you do?

A

refer the patient to A&E immediately

52
Q

a patient with an otherwise healthy dentition needs tooth 34 extracted. what are common peri-operative complications that can occure?

A
  • damage to adjacent teeth i.e. 33 or 35
  • crown or root fracture of tooth 34
  • fracture of the mandible
  • abnormal resistance- thick cortical bone or divergent roots
53
Q

when does fracture of alveolar bone usually occur during extraction?

A

in the buccal plate
to canines or molars

54
Q

what do you do if a jaw facture occurs during extraction?

A

inform the patient
post-op radiograph
refer (phone call)
ensure analgesia
stablise
if delay - prescribe antibiotic

55
Q

define neurapraxia

A

contusion of nerve/ continuity of epineural sheath and axons maintained

56
Q

define axonotmesis

A

continuity of axons
epineural sheath disrupted

57
Q

define neurotmesis

A

complete loss of nerve continuity/nerve transected

58
Q

what are the aetiological factors of a tuberosity fracture during extraction?

A

single standing molar
inadequate alveolar support
unknown unerupted wisdom tooth

59
Q

name the main causes of haemorrhage during extraction

A

local factors- mucoperiosteal tear or fracture of alveolar plate/socket wall
very few due to undiagnosed clotting abnormality
liver disease (clotting factors made in the liver)
medication e.g. warfarin

60
Q

how do you control a soft tissue haemorrage during extraction?

A

pressure
suture
LA with adrenaline (vasconstrictor)
diathermy

61
Q

how do you control a haemorrhage from bone during extraction?

A

pressure with swab
LA injected into socket
blunt instrument
bone wax
pack

62
Q

how would you manage a TMJ dislocation during extraction?

A

relocate immediately
give analgesia and advise on supported yawning
if relocation not possible;
1. LA into masseter intra-orally
2. immediate referral

63
Q

what is an alveolar nerve block (IDB) used for?

A

pulp of lower molars and second premolars

64
Q

what is a mental (incisive) nerve block used for?

A

dental pulp of lower premolars and canine
buccal gingivae of lower first premolar and canine

65
Q

what is a long buccal infiltration used for?

A

buccal gingivae of lower molars and second premolar

66
Q

how do you test that anaesthesia has been achieved?

A

ask the patient if they feel numb/tingling
probe around site and check if pain felt

67
Q

give possible causes of neuro-sensory deficits

A

crushing injury
cutting/shredding injury
transection of the nerve
damage due to LA

68
Q

draw flap of retained root of lower premolar

A
69
Q

What is the dental terminology for pins and needle feeling or partial loss of sensation ?

A

Parasthesia

70
Q

What is the dental terminology for painful, unpleasant sensation lasting for a fraction of a second ?

A

dysesthesia

71
Q

What is the dental terminology for total loss of sensation?

A

Anaesthesia

72
Q

What are 3 clinical reasons that could account for neurological-sensory deficits?

A

crushing injury
cutting/shredding injury
transection of the nerve
damage due to LA

73
Q

What type of surgical flap should be used to remove retained roots of tooth 44 ?

A

2 sided flap

Need to Know (21 decks)

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