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Oral surgery tutorials Flashcards

1
Q

What Anaesthetic is not recommended for pregnant women? and what ingredient causes the issue?

A
  • Citanest ; contains fellypressin which can induce labour
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2
Q

Standing positions of right handed operator?

A
  • Infront at 7 O’clock
    Upper anteriors
  • Infront
    Upper molars
    Upper premolars
    Left lower molars
  • Behind right shouder - 11O’clock
    Right lower molars
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3
Q

What is the patient position for extractions in upper dentition?

A
  • Patient head just below their shoulder height
  • Semi-supine
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4
Q

What is the best patient position for extractions in the lower dentition?

A
  • Patient head just below dentist elbow height
  • Upright
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5
Q

Describe the technique for using forceps to extract a multi-rooted tooth (3)

A
  • Apical pressure
  • Figure of 8 movements
  • Buccal expansion
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6
Q

Describe the technique for using forceps to extract a single rooted tooth? (2)

A
  • Apical pressure
  • Rotational movement
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7
Q

Give 3 principles in positioning extraction instruments?

A
  • Pressure applied away from soft tissues
  • Do not lean against teeth
  • Forceps engage the roots
  • Use under direct vision
  • Support instrument with other hand
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8
Q

What are the 3 actions in which you can use elevators?

A
  • Wedge
  • Lever
  • Wheel and axle
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9
Q

Give 5 post-op haemostasis methods?

A
  • Apply pressure
  • LA with vasoconstrictor
  • Suturing
  • Sugicel packing
  • Bone wax
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10
Q

What 3 things may be important in terms of scheduling an appointment for a patient on an anticoagulant?

A
  • Treat early in the day
  • Treat early in the week
  • Timing with anticoagulant intake
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11
Q

Give 4 systemic haemostatic agents?

A
  • Tranexamic acid
  • DDAVP (desmopressin)
  • Vitamin K
  • Replace missing clotting factors
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12
Q

What type of drug is Warfarin?

A

Vitamin K antagonist

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13
Q

What does INR stand for?

A

International normalised ratio

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14
Q

Give the normal INR for a non-warafrin patient?

A

1

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15
Q

Give the normal INR for a patient who is stably coagulated by warafrin

A

2-3

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16
Q

What should you do if a patient is taking warfarin and their INR is above 4 ?
They are getting an extraction

A
  • Delay treatment
  • Investigate and refer to patient haematologist
  • If an emergency patient refer to second care
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17
Q

If there is evidence of a patient being stably coagulated, what is the maximum time an INR can be taken before an extraction can go ahead?

A

72 hours

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18
Q

A patient requiring an extraction is on apixaban. What pre-op instructions will you give to the patient regarding his medication? (2)

A
  • Skip morning dose
  • Take it in the usual time in the evening
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19
Q

A patient requiring extractions is on rivaroxaban. What pre-op instructions will you give the patient regarding his medication?

A
  • Delay morning dose to 4 hours after haemostasis achieved
  • Take evening dose as normal
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20
Q

What information you would want to know about the patient who is on anti-coagulants or anti-platelets regarding their medical history

A
  • If they are taking any NSAIDs such as ibuprofen and diclofenac - as may increase bleeding risk
  • Their INR record if they are taking warfarin
  • Kidney, liver and blood conditions
  • Any herbal of complementary medicines
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21
Q

Name DOAC that are taken twice a day?

A
  • Rivaroxaban
  • Apixaban
  • Dabigatran
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22
Q

Name DOAC that are taken once a day in the morning?

A
  • Edoxaban
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23
Q

Give examples of injectable anticoagulants

A
  • Dalteparin
  • Enoxaparin
  • Tinzaparin
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24
Q

What post op instructions would you give specifically for a patient who had an extraction?

A
  • Rest while the local anaesthetic wears off and the clott fully forms (2-3 hours)
  • Avoid rinsing your mouth until the next day
  • Avoid sucking hard or disturbing the clot
  • Avoid hot liquid and hard foods
  • The day after treatment gently rinse with warm salty water 3-4 times a day for 5 days ( ts in glass of water)
  • Avoid using NSAIDs for pain and use paracetamol instead
  • Contact details for any questions or emergency
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25
Q

Give 2 types of antiplatelets?

A
  • Aspirin
  • Clopidogrel
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26
Q

A patient requiring extraction is on an anti-platelet what should you do? (3)

A
  • Do the treatment
  • limit initial treatment area
  • consider staging treatment plan
  • Use atraumatic technique
  • Apply local haemostatic measures
  • Expect prolonged bleeding and warn patient about risk of prolonged swelling and bruising
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27
Q

Give 4 principles of suturing?

A
  • Laid on sound bone
  • Achieve haemostasis
  • Reposition tissues
  • Do not close wound under tension
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28
Q

When to use a monofilament suture?

A
  • Mucogingival surgery
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29
Q

When to use a non resorbable suture?

A

OAF

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30
Q

When you can use a resorbable suture?

A
  • Post XLA haemostasis
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31
Q

How would you manage a patient for an extraction if they are on injectable anticoagulants? (low dose)

A
  • Treat without interrupting medication
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32
Q

How would you manage a patient for an extraction if they are on injectable anticoagulants on high or uncertain of the dose?

A
  • Consult prescribing clinician
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33
Q

What should you assess when treating a patient with anticoagulants or antiplatelet drugs?

A
  • Bleeding risk of dental treatment
  • Duration of treatment with drug
  • Any other relevant medical complications
  • Type of drug the patient is taking
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34
Q

In what groups of patient is it advised to not interrupt anticoagulant/antiplatelet medication?

A
  • Pts with metal prosthetic heart valves or coronary stents
  • Pts who had a pulmonary embolism or deep vein thrombosis in the last 3 months
  • Pts on anticoagulant therapy for cardioversion
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35
Q

What are the 4 categories of pain-related TMDs?

A
  • Myofacial pain
  • Arthralgia - pain in joint
  • Displacement of joint with or without reduction
  • Headaches
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36
Q

Give 4 causes of TMD?

A
  • Stress
  • Trauma
  • Mandibular displacement
  • Medical history - fibromyalgia
  • Anatomy of joint
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37
Q

What are 4 signs of TMD?

A
  • Hypertrophy of MoM
  • Crepitus
  • Deviation on opening
  • Pain on palpating TMJ
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38
Q

What symptoms may a TMD patient complain of? (6)

A
  • Pain in the morning
  • Intermittent pain
  • Headache
  • Clicking sounds
  • Limited mouth opening
  • TMJ pain
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39
Q

When should a TMJ patient be referred to oral medicine or maxfax for specialist investigations? (4)

A
  • Crepitus
  • Severe trismus
  • Failure of primary treatment
  • To carry out further investigations
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40
Q

Give 3 specialist investigations used to diagnose TMD?

A
  • Arthroscopy
  • CT scan of joint
  • MRI Scan
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41
Q

Give 3 management options for TMD in primary care?

A
  • Counseling
  • Bite splint
  • Physiotherapy
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42
Q

What counselling advice can you give a patient with TMD? (8)

A
  • Stop parafunctional habits
  • Manage stress
  • Avoid chewing gum
  • Soft food diet
  • Cut food into smaller pieces
  • Avoid chewy food
  • Avoid incising food
  • Support mouth when yawning
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43
Q

Give 3 management options for TMD in secondary care?

A
  • Botox
  • Tricyclic antidepressants
  • Joint replacement
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44
Q

What drugs can be used to manage TMD?

A
  • NSAID’s
  • Diazepam
  • Amitriptyline
  • Gabapentin
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45
Q

Give 2 sources of information which you can recommend for patient to read about TMD?

A
  • NHS Information
  • British association of oral surgeons
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46
Q

What type of joint is the TMJ?

A

Modified hinge (atypical) synovial joint

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47
Q

What artery supplies the TMJ?

A

Deep auricular

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48
Q

What nerve supplies the TMJ?

A
  • Auriculotemporal nerve
  • Masseteric nerve
  • Posterior deep temporal
    ** all branches of V3 **
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49
Q

What muscles are involved in elevation?

A
  • Temporalis
  • Masseter
  • Medial pterygoid
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50
Q

What muscles are involved in protrusion?

A
  • Medial pterygoid
  • Lateral pterygoid
  • Masseter
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51
Q

What muscles are involved in retraction

A
  • Deep part of masseter
  • Posterior fibres of temporalis
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52
Q

What muscles are involved in lateral deviation?

A
  • Ipsilateral masseter
  • Contralateral lateral pterygoid
  • both work with temporalis
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53
Q

What muscles are involved in depression? (3)

A
  • Mylohyoid
  • Geniohyoid
  • Digastric works with gravity
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54
Q

In terms of dis and condylar movement, describe how disc displacement with reduction occurs?

A
  • Articular disc displaced anteriorly to the condyle during opening
  • Leading to difficulty in opening the mouth wide until disc reduction occurs
  • This results in lockjaw then the joint clicks
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55
Q

What are the main symptoms of disc displacement with reduction? (4)

A
  • Clicking
  • Dislocation of joint
  • Pain
  • Deviation on opening
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56
Q

What is the risk of not treating symptomatic disc displacement with reduction?

A

Progress to osteoarthritis

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57
Q

How can you manage disc displacement with reduction?

A
  • Counselling
  • Limit mouth opening
  • Bite raising appliance
  • Surgery
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58
Q

Give 5 signs of a mandibular fracture?

A
  • Numbness of lower lip
  • Mandibular deviation
  • Occlusal derangement
  • Pain
  • Mobile teeth
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59
Q

What are the ways for classifying mandibular fractures? (6)

A
  • involvement of surrounding tissues
  • number of fractures
  • Side of fracture
  • Site of fracture
  • Direction of fracture
  • Specific fractures
  • Displacement of fracture
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60
Q

What radiographs can be used to assess mandibular fractures?

A
  • Towne’s view
  • PA mandible
  • OPT
  • Occlusal oblique
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61
Q

What is the treatment for undisplaced mandibular fracture?

A
  • Accept and monitor
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62
Q

What is the treatment of a displaced mandibular fracture?

A
  • Closed reduction with internal fixation
  • Open reduction with internal fixation
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63
Q

Give the bones that are involved in the three types of Le Fort fractures ?

A

1 - maxilla
2- maxilla and nasoethmoidal
3- maxilla , nasoethmoidal and zygomato-orbital

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64
Q

Give 5 signs of a zygomatico-orbital fracture?

A
  • Epistaxis
  • Diplopia
  • Bony step deformity
  • Peri-orbital bruising
  • Swelling
  • Subconjunctival haemorrhage
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65
Q

How would you clinically assess for a zygomatico-orbital fracture?

A
  • Palpate for depression of
    Supraorbital region
    infraorbital ridge
    zygomatic arch
  • Observe the movement of maxilla
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66
Q

What radiograph can be used for a zygomatico-orbital fracture?

A
  • Occiptomental ( parallax 0-30 degrees )
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67
Q

What initial management should you carry out for a zygomatico-orbital fracture? (4)

A
  • Rule out damage to orbital nerve - color vision test , visual acuity test
  • Prophylactic ABs
  • Avoid nose blowing
  • Refer to maxillofacial department
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68
Q

What are the 4 types of skull radiographs in maxillofacial trauma?

A
  • Occipitomental
  • PA mandible
  • Reverse Towne
  • CBCT
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69
Q

What is the occipitomental view primarily used for?

A

Maxillary middle third fractures

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70
Q

What PA mandible used for? (3)

A
  • Ramus fractures
  • Lower condylar fracture
  • Angle of the mandible fracture
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71
Q

What is Reverse Towne view used for ?

A
  • TMJ investigations
  • Coronoid notch
  • Condylar fracture
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72
Q

What is CBCT primarily used for in fractures?

A

Spatial assessment of fractures
in three planes
- coronal
- axial
- saggital

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73
Q

What are 5 radiographic signs of fractures?

A
  • Sharply defined radiolucent line
  • Radiopaque line
  • Change in normal outline or shape of bone
  • Opacification - new bone formation
  • Surgical emphysema (air)
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74
Q

What are 5 common fracture patterns that can be seen radiographically?

A
  • Mandibular displacement
  • Zygomatic arch fracture
  • Tripod fracture
  • Orbital blowout
  • Nasoethmoidal complex
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75
Q

Identify fracture?

A
  • Fracture of right condylar neck of mandible (subcondylar fracture)
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76
Q

Identify fracture?

A
  • Fracture of right body of mandible
  • Fracture of left angle of mandible
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77
Q

What type of radiograph is this?

A

PA mandible

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78
Q

What is this? and what type of image?

A
  • Left inferior orbital blowout fracture
  • CBCT
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79
Q

What is this radiographic view?

A
  • Occipitomental
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80
Q
  • 25 year old patient complaining of toothache
  • I/O - localised swelling in lower left quadrant

What is your provisional diagnosis?

A
  • Acute periapical abscess ( lower left region)
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81
Q
  • 25 year old patient complaining of toothache
  • I/O - localised swelling in lower left quadrant

What 4 further investigations will you carry out?

A
  • Percussion
  • Sensibility testing
  • Peri-apical of the lower left molar
  • Mobility testing of 46,45,43
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82
Q
  • 25 year old patient complaining of toothache
  • I/O - localised swelling in lower left quadrant

How will you manage this case? (5)

A
  • Assess cause of abscess using special investigations
  • Inform patient of treatment options for his case
  • Carry out emergency treatment for the patient
  • Provide analgesia advice + CHX 0.2% twice daily for 7D
  • Give instructions on what to do if infection returns
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83
Q
  • 25 year old patient complaining of toothache
  • I/O - localised swelling in lower left quadrant

when would you review after carrying out emergency treatment?

A

48-72 hours

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84
Q

Give 3 methods for abscess drainage post-incision?

A
  • Hilton technique - for areas of major nerves trunks
  • Pressure + gauze
  • Extra-oral drain
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85
Q

What common bacteria is found in dentoalveolar abscesses?

A
  • Anearobic - P.intermedia
  • Strepcocci - S.angiosus
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86
Q

What antibiotics are effective against P.intermedia?

A
  • Penicillin
  • Metronidazole
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87
Q

What Antibiotics are effective against S.angiosus?

A
  • Penicillin
  • Erythromycin
  • Clindamycin
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88
Q

What part of microorganism do penicillin act against?

A

Cell wall

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89
Q

What part of microorganism do erthromycin and clindamycin act against?

A

Protein synthesis

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90
Q

What part of microorganism do metronidazole act against?

A

DNA synthesis

91
Q

*Patient comes one week after draining an abscess with resolved dental pain
*C/O increased neck swelling and difficulty swallowing
* voice is hoarse and appears to be drooling
* E/O - right sided red and warm facial swelling
* I/O - reduced mouth opening, elevated and tender right FoM

Name 4 spaces in the head and neck which might be involved in the current spread of infection?

A
  • Buccal space
  • Submasseteric space
  • Submandibular space
  • Sublingual space
92
Q

*Patient comes one week after draining an abscess with resolved dental pain
*C/O increased neck swelling and difficulty swallowing
* voice is hoarse and appears to be drooling
* E/O - right sided red and warm facial swelling
* I/O - reduced mouth opening, elevated and tender right FoM

What are 5 questions that you should ask this patient?

A
  • When did the dental pain stop?
  • When did the swelling begin?
  • When did the dysphagia begin?
  • Is the swelling increasing or decreasing in size?
  • Do you have a fever?
93
Q

*Patient comes one week after draining an abscess
*C/O increased neck swelling and difficulty swallowing
* voice is hoarse and appears to be drooling
* E/O - right sided red and warm facial swelling
* I/O - reduced mouth opening, elevated and tender right FoM

What immediate investigation might be appropriate?

A
  • SIRS investigation ( Systemic Inflammatory response syndrome)
94
Q

What is SIRS?

A

Severe immune response to infection which presents with a significant risk of sepsis

95
Q

What is the Diagnosing criteria for sepsis?

A
  • Temperature less than 36 or more than 38
  • Pulse rate more than 90 beats per min
  • Respiratory rate more than 20 breaths per minute
  • White cell count less than 4 or more than 12 g/l
96
Q

What diagnosis is made when the SIRS criteria are met?

A
  • 2 or more critria met = SEPSIS
  • Look for one sign of SEPSIS red flags
97
Q

What treatment pathway when SEPSIS is diagnosed?

A
  • Sepsis emergency pathway
  • Need to seek advice from consultant
98
Q

How would you describe the key features to a consultant when suspecting sepsis?

A
  • Situation = pt name ,age, diagnosis (severe spreading submandibular odontogenic tumour/ ludwig’s angina)
  • Background = history, signs and symptoms
  • Assessment = I/O and E/O findings in details
  • Recommendation = what you think should be done and why?

SBAR

99
Q

*Patient comes one week after draining an abscess
*C/O increased neck swelling and difficulty swallowing
* voice is hoarse and appears to be drooling
* E/O - right sided red and warm facial swelling
* I/O - reduced mouth opening, elevated and tender right FoM

If the patient was to be admitted to a hospital how would they be managed? (6)

A
  • ABCDE
  • Sepsis 6 + resuscitation
  • IV antibiotics
  • Incision and drainage under GA
  • XLA of infected teeth
  • Pus aspirate sent to lab with susceptibility testing
100
Q

What 1st line antibiotics is used for dento-alveolar infections?

A

Pen V 250mg oral
Send = 40 tablets
Label = 2 tablets x4 daily

101
Q

What choice of ABs is used for dentoalveolar infections in patients who are allergic to penicillin?

A

Metronidazole 400mg
Send = 15 tablets
Label = 1 tablet x3 daily

102
Q

Despite effective antimicrobial activity against oral anaerobes, clindamycin is not routinely used instead of metronidazole - why?

A

Because it is linked to increased risk of Clostridium Difficile infection

103
Q

Co-amoxiclav can be used as a second line antibiotic, What 2 drugs are found in co-amoxiclav?

A

Amoxicillin and Clavulanic acid ( stops bacterial breakdown of amoxicillin)

104
Q

When should you prescribe co-amoxiclav? for a dental infection?

A
  • If they are likely to be managed in secondary or emergency care
  • Seek advice first
105
Q

What is SEPSIS?

A

A dysregulated host response causing life-threatening organ dysfunction

106
Q

Give 3 red flags of sepsis?

A
  • New deterioration in GCS (glasgow coma scale) / AVPU
  • Heart rate more than 130/min
  • Respiratory rate more than 25/min
  • Rash
  • Recent chemotherapy
107
Q

What is glasgow coma scale?

A

A clinical scale to measure level of consciousness after a brain injury

108
Q

You assess a patient and they have one sepsis red flag present. What must be done next?

A
  • Dial 999
    *State red flag Sepsis
  • SBAR
  • Arrange bluelight transfer
  • Administer PO2 > 94% in COPD patients between 88-92%
109
Q

What information to include on prescriptions? (7)

A
  • Patient information
  • Medication name
  • Number of days of treatment
  • Instructions on when to take the medication and how
  • Drug formulation + dose + quantity
  • minimum dose interval to take drug
  • Signature and prescriber information
110
Q

Give 8 general indications of XLA of Impacted M3M?

A
  • therapeutic indications
  • Surgical indications
  • Medical indications
  • Accessibility - limited access
  • Patient age - complications increase with age
  • Autotransplantation
  • General anaesthetic
111
Q

Give 3 surgical indications for removal of impacted M3M?

A
  • Fractured mandible
  • in resection of diseased tissue
  • orthognathic
112
Q

Give 4 therapeutic indications for removal of third molars?

A
  • Recurrent pericornitis
  • Impacted third molars
  • Cysts
  • Tumours
  • External root resorption of 7 or 8
113
Q

Give 4 medical factors for considering prophylactic removal of 3rd molars?

A
  • Planned bisphosphonate treatment
  • Pre-chemo or radiotherapy
  • Awaiting cardiac surgery
  • immunosuppressed
114
Q

What is pericoronitis?

A

Inflammation of operculum surrounding partially erupted 8 from food trap and poor clearance causing infection

115
Q

What are the signs and symptoms of pericoronitis? (5)

A
  • Pain
  • Difficulty eating
  • Foul taste in mouth
  • bad smell
  • Sinus (extra or intra-oral)
116
Q

What are 5 predisposing factors for pericoronitis? (5)

A
  • Partially erupted tooth
  • mechanical trauma from opposing 7 or 8
  • white race
  • full dentition
  • poor OH
117
Q

What are all the management options for for acute and recurrent pericoronitis? (7)

A
  • Incision and drainage of abscess
  • Irrigation - warm saline ± CHX mouthwash or gel
  • LA w/PMPR under operculum
  • Advise on analgesia - NSAIDs, frequent warm saline / CHX mouthwash or gel
  • XLA upper 8 (if traumatising operculum)
  • XLA lower 8 - routine, surgical corenectomy
118
Q

What 5 extra-oral checks should you carry out for lower third molars XLA ?

A
  • TMD assessment
  • limitation of opening
  • lymphadenopathy
  • Asymmetry
  • Trigeminal neuralgia exclusion
119
Q

What 5 intra-oral checks should you carry out for lower 3rd molars extraction?

A
  • Soft tissues
  • hard tissues
  • Mandibular second molar
  • Eruption status of M3M
  • Occlusion
  • Caries status
  • Periodontal status
  • OH
120
Q

Give 5 important pre-op factors to assess before going ahead with mandibular third molars extraction?

A
  • Angulation of impaction
  • Depth of impaction
  • Proximity to nearby anatomy
  • Condition of 7
  • Access to area
  • working distance (distal of lower 7 to ramus of mandible)
121
Q

What 3 radiographic signs show an intimate relationship between the third molar and the IAN canal, which significantly increases risk of post-op nerve injury?

A
  • Darkening of the roots where crossed by the canal
  • Deflection of the canal
  • interruption of the white lines of the canal
  • Juxta apical area
  • deflection of the root
  • Dark and bifid root
122
Q

If close proximity of the lower third molar is suspected, what other investigations should you carry out?

A

CBCT

123
Q

What is the most common third molar impaction angulation?

A

Mesio-angular impaction

124
Q

List all the treatment options for an impacted third molar?

A
  • Monitor
  • Corenectomy
  • Routine XLA
  • Surgical XLA
125
Q

Other than pain, bleeding , bruising and swelling give 6 risk factors that you would discuss with the patient

A
  • Altered taste
  • Jaw stiffness
  • Temporary/permanent loss of sensation in tongue, lip and chin
  • Infection
  • Dry socket
  • Damage to adjacent teeth and restorations
  • Further surgical procedures
126
Q

After what time its less likely for a nerve to recover ?

A

18-24 months

127
Q

What percentage of patients may experience temporary numbness?

A

10-20%

128
Q

What percentage of patients may experience permanent numbness?

A
  • less than 1%
129
Q

What are 3 principles of surgical access?

A
  • maximal access with minimal trauma
  • Scalpel used in single stroke
  • minimal trauma to papillae
130
Q

What are 3 principles of reflection?

A
  • Begin reflection from relieving incision
  • Free anterior papillae before proceeding distally
  • Reflect flap down to bone cleanly
131
Q

What are 3 principles of bone removal?

A
  • Electric saline-cooled straight handpiece with tungsten carbide bur (fissure or round)
  • Create a narrow deep buccal gutter
  • Remove bone distal to mesial
132
Q

What are 3 principles of debridement?

A
  • Physical - remove sharp edges
  • Irrigation - saline under flap
  • Suction - aspirate to remove debris
133
Q

Three principles of suturing?

A
  • Reposition tissues
  • Sutures should be laid on sound bone
  • Wounds not closed under tension
134
Q

3 instruments used in reflecting a flap?

A
  • Warwick James elevators
  • Howarth’s elevator
  • Mitchell’s trimmer
135
Q

3 instruments used in tissue retraction?

A
  • Minnesota retractor
  • Rake retractor
  • Howarths’s elevator
136
Q

At what point on the tooth should you horizontally for corenectomy?

A

3-4mm below enamel cementum junction

137
Q

Where would you section the tooth if you are planning to remove the whole tooth?

A

Above ECJ

138
Q

What are the two types of sectioning during a mandibular third molar extraction?

A
  • Horizontal
  • Vertical
139
Q

When would vertical sectioning be indicated?

A

When the roots are are separate

140
Q

What is the goal of vertically sectioning a tooth?

A
  • Dividing the tooth into smaller sections for easier extraction
141
Q

What is the indication for a coronectomy?

A
  • When there is a high risk of of permanent damage to IAN if surgical extraction would be carried out
  • Coronectomy reduces the risk of damage to the IAN
142
Q

What is a contraindication for a coronectomy?

A

Pulp of tooth is affected by caries or infection

143
Q

4 things to warn a patient about when consenting for a coronectomy?

A
  • If root mobilised during treatment the whole tooth should come out - likely with conically fused roots
  • Roots may have to be removed in the future
  • You might get a slow healing or painful socket
  • leaving the root behind may cause infection - rarely
144
Q

Outline the procedure for a coronectomy? (7)

A
  • Pre-op CBCT and assessment then LA
  • cut two of three sided flap to expose 3rd molar
  • Create buccal gutter using straight hand piece
  • Horizontally section the crown 3-4mm below ECJ
  • Remove coronal portion
  • Debride bone and remove sharp edges
  • Irrigate underflap and suture
145
Q

When would you review a patient after a Coronectomy?

A
  • 1-2 weeks
  • then 3-6 months
  • then 1 year
146
Q

What is the main risk associated with a XLA of upper 3rd molars?

A

Maxillary tuberosity fracture

147
Q

What is a cyst?

A

A pathological cavity that can be filled with fluid , semi-fluid or gas that is not caused by puss accumulation

148
Q

What are the 2 main categories of cysts?

A

Odontogenic and non-odontogenic

149
Q

What 3 epithelial remnants are linked to the development of odontogenic cysts? and from where do they originate?

A
  • Rests Malassez - hertwig’s epithelial root sheath
  • Rests of serres - dental lamina
  • Reduced enamel epithelium - dental follicle
150
Q

What teeth are radicular cysts mostly associated with?

A

non-vital

151
Q

What are the radiographic signs of a radicular cyst? (4)

A
  • Round well-defined radiolucency
  • Unilocular
  • Corticated margins
  • Continuous with lamina dura of non-vital tooth
152
Q

How do you differentiate between a radicular cyst and a periapical granuloma radiographically ?

A
  • Radicular cysts are larger , usually more than 15mm
  • Radicular cysts contain epithelial lining and inflammatory cells whereas periapical granuloma contains granulation tissue
153
Q

Give 3 histological signs of a radicular cyst?

A
  • Epithelial lining
  • Connective tissue capsule
  • Inflammation
154
Q

What would expect an syringe aspirate of a radicular cyst to be ?

A
  • Clear straw fluid
155
Q

What are the 2 types of inflammatory collateral cysts ?

A
  • Paradental cyst
  • Buccal bifurcation cyst
156
Q

What is the most common location of a paradental cyst ?

A
  • Distal aspect of partially erupted lower 3 molars
157
Q

What is the most common location of a buccal bifurcation cyst?

A

Buccal aspect of lower first molar

158
Q

Describe how dentigerous cysts arise?

A
  • Cystic change in dental follicle where reduced enamel epithelium is not fully resorbed
  • Fluid accumulation leading to the cyst formation
159
Q

What is the most common tooth associated with a dentigerous cyst?

A
  • Lower third molar
  • Upper canine
160
Q

What are the radiographic signs of a dentigerous cyst? (5)

A
  • Well defined radiolucency
  • Unilocular
  • Corticated margins associated with CEJ of unerupted crown
  • Displacement of tooth involved
  • May lead to bony expansion
161
Q

What are some histopathological signs of dentigerous cysts?

A
  • thin non keratinised stratified squamous epithelium
162
Q

What may be the cyst contents of a dentigerous cyst?

A
  • Cholesterol crystals
  • Proteinaceous , yellowish fluid
163
Q

What is the normal size of a follicular space ?

A

2-3mm

164
Q

What 2 radiographic signs would you look for to consider a cyst to be dentigerous rather than an enlarged follicle?

A
  • Aymmetrical radiolucency
  • More than 10mm in size
165
Q

What is an eruption cyst?

A

A dentigerous cyst associated with an erupting tooth

166
Q

What 2 teeth are eruption cysts associated with?

A
  • deciduous incisors
  • First permanent molars
167
Q

What cells are linked to the formation of OKC’s ?

A
  • Rests of Serres from the remnants of dental lamina
168
Q

Give the radiographic signs of an odontogenic keratocyst ?

A
  • Well defined radiolucency
  • Multilocular
  • Scalloped margins
169
Q

What are the risks associated with OKC?

A
  • may displace teeth
  • May grow disto-mesially
  • High rate of recurrence
170
Q

What is found in the contents of an OKC when aspirating it ?

A
  • White creamy thick aspirate
  • Low protein content (through protein test)
171
Q

What are some histological signs of an OKC?

A
  • thin folded parakeratinised squamous epithelium
  • Daughter cysts
  • thin connective tissue wall
  • No inflammation
172
Q

What is the reason for the high recurrance rates of OKC’s? (3)

A
  • it is an infiltrative growth which means enucleation may leave some of the cells leading to recurrence
  • daughter cells
  • Thin friable lining
173
Q

What syndrome is associated with multiple OKCs?

A
  • Basal cell naevus syndrome ( Gorlin-Goltz)
174
Q

What are the signs of gorlin goltz syndrome other than multiple OKCs ?

A
  • Multiple basal cell carcinomas on skin
  • Calcification of falx cerebri ( calcified dura matter in skull)
  • Mandibular prognathism
175
Q

Examples of non odontogenic epithelial cysts?

A
  • Nasapalatine duct cyst
176
Q

What cells are linked to the formation of nasopalatine duct cysts?

A

Nasopalatine duct epithelial remnants

177
Q

What are the radiographic signs of nasopalatine duct cyst ?

A
  • well defined round, ovoid or heart shaped radiolucency
  • Sclerotic margin
  • Unilocular
  • Over roots of maxillary incisors in anterior maxilla
178
Q

What is the normal size of the incisive fossa? and when should you assume the radiographic presentation is a nasopalatine duct cyst?

A

Normal size of incisive fossa is less than 6mm , assume NDC if radiolucency is greater than 10mm

179
Q

What are some examples of non-odontogenic non-epithelial cysts ?

A
  • Solitary bone cyst
  • Aneurysmal bone cyst
  • Stafne cavity - not really a cyst
180
Q

What are the radiographic signs of solitary bone cyst?

A
  • Well defined radiolucency with an irregular corticated margin
  • Scalloped
  • Spreads between roots and furcations of adjacent teeth
181
Q

What are the radiographic signs of stafne cavity?

A
  • Round or oval well demarcated radiolucency
  • Between premolar region and angle of the jaw
  • Located below inferior dental canal
182
Q

What may stafne cavity contain?

A
  • Ectopic salivary tissue in continuity with SMG
183
Q

What 3 radiographs that can be taken for cyst management?

A
  • OPT
  • CBCT
  • MRI
184
Q

Give 3 biopsy methods for cyst management?

A
  • Aspiration from cyst
  • Incisional biopsy
  • Enucleation
185
Q

What is the aim of enucleation?

A
  • Remove the whole cyst in a single appointment
186
Q

What are 3 advantages of enucleation?

A
  • Whole lining can be examined pathologically
  • Little aftercare required
  • Heals by primary closure
187
Q

What are 3 disadvantages of enucleation?

A
  • Risk of damage to nearby structures ( adj teeth or IAN)
  • Mandible fracture
  • Recurrence
188
Q

What is the goal of marsupialisation? (2)

A
  • Create a surgical window to and suturing the cyst walls to the surrounding epithelium
  • This reduce the size of the cyst before enucleation
189
Q

Which cysts are more likely to be marsupialised?

A
  • OKC
  • Large dentigerous cysts
190
Q

What are 3 disadvantages of marsupialisation?

A
  • Needs further surgery to remove cyst
  • Long treatment time
  • Chance of re-infection and might be uncomfortable
191
Q

What is segmental resection?

A

Removal of cysts with the margin of normal bone

192
Q

When is segmental resection used ? 2

A
  • Ameloblastoma
  • Sarcoma
  • Odontogenic myxoma
  • Commonly used in odontogenic tumours
193
Q

What are 5 ways in which endodontic treatment might fail? with one example of each

A
  • Obstruction to instrumentation - clacification
  • Root filling errors - underfilled or overfilled
  • Secondary pathology - apical cyst
  • poor host tissue response
  • Post placement
  • Lateral perforation
194
Q

What are 2 aims of periradicular surgery?

A
  • Remove existing infection
  • Achieve apical seal
195
Q

What 3 flap designs are used in peri-radicular surgery?

A
  • Semilunar flap
  • Triangular flap
  • Rectangular flap
196
Q

Give 2 instruments used in root end preparation?

A
  • Rotary bur
  • Ultrasonic
197
Q

Give 3 retrograde root filling materials?

A
  • Amalgam
  • ZOE
  • MTA
198
Q

Give 5 reasons for failure of peri-radicualr surgery?

A
  • Inadequate seal
  • Inadequate support - too much apex removed , poor perio status , apical third fracture
  • Poor healing response
  • Exposure of root apex
199
Q

What is periradicular surgery?

A

Surgical intervention at the apical region of the root to eliminate persistent or complex endodontic infections

200
Q

Give 3 reasons why a root may fracture during an extraction?

A
  • Gross caries
  • Tooth heavily restored
  • Root dilacerated
201
Q

Give 3 indications for leaving a root in situ? (3)

A
  • Proximity to IAN
  • Overdentures
  • Preserve ridge for future implant placement
202
Q

What is an OAC?

A

Pathological communication between oral cavity and the maxillary sinus

203
Q

What is the difference between OAC and OAF?

A

OAF is chronic communication between the oral cavity and the maxillary sinus involving the formation of epithelial lining

204
Q

What are 5 risk factors of an OAC?

A
  • Previous OAC
  • Older patient
  • Extraction of maxillary molars and premolars
  • Root proximity to sinus
  • Large bulbous roots
  • Last standing molars
  • Recurrent sinusitis
205
Q

What are 3 peri-op signs of OAC?

A
  • Direct vision (dark hole)
  • Bubbling at socket
  • Change in suction sound
  • Bone removed at trifurcation
206
Q

What are 4 post op signs of OAC?

A
  • Fluid from nose when drinking
  • Difficulty smoking or playing sound instruments
  • Non healing socket
  • Unilateral discharge
207
Q

5 ways in which an OAC might happen other than extractions?

A
  • Cysts and tumours
  • Osteonecrosis
  • Impants
  • Trauma
  • Tuberosity fracture
208
Q

What are 3 types of OAF closure methods?

A
  • Buccal advancement flap
  • Palatal rotation flap
  • Bone graft
209
Q
  • Extraction of UL7 appt
  • History of pain from ULQ
  • O/E - only retained roots of 7
  • Radiographically - close proximity of roots to maxillary sinus
  • Post extraction you suspect OAC

What should you do first?

A
  • Inform the patient about the incident and this risk was accounted for
  • Assure the patient that this can be managed
  • Close using buccal advancement flap or refer
210
Q

Does the size of an OAC affect its management?

A

Yes

211
Q

How would you manage an OAC that is less than 2mm?

A
  • Debride socket and encourage clot formation
  • Suture
  • Give post op advice
  • Review in one week

May heal spontaneously

212
Q

How would you manage an OAC that is more than 2mm?

A
  • Debride socket to encourage clot formation
  • Suture with buccal advancement flap over OAC
    *Consider ABS
  • Post op advice
  • review in one week
213
Q

What instructions would you give a patient after OAC treatment? (5)

A
  • Avoid touching socket to not disrupt healing
  • Sneeze with mouth open
  • No nose blowing
  • Avoid smoking
  • Avoid drinking through a straw
  • You may benefit from inhalation of menthol crystals steam
  • Use decongestants
  • CHX MW
214
Q

What 2 prescriptions would you consider post OAC treatment ?

A
  • Ephedrine 0.5% nasal drops - 2 drops 4xd as required , usr for maximum 7 days
  • Pen V 250mg oral = 2 tablets 4xd for 5 days
215
Q

What are the risks associated with not closing the OAC? (4)

A
  • Recurrent sinusitis
  • Food trapping
  • Infection
  • Impaired healing
216
Q

What % of patients get sinusitis if OAC not closed?

A
  • 50% within 2 days
  • 90% within 2 weeks
217
Q
  • Pt had UR6 XLA 6 weeks ago
  • Past week had a horrible taste in mouth
  • Feels blocked nose and feeling unwell
  • Pain in upper Jaw

O/E - pus discharge from UR6

What is your diagnosis?

A

OAF

218
Q
  • Pt had UR6 XLA 6 weeks ago
  • Past week had a horrible taste in mouth
  • Feels blocked nose and feeling unwell
  • Pain in upper Jaw

O/E - pus discharge from UR6

How will you manage this patient?

A
  • Inform patient about findings and gain consent
  • Immediate management or referral
  • Immediate management =
    Excise sinus tract
    Drain sinus
    Debride socket
    Suture with BAF
    Abs
    Post op instructions
    Review in one week
219
Q
  • XLA of carious 26
  • During XLA crown had decoronated and 2 roots were romoved
  • One root is missing

PA taken for assessment

Where is third root located?

A

Displaced through alveolar bone into right maxillary sinus

220
Q
  • XLA of carious 26
  • During XLA crown had decoronated and 2 roots were romoved
  • One root is missing

PA taken for assessment
Describe how you can manage this patient?

A
  • Inform pt about findings
  • Gain consent for monitoring if small ( risk of sinusitis and infection)
  • Do immediate management or refer
221
Q
  • XLA of carious 26
  • During XLA crown had decoronated and 2 roots were romoved
  • One root is missing

PA taken for assessment

You decide to proceed with immediate management , describe what you will do?

A
  • Raise BAF
  • Use copious amounts of saline and suction to see if you can retrieve the root
  • Widen the socket using water cooled bur to increase chance of retrieval
  • Use ribbon gauze to retrieve
222
Q

What 2 management options could you consider when treating a patient with lost root in sinus other than retrieval through socket?

A
  • Endoscopic approach
  • Caldwell luc procedure
223
Q
A

BDS4 (63 decks)

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