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Oral Surgery YR3 Flashcards

1
Q

What procedures count as oral surgery?

A
  • Simple exodontia - extractions- Complex exodontia - MOS- Soft tissue surgery - biopsy- Oral pathology management - tumours- Anxiety management - sedation- Medical condition management
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2
Q

What PPE is needed for simple exodontia?

A

Level 2 PPE:- eye- mask- apron- gloves

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3
Q

What are the legal considerations needed to allow simple exodontia?

A
  • Clear documented treatment plan- Medical history up to date- PreOP radiograph- Patient confirms reason for attendance and the tooth extraction
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4
Q

What is the definition of luxation?

A

Displacement or dislocation of an object

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5
Q

What is the definition of elevation?

A

The action of moving an object from its original position in a vertical plane

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6
Q

What is the definition of extraction?

A

The complete removal of an object from its surroundings

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7
Q

What are the 3 forms of techniques for simple exodontia?

A
  • Luxation- Elevation- Extraction
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8
Q

What is the definition of point of application?

A

The point at which an instrument becomes active and applies force to an object or surface

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9
Q

What is the point of application for a luxator? and in which area of the tooth?

A
  • At the periodontal ligament space| - Used in the long axis of the tooth
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10
Q

What is the process of using a luxator?

A
  1. Gentle apical pressure with lateral cutting action| 2. Incise the PDL, wedges between alveolar one and root surface
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11
Q

What is the point of application of an elevator? and what orientation and movement is it used?

A
  • Interproximal point of application- With a perpendicular orientation- Rotational movement (pulley lever)
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12
Q

What is needed when using elevators?

A

Fulcrum

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13
Q

What is the definition of primary drive?

A

Refers to the action used with a luxating or elevating instrument with utilisation of lever and fulcrum rests

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14
Q

What is the definition of primary movement

A

First stages of dental extraction by severing the PDL fibres and encouraging dilatation of alveolar bone

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15
Q

What is the definition of secondary movement?

A

Forceps are applied to the coronal section of the tooth to be extracted

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16
Q

What is the definition of secondary drive?

A

Forceps are used to grip and apply apical pressure

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17
Q

What other movements are used when using a forcep/

A

Rotational movement and 8-figure movements

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18
Q

How to use luxators safely?

A

Instrument in heel of hand, index finger guides tip, supporting digits straddle alveolus of quadrant

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19
Q

How to use elevators safely?

A

Instrument in heel of and, index finger guides tio, fulcrum on alveolar bone, perpendicular to extracting tooth, supporting digits straddle alveolus of quadrant

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20
Q

How to use forceps safely?

A

Operating gand conforms to grip of instrument, supporting hand reciprocates apical pressure and lateral movements

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21
Q

What is the order of use when extracting a tooth?

A
  1. wide narrow luxator2. elevators: starting with smallest3. delivery of tooth with extraction forceps using secondary movements
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22
Q

What are the ergonomics when extracting a tooth?

A
  • Standing- Right handers: LRQ standing behind and other quadrants in front- Upper teeth: patient high ad supie- Lower teeth: patient low ad upright- Supporting and reciprocates apical pressure and provides proprioceptive feedback
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23
Q

What are some peri-operative complications for simple exodontia?

A
  • ineffective La- excess bleeding- crown or root fracture- root displacement- communication- adjacent tooth damage- soft tissue injury- alveolar fracture- instrument fracture- tooth inhalation
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24
Q

What are some post-operative complication of simple exodontia?

A
  • Pain- Swelling- Bruising- Bleeding- Dry socket- Infection- Trismus- Difficulty eating- Prolonged healing
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25
Q

What is normal bleeding and how to deal with excessive bleeding?

A 
- Haemostasis within 3-5 minsIf continues:- apply Pa- place haemostatic agent in socket- suture socket with resorbable suture- rest with no mouth rinsing then reapply pressure
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26
Q

How to deal with crown/root fracture? and what increase the risk?

A
  • Should anticipate from pre-OP radiograph- Heavily restored, RCT, curved morphology- Refer to MOS`
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27
Q

How a communication forms? and how to deal with a sinus communication?

A

Loss of alveolar bone leading to communication| - Refer to MOS

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28
Q

How to deal with a dry socket?

A
  • Occurs 3-5 days postOP- Painkillers ineffective- Bad taste- Increased in smokers- Treatment irrigate with saline and dress with alvogyl
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29
Q

What is essential to ask a patient before extracting a tooth, in regards to their wellbeing?

A

Have they eat?, if not offer a glucose-based supplement

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30
Q

What is the relevant previous medical history, when assessing the difficulty of an extraction?

A

Bleeding disordersBisphosphonatesAntibiotic allergyAnticoagulants and Antiplatelets

Refer to the SDCEP guidelinesRadiotherapyChemotherapyHaemophiliaLiver/Kidney failure
Essential to liaise with necessary colleagues
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31
Q

What are the radiographs of choice for a extraction?

A

DPT and periapical

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32
Q

What consentual aspects must the patient know and understand for you to undertake an extraction?

A
  • The tooth to be extracted- risk vs benefits- justification for extraction- other viable options
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33
Q

What medical aspects must you understand before starting an extraction on a patient?

A
  • Changes since last visit- Changes to bleeding and healing times (anti-coagulants, immunosuppression or bisphosphonates)- Diabetes control- Has the patient eaten?
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34
Q

What should be included on the surgical safety checklist before a tooth extraction?

A
  • Team awareness- Patient points to tooth- Dentist identifies tooth- X-rays present- Previous medical history- Clearly planned and recorded
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35
Q

What equipment is essential for an extraction?

A 
PPE: level 2LA: topical, long/short needle, appropriate LA for patient's needsExtraction instrumentsGausePost OP instruction leaflet
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36
Q

What position of the patient is gold standard for a lower tooth?

A

Low and upright

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37
Q

What position of the patient is gold standard for a upper tooth?

A

Higher and more supine

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38
Q

What is the role of the working/dominant hand?

A

Control the extraction instrument

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39
Q

What is the role of the supporting hand?

A

Protects the patient by the digits straddling the alveolar bone providing proprioceptive feedback

40
Q

What general movement is done with forceps?

A

Bucco-lingual movement

41
Q

What movement with forceps are specific to single rooted teeth?

A

Rotational

42
Q

What movement with forceps are specific to lower molars?

A

Figure of 8

43
Q

What should you tell and give the patient after the extraction?

A 
First, stop the bleedingGive verbal and written instructionsExplain how to control bleeding (provide gause)Give OHISuggest soft dietNo smoking or alcoholOoH numberAsk if any questions
44
Q

What complications can occur during the extraction procedure?

A 
Pain, from LA failureExcessive bleedingSoft tissue traumaAdjacent tooth damageCrown fractureRoot fractureNeed to refer to MOS
45
Q

What complication can occur after the extraction procedure?

A 
PainSwellingDry socketInfectionPost-extraction hemorrhageBoney sequestration Medication related osteonecrosis of the jaw (MRONJ)
46
Q

What is the definition of a cavity?

A

A hollow space within within the body or tissues

47
Q

What is the definition of a cyst?

A

Cavity lined by epithelium

48
Q

What is the definition of a granuloma?

A

A collection of macrophages that adhere together down the microscopeNodule of red tissues seen by naked eye (granulation tissue)

49
Q

What is the definition of granulation tissues?

A

Capillaries and fibroblasts| Arrive at injured site, capillaries keep area oxygenated and fibroblast makes a scar

50
Q

What cells do chronic inflammation contains?

A

Lymphocytes, plasma cells, macrophages and some eosinophils

51
Q

What cells do acute inflammation contain?

A

Neutrophils

52
Q

What is the definition of odontogenic?

A

Derived from epithelial residues of tooth forming organ

53
Q

What is the definition of non-odontogenic?

A

Derived from other non-tooth cells

54
Q

Name 2 types of odontogenic cysts?

A

Inflammatory| Developmental

55
Q

Name 3 examples of inflammatory odontogenic cysts?

A

AbscessPeriapical granulomaPeriapical cyst

56
Q

What causes a periapical abscess?

A

Pulpal death is the cause due to caries, though may be subsequent traumaDue to microbial infection in the root canal after pulpal death

57
Q

How does an abscess form?

A

Neutrophils accumulate with bacteria in the centre| Granulation tissue grown in around central area

58
Q

Is an abscess a cyst?

A

No| The abscess forms a cavity filled with pus and is lined by granulation tissue

59
Q

How to treat a abscess?

A

Incise and drain centrePus drains outGranulation tissue resolvesSmall scar forms

60
Q

What happens if the abscess becomes infected or injury persists?

A

Get cavity lined by granulation tissue that persistsBecomes a periapical granulomaCan have chronic inflammation (plasma cells)

61
Q

What can a abscess progress to?

A

Chronic apical periodontitis

62
Q

What can inflammation stimulate in a periapical granuloma?

A

Stimulate epithelial remnants to proliferate and form a true cyst lining, which will become a periapical cyst or a combined periapical cyst and granuloma (can also become infected again forming another abscess)

63
Q

What is left after the tooth is extracted after periapical cyst?

A 
Residual cyst(radicular or apical periodontal cysts)
64
Q

What does a periapical cyst look like under a microscope?

A 
Fibroconnective tissue and scarring forming edge of lesionGranulation tissueSquamous epitheliumCapillariesNeutrophilsPlasma cells (if chronic)
65
Q

If there is a lateral opening of the root canal, what is a cyst called?

A

Lateral radicular cyst

66
Q

Name 4 developmental odontogenic cysts?

A

Odontogenic keratocystDentigerous cystGIngival cyst of newbornRare cyst

67
Q

What is a odontogenic keratocyst lined by, covered with and associated with?

A

Squamous epithelium, with a distinct wavy band of thin parakeratin (keratin with nuclei)Now designated a true tumour as it often recursRarely assoc with Gorlin-Goltz syndrome

68
Q

What are the symptoms of Gorlin-Goltz syndorme?

A

Multiple keratocysts in mouth and numerous skin tumours| Caused by mutation in the receptor sonic hedgehog (developmental patterning protein)

69
Q

Where are Dentigerous cysts found?

A

Cyst around crown

70
Q

What is the pathology of a dentigerous cyst and what is it derived from?

A

Squamous epithelial lining with occasional mucus secreting cellsFrom reduced enamel epitheliumDoes not recur

71
Q

What are some variants of dentigerous cyst?

A

An eruption cyst is a dentigerous cysts forming outside the boneCan also be called follicular cysts

72
Q

Where are gingival cysts of newborn found?

A 
In gingiva (Bohn's nodules)Resolve spontaneously
73
Q

What is the pathology for a gingival cysts of newborn?

A

Lined with squamous epithelium and filled with keratin

74
Q

Where are lateral periodontal cyst located?

A

Interproximally| Does not recur after enucleation

75
Q

What is the pathology of an lateral periodontal cyst?

A

Squamous lined cyst with focal thickened areas of epithelium

76
Q

Name 3 very rare developmental odontogenic cysts?

A

Glandular odontogenic cystGingival cysts of adultsBotryoid odontogenic cyst

77
Q

Where is the Glandular odontogenic cyst located and do they recur?

A

Anterior mandible| Recur

78
Q

Where is the Gingival cysts of adults located and do they recur?

A

Gingiva| Not recur after enucleation

79
Q

Where is the Botryoid odontogenic cyst located and do they recur?

A

Interproximally| Recur

80
Q

What is the definition of a non-odontogenic cyst?

A

Derived from other non-tooth cells

81
Q

Name 7 types of non-odontogenic cysts and cyst-like lesions?

A 
Salivary mucocoeleNasopalatine duct cystNasolabial cystTru bone cystDermoid cystEpidermoid cystThyroglossal cyst
82
Q

Name 2 types of salivary mucocoelecysts?

A

Extravasation mucocoele Mucous retention cyst

83
Q

What is the pathology and description for an extravasation mucocoele?

A

Not a true cyst but cyst-like as no epithelial liningCaused from traumaBall of mucinSpilled mucus from minor salivary gland ductGranulation tissue walls of area

84
Q

What is the definition of granulation tissue?

A

Capillaries and fibroblasts

85
Q

What is the pathology and description for a mucous retention cyst?

A

A true cyst which usually forms when salivary duct is blockedLined by epitheliumDilated salivary duct

86
Q

What occurs if a mucous retention cyst enlarge?

A

Burst| Become a combined mucous retention cyst and extravasation mucocoele

87
Q

What is 1 variation of mucosal retention cyst?

A

A ranulaA mucous retention cyst occurring in a large salivary glandIf it bulges out into neck its is called a plunging ranula

88
Q

Describe the location, origin and the epithelial lining of the nasopalatine duct cyst?

A

Swelling in midline of anterior palateOriginate from epithelium of nasopalatine duct in incisive canalEpithelial lining can be stratified squamous, respiratory, cuboidal or columnar cells

89
Q

Describe the location, origin and the epithelial lining of the nasolabial cyst?

A

Lesion in upper lip below nose, lateral to midlineDerived from remnants of the embryonic nasolacrimal ductPseudostratified columnar epithelium lining

90
Q

What is the meaning of ‘true’ for a true bone cyst?

A

True relates to the cavity wall is formed by bone forming tissue

91
Q

What is the solitary bone cyst lined by?

A

Bone cavity lined by CT in mandible of teenager

92
Q

What is a rare bone cyst and give an example?

A

Aneurysmal bone cyst| Not true cyst but a cavity in bone lined by CT and blood filled spaces

93
Q

Describe the location, origin and the epithelial lining of the dermoid cyst?

A

Developmental skin cyst in young childrenEmbryonic remnants of skin form ‘skin’ lined cystsSquamous lining produced by keratin and has skin appendagesRare in FoM

94
Q

Describe the epithelial lining and aetiology of the epidermoid cyst?

A

Squamous lined cyst which is thought to be acquired by traumatic implantation of surface epithelium

95
Q

Describe the location, origin and the epithelial lining of the Thyroglossal cyst?

A

Common in neck but rare in mouthEmbryonic ract runs from midline back of tongue, through hyoid bone to area of thyroid glandRarely found at back on tongueLined by epithelium, with surrounding thyroid tissue in wall

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