Revision Questions Flashcards
What are the indication for XLA?
Gross caries Advacned perio disease Tooth/root fracture Servere tooth surface loss Pulpal necrosis Apical infection
Traumatic position
Ortho indication
Syptomatic PE teeth
Interfernce with construction of dentures
What forces are applied to a single rooted tooth?
Apical pressure
Rotational movement (unscrewing)
Buccal and lingual expansion
What forces are applied to a molar tooth?
Apical pressure
Figure of 8 rotation
Buccal expansion
What are upper instruments?
Straight - anterior teeth Univerisal - canines and premolars Molars - left and right Roots - broken down roots/retained roots Bayonettes - wisdom teeth or 7's positioned distally Root Bayonettes - for roots
What are lower instruments?
Universal - lower 5-5
Molars - molar teeth
Roots - broken down roots/retained roots
Cowhorns - broken down molar teeth, apically gauages in furcation
What are the mechanical principles for tooth elevation?
Wheel and Axele
Lever
Wedge
What are the uses of elevators?
Removal of retained roots XLA without forceps Removal of root apices Removal of root stumps Loosen tooth prior to forceps Provide point of applicaiton for forceps
What are the types of elevators
Couplands chisel - elevates and loosens the tooth off, rotational movement
Cryers - Elevates and looses the tooth off, for molar roots
Warwick james - removes roots, placed perpendicular to long axis of tooth
Luxator - Seperates perio ligament and widening of tooth socket, parallel to long axis of tooth and pushes down to seperate perio ligament
What are the soft tissue retractors?
Howarth’s periosteal elevator
Bowdler Henry Retractor (rake)
What are some heamostatic agents?
Adrenaline containing LA
Oxidised regenerated cellulose - surgicel - framework for clot formation (careful in lower 8 region as acidic and can damage IDN)
Gelatin sponge - absorbable/meshwork for clot formation
Thrombin liquid and powder
Fibrin foam
What are some systemic haemostatic aids?
Vit K
Anti-fibrinolytics - tranexamic acid - prevents clot breakdown
Missing blood clotting factors
Plasma or whole blood
How is haemostasis achieved
Peri op - LA with vasoconstrictor, artery forceps, diathermy, bonee wax
Post op - pressure, LA, diathermy, WHVP, Surgicel, Sutures
What are post op instructions for an XLA
Tell them they will be sore over the next few days as LA wears off
Use analgesia when required
Do not exercise that day and avoid anything that increases blood pressure which may result in bleeding
Avoid hard/hot foods
Avoid alcohol for that day
Do not rinse for about 24hours then start warm salty rinses
If bleeding occurs bite on damp gauze for 20-30 mins
Avoid smoking due to delayed healing and dry socket
Any concerns contact the practice
What are peri op complications
Difficult of access and vision Abnnormal resistance Fracture Involvement of maxillary antrum Loss of tooth damage to nerves Damage to vessels Haemorrhage Dislocation of TMJ Damage to adjacent teeth Broken instruments
What is anaesthesia?
Numbness/total loss of sensation
Paraesthesia?
Tingling
Dysaesthesia
impleasant sensation/pain
Hypoaesthesia
reduced sensation
Hyperaesthesia
increased/heightend sensation
Neuropraxia
Contusion of nerve/ continuity of epineural sheath and axons maintained
Axonotmesis
Continuity of axons but not epineural sheath disrupted
Neurotmesis
Complete loss of nerve continuity/nerve transected
What is the management of a oro antral fistuala/communication
Inform patient
Small sinus intact - ecourage clot, suture margins, antibiotics, post op instructions
Large lining torn - close with buccal advacnement flap, antibiotics and nose blowing instructions
What are the causes of a fracture tuberosity?
Single standing molar
Unknown unerupted molar wisdom
XLA gone wrong
Not enough alveolar support
What is the diagnosis of a fractured maxillary tuberosity?
Noise
Tear on palate
More than one tooth moving
movement
How do you manage a fractured maxiallry tuberosity
Dissect out and close wound/ reduce and stabilise
Fixation - remove/treat pulp, ensure occulsion free, antiobiotics and antiseptics, post op instructions, remove tooth 8 weeks later after splint by surgical removal
What are the post op complications?
Pain Swelling Ecchymosis (bruising) Trismus Haemorrhage Prolonged effects of nerve damage Dry socket Sequestrum Infected socket Chronic OAF Osteomyelitis Osteroradionecrosis MRONJ Actinmycosis
Immediate haemorrahge (reactionary/rebound)
Occurs within 48hrs of XLA
Vessels open up/vasoconstrcition efftcs of LA wear off
sutures loose or lost
Patient traumatised area with tongue/finger/food
Secondary bleeding
Often due to infection
Commonly 3-7days after XLA
Uusually mild ooze but can be major bleedin
Symptoms of dry socket?
Dull aching pain bad taste Bad/characterstic smell Exposed bone sens and source of pain Throbs and can radiate to pts ear Keeps them awake at night
What are some predisposing factors for a dry socket?
Molars Mandible Smoking Females OCP LA - vasoconstrictor
Management of dry socket
Supportive - reassurance/systemic analgesia
LA block
Irrigate socket with saline
Curettage/debridement - encourage bleeding, new clot formation
Antiseptic pack (alvogyl)
Advise pt analgesia and hot salty mw’s
Review pt and change pack and dressings
What is osteomyeltisi?
Inflammation of the bone marrow - usually mandible due to poor blood supply
Infection of the bone
Pt often systemically unwell/ raised temp
Site of XLA tender
What are predisposing facotrs of osteomyelitits?
Odontogenic infections
Fractures of mandible
What is acute supparative osteomyelitis
Little or no radiograph change
At least 10-12 days required for lost bone to be detected radiographically
Chronic osteomyelitis
+/- pus - bony destruction in the area of infection
Treatment for osteomyeltis
Medical and surgical
Antibiotics - clindymacin/pencillin (longer course than normal)
Serve acute osteomyelitis may require hosiptal admission and IV antibiotics
Surgical - drain pus, remove any non vital teeth in area of infection, remove any loose peices of bone, removal of bony cortex, perofration of bony cortex, exicsion of necrotic bone
How can you prevent osteoradionecrosis?
Scaling/CHX Mw up to XLA
Careful XLA technique
Antibiotics, CHX mw and review
Hyperbaric oxygen - in increase local tissue oxyenation and vascualr in growth to hypoxic areas
What is treatment for osteoradionecorsis
Irrigation of necrotic debris
Antibiotics not helpful unless secondary infection
Loose Sequestra removed
Small wounds, heal over course of weeks/months
Factors for MRONJ
Deugs
Length of time patient is on drugs
Diabetes/ steriods/anti cancer chemo/smoking
What is the management for MRONJ?
Remove sharp edges of bone
CHX Mw
Antibiotics if suppration
What is actinomycosis?
Rare bacterial infection
It crodes through tissues rather than follow typical fascial planes and spaces
Thick lumpy pus
What is the treament for Actinomycosis?
I&D of pus accumulation
Excision of chronic sinus tracts
Excision of necrotic bone and foreign bodies
High dose antibiotics for intial control
Long term antibiotics to prevent reccurrence
What is infective endocariditis?
Inflammation of endocardium affecting heart valves or CMP caused by bacteria
What are the stages of surgery
Consent Safety checklist LA Access Bone removal tooth removal Debridement/wound management Suture Achieve haemostasis Post op instructions Follow up
Points for surgical access
Wide based incison - circulation and perufsion
Use scalpel in one form/firm stroke
No sharp angles and good sized flap
Minimise truama to dental papillae
No crushing and keep tissues moist
Make sure wounds are not closed under tension
Aim for healing by primary intentions to minimise scarring
Types of debridement
Physical - bone file or handpiece to remove sharp bony edges/ mitchell’s trimmer to remove soft tissue debirs
Irrigation - sterile saline into socket
Suction - Aspirate under flap, check oscket for reainted apices
What handpieces are used for surgery?
Straight handpiece with saline cooled bur
Round or fissue tungsten carbide bur
Why do you not use an air tubrine handpiece for surgery?
Can cause surgical emphysema
Aims of suturing
Achieve haemostasis Cover bone Healing by primary intention Reposition Tissues Prevent wound breakdown
What are the suture types
Resorable - mono - moncryl
- Poly - vicrly rapide
Non resorable - mono - proliene
- Poly - mersilk (black silk)
Monofilament sutures?
Single stranded and resistant to bacterial colonisation
Less filaments reduces the number of sources of possible infection
Polyfilament sutures
Several filaments twisted together
Easier to handle
Prone to wicking - more filaments increases the number of sources of possible infection, fluid and bacteria may accumulate
Resorable Sutures
Suture material absorbed by the tissues and patient does not need to come back
Used where suture removable is difficult
Non - resorable sutures
Tensile strength does not reduce and not absorbed by the tissues and patient must return for suture removable
Used in areas where suture is required for longer duration
Aims of retracting flap
Better access and vision
Retraction of soft tissues
Closure of OAF
4 things that influence flap design
Personal perfernces Access needed Procedure Surrounding nerves Ability to suture it back Area in mouth
Causes of neuro-sensory deficity?
Damage due to LA
Damage to nerve in surgery
Crushing on removal of tooth
Cutting/shredding due to LA or flap design
4 nerves damaged by XLA 3rd molar
Lingual nerve
Inferior alveolar nerve
Buccal nerve
Mylohyoid nerve
2 nerves that are blocked when injected into the pterygomandibular space
Lingual nerve
Inferior alveolar nerve
History of sharp pain that is not relieved by analgesia
Trigeminal Neuralgia
Stenson’s Duct opens opposite (parotid duct)
Upper 2nd molar
Incidience of sialolitheis (salivary gland stones)
Submandibular gland
Complication of PSANB
Heamatoma
