Surgical Extractions & Nerve Blocks Flashcards
Name some of the clinical signs that may indicate a surgical extraction may be necessary.
Halitosis
Pawing at mouth
Ptyalism
Oral hypersensitivity
Facial swelling
Oral hemorrhage
Sneezing
Nasal discharge
Expopthalmia
Abnormal behavior
Changes in eating habits
What is the general order of events for a dental extraction?
- perform dental nerve block
- create surgical flap
- remove alveolar bone
- section multi-rooted teeth
- elevate tooth
- extract tooth
- smooth alveolar bone
- post-extraction radiograph
- closure of flap w/o tension
What 2 drugs are used for dental nerve blocks?
lidocaine and bupivacaine
of the 2 drugs used for dental nerve blocks, which has a SLOWER onset but LONGER duration of action?
bupivicaine – onset is 5-15 minutes, but lasts for 6-10 hours.
what is the onset and duration for lidocaine for use of dental nerve block?
1-2 min onset
1-2 hour duration
Can you combine lidocaine and bupivicaine for dental nerve block? if so, what is the effect on onset and duration?
yes. the onset and duration become “medium” length compared to their short and long onset/duration individually.
T/F: you can add an opioid (ex. buprenorphine) to local anesthetic agent to increase and prolong analgesia
true
When doing a dental nerve block, why is it important that you aspirate?
the nerves are in a neuroVASCULAR bundle. We do not want these drugs to go IV.
What does the infraorbital block?
rostral maxillary teeth (from distal root of 107 and 207 forward)
Of the 2 approaches for infraorbital block, which do we do?
intraoral (open their mouth)
What does the maxillary nerve block block?
ALL maxillary teeth, palate, bone, and lips.
In what animals should you NOT do a maxillary nerve block and why?
cats and brachycephalic dogs.
The position of their eyes. You have the potential to create septic eyeball and subsequent enucleation.
Of the 2 approaches to the maxillary nerve block, which do we do?
intraoral
we go directly behind the commissure of the lips and insert the needle vertically behind 110 or 210.
Why is the mental dental block not very useful?
it only blocks the mandibular incisors, not even the mandibular canines.
For which block does the needle NOT actually enter the foramen?
mandibular
What does the mandibular nerve block block?
ALL mandibular teeth, bone, lips, rostral tongue, gingiva, and skin
Of the 2 approaches to perform a mandibular nerve block, which do we use?
extraoral
we feel for the notch and insert the needle perpendicular to the jaw
What flap technique is best for premolars and molars, especially when you are doing multiple-teeth extractions?
envelope flap
T/F: the envelope flap technique has NO vertical releasing incisions
true – the incision is made along the gingival margin and the gingiva is gently elevated only to expose the alveolar bone.
What flap technique is best for the canine, 4th premolar, 3rd incisors, as well as single tooth extractions in general?
mesial-based pedicle flap
Describe how to perform a mesial-based pedicle flap.
incise along the mesial edge on the gingiva and create an L shaped cut.
gently elevate the gingiva to expose the alveolar bone
what # blade do you use to incise the gingiva?
11 or 15
what tool do you use to elevate the flap and expose the alveolar bone?
molt elevator
what 3 sides of alveolar bone do you need to remove with your round bur?
- buccal/labial
- mesial
- distal
how much alveolar bone do you need to grind away?
enough until you can elevate the tooth
why do we section multirooted teeth?
roots have more strength when they are together.
what tool and technique do we use to elevate the tooth?
wing-tipped elevator
we hold it with an underhanded palm-grip and twist.
in what direction should you apply force when elevating a tooth?
The axis of strength ie the long axis of the tooth.
T/F: you should apply force in the horizontal axis of the tooth when extracting it with extraction forceps
false – still apply force in the long axis of the root.
what are the 2 reasons that we do post-extraction radiographs?
- verify you got all the roots out and there is no bone damage/fractures
- legal documentation
what is the purpose of an alveoplasty?
smooth rough or protruding edges of the alveolus to make the flap easier and more comfortable to close.
what suture do we use to close flaps?
4-0 or 5-0 absorbable suture
(monocryl or gut)
