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Oral Diseases > theme 3 - principles of OS > Flashcards

theme 3 - principles of OS Flashcards

1
Q

3 places bleeding likely to come from (not tooth) after extraction

A
  1. bone
  2. gingivae
  3. FOM
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2
Q

what is used for chemical cautery?

A

silver nitrate

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3
Q

when removing lower 8 what 2 things can be left behind?

A
  1. loose bone/root fragment

2. soft tissue pathology

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4
Q

how does suturing promotes healing?

A

minimises dead space
promotes healing
minimised scarring

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5
Q

4 aspects of ideal suturing

A
  1. close in layers
  2. ensure support
  3. close approximation of wound edges
  4. tension free
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6
Q

3 reasons to consider drainage

A
  1. infected site
  2. incision of abscess
  3. closure of dead space
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7
Q

2 types of drainage

A
  1. closed drain

2. open drain

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8
Q

5 ways to minimise infection after extraction

A
  1. sterile technique
  2. minimal damage
  3. debridement
  4. elimination of dead space
  5. drains where appropriate
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9
Q

3 life threatening complications of surgery

A
  1. airway obstruction
  2. haemorrhage
  3. infections
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10
Q

if tongue pushed back blocking airway how do you resolve this?

A

chin lift

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11
Q

4 factors infection depends on

A
  1. virulence of organsism
  2. number of organisms
  3. host resistance
  4. local anatomy
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12
Q

2 ways commensals change into pathogens

A
  1. change site

2. change in host resistance

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13
Q

what happens in days 0-3 of odontogenic infection?

A

inoculation + acute inflammation

soft mildly tender swelling

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14
Q

what happens in days 3-7 of odontogenic infection?

A

cellulitis
bacteria penetrating through tissue planes
hard erythematous swelling, warm, painful

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15
Q

what happens in days >5 of odontogenic infection?

A

abscess
undermines skin/mucosa
compressible + shiny + fluctuant

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16
Q

if you drained cellulitis what would it be?

A

serosanguinous fluid with flecks of pus

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17
Q

if abscess burst itself what does it become?

A

chronic abscess
decreased erythema, size + tendernes
residual firmness

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18
Q

microbiology behind sepsis

A

release of mediators - NO, bradykinin, histamine, prostaglandins due to bacteria or their endotoxins

state of vasodilation, enhanced capillary leak, myocardial depression

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19
Q

how does sepsis differ to infection

A

aberrant or dysregulated host response

presence of organ dysfunction

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20
Q

what happens in septic shock

A

end stage sepsis

low BP
serum lactate >2mmol

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21
Q

what is qSOFA?

A

quick sepsis related organ failure assessment

GCS <15 - drop in >= 1 with proven infection
RR>22
SBP<100

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22
Q

sepsis 6

A
  1. oxygen in
  2. iv broad spectrum antibiotics
  3. fluids in
  4. blood cultures (before antibiotics in)
  5. lactate
  6. fluid balance monitoring
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23
Q

what is crystalloid used for?

A

to treat high lactate +/or hypovolaemia in sepsis

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24
Q

what is SIRS?

A

systematic inflammatory response syndrome - systemic response to septicaremia

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25
Q

difference between bacteraemia + septicaemia

A

bacteraemia = bacteria in blood stream ranged by immune system

septicaemia = actively dividing bacteria’s in blood stream, leading to SIRS + hypovolemic shock

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26
Q

4 vital signs of infection

A
  1. pyrexia >38.3 or hypothermia <36
  2. tachC >90bpm
  3. tachyP >20RR
  4. WCC <4 or >12
27
Q

5 signs of infection

A
  1. vital signs
  2. airway
  3. eyes - swelling
  4. specialist environment - FBC, lactate, U&E, CRP +/- coagulation screen
  5. culture + sensitivity - aspirate > swab
28
Q

4 stages of treatment of surgical infection

A
  1. remove cause
  2. institue drainage
  3. prevent spread
  4. restore function
29
Q

type of infection in teeth, periodontist, bone + TMJ

A

bacterial

30
Q

types of infection in soft tissue

A

virus, bacteria + fungi

31
Q

types of infection in salivary glands

A

primary viruses

secondary bacteria

32
Q

3 methods of spread of orofacial infection

A
  1. venous
  2. lymphatics
  3. tissue/fascial planes
33
Q

how does pterygoid plexus + angular veins @ medial cants of eye allow brain infection

A

no valves

34
Q

into which superficial lymph nodes fo FOM, tip of tongue, lower lip + chin drain

A

submental

35
Q

into which superficial lymph nodes fo face, cheek, upper lips, anterior 2/3 of tongue drain

A

submandibular

36
Q

what are tissue spaces

A

not actually spaces
space between fascial planes + muscle attachments
full of connective tissue
CT destroyed by inflammation

37
Q

abscess in which tooth is most likely to cause palatal swelling?

A

lateral incisor

38
Q

how does infection spread if lower molar tooth perforated below mylohyoid?

A

goes below into submittal/submandibular - E/O swelling

39
Q

how does infection spread if lower molar tooth perforated above mylohyoid?

A

into FOM - I/O swelling

40
Q

what does all neck fascia lead to?

A

mediastinum

41
Q

5 consequences of spread of infection from tooth

A
  1. airway obstruction - Ludwig’s angina
  2. intracranial spread
  3. mediastinal infection
  4. necrotising fasciits
  5. sepsis
42
Q

what type of infection is hot potato voice common in

A

quinsy - peritonsillar abscess

43
Q

what is Ludwig’s cellultis

A

bilateral submandibular + sublingual cellulitis

can spread down through lateral pharynx space + larynx = oedema at glottis

44
Q

worrying signs + symptoms of intracranial spread of infection

A
  1. eye closure, altered movement, swelling

2. altered GCS

45
Q

2 complications of intracranial spread of infection

A
  1. cavernous sinus thrombosis

2. brain abscess

46
Q

rule for extra oral drainage to avoid mandibular branch of fascial nerve

A

2cm below inferior border of mandible

47
Q

what sort of epithelium lines maxillary antrum?

A

respiratory epithelium - cilia to allow drainage against gravity

48
Q

what connect maxillary sinus to nose?

A

osmium - allow drainage

49
Q

best imaging for maxillary sinus?

A

CT

50
Q

difference between OAC + OAF

A

OAF = epitheliased tract - takes 7-10days

51
Q

2 common causes of OAC

A

maxillary tuberosity damage

bony disruption

52
Q

instructions to patient after OAC

A

no nose blowing for 2/52
takes 2 weeks to epithelialize over
sneeze with mouth open - decreases sinus pressure
OHI

53
Q

what nasal decongestants can be used for OAC

A

ephedrine 0.5% - 1-2 drops a day

54
Q

if antibiotics for OAC/sinusitis

A

1st - amoxicillin

2nd - doxycycline

55
Q

how long should a splint/denture be warn for over OAC?

A

2 weeks

56
Q

3 surgical options of OAC

A

1st line = buccal advancement flap
2nd line = palatal advancement flap
3rd line = tongue flap

57
Q

why is slower LA better

A

more conc around nerve

58
Q

how long to inject IDB

A

1 min

59
Q

reasons for LA failure

A 
technique
pharmaceutical
treatment
anatomical
pathological
psychological
60
Q

anatomical reasons for LA failure

A

barriers to LA diffusion - dense cortical bone in mandible + zygomatic buttress upper 6s + PDL

anatomical variation

position of tooth - coring effect

accessory nerves

61
Q

how to remove mandibular accessory nerves

A

high block

62
Q

why does pathology affect LA success

A

alteration in pH
increased vascularity so LA removed faster
loss of LA via draining sinus
hyperalgesia

63
Q

2 types of high mandibular block

A

akinosi-vazarnai

gow gates

64
Q

which nerves for high mandibular blocks anaesthetise?

A

IAN, lingual, long buccal, mylohyoid, auricle temporal

not cervical - use buccal infil

Oral Diseases (14 decks)

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