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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
difference between bacteraemia + septicaemia
bacteraemia = bacteria in blood stream ranged by immune system septicaemia = actively dividing bacteria's in blood stream, leading to SIRS + hypovolemic shock
26
4 vital signs of infection
1. pyrexia >38.3 or hypothermia <36 2. tachC >90bpm 3. tachyP >20RR 4. WCC <4 or >12
27
5 signs of infection
1. vital signs 2. airway 3. eyes - swelling 4. specialist environment - FBC, lactate, U&E, CRP +/- coagulation screen 5. culture + sensitivity - aspirate > swab
28
4 stages of treatment of surgical infection
1. remove cause 2. institue drainage 3. prevent spread 4. restore function
29
type of infection in teeth, periodontist, bone + TMJ
bacterial
30
types of infection in soft tissue
virus, bacteria + fungi
31
types of infection in salivary glands
primary viruses | secondary bacteria
32
3 methods of spread of orofacial infection
1. venous 2. lymphatics 3. tissue/fascial planes
33
how does pterygoid plexus + angular veins @ medial cants of eye allow brain infection
no valves
34
into which superficial lymph nodes fo FOM, tip of tongue, lower lip + chin drain
submental
35
into which superficial lymph nodes fo face, cheek, upper lips, anterior 2/3 of tongue drain
submandibular
36
what are tissue spaces
not actually spaces space between fascial planes + muscle attachments full of connective tissue CT destroyed by inflammation
37
abscess in which tooth is most likely to cause palatal swelling?
lateral incisor
38
how does infection spread if lower molar tooth perforated below mylohyoid?
goes below into submittal/submandibular - E/O swelling
39
how does infection spread if lower molar tooth perforated above mylohyoid?
into FOM - I/O swelling
40
what does all neck fascia lead to?
mediastinum
41
5 consequences of spread of infection from tooth
1. airway obstruction - Ludwig's angina 2. intracranial spread 3. mediastinal infection 4. necrotising fasciits 5. sepsis
42
what type of infection is hot potato voice common in
quinsy - peritonsillar abscess
43
what is Ludwig's cellultis
bilateral submandibular + sublingual cellulitis can spread down through lateral pharynx space + larynx = oedema at glottis
44
worrying signs + symptoms of intracranial spread of infection
1. eye closure, altered movement, swelling | 2. altered GCS
45
2 complications of intracranial spread of infection
1. cavernous sinus thrombosis | 2. brain abscess
46
rule for extra oral drainage to avoid mandibular branch of fascial nerve
2cm below inferior border of mandible
47
what sort of epithelium lines maxillary antrum?
respiratory epithelium - cilia to allow drainage against gravity
48
what connect maxillary sinus to nose?
osmium - allow drainage
49
best imaging for maxillary sinus?
CT
50
difference between OAC + OAF
OAF = epitheliased tract - takes 7-10days
51
2 common causes of OAC
maxillary tuberosity damage | bony disruption
52
instructions to patient after OAC
no nose blowing for 2/52 takes 2 weeks to epithelialize over sneeze with mouth open - decreases sinus pressure OHI
53
what nasal decongestants can be used for OAC
ephedrine 0.5% - 1-2 drops a day
54
if antibiotics for OAC/sinusitis
1st - amoxicillin | 2nd - doxycycline
55
how long should a splint/denture be warn for over OAC?
2 weeks
56
3 surgical options of OAC
1st line = buccal advancement flap 2nd line = palatal advancement flap 3rd line = tongue flap
57
why is slower LA better
more conc around nerve
58
how long to inject IDB
1 min
59
reasons for LA failure
``` technique pharmaceutical treatment anatomical pathological psychological ```
60
anatomical reasons for LA failure
barriers to LA diffusion - dense cortical bone in mandible + zygomatic buttress upper 6s + PDL anatomical variation position of tooth - coring effect accessory nerves
61
how to remove mandibular accessory nerves
high block
62
why does pathology affect LA success
alteration in pH increased vascularity so LA removed faster loss of LA via draining sinus hyperalgesia
63
2 types of high mandibular block
akinosi-vazarnai | gow gates
64
which nerves for high mandibular blocks anaesthetise?
IAN, lingual, long buccal, mylohyoid, auricle temporal not cervical - use buccal infil

Oral Diseases (14 decks)

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