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Y4 - CAD > Third molar assessment > Flashcards

Third molar assessment Flashcards

1
Q

for third molars, what age is the
- crown completed
- roots completed
- eruption

A

Crown completion 12-16 yo
Roots completed 18-25 yo
Eruption approx 19-20 yo

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2
Q

what problems can eruption of third molars cause
what can these issues lead to

A

failure of eruption/partial eruption/ectopic development
-> abnormal positioning of tooth

impaction against adjacent tooth
-> food packing
-> distal cervical caries
-> root resorption in the second molar
-> soft tissue pathology such as cysts

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3
Q

what do you use to classify the types of third molar impaction for a patient

A

diagnostic evaluation of radiographs

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4
Q

what are the 4 types of impaction in mandibular third molars

A

mesioangular (mesially-tilted) -> MOST COMMON IN MANDIBLE
horizontal (perpendicular to adj tooth) -> MOST COMMON IN MANDIBLE
vertical (almost parallel to adj tooth)
distoangular (distally-tilted)

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5
Q

what are the 3 types of impaction in maxillary third molars

A

mesioangular (medially-tilted)
vertical (almost parallel to adj tooth)
distoangular (distally-tilted) -> MOST COMMON IN MAXILLA

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6
Q

What is the difference between a symptom and a sign

A

Symptom- an indication of disease noticed by a patient
Sign- observations by a health professional indicating disease or disorder

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7
Q

List 4 examples of signs that can occur in third molars

A

pathological pocket depth
bleeding on probing
tenderness on palpation
radiographic features

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8
Q

List 4 examples of symptoms that can occur in third molars

A

pain
swelling
bad breath
difficulty chewing

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9
Q
  • what is pericoronitis
  • what is it caused by
  • rarity
A
  • an infection of the soft tissue around the crown of a partially erupted tooth
  • usually caused by normal flora n
  • common
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10
Q

what problems can occur in partially erupted/unerupted third molars

A
  1. pericoronitis
    -> if untreated can lead to infection
  2. caries
  3. pathology (cysts/tumours)
  4. resorption
  5. trauma
  6. orthognathic surgery
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11
Q

5 factors making you susceptible to pericoronitis

A
  • Compromised host defences e.g. diabetes/medication
  • ‘Trauma’ – often from opposing dentition
  • Food trapping under the operculum
  • Bacterial infection
  • Poor oral hygiene
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12
Q

Which 3 bacteria are involved in pericoronitis

A
  • Prevotella intermedia
  • Fusobacterium species
  • Anaerobic streptococci
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13
Q

5 local symptoms of pericoronitis

A

pain
halitosis
swelling
erythema
bad taste

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14
Q

5 systemic symptoms of pericoronitis (caused by progression of local symptoms)

A

trismus - difficulty opening mouth
pyrexia - raised body temperature
lymphadenopathy - (localised) swelling of lymph nodes
malaise - feeling sick
dysphagia - difficulty swallowing

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15
Q

3 local measures to manage pericoronitis

A
  • irrigation with saline/chlorhexidine
  • oral analgesia (paracetamol/NSAIDs if no C/l)
  • oral rinse (warm salt water/CXD mw - check sensitivities)
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16
Q

what is the issue with using chlorhexidine for irrigation as a local management technique

A

can cause anaphylactic reaction

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17
Q

5 systemic measures to manage pericoronitis

A
  • ABCDE
  • Irrigation with saline
  • Oral analgesia (paractemol / NSAIDs if no C/I)
  • Oral rinse warm salt water / CXD m/w – check sensitivities
    AND
  • Broad spectrum antibiotic for 5/7 days
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18
Q

what broad spectrum antibiotics can be taken for managing pericoronitis
how often should you take them

A

Amoxicillin 500mg TDS (3)
Penicillin V 500mg QDS (4)
Metronidazole 400mg TDS (3)

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19
Q

list an overview on how to assess for pericoronitis

A

c/o
history- socrates, MH
examination - EO, IO
investigation - vitality testing, radiographs
diagnosis
tx plan

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20
Q

what 3 different factors are important when assessing for pericoronitis

A

patient factors
surgical factors
operator/environment factors

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21
Q

8 patient factors you need to consider when assessing for pericoronitis

A

age
social history
medical history
drug history
BMI
ethnicity
capacity
anxiety

22
Q

why is age an important patient factor when assessing for pericoronitis

A

Increased morbidity with age
- physiological changes
- co-morbidities
- recovery period (older=longer)
- after 24yo complications with third molars increases significantly

23
Q

why is social history an important patient factor when assessing for pericoronitis

A

Smoking, vaping, alcohol, diet - all affect healing
Occupation - long term deployment
Access to care
Post-operative care

24
Q

why is drug history an important patient factor when assessing for pericoronitis

A

Steroids
Bisphosphonates
Biologics / Immunomodulators
Antiplatelets / Anticoagulants

affects healing/treatment/prognosis

25
Q

why is BMI an important patient factor when assessing for pericoronitis

A
  • higher BMI increases risk of diabetes, hypertension, CVD
  • people with higher BMI tend to have smaller mouths, therefore access is more difficult
26
Q

why is ethnicity an important patient factor when assessing for pericoronitis

A

afro-carribean tend to have denser bone

27
Q

why is capacity an important patient factor when assessing for pericoronitis

A

patients need capacity to consent for treatment

28
Q
  • why is anxiety an important patient factor when assessing for pericoronitis
  • how can you measure anxiety of a pt
A
  • more anxious pt=more difficult to tx
  • can measure anxiety with MDAS questionnaire
29
Q

6 surgical factors to consider when assessing for pericoronitis

A

third molar
periodontal status
surgical anatomy
mouth opening
adjacent structures
associated pathology

30
Q

why is the third molar itself an important surgical factor when assessing for pericoronitis

A

Can assess the clinical picture to see if
-> fully erupted/partially erupted
-> presence/absence of disease/infection

Helps with the early formation of a differential diagnosis

31
Q

why is imaging important when assessing for pericoronitis

A

Appropriate radiographic interpretation is used in combination with clinical information and other tests to formulate a differential diagnosis

32
Q

why is surgical anatomy an important surgical factor when assessing for pericoronitis

A

Inferior alveolar nerve - enters the mandible through the mandibular foramen, runs through the mandible from lingual to buccal and exits through the mental foramen- and supplies sensation to lower teeth gums, lower lip and skin of the chin

Inferior alveolar artery- likely runs posterior/postero-lateral to IAN

Inferior alveolar vein - no pattern can be 2 veins, lateral to the bone

Lingual nerve- runs alongside IAN but is superficial to it, supplies sensation to tongue and corded tympany (supplies taste to the tongue)
-> can sit high in soft tissues sometimes so need to be careful distal to mandibular third molar and lingual to the bone

Facial nerve

Trigeminal nerve

Need to be able to assess relationship of the apices of the tooth to the maxillary sinus

33
Q

what does it mean if you start to see blood pooling in the base of a mandibular third molar socket

A

very close to the nerve

34
Q

Acronym to report abnormal findings on radiographic imaging

A

SSSTOP

Site
Size
Shape
Translucent/opaque
Outline
Previous imaging (for comparison)

35
Q

Name 4 red flags on radiographic imaging

A
  • Loss of symmetry / apparent soft tissue mass
  • Distorted anatomy – displaced teeth
  • Bone erosions – look at anatomical margins
  • Teeth ‘floating’
36
Q

10 things to include on a radiographic report

A

➢ Presence of caries
➢ Condition of existing restorations
➢ Alveolar bone levels
➢ Root morphology
➢ Morphology of pulp chamber
➢ Signs of periodontal pathology
➢ Position of unerupted teeth or retained roots
➢ Other pathology of the jaws
➢ Form and quality of edentulous ridge and underlying bone
➢ Boundaries of relevant anatomical features

37
Q

4 aspects to particularly look at when reporting radiographic imaging for third molars

A

➢ Relationship to vital structures
➢ Configuration of roots
➢ Condition of the surrounding bone
➢ Apical e.g. pathology

38
Q

What are 4 vital structures near to mandibular third molars

A

lingual nerve
long buccal nerve
mylohyoid nerve
inferior alveolar nerve

39
Q

name 2 vital structures near to maxillary third molars

A

maxillary tuberosity
maxillary antrum

40
Q

7 high-risk abnormalities you may see on third molars on a plain-film radiograph

A

dark and bifid apex of root
deflection of root
narrowing of root
narrowing of canal
darkening of roots
interuption of white line of canal
diversion of canal

41
Q

if you see any of the 7 abnormalities on a plain-film radiograph

A

considered an intimate relationship
consider doing cone CBCT to visualise further

42
Q
  • What is a CBCT
  • Advantage of doing CBCT over plain-film radiograph
A

Advanced Cone Beam CT
plain film=2D, CBCT=3D imaging in coronal, sagit tal and axial planes

43
Q

What must be done before carrying out a CBCT

A
  • must be justified on an individual basis by demonstrating that the benefits to the patients outweigh the potential risk, images should potentially add new information to aid the patients management
  • history and clinical examination have been performed

‘routine’ imaging is unacceptable practice

44
Q

when assessing roots what 5 factors should you look at

A

➢ Number
➢ Curvature
➢ Degree of root divergence
➢ Size and shape of roots - bulbous, conical, long, short, hooked
➢ Other - root resorption, caries, ankylosis

45
Q

what is the difference in the bone of younger (e.g. <18yo) and older (e.g. >35yo) patients

A

Younger:
- Less dense
- Pliable
- Expands
- Bends
- Easier to cut / expand

Older:
- Much denser bone
- Decreased flexibility
- Decreased ability to expand
- More bone removal required
- Higher risk of fracture

46
Q

what does bone density determine in terms of extractions

A

difficulty
denser = more difficult

47
Q

why is access an important surgical factor when assessing for pericoronitis

A

good access to site=easier to operate

48
Q

why is depth of impaction an important surgical factor when assessing for pericoronitis

A

the deeper the impaction, the more complex the procedure

49
Q

name 11 factors that can increase the risk of complications with third molars

A
  • Underlying systemic disease
  • Increased age
  • Infection
  • Anatomical position of tooth/root morphology
  • Local anatomical relations
  • Status of adjacent teeth
  • Reduced access
  • Dense bone
  • Lack of PDL space – ankylosis
  • Pathology
  • Poor patient cooperation/compliance
50
Q

what is an operculum

A

a gum tissue flap covering a partially erupted wisdom tooth

Y4 - CAD (5 decks)

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