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CAD > Third Molars > Flashcards

Third Molars Flashcards

1
Q

What does the trigeminal nerve supply?

A

Sensation

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2
Q

What supplies the muscles of facial expression?

A

Facial nerve

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3
Q

What does the inferior alveolar nerve supply?

A

Sensation to all of the lower teeth, gingivae and exits through mental foramen, terminal branch supplies sensation to lip and chin.

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4
Q

Where does the mylohyoid nerve supply?

A

Tiny bit of skin on chin

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5
Q

What does the lingual nerve supply?

A

Sensation to the tongue - anterior 2/3rds

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6
Q

What does the chorda tympani supply?

A

Taste to anterior 2/3 of tongue

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7
Q

What is the lingula?

A

Variety of shapes - triangular, truncated and nodular
25% prominent lingula
Used in landmarks for blocks

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8
Q

What are high risk signs on radiographs for removal of third molars?

A
  • Deviation of canal
  • narrowing of canal
  • periapical radiolucent area
  • darkening of the root
  • narrowing of root
  • curved roots
  • loss of lamina dura
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9
Q

When looking at roots on a radiograph what signs are we looking out for?

A

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

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10
Q

If you see signs of a difficult extraction how would you manage this?

A

Take a CBCT scan

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11
Q

Why does age impact the condition of surrounding bone?

A

<18 - less dense, pliable, expands and bends and easier to cut
>35 - much denser, decreased flexibility, decreased ability to expand, more bone removal required and higher risk of fracture

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12
Q

What predicts difficulty?

A

Alveolar bone level, tooth position, application depth and point of elevation all dictate how much bone is required to be removed.

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13
Q

What increases complications?

A

Age, underlying disease, anatomical position of tooth and root, local anatomical relationships, status of adjacent teeth, access, patient co-operation and compliance, bone density, ankylosis, infection and pathology.

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14
Q

What can cause an OAC?

A

Closeness of tooth to the floor of the antrum, fractured tuberosity.

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15
Q

What is the best way to fix a fractured tuberosity before sending the patient to oral surgery?

A

Plug the hole with the tooth

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16
Q

How do you know when to stop when extracting an upper 8?

A

The soft palate starts to move or tear

17
Q

What else can happen in regards to the antrum and maxillary third molar?

A

It can get pushed up into the antrum with instruments

18
Q

What are treatment options for third molars?

A

Conservative management/monitor
Operculectomy
Complete extraction of third molar
Coronectomy

19
Q

What are risks?

A

Pain, bruising, bleeding, swelling, dry socket, damage to adjacent teeth, infection, loss/altered sensation, OAC/OAF, stiff jaw

20
Q

What must you warn a patient about when having mandibular third molar extractions?

A

Temporary or permanent loss/altered sensation to the lower lip, skin of chin, gums of lower teeth, lower teeth, tongue and taste.
Altered sensation may be painful (neuralgia) or a tingling sensation
- trismus
- time off work
- significant swelling and bruising which can spread to the neck/chest
- rarely hospital admission requiring treatment
Permanent <1% risk, temporary - 2-4% usually

21
Q

Why are risks increased using general anaesthetic over local?

A

Clinicians are less careful under GA

22
Q

Complications of maxillary third molar removal?

A

OAC/OAF development
Fractured tuberosity
Damage to adjacent teeth

23
Q

What is the best way to avoid compliations?

A

Good anaesthesia
Minimal trauma
Good tx planning
Anatomical knowledge

24
Q

Why would you do an operculectomy?

A

Enables oral hygiene to be effective
Often ineffective and sore so not really done

25
Q

What does surgical removal involve?

A

Cutting a flap and drilling bone to expose the impacted tooth

26
Q

What is the anaesthetic and analgesic protocol for surgical extractions?

A

Pre-op 400mg ibuprofen (no contra indications)
LA - ID block with lidocaine and buccal infiltration with 4% articaine
Check anaesthesia
Post op - 400mg ibuprofen TDS + 1g paracetamol QDS for at least 48 hours
Salt water rinses 4x a day for a week

27
Q

What are the principles of flap design?

A

Base > free margin
Width of base> length of flap
Axial blood supply
Preserving vital structures
Margins on sound bone
Uncomplicated closure

28
Q

How do you remove a vertically impacted tooth?

A

Drill down into the furcation and remove two separate bits of tooth and root

29
Q

How do you remove a horizontally impacted tooth?

A

Decoronate the tooth and lever out roots

30
Q

What plate of bone do we conserve most of?

A

Buccal plate

31
Q

Why don’t we use handpieces that produce air?

A

Don’t want air in the soft tissues that can lead to surgical emphysema

32
Q

What do you mention for post operative care?

A

Analgesics
No smoking or vaping for a week
Written and verbal instructions
Post op call next day
Written contact details for emergencies

33
Q

What is a coronectomy?

A

Removal of a crown from the roots of a healthy tooth in healthy patients indicated to prevent IA nerve injury in a high risk case ie for pericoronitis

34
Q

What are the guidelines for coronectomy?

A
  • NOT with infected teeth
  • NOT with mobile teeth
  • Leave retained root fragment at least 3mm inferior to the crest of bone
  • Leave exposed pulp
  • Late migration of root may occur but is unpredictable
    Operative site should be closed in tension free manner
    Dry socket treated in conventional way
35
Q

What are considerations for coronectomy?

A

Caries with pulpal involvement - potential infection risk
Apical disease - progressing to chronic disease
Mobility of roots - potential infection
Pathology eg cyst
Pre orthognathic surgery - in line of cuts
Immunocompromised - risk of infection
Pre-radiotherapy - risk of osteoradionecrosis

CAD (4 decks)

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