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Oral Surgery 2 > Third Molars > Flashcards

Third Molars Flashcards

1
Q

impacted tooth

A

failure to fully erupt within the expected developmental time period

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2
Q

unerupted tooth

A

tooth not having perforated the oral mucosa

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3
Q

T/F: all unerupted teeth are impacted

A

false, not all

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4
Q

theories behind impacted 3rd

A
  1. differential root growth between mesial and distal
  2. inadequate arch space
  3. dental developmental lags skeletal development
  4. obstruction secondary to cyst, tumor, supernumerary teeth
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5
Q

winter’s classification of 3rd molars are based on what?

A

on inclination of impacted tooth to long axis of 2nd molar

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6
Q

winter’s classification of 3rd molars

A
  1. mesioangular
  2. distoangular
  3. horizontal
  4. vertical
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7
Q

what percent of mand 3rd molars according to winter’s classification is MESIOANGULAR?

A

43%

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8
Q

which mand 3rd molars are generally the easiest to extract?

A

mesioangular

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9
Q

what percent of mand 3rd molars according to winter’s classification is DISTOANGULAR?

A

6%

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10
Q

which mandibular 3rd molars are the most difficult to extract?

A

distoangular

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11
Q

what percent of mand 3rd molars according to winter’s classification is HORIZONTAL?

A

3%

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12
Q

T/F: mand horizontal 3rd molars are easy to extract

A

false, difficult

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13
Q

what percent of mand 3rd molars according to winter’s classification is VERTICAL?

A

38%

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14
Q

T/F: mand vertical 3rd molars are generally easy to extract

A

true

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15
Q

T/F: winter’s classification can be used to classify maxillary 3rds

A

true

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16
Q

what is the most common MAXILLARY 3rd?

A

vertical

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17
Q

what percent of maxillary 3rds are vertical?

A

63%

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18
Q

what is the 2nd most common MAXILLARY 3rd?

A

distoangular

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19
Q

what percent of maxillary 3rds are distoangular?

A

25%

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20
Q

what percent of maxillary 3rds are mesioangular?

A

12%

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21
Q

what percent of maxillary 3rds are horizontal?

A

rarely seen <1%

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22
Q

coding classification of 3rd molars

A
  1. soft tissue
  2. partial bony
  3. fully bony impaction
  4. complex, fully bony impaction
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23
Q

indication for 3rd molar removal

A
  1. therapeutic

2. prophylactic

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24
Q

therapeutic indication for 3rd molar removal

A

to treat a currently active process/disease

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25
Q

prophylactic indication for 3rd molar removal

A

to prevent future disease or other problems

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26
Q

T/F: asymptomatic does NOT mean disease free

A

true

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27
Q

why might 3rd molars that have erupted into the mouth in a normal, upright position not be problem-free?

A
  1. location intraorally makes them extremely difficult to keep clean
  2. bacteria that cause perio disease may exist in and around asymtomatic 3rd molars, leading to damage before symptoms appear
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28
Q

T/F: pathology is always present before symptoms appear

A

true

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29
Q

a 7 year study advised that even most 3rd that are asymptomatic and free of disease are at risk for what?

A

risk for chronic oral infections and tooth decay and should be considered for removal in young adulthood

30
Q

indications for removal of 3rds

A
  1. pericoronitis
  2. caries
  3. pathological resorption
  4. pathology
  5. eruption pain
  6. crowding
  7. post-orthodontic
  8. orthognathic surgery
  9. in line of a mandible fracture
  10. perio diseae
  11. lack of attached gingiva
  12. crowding
31
Q

when does the crown of 3rd form?

A

~14 years

32
Q

when does root of 3rd molars form?

A

approximately 50% by 16 years

33
Q

average formation of 3rd molars is what age?

A

20 years and as late as 24 years

34
Q

position of 3rd molars do not change substantially after how many years?

A

25 years

35
Q

ideal patient with 3rd molars

A
  1. 2/3rd root formation
  2. 18-25 year old
  3. healthy
  4. no psychological contraindications
  5. no job restrictions to “numb lip”
36
Q

why is it better to remove 3rd molars around young adulthood?

A
  1. young adult wisdom teeth have incomplete root systems
  2. surgery less complicated
  3. healing process quicker
37
Q

why should you not remove 3rd molars at a young age?

A

mandible may grow to accommodate 3rd molars

38
Q

what is the most common contraindications for removal of 3rds?

A

OLD AGE… no prophylactic removal 40+ year old

39
Q

why is it a contraindication to remove 3rd molars at old age (>40)?

A
  1. highly calcified bone
  2. less flexible bone
  3. recurperate more slowly
  4. if tooth ha been retained without sequellae, it may be less likely for problems to develop
40
Q

patients who have 3rd molars removed at old age (>40 yo) have an increased tendency toward what?

A
  1. mandibular fracture
  2. non-resolving parasthesisa
  3. infection (osteomyelitis)
41
Q

how often should you monitor old age patients with panoramic x-ray?

A

every 1-2 years

42
Q

when should surgical intervention on old age patients with 3rd molars be done?

A

when there’s clinical symptoms or radiographic signs

43
Q

how to consult for 3rd molars

A
  1. gather data in systematic fashion
  2. physical exam
  3. panorex exam
  4. talking to your patient
44
Q

most healthy 3rd molar patients benefit from what?

A

IVSA/GA

45
Q

post-operative concerns

A
  1. expected recovery period of 3-4 days
  2. expected mild-moderate pain
  3. expected mild-moderate swelling to peak at day 3 and decrease after
  4. expected to feel lousy
46
Q

what should you document before going forward with 3rd molar extraction?

A
  1. record probing depths
  2. detailed clinical and radiographic findings
  3. patient education
  4. consent
47
Q

what are some complications you should be aware of when extracting maxillary 3rd molars?

A
  1. elevator extraction
  2. buccal fat pad
  3. sinus
  4. infratemporal fossa
  5. tuberosity
  6. fusion with adjacent tooth
48
Q

what should you be mindful of when designing flap for mandibular 3rds

A

“no man’s zone”

49
Q

controlled amounts of force should be along what when extracting mandibular 3rds?

A

long axis of tooth

50
Q

what happens if you come across resistance when extracting mandibular 3rds?

A

remove more bone or divide the tooth into smaller segments

51
Q

approach when extracting mandibular 3rds

A
  1. elevate segments judiciously
  2. elevate and deliver roots
  3. carefully debride and inspect
  4. osseous recontour
  5. suturing
52
Q

what should you do if a path of withdrawal does not exist when extracting mandibular 3rds?

A

remove more bone or section tooth

53
Q

what should be used when suturing mandibular 3rds?

A

3-0 chromic

54
Q

what happens if there are excessive sutures?

A

leads to excessive swelling so keep it minimal

55
Q

how to suture

A

reapproximate passively with minimal tension

56
Q

intraoperative complications with 3rd molar extractions

A
  1. hematoma
  2. gingival compromise
  3. injury to adjacent teeth and osseous structures
  4. lacerations
  5. burns
57
Q

maxillary intraoperative complications

A
  1. infratemperoral fossa
  2. tuberosity “tuberectomy”
  3. oroantral communication
58
Q

mandibular intraoperative complications

A
  1. root tip out lingual plate
  2. submandibular, lingual
  3. nerve injury
  4. fracture
59
Q

what should you do if there’s bleeding intraoperatively?

A
  1. give local
  2. bone wax
  3. gelfoam
  4. surgicel
  5. pressure pack if needed
60
Q

what to do if a sinus if perforated?

A
  1. antibiotic
  2. decongestants
  3. Afrin nasal spray
  4. written and verbal instructions
  5. suture tight
  6. follow-up
61
Q

what to do if there’s a nerve injury?

A
  1. follow
  2. document, document, document
  3. steroid dose pack
  4. neurosensory testing
  5. when to refer?
  6. malpractice
62
Q

post-operative complications

A
  1. dry socket
  2. secondary bleeding
  3. subperiosteal abscess
  4. retained root tips
  5. infection (very rare!)
63
Q

how do you know if it’s a dry socket?

A
  1. fetid breath
  2. very bad pain - radiates to ear
  3. 3-5 days post-op
  4. female
  5. > 40 y.o
  6. steroids
  7. prior infection
  8. long operative time
64
Q

what to do if there’s secondary bleeding?

A
  1. suction oral cavity
  2. examine site
  3. apply pressure for 5 minutes
  4. local
  5. curettage
  6. identify and control source of bleeding
  7. monitor for 15 minutes before discharge
65
Q

what to do if there’s subperiosteal abscess?

A
  1. collection of purulence between periosteum of flap and bone
  2. 2-3 weeks post op
  3. flap and irrigate
  4. abx
  5. poor local anesthesia
66
Q

when should a postoperative panorex be taken?

A

important when out more than one week and suddenly worse

67
Q

osteomyelitis

A

odontogenic bacteria invade bone marrow causing inflammation and edema

68
Q

osteomyelitis results in what?

A

ischemia and bone necrosis

69
Q

osteomyelitis occurs more often in the mandible or maxilla?

A

mandible

70
Q

why does osteomyelitis happen?

A
  1. smokers
  2. end-stage process of long wound healing
  3. immunocompromised
71
Q

acute osteomyelitis

A
  1. duration <1 month
  2. pain
  3. minimal to no radiogrpahic changes
72
Q

chronic osteomyelitis

A
  1. > 1 month
  2. dull discomfort
  3. paresthesia
  4. moth eaten appearance of bone on film

Oral Surgery 2 (13 decks)

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