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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
prophylactic indication for 3rd molar removal
to prevent future disease or other problems
26
T/F: asymptomatic does NOT mean disease free
true
27
why might 3rd molars that have erupted into the mouth in a normal, upright position not be problem-free?
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
28
T/F: pathology is always present before symptoms appear
true
29
a 7 year study advised that even most 3rd that are asymptomatic and free of disease are at risk for what?
risk for chronic oral infections and tooth decay and should be considered for removal in young adulthood
30
indications for removal of 3rds
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
when does the crown of 3rd form?
~14 years
32
when does root of 3rd molars form?
approximately 50% by 16 years
33
average formation of 3rd molars is what age?
20 years and as late as 24 years
34
position of 3rd molars do not change substantially after how many years?
25 years
35
ideal patient with 3rd molars
1. 2/3rd root formation 2. 18-25 year old 3. healthy 4. no psychological contraindications 5. no job restrictions to "numb lip"
36
why is it better to remove 3rd molars around young adulthood?
1. young adult wisdom teeth have incomplete root systems 2. surgery less complicated 3. healing process quicker
37
why should you not remove 3rd molars at a young age?
mandible may grow to accommodate 3rd molars
38
what is the most common contraindications for removal of 3rds?
OLD AGE... no prophylactic removal 40+ year old
39
why is it a contraindication to remove 3rd molars at old age (>40)?
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
patients who have 3rd molars removed at old age (>40 yo) have an increased tendency toward what?
1. mandibular fracture 2. non-resolving parasthesisa 3. infection (osteomyelitis)
41
how often should you monitor old age patients with panoramic x-ray?
every 1-2 years
42
when should surgical intervention on old age patients with 3rd molars be done?
when there's clinical symptoms or radiographic signs
43
how to consult for 3rd molars
1. gather data in systematic fashion 2. physical exam 3. panorex exam 4. talking to your patient
44
most healthy 3rd molar patients benefit from what?
IVSA/GA
45
post-operative concerns
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
what should you document before going forward with 3rd molar extraction?
1. record probing depths 2. detailed clinical and radiographic findings 3. patient education 4. consent
47
what are some complications you should be aware of when extracting maxillary 3rd molars?
1. elevator extraction 2. buccal fat pad 3. sinus 4. infratemporal fossa 5. tuberosity 6. fusion with adjacent tooth
48
what should you be mindful of when designing flap for mandibular 3rds
"no man's zone"
49
controlled amounts of force should be along what when extracting mandibular 3rds?
long axis of tooth
50
what happens if you come across resistance when extracting mandibular 3rds?
remove more bone or divide the tooth into smaller segments
51
approach when extracting mandibular 3rds
1. elevate segments judiciously 2. elevate and deliver roots 3. carefully debride and inspect 4. osseous recontour 5. suturing
52
what should you do if a path of withdrawal does not exist when extracting mandibular 3rds?
remove more bone or section tooth
53
what should be used when suturing mandibular 3rds?
3-0 chromic
54
what happens if there are excessive sutures?
leads to excessive swelling so keep it minimal
55
how to suture
reapproximate passively with minimal tension
56
intraoperative complications with 3rd molar extractions
1. hematoma 2. gingival compromise 3. injury to adjacent teeth and osseous structures 4. lacerations 5. burns
57
maxillary intraoperative complications
1. infratemperoral fossa 2. tuberosity "tuberectomy" 3. oroantral communication
58
mandibular intraoperative complications
1. root tip out lingual plate 2. submandibular, lingual 3. nerve injury 4. fracture
59
what should you do if there's bleeding intraoperatively?
1. give local 2. bone wax 3. gelfoam 4. surgicel 5. pressure pack if needed
60
what to do if a sinus if perforated?
1. antibiotic 2. decongestants 3. Afrin nasal spray 4. written and verbal instructions 5. suture tight 6. follow-up
61
what to do if there's a nerve injury?
1. follow 2. document, document, document 3. steroid dose pack 4. neurosensory testing 5. when to refer? 6. malpractice
62
post-operative complications
1. dry socket 2. secondary bleeding 3. subperiosteal abscess 4. retained root tips 5. infection (very rare!)
63
how do you know if it's a dry socket?
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
what to do if there's secondary bleeding?
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
what to do if there's subperiosteal abscess?
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
when should a postoperative panorex be taken?
important when out more than one week and suddenly worse
67
osteomyelitis
odontogenic bacteria invade bone marrow causing inflammation and edema
68
osteomyelitis results in what?
ischemia and bone necrosis
69
osteomyelitis occurs more often in the mandible or maxilla?
mandible
70
why does osteomyelitis happen?
1. smokers 2. end-stage process of long wound healing 3. immunocompromised
71
acute osteomyelitis
1. duration <1 month 2. pain 3. minimal to no radiogrpahic changes
72
chronic osteomyelitis
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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