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Oral Surgery > Third Molars - Diagnosis & Management > Flashcards

Third Molars - Diagnosis & Management Flashcards

1
Q

What are some issues surrounding third molars?

A

Objective

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2
Q

What current guidelines exist for third molar surgery and what are some controversies?

A

Objective

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3
Q

What signs and symptoms are associated with third molars?

A

Aim

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4
Q

How do you diagnose and investigate third molars?

A

Aim

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5
Q

What are the treatment modalities for third molars?

A
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6
Q

What are the risks involved with third molar surgery?

A
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7
Q

What are some basic surgical principles in relation to oral surgery?

A

Aim

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8
Q

What are some surgical techniques for management of third molars?

A

Aim

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9
Q

Why do we in the uk not extract 3rd molars straight away?

A

?

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10
Q

What can cause impacted third molars?

A

Developmental anomaly
Obstruction in the eruption path
Ectopic position of the tooth
Ave eruption completion is 20yrs
Upto 25yrs

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11
Q

What does ectopic mean?

A

In an abnormal place or position

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12
Q

What are the different types of third molar impaction?

A

3 - types of impaction
1. Partially covered by soft tissues
2. Completely covered by soft tissues
3. Completely covered by bone

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13
Q

What are the different classifications of impacted third molars? (CAD and CP4 and CP5)

A
  1. Mesioangular - This is where the tooth is pointing mesially (25.5% visible)
  2. Distoangular - This is where the crown of tooth is tilting distally (Most complex, but least common) (6.7%)
  3. Horizontal - This is where the tooth is fully mesial horizontally (4%)
  4. Vertically impacted - This is where the tooth is vertical |(normal eruption path but something overlying it, for example could be either soft or hard tissue or sometimes both (61.8%)
  5. Transverse (dont see this often)
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14
Q

Are the impaction of maxilla the same as Mandibular?

A

Yes

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15
Q

How do you describe a impacted Third molar in a Radiogrpah?

A

Start by
1. Whether its acceptable or not acceptable
2. OPT taken for Third molars
3. Adult Dentition
4. Doesn’t seem restored or does seem restored
5. Type of impaction, any radiolucencies, Take a look at the ID nerve and Bone loss

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16
Q

What is the Difference between a Symptom and a sign?

A

Symptom: the indication of disease noticed by a pt
- e.g, Pain, swelling, restricted mouth opening, bad breath, difficult chewing

Sign: Observations by a health professional indicating disease or disorder
- Bleeding on probing, Pathological pocket depth,tenderness on palpation, Radiographic signs of pathology

17
Q

Why do we removed 3rd molars?

A

When the tooth gives us problems - most common is recurrent Pericoronitits
Other problems include, Cysts/Pathology. Malignant tumour. Trauma (fracture mandible in that area). Unrestorable caries, Peri-apical disease and abscess Orthognathic surgery (changing patients jaw bone to get a better occlusion). Osteomyelitis (

18
Q

What is periocoronitis and what causes it?

A

Peri - Around - Coron - crown - Itis - Inflammation
They start to erupt, food gets stuck (if left can cause infection) around the flap. Then they have pain and swelling.
Large amt of soft tissues
Operculum : Flap of gum the tooth is coming throug
DEFINITION An infection of the soft tissue around the crown of a partially impacted tooth usually caused by normal oral flora

19
Q

What causes pericoronitis?

A

1.Compromised Host defences ( cold, cough, UTI, Medication) - may give rise to normal microflora causing infection
2. Minor trauma from opposing maxillary dentition (Operculum)
3. Food trapping from under operculum
4. Bacterial infection - strep and anaerobes
5. Poor Oral Hygeine

20
Q

What are the signs and symptoms of Pericoronitis?

A

Presents with -> If not treated may lead to (Suggests systemic involvement - Needs antibx
1. Pain. 1. Trismus (Limited mouth opening from Inflammation of muscles of mastication
2. Halitosis. 2. Pyrexia (High temperature)
3. Swelling. 3. Lymphadenopathy (Swollen lymph nodes/glands) -> Can spread to media-sternum and causes sepsis
4. Erythema. 4. Malaise (discomfort)
5. Bad taste. 5. Dysphagia (Difficulty Swallowing) (Warning sign, consider referral)

21
Q

What should you consider if a patient arrived with swelling in their molars?

A

We need to know where the swelling is and which facial space is likely to be at risk. As the swelling will drain or progress into that space

22
Q

Which fascial spaces are at risk? And which muscles border these spaces?

A

Submandibular Abscess
- In submandibular space, bordered by mylohoid and platysma

Sublingual abscess
- Above mylohoid so elevated the floor of the mouth

Buccal Space infection
- within the buccal space, not spread into submandibular/sublingual
- visible as swelling in cheek

Could also be Bilateral of these! On both sides

23
Q

What would happen if a patient arrives with a Bilateral submandibular with huge swelling?

A
  • Ludwig’s Angina - Bacterial infection (cellulitis) that affects neck and floor of mouth
  • can affect ability to breath
  • cause for concern
  • could cause airway obstruction if left untreated
  • emergency tracheotomy performed

Submandibular and sublingual swellings are dangerous

24
Q

What do you do if patient arrives with peritonsillar abscess? (Tonsillitis)

A

This should be referred to ENT

25
Q

IS unilateral tonsillar issue bad>?

A

Yes, can push uvula to one side , could be tonsillitis or malignancy

26
Q

What would you do if patient presents with bilateral tpnsular abscess

A

Refer to gp for them to find a diagnosis who will probably prescribe with penicillin b (need to confirm)

27
Q

What is the first step of treatment for pericoronitis?

A

Local measure treatment such as - Warm Saline (Warm water with table salt) (Using a Monoject syringe)
Fire it underneath the operculum and eject should clean all rubbish out , in a week or so it will get better
Care with Chlorhexidine |(2 fatality’s due to anaphylaxis so need to make sure we check and be very cautious)
Analgesia -
For
-> Pain, Halitosis, Swelling, Erythema (Lesion of oral mucosa), Bad breath

28
Q

How would you treat pericoronitis if a patient presents with Trismus, Pyrexia, Lymphadenopathy, Malaise and dysphagia

A

Metronidazole (200mg, TDS for 3/7) or Amoxicillin 500mg TDS for 3/7

29
Q

What type of bacteria does Metronidazole tackle?

A

Specific for Anaerobic Bacteria, so if there’s a mixed infection it wont hit all the bugs.

30
Q

What type of bacteria does amoxicillin tackle?

A

Broad spectrum antibiotic Both anaerobes and aerobes but not as many anaerobes as metronidazole.

31
Q

If a patient has a really bad infection can you prescribe both metronidazole and amoxicillin?

A

Yes

32
Q

After prescribing antibiotics for pericoronitis the patient still has pain whys this and what can you do? (PERICORNOITIS in EXAMS)

A

If after 3 days not better, possibly got the wrong diagnosis, patient is not compliant (not taking them) or something else is going on which is going to be missed.

33
Q

When should you not prescribe metronidazole?

A

For patients taking anti-coagulants (med to help with blood clotting, cascade so that they don’t clot as easily, ore susceptible for prolonged bleeding) such as Warfarin or pt is alcoholics)

34
Q

What do the Nice guidelines say on the indications for Third molar removal? (Need to know list)

A
  1. Unrestorable caries
  2. Non-treatable pulpal and/or periapical pathology
  3. Cellulitis
  4. Abscess
  5. Osteomyelitis
  6. Internal/External resorption of the tooth or adjacent tooth
  7. Fracture of tooth
  8. Disease of the follicle inc cyst/tumour
  9. Tooth/Teeth impeding surgery
  10. Reconstructive jaw surgery
  11. Tooth is involved in the field of tumour resection

12 - separate from the nice guidelines - Distal caries or problems in the 7 - is an indication separate to NICE
Therefore NICE guidelines can be controversial (according to MONTGOMERY CONSENT) (FDS GUIDELINES ALSO SAY YOU HAVE A RESPONSIBILITY 2020)

35
Q

What patient factors would you look at for third molar assessment?

A

Age
Social history
Medical History
Drug History
BMI
Ethnicity
Capacity

36
Q

What surgical factors would you look at for third molar assessment?

A

The third molar
Systemic
Periodontal status
Surgical anatomy
Mouth opening
Adjacent structures
Associated pathology
TMJ
The operator

37
Q

What’s two things would you look at when it comes to third molar assessment

A

Patient factors, Surgical factors

38
Q

Why is age a factor in oral surgery?

A

Medical complexity usually
Increased complications on patients >25
Mental health (dementia,Alzheimer’s,Parkinson’s, post stroke IHD)
Retained carious teeth (inc third molars)
Bone quality

39
Q

Why is medical & drug history a factor in Oral surgery?

A

Anticoagulants
Steroids
Immunosuppressants (Immunological (addisons disease , multiple sclerosis and rheumatological diseases (Osteoartheritus)
Interactions
Bisphosphonates (Bisphosphonate-associated osteonecrosis of the jaw E.G, MRONJ (Medication-related osteonecrosis of the jaw)
Antibiotic Prophylaxis - (Administering antibiotics before performing surgery to help decrease the risk of postoperative infections)

Oral Surgery (1 decks)

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