tooth extraction under local anaesthesia

Question 1

what is oral surgery

Answer 1

The diagnosis and management of pathology of the mouth and jaws the require surgical intervention

Question 2

List some indications for exodontia

Answer 2

1. Caries
2. Pulpal necrosis
3. Periodontal disease
4. Orthodontic treatment
5. Infection
6. Trauma
7. Radiotherapy
8. Pathology
9. Dental anomalies

Question 3

List soem contra indications for exodontia

Answer 3

1. Suspicious lesions
2. No diagnosis
3. Acute inflammation
4. Infection

Question 4

What patient factors do we need to consider when looking at a patient who needs teeth extracted

Answer 4

1. Age
2. General health
3. Anxiety
4. BMI

Question 5

Why do we need to consider age when thinking about extraction teeth

Answer 5

Increased age increases chances of complications
Neoplasia
Medical complexities more prevalent in elderly patients

Question 6

List some drugs that may make us hesitant to carry out exodontia

Answer 6

1. Anticoagulants
2. Steroids
3. Biphosphonates
4. Immunosuppressants

Question 7

What operator factors do we need to consider before carrying out an extraction

Answer 7

1. Competence
2. Experience
3. Environment
4. Assistance

Question 8

What surgical factors do we need to consider before carrying out an extraction

Answer 8

1. Access- does the mouth open sufficiently
2. Imagining of the bone, tooth, surrounding structures and surgical anatomy
3. Associated pathology
4. Clinical picture of the tooth

Question 9

During an extra oral assessment what do we need to look for

Answer 9

1. Cervical lymphadenopathy
2. Mouth opening
3. TMJ
4. Facial asymmetry
5. Facial swelling
6. VII and V nerves

Question 10

During an intra oral assessment what do we need to look for

Answer 10

1. Soft tissues (tongue, FOM, buccal mucosa etc)
2. Hard tissues ‒ dentition
3. Focus on area in question
4. Special tests

Question 11

When carrying out an exam what other factors may you find that may be a contra indication for exodontia

Answer 11

1. Thick dense bone
2. Short clinical crowns
3. Signs of attrition
4. Hyper cementosis
5. Long divergent roots
6. Extensive caries, root caries, large amalgom restorations
7. Deciduous teeth in permanent dentition

Question 12

List some red flags we might see on an X-ray

Answer 12

Loss of symmetry
Distorted anatomy
Bone erosion
Teeth floating in air

Question 13

Name the 2 chemical structures that LA can have

Answer 13

1. Esters
2. Amides

Question 14

What is LA usually made up of

Answer 14

A drug and vasoconstrictor

Question 15

What is the benefit of having a vasoconstrictor

Answer 15

Increased speed of onset
Extends duration
Increased depth of anaesthesia
Reduction of intra operative haemorrhage

Question 16

Name a Sympathomimetic Amine

Answer 16

Adrenaline

Question 17

What does adrenaline do

Answer 17

1. Increases rate and force of contraction of heart
2. Increases blood pressure and cardiac output
3. Vasoconstrictor

Question 18

Name a synthetic polypeptides

Answer 18

Felypressin

Question 19

What does Felypressin do

Answer 19

1. Vascular smooth muscle contraction
2. Coronary artery vasoconstriction
3. Oxytoxic effects on uterus

Question 20

Name the most common LA we use

Answer 20

2% lidocaine with 1:80,000 adrenaline

Question 21

What is the max dose of 2% Lidocaine with 1:80,000 Adrenaline we can give

Answer 21

max dose 4.4mg per kg

Question 22

Describe what happens in the first week as the tooth socket is healing

Answer 22

1. White blood cells remove bacteria and break down debris
2. Fibroplasia begins
3. Ingrowth of fibroblasts and capillaries
4. Epitheiulm migrates down socket wall
5. Osteoclast accumulate along crestal bone

Question 23

Name the 4 phases of acute wound healing

Answer 23

1. Hemostasis
2. Inflammatory phase
3. Proliferative phase
4. Remodelling phase

Question 24

When extracting a tooth what structures do we need to be aware of

Answer 24

1. Periodontal ligament
2. Bone
3. Socket expansion

Question 25

How do we carry out extraction

Answer 25

1. Expansion of the alveolar socket
2. Separation of attachment of periodontal ligament
3. Controlled force: Luxators, Elevators, Forceps
4. Expand (fracture) alveolar socket
5. Avoid damage to the adjacent structures / local anatomy

Question 26

What do we need to check after extracting a tooth

Answer 26

1. Check apices
2. Check socket
3. Gain haemostasis