Unit 310 Flashcards
Examples of major oral surgery?
treatment and reconstructive surgery for oral cancer
orthognathic surgery to correct skeletal problems
head and neck trauma surgery
During MOS treatments what is the dental nurses main role?
reassurance and monitoring of the patient
Replacements after extractions:
bridge, denture, implant
Why may an extraction be necessary?
tooth is causing infection and pain due to gross caries, periodontal disease or trauma
Why may a tooth need to be removed for orthodontic reasons?
poorly positioned to be aligned with ortho treatment, provide space in the dental arch for movement
What does bacteraemia mean?
infection has spread into the blood stream - patient generally unwell
raise of concern with elderly and medically compromised patients
How does a dentist decide on the complexity of an extraction procedure?
what tooth is involved
how many roots
roots curved
position in the jaw bone - near any sinuses?
What does root resorption mean?
the progressive loss of part or parts of the tooth due to odontoclasts.
What are odontoclasts?
a cell, that is responsible for breaking down the roots of deciduous teeth so they will eventually fall out.
What is considered with deciduous tooth extractions:
has root resorption occurred, is the underlying permanent tooth present could it be damaged during xla?, infection present?, age and co-operation may they need to be referred?.
What is considered with permanent tooth extractions:
infection present?, medications, co-operation adult patients with special needs may need sedation, age older patients have more friable soft tissues, grossly carious tooth is likely to need surgical.
What are simple extractions?
the tooth or root is removed whole from the dental arch without any surgical procedures.
How is a tooth actually extracted during simple extractions?
it is pushed out of the socket by the root.
What are forceps used to do?
Grip a tooth or root at its neck before applying appropriate wrist actions to loosen the tooth/root in its socket.
What are luxators used to do?
widen the socket and sever the periodontal ligament attachment.
What are elevators used to do?
prise the tooth/root out of the socket
e.g. cryers, warwick james, winters
What are fine bore aspirators?
disposable narrow suction tips used to suck away all the blood + tooth debris and maintain good moisture control
What are haemostats?
Gelatine sponges or oxidised cellulose packs that are inserted into the socket after extraction to aid blood clotting and achieve haemostasis.
How to tell if a forcep is upper?
Handles and blades roughly in line with each other
How to tell if a forcep is lower?
right angles to each other for easier access to the lower arch
How to tell if a forcep is for multirooted molar teeth?
blades that are shaped like beaks so they can grip the FURCATION area between the roots
How to tell if a forcep is for single rooted tooth?
Smooth blades
Upper incisor and canine forceps look like:
straight with single rounded blades and have both wide and narrow patterns
Upper root forceps look like:
similar to upper incisor and canines but have narrow straight blades
Upper pre-molar forceps look like:
slightly curved handles and single rounded blades
Upper left molar forceps:
curved handles and a beaked blade to the right of the instrument and a rounded blade to the left to grip the buccal/palatal roots “beak to cheek”
Upper right molar forceps:
curved handles and the beaked blade is to the left of the instrument
Upper bayonet forceps:
third molars
extended handles and angled blades or have angled pointed blades to gain access to fractured roots.
Lower anterior forceps:
single rounded blades at right angles to the handle that are particularly useful for extracting lower premolars.
Lower root forceps:
similar to anterior with narrow and straight blades that are also useful for extracting small/crowded incisors
Lower molar forceps:
beaked blades at right angles to the handles to grip the furcation of two roots
Lower cowhorn forceps:
curved and pointed blades at right angles to the handles
MOLAR teeth
What does furcation mean?
the area where the roots divide and branch into multiple teeth at a time
What are elevators specifically used to elevate?
retained roots and impacted teeth where access to the root or tooth is not possible with forceps
Cryers elevators:
left and right patterns
can be used on either side depending whether they are engaged mesially and distally.
tips are triangular and pointed
Winters elevators:
Similar bladed design as cryers but have a cork scew styled handle to give more leverage
Warwick james elevators:
Left, right and straight patterns
tips are similar to the round blade of forceps
Couplands chisel:
single bladed chisel, available for splitting multirooted teeth.
A bite pack is placed over the socket and the patient is asked to bite on this for how long?
30 minutes
What does haemostasis mean?
stop the bleeding
Within a bite pack there is a gauze covering what is the reason for this?
to prevent wool fibres becoming stuck in the blood clot as it forms.
What does the “no touch” technique of dental instruments help maintain?
infection control
Throughout an extraction procedure what will the dental nurse check for?
any signs of distress to notify the dentist
When extraction instruments are being used the nurse may be required to stabilise the patients head or mandible.
Whichever technique is used to extract a tooth or root is considered a surgical one. So if the working area is not treated as a sterile field what could happen?
risk of cross infection
What precautions are taken by the dental team to prevent cross infection during an extraction?
Sterile bagged instruments, PPE, disposable items, sterile field
suction equipment - should be ran through immediately after procedure with required disinfectant solution to remove all traces of blood from its inner workings
During an extraction the chair should be covered with a single use impervious membrane (e.g chair sleeve) why?
to prevent blood contamination
In regards to decontamination after extraction with instruments before placing them in the autoclave to sterilise what should they go in first?
washer disinfector unit or an ultrasonic bath
Preoperative instructions:
LA, aspirin is not advised to be taken prior extraction due to the prevention of blood clotting, light snack prior, if the patient is nervous they should bring a friend or family member to put them at ease.
How should postoperative instructions be given?
verbally and written
Postoperative complications tend to occur because of what?
disturbance to the blood clot that forms in the area
Postoperative instructions:
pain swelling bruising, analgesics may be taken as normal other than ASPIRIN, alcohol exercise and hot drinks should be avoided for 24 hours, hot salt mouth rinses should be carried out the next day for up to 1 week, bite packs provided with instructions, emergency phone number incase complications occur (attend A&E, 999)
What procedures are referred to as surgical?
removal of soft tissue alone or soft tissue and alveolar bone to gain access to tooth/root.
Multi-rooted tooth may need to be dissected into sections with a single root attached then extracted separately.
Why may surgical extractions be necessary?
retained root left in the alveolar bone, grossly carious, roots are curved, tooth is partially erupted and impacted, tooth is unerupted but has associated pathology e.g. cyst.
What does ankylosed mean?
deciduous tooth has failed to exfoliate because the root has become cemented to the alveolar bone and natural exfoliation cannot occur.
Surgical extractions fall into what categories?
-soft tissue exposure
-tooth sectioning
- raising of a mucoperiosteal flap
What differs surgical extractions to simple?
the list of instruments
Extractions involving soft tissue exposure- retained roots?
when a section of root remains after a previous extraction, the surrounding gingivae will grow over the stump. Bone will NOT regrow over the stump. So when a denture is placed it may be tender during chewing for the patient.
Implants - when a radiograph is taken an implantologist will decide on surgical removal
Following a soft tissue exposure extraction a radiograph is taken to see what?
the position of the retained root.
For edentulous patients a location device should be used- lead foil from an x-ray packet molded around an available tooth to locate
Soft tissue exposure procedure:
2 sided incision on top of the retained root, luxator is used, forceps are NOT used, incision is then closed after removal using sutures.
Extractions involving tooth sectioning - multi-rooted teeth?
Unfavourable root curvature or gross root caries that prevents simple forceps removal of roots.
Sometimes it may be necessary to remove some of the septal bone that lies between the roots and forms the individual socket walls.
Extractions involving tooth sectioning procedure:
use of high speed turbine and diamond bur (usually crown prep)
couplands chisel to achieve final separation of roots
surgical handpiece and bone burs to remove any septal bone
Extractions involving mucoperiosteal flaps
unerupted or impacted tooth
buried retained root
root curvature requires extensive bone removal
gross root caries
What is the mucoperiosteal flap?
teeth lie in sockets of alveolar bone with a covering of mucoperiosteum over the bone that runs into the gingivae around each tooth.
The mucoperiosteal flap has to be sutured back into place how long can it take for the reattachment to occur?
7 days
Patients with a compromised medical history may require the surgical procedure to be carried out in a hospital or dental clinic environment.
What does an osteotrimmer do?
raises the corners of the mucoperiosteal flap off the underlying alveolar bone.
During surgical procedures what type of irrigation is used?
saline