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4th yr- CAD- Oral surgery > 3rd molar assessment > Flashcards

3rd molar assessment Flashcards

1
Q

What are problems with messy angular impaction of a third molar

A

Pericarditis

  1. Dental caries
  2. Periodontal disease
  3. Distal caries in second molars
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2
Q

Define symptoms

A

An indication of a disease noticed by a patient

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3
Q

Define sign

A

Observation by heath professional indicating disease or disorder

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4
Q

What problems can 3rd molars cause

A

Swelling
Caries
pericoronitis

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5
Q

What is pericoronitis

A

A partially erupted toothn covered by a large amount of soft tissue (operculum) that can get infected

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6
Q

How can we treat pericoronitis

A

Remove the tooth

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7
Q

What are the causes of pericoronitis

A
  1. Patients with compromised host defenses
  2. Minor trauma
  3. Food trapping under the operculum
  4. Bacterial infection
  5. Poor OH
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8
Q

List some signs and symptoms of pericoronitis

A
  1. Pain
  2. Halitosis
  3. Swelling
    4, Erythema
  4. Bad taste
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9
Q

What can happen if pericoronitis not treated

A
  1. Trismus
  2. Pyrexia
  3. Lymphadenopathy
  4. Malaise
  5. Dysphagia
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10
Q

List some spaces in the head that can get infected in a patient with untreated pericoronitis

A

Submandibular space
Sublingual space
Buccal space

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11
Q

What can pericoronitits be mistaken for

A

Tonsillitis

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12
Q

How can we differentiate between Pericoronitis and tonsillitis

A

Unilateral tonsil affected in Pericoronitis

Bi lateral tonsils affected then tonsillitis which requires antibiotics

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13
Q

What do we use to irrigate sockets

A

Saline

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14
Q

What are the benefits of saline

A

Body already makes it

Easy for patients to make at home

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15
Q

IF we suspect systemic involvement following pericoronitis what should we do

A

Prescribe antibiotics

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16
Q

Which antibiotics do we prescribe for systemic pericoronitis

A

Metronidazole 200mg TDS for 3/7

Amoxicillin 500mg TDS for 3/7

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17
Q

Why can some third molars be impacted

A

Due to an obstruction in their eruption path, pathology or lack of physical space

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18
Q

List the different types of impaction

A
  1. Partially erupted and partially covered by soft tissues
  2. Unerupted and completely covered by soft tissue
  3. Unerupted and covered by bone and soft tissue
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19
Q

When on average does a 3rd molar complete its eruption

A

20 but uptown 25

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20
Q

How are third molars classified

A

Classified by the position of their impaction

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21
Q

Name the different classification of 3rd molar impaction 1

A
  1. mesioangular
  2. Horizontal
  3. Vertical
  4. Distoangular
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22
Q

How common are Mesio angular 3rd molar impactions

A

25.5%

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23
Q

How common are horizontal 3rd molar impactions

A

4%

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24
Q

How common are vertical 3rd molar impactions

A

61.8%

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25
Q

How common are disto angular 3rd molar impactions

A

6.7%

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26
Q

Talk through the guidance of extractions of wisdom teeth given by NICE

A
  1. Unrestorable caries
  2. Non treatable pulpal and or periapical caries
  3. Cellulitis
  4. Abscess
  5. Osteomyelitis
  6. Internal / External resorption of the tooth or adjacent teeth
  7. Fracture of tooth
  8. Disease of the follicle inc cyst/tumour
  9. Tooth / teeth impeding surgery
  10. Reconstructuve jaw surgery
  11. Tooth is involved in the field of tumour resection
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27
Q

List some patient factors we must consider when assessing an oral surgery patient

A
  1. Age
  2. Social History
  3. Medical history
  4. Drug history
  5. BMI
  6. Ethnicity
  7. Capacity
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28
Q

List some surgical factors we must consider when assessing an oral surgery patient

A
  1. The tooth itself
  2. Periodontal status
  3. Surgical anatomy
  4. Systemic
  5. Mouth opening
  6. Adjacent strucutres
  7. Associated pathology
  8. TMJ
  9. Occlusal relationship
  10. Surgeons skill
29
Q

Why is important to consider age when assessing an oral surgery patient

A
  1. Medical complexity increases with age
  2. Increased complications after 30 years
  3. Mental health eg demential alzeimers
  4. Retained carious third molars more common in older patients
30
Q

What drugs do we need to look out for when assessing an oral surgery patient

A
  1. Anticoagulants
  2. Steroids
  3. Immunosuppressive
  4. Interactions
  5. Biphosphonates
  6. Antibiotics prophylaxis
31
Q

Why do we need to consider BMI WHEN assessing an oral surgery patient

A

Higher BMI linked with harder access and larger neck and oral cavity
Medical conditions such as diabetes
Metabolism and healing may be different in patients with higher BMI

32
Q

Which structures do we check when doing an extra oral examination

A
  1. Cervical lymphadenopathy
  2. Mouth opening
  3. TMJ
  4. Facial symmetry
  5. Facial swelling
  6. Trigeminal nerve
33
Q

Which structures do we check when doing an intra oral examination

A
  1. Soft tissues
  2. Hard tissues
  3. Status of second molars
34
Q

How can we come to a differential diagnosis

A
  1. Assess patients symptoms and signs

2. Radiological assessment

35
Q

Why do we need imaging when assessing third molars

A
  1. Check for presence of caires
  2. Conditions of existing resotrations
  3. Alveolar bone levels
  4. Rooth morpholgy
  5. Morphology of pulp chamber
  6. Signs of periodontal pathology
  7. Position of unerupted teeth or retained roots
  8. Other pathology of the jaws
36
Q

Which radiographs may we take to image third molars

A
  1. Peri-apical Radiograph
  2. Orthopantomogram
    (sectional or full)
  3. Cone Beam CT
37
Q

What does a periapicla radiograph show us

A

Shows individual teeth and apical area

Detailed information of the teeth, hard tissues and associated pathology

38
Q

Give some indications for a peri apical radiograph

A
  1. Detection of apical inflammation / infection
  2. Assessment of the periodontal status
    3, Post trauma
  3. un-erupted teeth
  4. Root morphology
    6, During endodontics
  5. Apical surgery
  6. Apical pathology
  7. Implants post op
39
Q

What are the disadvantages fo peri apical radiographs

A
  1. Technique sensitve
  2. Gag reflex
  3. Edentulous alveolar ridge
  4. Children
  5. Coperation
40
Q

Give some indications for am OPT

A
  1. Gross negelct
  2. Prior to general anaesthesia
  3. Oral surgery
  4. Orthodontics
  5. TMJ
41
Q

Do we have to take an OPT for every third molar impaction

A

NO

42
Q

Describe what cone beam CT can show us

A
  1. Thin slices with variable thickness
  2. Can be viewed in all planes
  3. Eliminates super imposition
  4. High contrast resolution
43
Q

What are some benefits fo cone beam CT

A
  1. Reduction in dose
  2. Short scan time
  3. High resolution
  4. Interactive software
44
Q

What are some issues surrounding CONE BEAM CTs

A

Issues with artefacts

45
Q

Should a cone beam CT be taken for every oral surgery patient

A

NO only take a CBCT if justified

46
Q

When might a CBCT be indicated

A

Where conventional radiographs show a close relationship between the mandibular third molar and the inferior alveolar canal

47
Q

What do we check to see if a radiograph is diagnostic quality

A
  1. Contrast and density
  2. Region of interest clearly visible
  3. Surrounding normal tissue
  4. No distortion
48
Q

Name the key areas to focus on in a radiograph

A
  1. Teeth
  2. Apical tissues
  3. Periodontal tissues
  4. Body and ramps of the mandible
49
Q

What should we do if we think we se something abnormal

A 
S.T.O.P
Site
Translucency 
Outline e
Previous imaging
50
Q

List some red flags we may see on a radiograph

A
  1. Loss of symmetry
  2. Apparent soft tissue mass
  3. Distorted anatomy- displacement of teeth with no obvious cause
  4. Teeth floating in air
  5. Relevant medical history and clinical correlation
51
Q

When looking at the tooth on a radiograph what do we assess

A
  1. Number of teeth present
  2. Stage of development
  3. Position
  4. Condition of the crown
  5. Condition of the roots
52
Q

If you see a lesion what should your description include

A
  1. Site or anatomical position
  2. Size
  3. Shape
  4. Outline
  5. Relative radiodensity and internal structure
  6. Effect on a adjacent structures
  7. Time present
53
Q

Relationship with which adjacent structures is it important to assess when looking at a third molar

A
  1. Maxillary antrum and tuberosity
  2. Inferior alveolar nerve and associated vessels
  3. Lingual nerves
  4. Mylogyoid nerve
  5. Long buccal nerve
54
Q

What can the mandibular canal be in close association with

A

The apices of the mandibular teeth

55
Q

List some signs on a plain film imaging which may suggest close/intimate relationship between the canal and the third molar

A
  1. Super imposition of the inferior alveolar nerve canal and third molar
  2. Diversion of the inferior alveolar nerve canal
  3. Darkening of the root where it is crossed by the canal and the widening of the canal
  4. Interruption of the white lines on the canal
  5. Darkening of the roots with associated widening of the canal
  6. Juxta apical area
56
Q

Where is the inferior alveolar artery positioned in relation to the nerve

A

Likely posrterior/postero-lateral to nerve

57
Q

Where is the inferior alveolar vein situated

A

Lateral to the bone

58
Q

Where is the inferior alveolar nerve situated

A

Likely anterior to the vessel

59
Q

What is the lingual

A

The tongue

60
Q

Can we see nerves on radiographic film

A

No but we can see canals

61
Q

What do we look at regarding roots

A
  1. Number of roots
  2. Curvature of roots
  3. Degree of root divergence
  4. Size and shape of roots
  5. Root resorption
  6. Caries
62
Q

Describe the most favourable type of roots

A

Fused or conical roots

63
Q

How does the bone determine the difficult of a third molar extraction

A

Bone density detainees difficulty

64
Q

Describe the bone in a patient under the age of 18

A
  1. Less dense
  2. Pliable
  3. Expands
  4. bends
  5. Easier to cut/ expand
65
Q

Describe the bone in a patient OVER the age of 35

A
  1. Much denser bone
  2. Decreased flexibility
  3. Decreased ability to expand
  4. Much bone removal required
  5. Higher risk of extraction
66
Q

List some predictors of difficulty

A
  1. Alveolar bone level
  2. Tooth positon
  3. Application depth
  4. Point of elevation
67
Q

List some factors which increase risk of complication

A
  1. Underlying systemic disease
  2. Age
  3. Anatomical post of tooth and root morphology
  4. Local anatomical relationships
  5. Status of adjacent teeth
  6. Access
  7. Patient co operation
  8. Bone density
  9. Infection
  10. Pathology
  11. Ankylosis
68
Q

What are the risks associated With all patients undergoing surgery

A
  1. Pain
  2. Swelling
  3. Bleeding
  4. Bruisng
  5. Infection
  6. Dry socket
  7. Difficulty opening
  8. Damage/ sensitive to adjacent teeth

4th yr- CAD- Oral surgery (8 decks)

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