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REVISION BDS > MOS minor oral surgery 327 (331) > Flashcards

MOS minor oral surgery 327 (331) Flashcards

1
Q

acetylsalicyclic acid

A

aspirin

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2
Q

why use aspirin

A

analgesic

superior anti inflammatory properties to paracetamol
but ibuprofen more commonly used

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3
Q

prostaglandings in pain

A

trauma and infection causes breakdown of membrane phospholipids producing arachidonic acid

arachindonic acid can be broken down to form prostaglandins

these sensitise the tissue to other inflammaotyr products e.g. leikotrienes = pain

therefore if prostaglandin reduction is descreased - pain moderated

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4
Q

mechanism of action of aspirin

A

reduced prostagland production

inhibits COX1 and COX2 (150x better at COX1)
* reduces platelet aggregation and predisposes to gastric mucosa damage

mainly peripherally acting agent

antipyretic
* reduces temp raising effect of IL-1 and brain levels of prostaglandings
* reduces elevated temp in fever
* doesn’t bring temp below normal if temp normal prior to taking drug

anti inflammatory
* vasodilators and therefore affect capillary permeability
* reduced redness, swelling and pain

metabolic
* BMR inc
* platelet aggregation dec
* prothrombin dec

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5
Q

adverse effects of aspirin

A

GIT problems -care with GORD and ulcer pts; PGE2 and PGI2 )inhibit glastic acid secretion, inc blood flow through mucosa)

hypersenitivity - acute bronchospasm, skin rashes, allergies

overdose - tinnitis, metabolic acidosis

mucosa aspirin burns

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6
Q

aspirin interaction

A

WARFARIN

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7
Q

aspirin and warfarin

A

enhances warfarin

displaces from binding sites on plasma proteins inc warfarin availability

warfarin is usually bound and inactive

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7
Q

aspirin and warfarin

A

enhances warfarin

displaces from binding sites on plasma proteins inc warfarin availability

warfarin is usually bound and inactive

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8
Q

aspirin and pregnancy

A

reduces platelets in baby
inc haemorrhage risk
jaundice risk
delayed labour
reye’s syndrome - causes liver and brain swelling, seizures and coma

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9
Q

steroid pts and aspirin

A

25% develop PUD

aspirin can cause perforation

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10
Q

aspirin and pts with renal or hepatic issues

A

aspirin is metabolised in liver and excreted by kidney - so reduce dose

nephrotoxicity - PGE2 and PGI2 made in kidney; if inhibited then reduced sodium retention, poor renal perfusion and failure may result

hyperkalaemia adn interstitial nephritis possible

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11
Q

G6PD deficiency and aspirin

A

gluc-6-phos dehydrogenase
med and african populations
can develop acute haemolytic anaemia
max aspirin dose 1g per day

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12
Q

max dose ibuprofen

A

2.4g daily in adults

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13
Q

iburpofen caution

A

previous or active PUD
elderly
pregnancy/lactation
renal/cardiac impairment
hypersensitivity
asthma
taking other NSAIDs
long term systemic steroids

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14
Q

overdose of ibuprofen signs

3

A

nausea
vomiting
tinnitus

activated charcoak if more than 400mg/kg in last hour

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15
Q

e.g. cox-2 selective

A

celecoxib

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16
Q

use of celecoxib

A

useful anti-inflammatory actions
fewer damaging GI actions
has fewer upper GI effects compared to non-selectives

all NSAIDs inc selective COX-2 inhibitors are contraindicated in active PUD

selective cox-2 inhibitor

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17
Q

use of celecoxib

A

useful anti-inflammatory actions
fewer damaging GI actions
has fewer upper GI effects compared to non-selectives

all NSAIDs inc selective COX-2 inhibitors are contraindicated in active PUD

selective cox-2 inhibitor

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18
Q

cox-2 selectives mech of action

A

COX-2 enzyme resposible for generation of inflammatory prostaglandins altought sometimes COX-1 involved

PGE2 is generated in low physiolcal amounts by COX1 in gastric tissues and has protective effect

prostaglandins esp PGE2 are generated in excessive amounts during inflammation via elevated COX2 levels
* prodcues inc vasodilation, inc vascular permeablity and sensitises pain fibre nerve endings to bradykinin, 5HT and other mediators

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19
Q

acetaminophen

A

paracetamol

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20
Q

paracetamol mode of action

A

simple analgesic without anti-inflammatory action

  • hydroperoxides generated from metabolism of arachidonic acid by COX and exert postive feedback to stimulate COX activity
  • feedback is blocked by paracetamol which indirectly inhibits COX esp in brain
  • helps reduce prostaglandin activity in the pain pathways of the CNS (e.g. thalamus)
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21
Q

effects of paracetamol

7

A
  • analgesic
  • antipyretic
  • little anti-inflammatory action
  • no effects on bleeding
  • no significate warfarin interaction
  • less irritant to GIT
  • suitable for kids
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22
Q

cautions for paracetamol

3

A

renal impairment
hepatic impairment
alcohol dependence

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23
Q

side effects of paracetamol

4

A

rashes
blood disorders
hypotension when infused
liver damage and less freq kidney damage with OD

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24
Q

possible interaction with paracetamol

4

A

cytotoxics
domperidone (antemetic/sickness)
lipid regulating drugs
metoclopramide (antiemetic)

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25
Q

max dose paracetmol

A

4g for adults (8x500mg tablets)

risk hepatic damage (hepatocellular necrosis) and renal tubular necrosis

may not present for several days after

send to A&E for assessment

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26
Q

signs paracetamol overdose

3

A

anorexia, nausea, vomitting
for early 24hrs

persistence of nausea and start abdo pain (right subcostal - indicate hepatic necrosis)

liver damage is max at 3-4days - jaundice, renal failure, haemorrhage, hypoglyceamia, encephalopahty, cerebral oedema, death

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27
Q

caution to pts with paracetamol

A

other preparation often contain e.g. night nurse, co-codamol, coproxamol

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28
Q

opioid analgesic used in dentistry

A

dihydrocodeine

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29
Q

dihydrocodeine qualities

A

acts in spinal cord- dorsum horn pathways and associated palei-spinothalamic pathway
* specific receptors which are closely associated with neuroanl pathways that transmit pain to CNS
* withdrawal from drug will lead to psychological cravings and pt will be ill

BNF states relatively ineffective in dental pain

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30
Q

opioid issues

A

tolerance and dependence

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31
Q

tolerance and opioids

A

pt build up tolerance, dose needs progressivly inc to have same effect

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32
Q

opiod effect on smooth muscle

A

constipation
urine and bile retention

33
Q

opioid side effects

A

constipation
vomitting
drowsiness
pupil constriction
tolerance and dependence
inc salivation

34
Q

opioid interactions

A

enhanced by alcohol
antidepressants and mono-amine oxide inhibitors
dopaminergics (parkinsons)

35
Q

dihydrocodeine caution with

A

hypotension
asthma
pregnancy/lactation
renal and hepatic disease
elderly and children
never in raised intracranial pressure or head injury

36
Q

overdose of opioid
signs
management

A

degrees of come, resp depression and pupil constriction

naloxone - antidotes to coma/bradypnoea (amount dependent on severity)

37
Q

carbamazepine is an

A

anti-epileptic/anti-neuropathic drugs

38
Q

carbamzepine uses in dental setting

3

A

trigeminal neuralgia
post herpetic neuralgia
functional, TMD, atypical facial pain

39
Q

dose for cabmazepine

A

100mg tablets
1 tablet, 2 times daily

send 20 tablets(10days)

build up from there

40
Q

dose for paracetamol

A

500mg tablets
2 tablets, 4 times a day

send 40 tablets (5 day)

41
Q

dose for ibuprofen

A

400mg tablets

1 tablet, 4 times a day

send 20 tablets (5day)

42
Q

what to do when pt on carbamazepine

A

monitor pts bloods and liver function - FBC and liver function tests

side effects of carbamazepine
* leukopenia
* dizziness
* ataxia
* drowsiness common

43
Q

contraindications to carbmazepine use

3

A

AV conduction abnormalities (unless paced)
history of bone marrow depression
porphyria

44
Q

other useful drugs for neuropathic pain

2
not on dental list

A

gabapentin
phenytoin

GMP or oral med

45
Q

common side effects of carbamazepine

4

A

leukopenia
dizziness
ataxia
drowsiness

46
Q

basic stages of surgery

10

A

consent (written)
anaesthesia
surgical access
bone removal as necessary
tooth division as necessary
procedure
debridement
suture
achieve haemostatsis
post op instructions and medications

47
Q

principels of surgical access

11

A
  • wide based incision (circulation)
  • scalpel in 1 firm continuous stroke
  • no sharp angles
  • adequately sized flap
  • flap retraction down to bone and done clearly
  • minimise trauma to ID papillae
  • no crushing
  • keep tissue moist
  • ensure flap margins and sutures on sound bone
  • ensure closure not under tension
  • aim for healing by primary tension -> minimise scarring
48
Q

purpose of soft tissue retraction

3
and how

A
  • access to operative field
  • protection of soft tissues
  • flap design facilitates retraction

dones with care using
* Howarth’s periosteal elevator
* rake retractor

49
Q

equipment for bone removal and tooth division

A

eletrical straight handpience with saline cooled bur
air driven handpiece - may lead to surgical emphysema

bur made of tungsten carbide
* round bur for buccal gutter
* fissure bur for separation

protect soft tissues and caution of nerves if bur slips

50
Q

priciples of elevator use

A

mechanical advantage, avoid excessive force

support instrument to avoid injury to pt should it slip
ensure applied force away from major structures e.g. antrum, IDC, mental nerve
always use in direct vision

movements
* wheel and axle
* wedge
* lever

51
Q

3 modes of surgical debridement

A

physical
* bone file or nibblers to remove sharp bony edges
* mitchell’s trimmer or victoria currette to remove soft tissue debris

irrigation
* sterile saline into socket and under flap#

suction
* aspirate under flap to remove debris
* check socket for retained apices etc

52
Q

aims of suturing

5

A
  • reposition tissues
  • cover bone
  • prevent wound breakdown
  • achieve haemostasis
  • encourage healing by primary intention
53
Q

types of suture

A

monofilament (monocryl R, nylon, prolene NR)
single stranded, pass easily through tissue, resistance to bacterial colonisation

polyfilament (vicryl R, silk NR)
severeal filaments twisted together, easier handling, prone to wicking

resorbable or non resorable (silk)

54
Q

peri-operative haemostasis

4

A

LA with vasoconstrictor
artery forceps
diathermy
bone wax

55
Q

post operative haemostatsis

5

A

pressure and damp gauze
LA infiltration
diathermy
surgicel - oxidised cellulose
sutures

56
Q

causes of tooth fracture

6

A

thick cortical bone
root shape and number (splayed, bulbous, kinks)
hypercementosis
ankylosis
caries
alignment

57
Q

difficult access causes

4

A

microstomia (small mouth)
scarring
tooth crowding
trismus

58
Q

abnormal extraction resistance causes

4

A

thick cortical bone
shape/form/no roots
hypercementosis
ankylosis

59
Q

causes for buccal alveolar plate fracture

A

3s and 6-8s

excess force

60
Q

fractures peri op situations

A

tooth
root
bone - maxilla tuberosity, mandible, alveolar plate

locate fracture and decide if need to go surigcal to get rest out
beware - sinus, IDC

61
Q

maxiallary tuberosity # aetiology

5

A
  • single standing molar
  • unknown unerupted 8
  • patholgical gemination
  • extraction in wrong order - should be back to front, lower then upper
  • inadequate alveolar support
62
Q

tx of maxillary tuberoisty #

A
  • remove/tx pulp
  • splint and ensure occlusion free
  • antibiotics and antiseptics
  • post op instructions
  • remove tooth 8 weeks later
63
Q

aetiology of mandible # peri op

A

impacted 8
large cyst/atrophic mandible
excessive force and inadequate support

64
Q

dx of oro-antral communication

7

A
  • radiographic position of roots in relation to sinus
  • bone came out with roots
  • bubbling of blood
  • nose holding test (can create an OAF)
  • direct vision
  • good light and suction - change in sound
  • probe - careful, avoid as can create
65
Q

management of OAC if small

A

post op instructions - avoid nose blowing, muscial instruments, straws, smoking

review

66
Q

managment of OAC if large

A

suture over
post op instruction
antibiotics cover?

67
Q

loss of tooth management

A

stop

where is it

suction

radiograph - into sinus/inhaled

68
Q

damage to nerves/vessels perio op can be by

4

A

crush
cutting/shredding
transection
from LA

may not know at the time

69
Q

neurapraxia

A

contusion of nerve/continuity of epineural sheath and axons maintained

70
Q

axontemesis

A

continuity of axons but not epineural sheath (disrupted)

71
Q

neurotemesis

A

complete loss of nerve

72
Q

anaesthesia

A

numbness

73
Q

paraesthesia

A

tingling

74
Q

dyseasthesia

A

unpleasant sensation/pain

75
Q

hypoaesthesia

A

reduced sensation

76
Q

hyperaesthesia

A

inc/heightened sensation

77
Q

dislocation of TMJ management

A

relocate immedaiated (analgesia and advice - support)
unable to relocated - try LA into masseter intraorally or referral A&E

muscle spasm

78
Q

how manage broken instruments peri op

A

stop
where
can retrieve?
radiograph?

79
Q

consent for XLA

A

pain, bleeding, brusing, swelling, infection
damage to adj teeth/restorations,
damage/extraction to developing tooth (if primary XLA)
temporary or permanent altered senation
jaw stiffness/fracture
need for another procedure/RR
sinus involvement - radiograph

REVISION BDS (43 decks)

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