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Minor Oral Surgery > SIGN guidelines > Flashcards

SIGN guidelines Flashcards

1
Q

When are there strong indications for the removal of 3rd molars according to NICE guidelines ?

A
  • recurrent episodes of infection such as pericoronitis, cellulitis, abscess formation or untreatable pulpal/periapical pathology
  • caries in the third molar and tooth unlikely to be restored
  • caries in 2nd molar which is unrestorable without removal of 3rd molar
  • periodontal diseas due to position of 3rd molar and associatio with the 2nd molar tooth
  • dentigerous cyst formation or related oral pathology
  • external resorption of the 3rd molar or 2nd molar where it appears to be caused by the third molar
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2
Q

When is the removal of unerupted and impacted molars advisable according to NICE guidelines?

A
  • significant infection associated with unerupted or impacted 3rd molar teeth
  • patients with predisposing risk factors whose occupation or lifestle precludes ready access to dental care (e.g. astronauts, submarine engineers)
  • in patients with a medical condition when the risk outweighs the associated removal of 3rd molars e.g. prior to radiotherapy or cardiac surgery
  • patients who have agreed to tooth transplant procedure, orthognathic surgery or other relevant local surgical procedures
  • where GA is to be administered for the remobval of at least one 3rd molar; consideration should be given to simultaneous removal of contralateral 3rd molars
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3
Q

Outline other indications for removal of 3rd molars

A
  • autogenous transplantation to a first molar socket (first molar is lost)
  • in cases of fracture of the mandible in the 3rd molar
  • 3rd molar involved in tumour resection
  • unerupted 3rd molar in atrophic mandible
  • prophylactic removal of partially erupted 3rd molar
  • atypical pain from unerupted 3rd molar
  • partially erupted or unerupted third molar, close to the alveolar surface prior to denture construction or close to planned implant
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4
Q

What differential diagnoses for atypical pain in the 3rd molar region must you rule out before considering removal?

A
  • TMJ pain
  • muscle dysfunction
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5
Q

Following radiographic examination, what information should be noted with regards to characteristics of the 3rd molar?

A
  • type and orientation of impaction and access to the tooth e.g. distinction between vertical and disto-angular orientation may affect surgical approach with regards to requirements for bone removal
  • crown size and condition
  • root number and morphology; including presence of apical hooks
  • alveolar bone level; including depth and point of elevation and density
  • follicular width
  • periodontal status, together with that of adjacent tooth
  • relationship or proximity of upper 3rd molars to maxillary sinus and lower 3rd molars to mandibular canal
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6
Q

What interim measures can be taking in preparation of surgical removal of 3rd molars to mitigate post-operative complications?

A
  • systemic antibiotic administration
  • chlorhexidine mouth rinses
  • operculectomy
  • local dressing
  • Lavage
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7
Q

When is it particularly important to use resorbable sutures?

A

where no review is planned

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8
Q

When are antibiotics appropriate for the management of 3rd molar removals ?

A
  • acute infection at time of operation
  • significant bone removal
  • prolonged operation
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9
Q

When should pre-operative steroids be considered for use ?

A

when there is risk of significant post-operative swelling

(antiinflammatory effects of steroids)

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10
Q

Where there are signs of systemic involvement, __________ should be prescribed

pyrexia
lymphadenopathy

A

Antibiotics

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11
Q

What does wound dehiscence refer to?

A

this occurs when a cut made during surgery re-opens

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12
Q

What are patients advised to do in the occurence of wound dehiscence in the absence of pain or infection?

A

continue wound toilet e.g. hot salty mouthwashes and sicket syringing

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13
Q

Outline serious complicatons associated with 3rd molar removals

A
  • fracture of mandible
  • fracture of tuberosity
  • OAC
  • broken instrument
  • complete transection of lingual or inferior alveolar nerves
  • late recognition of nerve damage
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14
Q

When are review appointments following 3rd molar extractions required?

A
  • when non-resorbable sutures have been placed
  • where complications arise
  • at patients or surgeons request
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15
Q

A discharge letter is always sent to the referring clinician. What should it include ?

A
  • how to look after mouth post-operatively
  • possible complications and side effects
  • any problems specific to the operation undertakken
  • any drug therapy required
  • whether a review appt is required
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16
Q

Prevalece of unerupted 3rd molars vary widely. What is the prevalence influenced by?

A
  • age
  • gender
  • ethinicity
17
Q

Define the meaning of an unerupted tooth

A

a tooth lying within the jaws, entirely covered by soft tissue, and partially or completely covered by bone

18
Q

Define the term “ partially erupted tooth”

A

tooth that has failed to erupt fully into a normal position.

this term implies the tooth is partly visible and in communication with the oral cavity

19
Q

What is an impacted tooth?

A

tooth that is prevented from completely erupting into a normal functional position

20
Q

What are the potential cause of an impaction?

A
  • lack of space
  • obstruction by another tooth
  • abnormal eruption path
21
Q

Upper 3rd molars are more likely to erupt compared to their lower counterparts. True or false

A

True

22
Q

When are 3rd molar removals NOT advisable?

A
  • 3rd molars that have erupted successfully and have a functional role in the dentition
  • patients whose medical history renders the removal an unacceptable risk to overall health of the patient
  • in patients where there is planned single third molar removal under LA; there should be no simultaneous removal of asymptomatic contalateral 3rd molars
23
Q

What kind of orthoghathic surgery is it appropiate for 3rd molars to be extracted?

A

sagittal split osteotomy

24
Q

Why is the removal of 3rd molars acceptable/indicated in cases of fracture of the mandible in the 3rd molar region ?

A

this is because the presence of a tooth in a fracture line increases the risk of infection in some cases especially when the tooth has been displaced or rendered non-vital

25
Q

What risk is associated with 3rd molar extraction in a patient undergoing radiotherapy?

A

risk of infection could result in osteoradionecrosis

26
Q

What risk is associated with 3rd molar extratctions in patient who is to receive cardiac surgery?

A

risk of infection could result in endocarditis

27
Q

Pain associated with lower 3rd molar teeth is commonly exarcebated by …

A

the upper 3rd molar biting on the gum flap, causing pain and discomfort

extraction of upper 3rd molar teeth can be considered in these cases as they are easier to extract

28
Q

When more than one 3rd molar requires assessement, what is radiographic examination of choice? Why is this ?

A

panoramic radiograph

radiation dose of panoramic radiograph is lower than from 4 PA views and the diagnostic yield is higher

Field size limitation can also be used to prevent exposing radiation to areas not in the field of view

29
Q

Routine regular radiographic examination of unerupted 3rd molars is recommended. True or false

A

false

this is because there is no sufficient incidence of pathological change associated with unerupted 3rd molars

30
Q

Why is the identification and documentation of apical hooks following radiographic examination important?

A

they may fracture during removal

important factor when deciding whether or not to remove the 3rd molar

31
Q

Why should you monitor the follicular width of an unerupted 3rd molar?

A
  • the dimension of the follicle may give an indication of cystic changes that have taken place; however there is no substantive evidence for this
32
Q

Where there is doubt regarding cystic changes to the 3rd molar follicle, in the absence of other positive indications for tooth removal, what is the recommended course of action?

A

radiological review between 6 and 12 months

33
Q

What is the referring clinician required to provide for the specialist regarding 3rd molar removals/assessments?

A
  • all clinical findings on presentation
  • medical history
  • any radiographs pertinent to the case
34
Q

What does a wound toilet refer to ?

A

cleansing of wound and skin around it

35
Q

How can soft tissue bleed be managed?

A
  • haemostatic agents
  • bipolar diathermy
  • sutures
36
Q

How can the pain from alveolar osteitis managed?

A
  • irrigation with saline or CHX
  • placement of obtundant such as proprietary iodoform based medication

can rarely require long term antibiotic therapy

37
Q

What constitutes an unsuccessful outcome following 3rd molar removal ?

A
  • persistent pathology
  • sensory nerve damage
  • OAF
  • TMJ dysfunction
  • psychological complications
  • damage to adjacent teeth
38
Q

Bruising and swelling following 3rd molar removal resolves within …

A

2 weeks

Minor Oral Surgery (36 decks)

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