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

3rd molar assessment Flashcards

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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
How common are disto angular 3rd molar impactions
6.7%
26
Talk through the guidance of extractions of wisdom teeth given by NICE
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
27
List some patient factors we must consider when assessing an oral surgery patient
1. Age 2. Social History 3. Medical history 4. Drug history 5. BMI 6. Ethnicity 7. Capacity
28
List some surgical factors we must consider when assessing an oral surgery patient
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
Why is important to consider age when assessing an oral surgery patient
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
What drugs do we need to look out for when assessing an oral surgery patient
1. Anticoagulants 2. Steroids 3. Immunosuppressive 4. Interactions 5. Biphosphonates 6. Antibiotics prophylaxis
31
Why do we need to consider BMI WHEN assessing an oral surgery patient
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
Which structures do we check when doing an extra oral examination
1. Cervical lymphadenopathy 2. Mouth opening 3. TMJ 4. Facial symmetry 5. Facial swelling 6. Trigeminal nerve
33
Which structures do we check when doing an intra oral examination
1. Soft tissues 2. Hard tissues 3. Status of second molars
34
How can we come to a differential diagnosis
1. Assess patients symptoms and signs | 2. Radiological assessment
35
Why do we need imaging when assessing third molars
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
Which radiographs may we take to image third molars
1. Peri-apical Radiograph 2. Orthopantomogram (sectional or full) 3. Cone Beam CT
37
What does a periapicla radiograph show us
Shows individual teeth and apical area | Detailed information of the teeth, hard tissues and associated pathology
38
Give some indications for a peri apical radiograph
1. Detection of apical inflammation / infection 2. Assessment of the periodontal status 3, Post trauma 4. un-erupted teeth 5. Root morphology 6, During endodontics 7. Apical surgery 8. Apical pathology 9. Implants post op
39
What are the disadvantages fo peri apical radiographs
1. Technique sensitve 2. Gag reflex 3. Edentulous alveolar ridge 4. Children 5. Coperation
40
Give some indications for am OPT
1. Gross negelct 2. Prior to general anaesthesia 3. Oral surgery 4. Orthodontics 5. TMJ
41
Do we have to take an OPT for every third molar impaction
NO
42
Describe what cone beam CT can show us
1. Thin slices with variable thickness 2. Can be viewed in all planes 3. Eliminates super imposition 4. High contrast resolution
43
What are some benefits fo cone beam CT
1. Reduction in dose 2. Short scan time 3. High resolution 4. Interactive software
44
What are some issues surrounding CONE BEAM CTs
Issues with artefacts
45
Should a cone beam CT be taken for every oral surgery patient
NO only take a CBCT if justified
46
When might a CBCT be indicated
Where conventional radiographs show a close relationship between the mandibular third molar and the inferior alveolar canal
47
What do we check to see if a radiograph is diagnostic quality
1. Contrast and density 2. Region of interest clearly visible 3. Surrounding normal tissue 4. No distortion
48
Name the key areas to focus on in a radiograph
1. Teeth 2. Apical tissues 3. Periodontal tissues 4. Body and ramps of the mandible
49
What should we do if we think we se something abnormal
``` S.T.O.P Site Translucency Outline e Previous imaging ```
50
List some red flags we may see on a radiograph
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
When looking at the tooth on a radiograph what do we assess
1. Number of teeth present 2. Stage of development 3. Position 4. Condition of the crown 5. Condition of the roots
52
If you see a lesion what should your description include
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
Relationship with which adjacent structures is it important to assess when looking at a third molar
1. Maxillary antrum and tuberosity 2. Inferior alveolar nerve and associated vessels 3. Lingual nerves 4. Mylogyoid nerve 5. Long buccal nerve
54
What can the mandibular canal be in close association with
The apices of the mandibular teeth
55
List some signs on a plain film imaging which may suggest close/intimate relationship between the canal and the third molar
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
Where is the inferior alveolar artery positioned in relation to the nerve
Likely posrterior/postero-lateral to nerve
57
Where is the inferior alveolar vein situated
Lateral to the bone
58
Where is the inferior alveolar nerve situated
Likely anterior to the vessel
59
What is the lingual
The tongue
60
Can we see nerves on radiographic film
No but we can see canals
61
What do we look at regarding roots
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
Describe the most favourable type of roots
Fused or conical roots
63
How does the bone determine the difficult of a third molar extraction
Bone density detainees difficulty
64
Describe the bone in a patient under the age of 18
1. Less dense 2. Pliable 3. Expands 4. bends 5. Easier to cut/ expand
65
Describe the bone in a patient OVER the age of 35
1. Much denser bone 2. Decreased flexibility 3. Decreased ability to expand 4. Much bone removal required 5. Higher risk of extraction
66
List some predictors of difficulty
1. Alveolar bone level 2. Tooth positon 3. Application depth 4. Point of elevation
67
List some factors which increase risk of complication
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
What are the risks associated With all patients undergoing surgery
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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