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Spring 2018 > Oral Surgery Final > Flashcards

Oral Surgery Final Flashcards

(70 cards)

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1
Q 
Odontogenic infection
% aerobic
% anaerobic
  -Gram positive _
  -Gram negative _
A

25% aerobic
75% anaerobic
Gram positive cocci
Gram negative rods

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2
Q

Typical infections
_ are aerobes only
_ are mixed
_ are anaerobic only

A

7%
60% mixed
33% anaerobic

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3
Q

2 stages of ondontogenic infection

A
  1. Aerobic bacteria initiation
    - spreading factors
    - necrosis and hypoxemia
  2. Anaerobic bacteria
    - toxins
    - wall off infection (abscess)
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4
Q

Course of odontogenic infection (3 stages)

A

Cellulitis
Abscess
Fistula

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5
Q

What causes cellulitis

Early vs. late cellulitis

A

Strep

Early: mild, soft, red, easy to treat

Late: diffuse, hard, life threatening, hard to treat

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6
Q

Abscesses are filled with _

A

Anaerobes

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7
Q

3 things that determine how odontogenic infections spread

A

Muscle attachments
Bone thickness
Root angulation

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8
Q

_ infection occurs in max anterior teeth because the roots are below _

A

Vestibular

Muscles

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9
Q

_ space infection occurs in the max posterior because roots of the teeth are _

A

Buccal

Above buccinator muscle

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10
Q

How to distinguish a buccal space infection

A

Feel inferior border of mandible, all infection is above it

Can drain in mouth

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11
Q

How to determine a submandibular space infection

A

Infection is below inferior border of mandible

Hard to drain into mouth

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12
Q

Ludwig’s angina

A

Bilateral submandibular, sublingual and submental space cellulitis

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13
Q

Primary space infections (6)

A 
Vestibular
Canine
Buccal
Sublingual
Submental
Submandibular
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14
Q

Vestibular space infections are where

A

Max anterior gingiva

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15
Q

6 secondary spaces can be infected

A 
Pterygomandibular
Masseteric
Superficial and deep temporal
Lateral pharyngeal
Retropharyngeal
Pre-vertebral
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16
Q

If infection gets into masticator space, what is hallmark of infection?

A

Can’t open mouth more than 15 mm (trismus)

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17
Q

How can a dentist cause pterygomandibular infection

A

Inject into a real dirty mouth

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18
Q

3 major complications of lateral pharyngeal space infections

A

Airway impingement
Spread to superior mediastinum
Spread into danger space/inferior mediastinum

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19
Q

How do severe fascial space infections happen

Prevent?

A

High speed hand piece, non-sterile air and water vented into space

Back venting air piece

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20
Q

What 5 things need to be considered in determining severity of disease

A 
Rate of progression
Quality and quantity and location of swelling
Trismus
Systemic involvement
Airway
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21
Q

Admission is advised for swelling in _ and _

A

Secondary and neck spaces

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22
Q

Trismus indicates _

A

Secondary space involvement

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23
Q

Temp > _ indicates systemic involvement

A

101

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24
Q 
Who is referred/admitted?
_ onset
_ compliance
Severe swelling
_ involvement
 _
Airway concerns
Immunocompromised
A 
Rapid onset
Poor compliance
Secondary space involvement
<15mm opening
Temp >101
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25
Main surgical goal, 2 others
Remove source of infection Drain pus Release tension, improve circulation
26
Mild infection antibiotics: Moderate infection antibiotics: PCN allergy
Mild: amoxicillin 500 mg Mod: amox 500 mg and metronidazole 500 mg PCN allergy: cephalexin (with metro)
27
For a severe odontogenic infection, do what? Mild allergy? Severe allergy?
Penicillin G with metronidazole Cephalexin for mild allergy Clindamycin for severe allergy
28
#1 reason for treatment failure
Inadequate surgery
29
Least likely reason for treatment failure
Antibiotic problems
30
3 types of bony preprosthetic surgery
Alveoloplasty Torus reduction Tuberosity reduction
31
3 types of soft preprosthetic surgery
Inf. Papillary hyperplasia Inf. Fibrous hyperplasia Frenal attachments
32
3 systemic and 3 local factors responsible for variation in amount of bone resorption
Systemic: Nutritional abnormalities Osteoporosis Endocrine dysfunction Local: Alveoloplasty at time of extraction Dentures Facial form
33
6 anatomical factors to consider when planning a tissue supported prosthesis
``` Ridge form Osseus prominences Tuberosity form Vestibular depth Adjacent vital structures Inter-arch distance ```
34
Immediate vs delayed alveoloplasty
Immediate: at time of extractions Delayed: after bony healing of socket, 2 surgeries
35
3 types of alveoloplasty
Digital compression Intraseptal Surgical
36
Tori vs. exostoses
Tori on lingual Exostoses buccal Tori harder to remove
37
Max tori consideration
Can be pneumatized and communicate with nasal passage
38
What causes inflammatory papillary hyperplasia Treatment
Mechanical irritation Ill-fitting dentures Poor oral hygiene Fungal infections Non-surgical (denture adjustment, antifungal) Surgical excision Abrasion of superficial layer of palatal mucosa
39
What causes inflammatory fibrous hyperplasia
Denture irritation from ill fit or allergy
40
Tissue excised from infla. Fibrous hyperplasia should be _
Submitted for histological evaluation
41
4 steps to metastatic infection
Surgery Transient bacteremia Distant susceptible site Infection
42
How does SBE form
Extraction, bacteremia Agglutination antibodies bind bact. Bacteria complex circulates Infect sterile thrombus
43
2 people who need prophylaxis
Prosthetic cardiac valve | Previous infective endocarditis
44
_% of SBE comes from dentistry
13%
45
Antibiotic prophylaxis regimen | Why?
Amoxicillin 2 mg 1 hr preposterous | Predictable blood level from 1 dose
46
If allergy to penicillin
Clindamycin 600 mg 1 hr preop
47
What if a patient is already on antibiotics
Use different one
48
T/F prophylactic antibiotics are recommended prior to dental procedures to prevent prosthetic joint infections
FALSE not recommended anymore
49
Prophylaxis principles
Give to those with significant risk (rare in dentistry) Time it correctly (before treatment) Correct antibiotic and dose Stop after surgery
50
T/F treatment for prevention is different than treatment for actual infection
TRUE
51
T/F give antibiotics to prevent dry socket
FALSE - rinse with chlorhexidine or administer local
52
Indications for prophy for dentoalveolar surgery
``` Poorly controlled metabolic disease Immunosuppressed Surgery longer than 3 hrs Contaminated wound Insertion of major foreign body Surgery adjacent to sinus Bony impaction ```
53
4 indications for biopsy
Lesions persist 2+ weeks Persistent changes in epithelial tissue Lesions that interfere with function Bone lesions not identifiable by clinical or radiological findings
54
5 things to note about lesions
``` Size/shape Single/multiple Surface texture Color Sharpness of bordersa ```
55
4 types of biopsies
Oral cytology Aspirational biopsy Incisional Excisional
56
Cytology biopsy How Why
Brush smeared over and onto slide Large areas of mucosal change
57
Aspiration biopsy What Why
Syringe, take fluid Lesions suspected to contain fluid or intraosseus lesion
58
Incisional biopsy What Why
Deep and narrow wedge taken out Extensive lesion, hazardous location Suspicion of malignancy
59
Excisional biopsy What Why
Take whole lesion (all the way around it) Small, benign appearance
60
Why refer a biopsy
``` Malignancy suspected Close to anatomical structure Sedation Medically compromised Further surgery ```
61
Put biopsied tissue in what
10% formalin solution | 20 times the volume of the specimen
62
When taking a bone biopsy, how much to take
4-5 mm of sound bone around lesion
63
When a biopsy is done, what needs to be documented
``` Preop counseling Post op counseling Date/time History Clinical description Follow up ```
64
4 things required in a patient provider relationship
Chief complaint and diagnostic studies History of present illness and diagnosis Med history Physical exam
65
6 things dentists can prescribe
``` Analgesics Antibiotics Antimicrobials Anti-inflammatory Anxiolytics Muscle relaxants ```
66
3 things required before a dentist can write a prescription
State license Registration DEA registration number
67
5 things on a prescription
``` Patient info Date issued Drug info Refill authorization Prescriber info ```
68
Drug info includes
``` Drug name Strength Dosage form Route Directions for use Duration Quantity Special instructions ```
69
``` Abbreviations: a.c. ad lib b.i.d caps d.a.w Gtt, gtts p.r.n q.d. q.i.d t.i.d ```
``` Ac=before meal Ad lib= use freely Bid = twice daily Caps=capsules Daw= dispense as written (brand) Gtt=drops Prn= as needed Qd=once a day Qid=4 times a day Tid=3 times a day ```
70
Max dose per day: Acetaminophen Aspirin Ibuprofen
4000mg 4000mg 2400mg/3200mg

Spring 2018 (18 decks)

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