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BDS4 > Oral Surgery > Flashcards

Oral Surgery Flashcards

Symposium 2, 3, 4, 5, 6, 7 still to do

1
Q

What are the 4 types of sutures and what are their characteristics?

A

Absorbable- loose most of their tensile strength early and are fully absorbed by the tissue.
Non-absorbable- retains tensile strength and need to be removed physically. Usually used when healing may take longer in cases like OAC or to hold dressings when exposing canines.
Mono-filament- made of a single strand. less surface area for infection to colonise.
Polyfilament- made from several smaller strands which are twisted together. Warning with wicking (where infection spreads along suture and enters the wound) and infection colonisation.

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2
Q

What are some examples of sutures?

A

Vicryl, Velosorb- polyfilament, absorbable
Monocryl- monofilament, absorbable
Nylon, Prolene- monofilament, non-absorbable
Silk- polyfilament, non-absorbable

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3
Q

What are the characteristics of the condyle?

A

articulating surface is covered but small layer of fibrocartilage, lateral pterygoid attaches just below the ridge on the mediolaeral surface of the condyle.

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4
Q

What is the glenoid fossa?

A

a hollow on the inferior surface of of the temporal bone which is covered by a thin layer of fibrocartilage

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5
Q

What is the blood supply for the TMJ?

A

deep articular artery - which is a branch of the internal maxillary artery

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6
Q

What is the nerve supply for the TMJ?

A

auriculotemporal, masseteric, posterior temporal nerves

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7
Q

What is the most common cause of TMJ pain and what causes it?

A

temporomandibular dysfunction/myofacial pain.

Caused by inflammation caused by repeated or prolonged stresses on muscles of mastication which is self limiting.

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8
Q

What is internal derangement?

A

Patient may present with a painful clicking of the jaw which happens when the articulation disk and condyles have a lack of coordination.

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9
Q

What is disc displacement with reduction?

A

Most common cause of TMJ clicking. disc is displaced anterior on the opening of the mouth and becomes stuck in that position. There may also be a deviation on opening as the patient tries to avoid the displacement from happening. (can progress to osteoarthritis)

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10
Q

what is the management of disc displacement?

A

Limit mouth opening
Stabilisation splint
surgery- should not be considered lightly.

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11
Q

What are the aims of peri-radicular surgery?

A

to achieve an apical seal and remove existing infection via the excison of the apex

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12
Q

What are the possible causation of peri-radicular infection?

A
  1. obstruction to instrumentation
  2. root filler error
  3. poor tissue respons/poor drainage of infection
  4. lateral canals
  5. lateral perforation
  6. pathologies - apical cyst, recurrant infection, resorption .
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13
Q

What is the technique for an apicectomy?

A 
1- flap to open access to area
2-bone removal for access to the apex 
3-once vision has been achieved then removal of the apex - 
-3mm of the apex 
-right angle cut to reduce surface area
-removal of the root filling material with the use of an ultrasonic (curettage)
4-seal the root 
5- suture the flap closed
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14
Q

What may you use to restore the apical seal on a prei-redicular surgery?

A

resin modifed zinc oxide

mineral trioxide aggrigate

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15
Q

What are the characteristics of resin modifed zinc oxide?`

A 
cheap
easy to use
radiopaque 
bacteriostatic
sensitive to moisture 
me resorb 
doesnt promote cementogenesis
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16
Q

What are the characteristics of mineral trioxide aggregate?

A 
moisture resistant
promotes cementogenesis 
very good seal 
expensive
long setting time 
difficult to use
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17
Q

What are some causes of peri-radicular surgery failure?

A

INADEQUATE SEAL

  • extra of bifid root
  • too little root removed

INADEQUATE SUPPORT FOR TOOTH - too much apex removed

  • poor perio status
  • excessive occlusal loading
  • apical third fracture

LONGITUDINAL ROOT SPLIT

POOR HEALING RESPONSE

EXPOSURE OF ROOT APEX

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18
Q

When would you review a patient after PRS?

A

radio immediately after treatment or within 1-12 weeks
further review in 3-6 months
then review 6 months - 4 years

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19
Q

How would you treat reversable TMD?

A

-counselling
- jaw exercises
physio - massage, heat , acupuncture, relaxation, TENS, hypnosis
medications- NSAIDS, muscle relaxants , tricyclic antidepressants, botox, steroids
SPLINTS

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20
Q

What is the treatment for irreversable TMD?

A 
occlusal adjustment 
TMJ surgeries- 
arthrocentesis 
arthoscopy 
disc repair/removal 
total joint replacement 
repositioning
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21
Q

What is disc displacement?

A

a lack of cordinated movement from the TMJ between the condyle and articular disc. The condyle has to overcome the mechanical obstruction vbefore full joint movement can be achieved.

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22
Q

What is anterior disc displacement with reduction?

A

most common cause of TMJ clicking. The disc is initally displaced anteriorly by the condyle during opening untill disc reduction occurs, if left can progress to oestoarthritis.

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23
Q

what are the symptoms/signs?

A

jaw tightness- jaw movement is impair for a short period of time untill the disc reduces.
the mandible may initially deviate to the affected side before returning to the midline

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24
Q

what are the clincial signs of a mandibular fracture?

A 
pain, swelling and limitation of function 
occlusal derangement 
numbness of the lip 
loose or mobile teeth 
bleeding 
AOB
facial asymmetry 
divation on the opposite side
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25
Q

whatare the potential cause of mandibular fractures?

A 
generalised bone disease 
oesteogenesis imperfecta 
osteoporosis 
fibrous dyplasia 
hyperparathyroism
26
Q

How would you classify mandibular fractures?

A 
INVOLVEMENT OF SURROUNDING TISSUE 
-single 
-compound 
-comminuted 
NUMBER OF FRACTURES
SIDE OF THE FRACTURE 
SITE OF FRACTURE 
-angle 
-sub condylar
-parasymphyseal
-body 
-ramus 
-coronoid 
-condylar (intra-extra capsular)
-alveolar process 
DIRECTION OF THE FRACTURE LINE 
-favorable 
-unfavorable 
SPECIFIC FRACTURES
-green stick fracture 
-pathological fracture
DISPLACEMENT OF THE FACTURE
27
Q

What factors cause displacement of a fracture?

A
  1. magnitude of force
  2. opposing occlusion
  3. mechanism of injury
  4. intact soft tissue
  5. direction of the fracture line
28
Q

What radiographs are usually taken for a mandibular fracture?

A

PA and OPT

29
Q

What 2 principles of mandibular fracture replacement ?

A

FIXED- which is used if fracture is displaced or mobile in order to keep it in place

REDUCTION- which is the prevention of further harm to the fracture (not required then no treatment required )

30
Q

What are the nerves at risk when surgical XLA of lower third molars?

A

lingual
IAN
mylohoid
long buccal

31
Q

where in relation to the mandible would you find the lingual nerve?

A

found at or above the level of the lingual plate in about 15%-18% of cases and found 0-3.5mm medial to the mandible

32
Q

When did the sign guidelines get withdrawn?

A

feb 2015 - however still used as guidance

33
Q

Regarding the SIGN guidelines, when is it not indicated to XLA unerupted/impacted third molars?

A

when the third molar is due to erupt successfully and have a funtioning role in the dentition
where risk exceeds the benefit - overall health of the patient
no local or systemic involvement of the third molars
where the chance of mandibular fracture or sugical complication are high
would not normally suggest the removal of contralateral tooth if asymptomatic

34
Q

According to SIGN guidelines when would it be suggested that third molars which are unerupted or impacted are removed?

A

if a patient has experienced or is currently experiencing significant infection
in patient with predisposing risk factors who do not have easy access to dental care
in medical conditions where risk of retention outweighs the potential complications of removal
when GA is given for at least one third molar - consider multipal removals
when some surgery is already being carried out

35
Q

STRONG indications for XLA of third molars ?

A

one or more episodes of infection
there is caries in third molar and resorability is unlikely
When caries is occuring in the second molar which cannot be treated without the removal of the third molar
perio disease caused by the third molar
oral pathology including cyst formation
extrenal resobtion of the 3rd or 2nd ,olar which has been cause by the third molar

36
Q

Why else may a third molar be removed?

A

autogenous transplant in to first molar position
tumor resection or mandibular fracture
unerupted in a atropic mandible
in way of implant planning

37
Q

when considering how much bone removal for surgical XLA of an 8, hhow would you class its depth?

A

superficial- crown of 8 related to the crown of 7

Moderate - crown of 8 related to crown and root of 7

Deep - crown of 8 related to the roots only of the 7

38
Q

What is pericoronitis ?

A

inflammation of the soft tissue surrounding a partiall y erupted tooth, when contamination from oral cavity and tooth - food and debris gets trapped. most commonly happens with lower third molars.

39
Q

When surgucally removing a third molar what ways may you section the tooth?

A

horizontal - tooth is sectioned above the EDJ - unless coronectomy in which it is done below the EDJ

Vertical section- down through furcation and distal aspect is removed first

40
Q

What is a coronectomy and why may it be carried out?

A

the removal of only the coronal aspect of the tooth leaving behind the roots with an untreated pulp in order to prevent damage to the IAN

41
Q

What are the possible risks of a coronectomy?

A

root becomes mobilised during surgery then full XLA required
possible infection from remaining roots
can be a slow/uncomfortable healing
roots may migrate and later need an XLA

42
Q

What is osseointegration?

A

direct bone anchorage to an implant, it provides a foundation to support a prosth which in turn allows for the transmition of occlusal forces down the bone directly

43
Q

How would you keep trauma as low as possible for placement of an implant?

A
  • low drill speeds
  • low torque cutting drills
  • sharp cutting burs
  • graduated cutting burs
  • profuse irrigation
44
Q

What are the relative contraindications for implants?

A
  • angina
  • arrhythmias
  • congenital cardiac arrest
  • rheumatic heart disease
45
Q

What are the absolute contraindications for implant placement?

A
  • Recent MI
  • valve replacement
  • cardiac failure
  • previous endocarditis
46
Q

What are the characteristics ofr the maxillary sinus?

A

Usually the largest of the sinuses

Pyramid-shaped cavity within the body of each maxilla

Volumetric space 15ml in average adult

Average: 37mm high, 27mm wide & 35mm antero-posteriorly

Opening roughly 4mm in diameter

Lined with mucosa – sinuses is pseudostratified with cilia

Located superior on medial wall of sinus

47
Q

what is the maxillary sinus?

A

the alveolar canals which transport the posterior alveolar nerves and blood supply to the max posterior teeth.
obstruction of the ostia (opening of the sinus which is found in the middle nasal metus)

48
Q

what are the possible causes of sinusitis?

A 
RCT- introducing bacteria 
XLA- root displacement or OAC
Beginig lesions- cysts, tumors, polyps 
Trauma 
malignant lesions 
progression from an infection such as a cold
49
Q

What are the indications that sinusitis is present?

A
  • discomfort on palpation of the infraorbital region
  • a diffused pain in maxillary teeth
  • equal sensitivity from percussion on multiplpe teeth in the same region
  • pain that worsens with head or facial movements`
50
Q

What is the treatment for sinusitis?

A

pseudoephidrine - nasal drops
oxymetazoline- nasal spray
humidified air
antibiotics if systemic - amoxy 7 days or doxycycline

51
Q

What are the characteristics of aspirin?

A

In the past aspirin was one of the more commonly used NSAIDs

Effective for dental and TMJ pain

Superior anti-inflammatory properties to paracetamol

Can be bought over the counter

Aspirin reduces production of prostaglandins

It inhibits cyclo-oxygenases (COX-1 & 2) It is more effective at inhibiting COX-1

COX-1 inhibition reduces platelet aggregation and predisposes to damage of the gastric mucosa

  1. analgesic
  2. antipyretic
  3. anti-inflam
  4. metabolic
52
Q

What are the characteristics of Ibuprofen ?

A

Similar but not identical effect as aspirin. Less effect on platelets (not used therapeutically for this)

Irritant to gastric mucosa but lower risk than aspirin

May cause bronchospasm (care in asthmatics but not completely contraindicated)

Lots of drug interactions such as ACE inhibitors, anticoagulants, calcium channel blockers, Beta- Blockers, corticosteroids ect.

Maximum dose is 2.4mg in adults

53
Q

what are the characteristics of paracetamol ?

A

Paracetamol is traditionally included under the banner of NSAIDs although In reality, it is a simple analgesic without anti-inflammatory activity.

Little or no anti-inflammatory action

No effects on bleeding time

Does not interact significantly with Warfarin

Less irritant to GIT

Suitable for children

Max does 4g per day

COX inhibotor

54
Q

What are the characteristics of opiod for pain relief?

A

Act in the spinal cord - especially in the dorsal horn pathways associated with paleo-spinothalamic pathway

They produce their effects via specific receptors which are closely associated with the neuronal pathways that transmit pain to the CNS

Opioid is a term used for both naturally occurring and synthetic molecules that produce their effects by combining with opioid receptors

Opioid analgesics are relativley ineffective in dental pain!!!!!

55
Q

What are the characteristics of codine?

A

A natural alkaloid found in opium (opioid)

1/12th the potency of morphine

Low dependence

Usually in combination with NSAIDs or Paracetamol e.g. Co-codamol 8mg Codeine 500mg Paracetamol

Effective cough suppressant

Available over the counter

Only codeine combination on dental list is dihydrocodeine orally -30mg every 4-6 hours as necessary

Used for moderate to severe pain however little value to dental pain

56
Q

What are the principles of flap design?

A

Maximal access with minimal trauma

No matter what size the flap will heal the same regardless of size

Flap should be a clean cut down to bone

No sharp angles

Keep tissue moist

Ensure the margins of flap and sutures will lie on sound bone

Ensure the flaps are not closed under tension

Be aware of adjacent soft tissues

Bare in mind the post –op aesthetics#

Use scalpel in one firm continual stroke

57
Q

What are the types of surgical debridement?

A

PHYSICAL
– removal of sharp bony edges
-or soft tissue debris

IRRIGATION
- Sterile saline into socket and under flap to “wash out”

SUCTION

  • aspirate under flap to remove the debris
  • check socket for any debris
58
Q

What is the aim of suturing?

A

Reposition tissues

Cover bone

Prevent wound breakdown

Achieve hemostasis

Encourage healing

59
Q

What are the possible post op bleeds?

A
  • Immediate/ intra-operative/ peri-operative (during surgery)
  • Immediate post-operative/ short term post-operative
  • reactionary/rebound
  • occurs within 48 hours of extraction
  • vessels open up/vasoconstricting effects of LA wear off/ sutures loose or lost /patient traumatises area with tongue/finger/food

• Long term post-operative/ Secondary

  • often due to infection
  • commonly 3-7 days
  • usually mild ooze but can occasionally be a major bleed
60
Q

What are the clinical features of trigeminal neuralgia?

A

Severe spasms of pain: ‘Electric shock’, lasts seconds

Usually unilateral

Older age-group

Trigger spot identified

Females more than males

Periods of remission

Recurrences often greater severity

61
Q

What woul dbe the treatment for trigeminal or post herpatic neuralgia?

A

Carbamazepine- which is an anti-convulsant

  • 100 or 200 mg tablets - Starting dose 100mg once or twice daily (but some patients may require higher initial dose) - Increase gradually according to response - Usual dose 200mg 3-4 times daily, up to 1.6g daily in some patients

Contraindicated by AV, bone marrow depression and porphyria

Gabapentin & Phenytoin also used for trigeminal neuralgia however they are not available to be prescribed by a dentist.

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