All Prelims

Question 1

What are the 5 principles of surgery

Answer 1

Atraumatic surgery
Asepsis
Patent airway
Profound anesthesia
Control of infection

Question 2

Pus will make the environment ___

Answer 2

Acididc

Question 3

Blade #15 is used for?

Answer 3

Any areas in the mouth except in posterior 2nd and 3rd molars

Question 4

Blade #11 is used in?

Answer 4

Drainage and stabbing the incision biopsy

Question 5

Principles of incision

Answer 5

Use a sharp blade of the proper size
Firm, continuous stroke
Avoid cutting vital structures
Blade held perpendicular to the epithelial surface
Incision should be properly placed

Question 6

Are to gain surgical access to an area or to move tissue from one place to another

Answer 6

Flap design

Question 7

Principles of flap design to prevent flap necrosis

Answer 7

1. Apex should be wider than base
2. Length of a flap should not be twice the width of the base
3. Have its own blood supply
4. Base of flap should not be excessively twisted

Question 8

A partial or total separation of previously approximated wound edges, due to a failure of proper wound healing

Answer 8

Flap dehiscence

Question 9

How to prevent flap dehiscence

Answer 9

Handle the tissues gently
Not placing under tension

Question 10

What are the means of promoting wound hemostasis

Answer 10

1. Direct pressure to the blood vessels - promotes coagulation
   (Small BV - 20 to 30 sec, Large BV, 5 to 10min)
2. Thermal coaulation
3. Suture ligation
4. Epinephrine in the wound

Question 11

Local measurements to achieve hemostasis

Answer 11

Direct pressure
Inject direct anesthesia w/ epinephrine
Cold compress
Let the patient bite a tea bag - contains tannins which are hemostatic

Question 12

A sequence of cellular and biochemical responses directed toward restoring tissue integrity and functional capacity following injury

Answer 12

Wound healing

Question 13

What are the stages of wound healing

Answer 13

Inflammatory
Fibroblastic
Remodeling

Question 14

Stage of wound healing that begins the moment tissue injury occurs

Answer 14

Inflammatory stage

Question 15

Lasts 3-5 days

Answer 15

Inflammatory stage

Question 16

The passage of blood cells through the intact walls of the capillaries, typically accompanying inflammation

Answer 16

Diapedesis

Question 17

2 phase of inflammatory stage

Answer 17

Vascular and cellular

Question 18

set in motion during inflammation begin with an initial vasoconstriction of disrupted vessels as a result of normal vascular tone. The vasoconstriction slows blood flow into the area of injury, promoting blood coagulation. Within minutes, histamine and prostaglandins E1 and E2, elaborated by white blood cells, cause vasodilation and open small spaces between endothelial cells, which allows plasma to leak and leukocytes to migrate into interstitial tissues. Fibrin from the transudated plasma causes lymphatic obstruction, and the transudated plasma aided by obstructed lymphatic vessels accumulates in the area of injury, functioning to dilute contaminants. This fluid collection is called edema

Answer 18

Vascular phase of inflammatory stage

Question 19

Cardinal signs of inflammation

Answer 19

Rubor - Redness
Calor - increased heat
Tumor - Swelling
Dolor - Pain
Functio laesa - Loss of function

Question 20

In cardinal sign

Warmth and erythema are caused by?

Answer 20

Vasodilation

Question 21

In cardinal sign

___ is caused by transudation of fluid

Answer 21

Swelling

Question 22

In cardinal sign

___ and ___ are caused by histamines, kinins and prostaglandins released by leukocytes as well as by pressure form edema

Answer 22

Pain and loss of function

Question 23

triggered by the activation of serum complement by tissue trauma. Complement-split products, particularly C3a and C5a, act as chemotactic factors and cause poly- morphonuclear leukocytes (neutrophils) to stick to the side of blood vessels (margination) and then migrate through the vessel walls (dia- pedesis). Once in contact with foreign materials (e.g., bacteria), the neutrophils release the contents of their lysosomes (degranulation). The lysosomal enzymes (consisting primarily of proteases) work to destroy bacteria and other foreign materials and to digest necrotic tissue. Clearance of debris is also aided by monocytes such as mac- rophages, which phagocytize foreign and necrotic materials. With time, lymphocytes accumulate at the site of tissue injury.

Answer 23

Cellular phase of inflammation

Question 24

Sometimes refers to as lag phase

Answer 24

Inflammatory phase

Question 25

Immature phase. Fibrin, which are derived from blood coagulation , crisscross wounds forming a latticework on which fibroblasts begin laying down ground substance and tropocollagen. Ground substance consists of mucopolysaccharides, which cements collagen fibers together. Begins on the third or fourth day after tissue injury. Fibroblasts secretes fibronectin, which stabilizes fibrin, assists in recognizing foreign materials, acts as chemotactic for fibroblasts and helps guide macrophages for phagocytosis.

Answer 25

Fibroblastic stage or proliferative phase

Question 26

“Wound maturation” phase

Answer 26

Remodeling stage

Question 27

Old collagen fibers are destroyed by new collagen fibers to better resist tensile force on the wound Scar tissue is only 805 as strong as the original tissue Wound contraction, edges of a wound migrate toward each other 3 weeks to 2years

Answer 27

Remodeling stage

Question 29

Immediate to 2-5days Bleeding stops (hemostasis) - constriction of BV - platelets starts to clot - formation of scab Inflammation - opening of the blood supply - cleansing of the wound

Answer 29

Inflammatory phae

Question 30

5days to 3 weeks Granulation - new collagen tissue is laid down - new capillaries fills in defect Contraction - woiund edges pull together Epithelialzation - cells cross over the moist surface - cell travel about 3cm from point of origin

Answer 30

Proliferate phase

Question 31

Collagen forms which increases tensile strength to wounds Scar tissue is only 805 as strong as original tissue 3weeks to 2years

Answer 31

Maturation phase

Question 32

Factors that impair wound healing

Answer 32

Foreign material Necrotic tissue Ischemia Tension

Question 33

Occurs when a clean laceration or surgical incision is closed primarily with sutures, or other means and healing proceeds rapidly with no dehiscence and minimal scar formation

Answer 33

Primary intention

Question 34

Wound healing is complicated and occurs through a protracted filling of the tissue defect with granulation and connective tissue Healing is slower and produces more scar tissue Commonly associated with avulsive injury, local infection, or inadequate closure of the wound

Answer 34

Secondary intention

Question 35

Healing of wounds through the use of tissue grafts to cover large wounds and bridge the ap between wound edges Procedure that combines secondary healing with delayed primary closure The avulsive or contaminated wound is debrided and allowed to granualte and heal by second intention for 5 - 7 days Once adequate granulation, tissue has formed and the risk of infection appears minimal, the wound is sutured close to heal by first intention

Answer 35

Tertiary intention

Question 36

Wound edged can be pulled together and secured Heals by connective tissue deposition

Answer 36

Primary intention

Question 37

Wound is left open secondary to cnotamination or comorbid condition Healths through deposists of granulation tissue and contraction of wound margin

Answer 37

Secondary intention

Question 38

Delayed surgicalclosure of wound due to contamination Heals by granulation tissue and delayed closure technique

Answer 38

Tertiary intention

Question 39

Extracted sockets are what type of wound healing intention

Answer 39

Second intention

Question 40

Clot forms a temporary scaffold upon which inflammatory cells migrate Epithelium at the wound periphery grows over the surface of the organizing clot Osteoclasts accumulate along the alveolar bone crest setting the stage for active crestal resorption Angiogenesis proceeds in the remnants of the PDL

Answer 40

1st week of extracted wound socket

Question 41

The clot coninues to get organized through fibroplasia and angiogenesis begin to penetrate towards the center of the clot Trabecular of osteoid slowly extends into the lot from the aveolus, and osteoclastic resorption of the cortical margins of the alveolar socket is more distinct

Answer 41

2nd week of extracted wound socket

Question 42

The extraction socket is filled with granulation tissue and poorly calcified bone forms at the wound perimeter The surface of the wound is completelyreepitheliaized with minimal o no scar formation Active bone remodeling by deposition and resorption continues for several more weeks

Answer 42

3rd week of extracted wound socket

Question 43

After extraction of tooth, radiographic evidence of bone formation does not become apparent until _____ weeks

Answer 43

6 to 8 weeks

Question 44

Dry socket usually occurs on the ___ day after extraction

Answer 44

3rd day

Question 45

Refers to a comprehensive an systematic program tat, when applied,prevents the transmission of infectious agents among persons who are in direct or indirect contact with health care environment

Answer 45

Infection control

Question 46

Is the transfer of oral fluids and debris from a client to surfaces, equipment, materials, workers hand or another client

Answer 46

Cross contamination

Question 47

Examples of direct cross contamination

Answer 47

When workers failst. To change gloves between clients When instrument are not cleaned or sterilized between use Use of disposable dental products such as saliva ejector on multiple patients

Question 48

Factors for infection

Answer 48

Pathogen Reservoir Mode of transmission Portal of entry Susceptible host

Question 49

A process that destroys or eliminates all fors of microbial life and carried out in health-care facilities by physical and chemical methods

Answer 49

Sterilization

Question 50

Required degree for sterilization

Answer 50

132 degrees celcius

Question 51

A process that eliminated many or all pathogenic microorganisms, except bacterial spores on inanimate objects

Answer 51

Disinfection

Question 52

The removal of visible dirt from objects and surfaces and normally accomplished manually or mechanically using water with detergent

Answer 52

Cleaning

Question 53

How to minimize pathogens

Answer 53

Sterilization and disinfection Cleaning Patient care items

Question 54

Examples of indirect cross contamination

Answer 54

When instruments, containers, equipments are contaminated with client’s oral fluid When a chart or dental chart is handled with contaminated gloves

Question 55

Provides the greatest hazard for potential infection

Answer 55

Blood

Question 56

Other potentially infective materials

Answer 56

Body fluids or any fluids

Question 57

How to avoid mode of transmission of pathogens

Answer 57

Hand hygiene Use sterile surgical gloves Avoid handling of biopsy specimen directly with your hands Clean dental unit waterlines and check water quality Maintain dental unit waterlines

Question 58

Bacteria in water used as coolant/ irrigant for nonsurgical dental procedures should be less than ___ colony forming units per milliliter (CFU/ml)

Answer 58

500

Question 59

How many seconds needs to dscharge water and air each patient after their procedures?

Answer 59

20 - 30 seonds

Question 60

The CDC recommended that dental waterliens should be flushed when?

Answer 60

At the beginning of the clinic day (They can reach 200,000 CFU within 5 days after installation of new dental unit waterlines)