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CAD ORAL SURGERY Flashcards

1
Q

Principles of exodontia

A
  1. Expansion of the bony socket
  2. Separation of periodontal ligament attachment (sever them)
  3. Separation of the gingival soft tissue attachment
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2
Q

What happens 24-48 hours post extraction?

A
  1. Clot formation
  2. Fibrin meshwork
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3
Q

What happens 7 days post extraction?

A
  1. Epithelial migration over the socket
  2. Clot becomes granulation tissue
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4
Q

What happens 20 days post extraction?

A

Granulation tissue becomes collagen and ‘early’ bone.

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5
Q

What happens 8 weeks post extraction?

A

Bone marrow occupies the socket replacing woven bone

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6
Q

How long post extraction is classed as delayed healing?

A

8 weeks

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7
Q

How much vertical and horizontal bone loss does the alveolar ridge undergoes in the first 6 months?

A

Vertical -1.24mm
Horizontal -3.8mm

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8
Q

What do we want to preserve during exodontia?

A

Buccal plate bone

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9
Q

What happens to the buccal plate post exodontia?

A

It exhibits more resorption compared to the lingual plate

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10
Q

Why does the buccal plate easily fracture/break?

A

It is very thin

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11
Q

Healing stages of bone post exodontia

A
  1. Day 1 - tooth extraction
  2. Day 1 -3 weeks - Initial angiogenesis
  3. 3-4 weeks - new bone formation
  4. 4-6 weeks - bone growth
  5. 6 weeks - 4 months - Bone reorganisation
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12
Q

What are the three bone preserving techniques?

A
  1. Sever connective tissue fibres
  2. Minimise soft tissue reflection
  3. Section multirooted teeth
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13
Q

Why is it better to get implants earlier?

A

Due to bone resorption of the mandible, there is less bone for the implant to be placed. The mental foramen also appears to go higher/up as we get older and could even be on the ridge (dangerous to place implants as nerves are coming out of the foramen).

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14
Q

What are elevators and how do they work?

A

They are single shanked instruments used between bone and tooth and move the tooth/roots by applying force on root surface.

They have 3 parts: handle, shank and blade (see diagrams from lectures/in ADC).

We can use them in two basic ways:
1. Down long axis of the tooth (Coupland)
2. Horizontally (45 degree angle) in between root and adjacent inter-radicular bone.

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15
Q

What is the aim of an elevator?

A

Safely widen socket and loosen the tooth/root.

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16
Q

Post extraction healing in terms of immunity

A
  1. Haemorrhage
  2. Bleeding into the socket
  3. Platelet aggregation
  4. Clot formation ( platelets and leukocytes in a fibrin gel)
  5. After 2-3 days, inflammatory cells migrate, ‘clean’ the site prior to new tissue formation.
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17
Q

Three types of elevators

A
  1. Couplands
  2. Cryers
  3. Warick James
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18
Q

What is the apex technique (long axis) for elevators?

A

This is similar to a luxator as it widens the socket.
Push the elevator along the axis of the tooth towards the apex. This widens the socket and severs the PDL and applies displacing forces to move tooth coronally.

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19
Q

What is the horizontal technique for elevators?

A

This involves rotating around the fulcrum.
We engage the tooth surface horizontally and applies a force whilst rotated about a fulcrum to coronally move the tooth.

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20
Q

What are the three principles of elevator action?

A
  1. Lever
    2.Wedge
  2. Wheel& Axle
    NB: Position of elevator tip should be against the root, not the crown.
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21
Q

Describe the Lever action of elevators

A

Fulcrum must be on bone, not tooth.
(See lecture diagram for better idea)

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22
Q

Describe the Wedge action of elevators

A
  1. Can be used alone or paired with lever principle
  2. Can use with both elevators and luxators (slightly different movement with luxators).
  3. Used down the long axis of the tooth towards the apex with firm pressure to displace the root coronally.
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23
Q

Describe the wheel and axle action of elevators

A
  1. Used with Cryers and curved warick james.
  2. Modified form of lever.
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24
Q

What are Couplands elevators?

A
  1. Most frequently used in oral surgery
  2. Shape: Straight with concave cross section
  3. 3 sizes: 1,2,3 (narrow to wide)
  4. This is the only type of elevator that has both a luxating and elevating function.
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25
Q

What are Cryers elevators?

A
  1. Useful to take our retained roots / multirooted teeth
  2. Shape: sharp pointed end ( have a right and left side type)
  3. Potential for a lot of force so be careful
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26
Q

What are Warick James?

A
  1. Useful for taking out curved wisdom teeth and raising periosteal flaps.
  2. Shape: Curved types (hooks around root) and straight type - R&L sides
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27
Q

What damage occurs with elevator usage?

A
  1. Trauma to palate
  2. Soft tissue tears
  3. Fracture to buccal or lingual plate if used as a fulcrum
  4. Accidentally elevate adjacent tooth
  5. Damage adjacent tooth
  6. Displace roots into antrum
  7. Create OAC
  8. Fracture jaw/tuberosity
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28
Q

Golden Rules

A
  1. Elevators elevate, luxators luxate
  2. These instruments are sharp and can cause injury so ensure good finger rest when applying force to minimise risk of damage if you slip

3.Levering motions likely to fracture something so avoid when starting out (eg. Don’t put couplands in mesial of U7 and twist back- can fracture tuberosity).

  1. Luxators are more effective but dangerous when sharp - we should sharpen them for the next user
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29
Q

Elevators should be used by rotation around their long axis. What affects the force at the tip?

A
  1. Force applied to elevator handle (E)
  2. Diameter of the elevator handle (D)
  3. Diameter of the elevator tip (d)
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30
Q

What are Luxators?

A

1.Single shanked instruments with a sharp bevelled tip.
2. Thin and sharp- able to fit into tight spaces
3. Good at severing PDL - similar to periotomes
4. Can seperate tooth and bone / expand socket
5. Technique sensitive
6. Bone preserving

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31
Q

Why are luxators used in oral surgery?

A
  1. Decreases RO trauma
  2. Preserves bone for restorative work (eg. implants)
  3. Makes forceps extraction easier and is kinder to patient when done safely
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32
Q

What types of luxators are there?

A
  1. 2 sizes - 3mm and 5mm
  2. There are straight and curved types ( S and C)
  3. 3C most commonly used
  4. Curve allows you to get further back in mouth
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33
Q

When do you use a straight or angled luxator?

A

Straight for anterior teeth
Angled for posterior teeth

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34
Q

How to use a luxator?

A
  1. Hold handle with finger along length of shank
  2. Use a supporting hand as normal
  3. Insert blade into gingival crevice angled onto root and towards root surface to the apex.
  4. Apply axial/apical pressure as you work down the root surface.
  5. Gently rock side to side to sever the PDL
  6. Gently wiggle to widen socket - the space created will allow air to spell into the apical socket, break the vacuum, allowing easier tooth removal
  7. Use forceps/elevator to deliver tooth
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35
Q

What are periotomes?

A

Used to sever the PDL in anterior teeth (3-3).
Must be slow and gentle pressure so tip does not break.

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36
Q

How are periotomes used?

A
  1. Insert long axis of blade into interproximal region, protecting the buccal plate. Tip is located within alveolar bone crest.
  2. Push deeper into PDL space along mesial and distal sides, severing the PDL immediately below the alveolar crest (Don’t use on facial plate as thin and will get damaged)
  3. Leave in situ for 10-20 seconds to allow biomechanical creep to occur to bone and PDF. As tooth is pushed against alveolus, bone will expand and allowing tooth to exit socket
  4. Gently push further down PDL towards apex- can use light tap/mallet and continue this along the crestal third of the tooth (should become mobile)
  5. Now periotome becomes a lever. Blades are 3/4MM wide.
  6. When handle rotated slightly, one side is applied to root, other to bone
  7. Width of the wedge is now the length of a bevel, magnifying the rotation force
  8. Rotation of the handle increases tooth mobility and the force against opposite cortical plate to further expand.
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37
Q

Where do we apply luxators/elevators?

A

Almost always mesially/ buccally.

Only palatal for upper 3-3 if really struggling

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38
Q

How many pairs of paranasal sinuses is there?

A

4

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39
Q

Name the four pairs of paranasal sinuses?

A

Frontal sinus
Ethmoid sinus
Maxillary sinus
Sphenoid sinus

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40
Q

What are the functions of the maxillary sinus?

A

Vocal resonance
Olfactory function
Warming and humidifying air
Decrease the weight of the skull

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41
Q

What is pneumatisation?

A

Sinus extension into a particular anatomical structure. This is poorly understood and results as an increase in volume of the sinus.
It occurs with increasing age following loss of post dentition.

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42
Q

What is an Oro-antral Communication (OAC)?

A

A (non-epithelialised) passage between the oral cavity and the maxillary antrum, which can be as a result of exodontia.

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43
Q

What is an Oro-antral Fistula (OAF)?

A

A pathological epithelial lined passage between the oral cavity and the maxillary antrum.
In other words, it is an OAC that has tried to heal.

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44
Q

What are the risk factors for an OAC?

A

Close to the sinus
Thin alveolar bone
Periapical pathology/infection
Root morphology
Lone standing molars
Traumatic/difficult extractions
Technique

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45
Q

What are lone standing molars likely to cause?

A

An OAC

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46
Q

What are the symptoms of an OAC?

A
  • Congestion
  • Pain
  • ‘Sinus’ like symptoms
  • Air escaping into the mouth e.g. whistling sound when you talk
  • Air/liquid ‘bubbling’/ reflux into the nose
  • Discharge of infected material
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47
Q

Should you instruct a patient to hold their nose and blow when inspecting for an OAC? Why?

A

No.

If the patient does not have an OAC and they blow whilst holding their nose, this will now result in them having an OAC despite not having it earlier.

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48
Q

What are the Basic Prescribing Principles?

A

Black ink
Legible
Date
Patient details (inc DOB)
Practice details

Drug name
Dose
Frequency
Quantity to be supplied

Sign
Print Name

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49
Q

What is the name of the NHS Prescribing Dental Practice in England called?

A

FP10D

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50
Q

What is this common abbreviation– “cap”

A

capsule

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51
Q

What is this common abbreviation– “tabs”

A

tablets

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52
Q

What is this common abbreviation– “mg”

A

milligrams

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53
Q

What is this common abbreviation– “mcg”

A

micrograms

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54
Q

What is this common abbreviation– “ml”

A

millilitres

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55
Q

What is this common abbreviation– “mitte”

A

send

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56
Q

What is this common abbreviation– “nocte”

A

at night

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57
Q

What is this common abbreviation– “mane”

A

morning

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58
Q

What is this common abbreviation– “bid/bd”

A

twice a day

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59
Q

What is this common abbreviation–“tid/tds”

A

three times day

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60
Q

What is this common abbreviation–“qid/qds”

A

four times day

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61
Q

What is this common abbreviation–“prn”

A

as needed/required

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62
Q

What is this common abbreviation– “stat”

A

immediately

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63
Q

Where do you register any adverse effects?

A

MHRA

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64
Q

What does “OTC” mean?

A

Over the counter

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65
Q

What does “POM” mean?

A

Prescription only

66
Q

Why should we not prescribe OTC medications on a prescription?

A

it costs more for the NHS

67
Q

Name 3 common analgesics

A

Paracetamol
Ibuprofen (NSAID)
Co-codamol (Codeine Phosphate + Paracetamol)

68
Q

What are the Indications of Paracetamol?

A

Pyrexia
Pain
WHO Level 1

69
Q

What is the Action of Paracetamol?

A

Precise mode of action is unclear
Weak inhibitor of COX-1 and COX-2
Analgesic and Anti-pyretic activity
Weak anti-inflammatory activity

70
Q

What is the Pharmacology detail of Paracetamol?

A

30-60min peak plasma orally
Bound to plasma proteins
Drug inactivated in the liver- conjugated to give glucuronide or sulphate

71
Q

What is the dose of Paracetamol?

A

Oral or intra-venous
500mg/1g QDS
Max dose 4 in 24hrs– care with OD (2-3 x dose)– liver damage

72
Q

Overdose of Paracetamol can cause what? and what should you do?

A

Liver damage

See Medical Practitioner

73
Q

What are the Contra-indications of Paracetamol?

A

Allergy (rare)
Liver damage

74
Q

What are the Indications of Ibuprofen?

A

Inflammation
Pain- particularly musculoskeletal, rheumatic and joint problems
WHO Level 1+/- in combination with paracetamol

75
Q

There are more than 50 different types of NSAIDS on the market, try to name a few of them….

A

Naproxen, Diclofenac, Ketoprofen, Mefanamic Acid

76
Q

What is the action of Ibuprofen?

A

Proprionic acid derivative, blocks synthesis of T-A2 in platelets from arachidonic acid
Binds to and inhibits COX(unselective)
Competitive inhibition

77
Q

What is the Pharmacology detail of Ibuprofen?

A

Plasma 1/2 life 2hrs
Metabolised and biotransformed in the liver
Renal elimination- completely in 24hrs after the last dose
Elimination is not impaired by age or renal impairment

78
Q

What is the dose of Ibuprofen?

A

Oral
400mg QDS
With or just after food

79
Q

Why should you take ibuprofen with or just after food?

A

because ibuprofen can cause gastric irritation

80
Q

What are the contraindications of Ibuprofen?

A

Allergy
GI disturbances
Renal failure
Asthma/COPD

81
Q

What is co-codamol made of?

A

Codeine phosphate + Paracetamol

82
Q

What are the Indications of co-codamol?

A

Level 2/3 WHO analgesic ladder
Compound analgesia

83
Q

What is the Action of co-codamol?

A

Opioid based medication, reduces endorphins. Combine with gamma receptor in the brain.
Blocks pain transmission.
Prodrug.

84
Q

What is the Pharmacology detail of co-codamol?

A

Well absorbed orally.
Undergoes considerable first-pass metabolism and therefore less potent orally compared to IV opioids.

85
Q

What is the Dose of co-codamol?

A

Two doses
8/500 available OTC = 8mg codeine and 500mg paracetamol— Dose is TT QDS

30/500 available POM = 30mg codeine and 500mg paracetamol– Dose is TT QDS

86
Q

What is the contraindications of co-codamol?

A

Asthma, Drug dependence history, liver
Side effects are constipation, N&V and in larger doses respiratory depression

87
Q

Give 4 reasons why the BNF does not recommend the use of Dihydrocodeine

A

relatively ineffective against dental pain
causes nausea
causes constipation
potential for abuse– develop dependence

88
Q

What is the aim of Antimicrobials?

A

To treat infection with a drug which the causative organism is sensitive, but often ‘empirical treatment’. Ideal– after sensitivity of pathology

89
Q

If you have a dental infection what should you do?

A

Remove the cause priority:
Incision + drainage (Don’t do if inexperienced!)
Extraction
Can give Antibiotics if spreading infection

90
Q

Define Bacteriocidal

A

Kills bacteria

91
Q

Define Bacteriostatic

A

inhibits multiplication of bacteria but not killing pathogen

92
Q

What are the principles of Antimicrobial therapy?

A

Fever + acute infection
Spreading infection without localisation
Chronic infection despite drainage etc
Infection and Medically compromised
Certain conditions- e.g. osteomyelitis, perio etc

93
Q

Clostridium difficile causes what?

What can you see on colon if pt has C.diff?

A

Diarrhoea

Pseudomembranes (yellow-white plaques on colon)

Pseudomembraneous colitis

94
Q

Name some Antibiotics?

A

Penicillin– Phenoxylmethylpenicillin (narrow spectrum), Amoxicillin (Broad spectrum), Flucloxacillin (Penicillinase resistant)

Cephalosporin/ Beta- lactams

Erthyromycin (macrolide)

Clindamycin (macrolide)

Tetracyclines

Metronidazole

95
Q

What is the other name for Phenoxymethylpenicillin?

A

Penicillin V (pen V)

96
Q

Why should you prescribe Pen V rather than Amoxicillin?

A

Pen V is more narrow spectrum than Amoxicillin, so reduce likelihood of antibiotic resistance.

97
Q

What are the…
–> Indications
–>Action
–> Pharmacology details
–> Dose
–> Contraindications
for Phenoxymethylpenicillin (penicillin V)

A

Indications:
-Acute dental infections- purulent infection
-Post-surgical infection
-Pericoronitis
-Salivary gland infections

Action:
-Bactericidal
-Inhibits cell wall synthesis by inactivating the enzyme transpeptidase
-Effective against alpha haemolytic stpre and penicillinase -ve staph, aerobic G+ve and some anaerobic G-ve organisms

Pharmacology:
-‘erratic’ absorption from GI
-Virtually non-toxic

Dose:
500mg QDS

Contraindications:
-Allergy

98
Q

Why do people still prescribe Amoxicillin rather than Pen V?

A

pt more compliant as amoxicillin taken 3 times a day so pt take with meals

99
Q

What are the…
–> Indications
–>Action
–> Pharmacology details
–> Dose
–> Contraindications
for Amoxicillin?

A

Indications:
-Acute dental infections- purulent infection
-Post-surgical infection
-Pericoronitis
-Salivary gland infections

Action:
-Bactericidal and broader than Pen V
-Inhibits cell wall synthesis by inactivating the enzyme transpeptidase
-Effective against alpha haemolytic stpre and penicillinase -ve staph, aerobic G+ve and some anaerobic G-ve organisms

Pharmacology:
-‘erratic’ absorption from GI
-Virtually non-toxic

Dose:
500mg TDS

Contraindications:
-Allergy
-Issue with susceptibility to beta-lactamase (ref C-Amoxicilav)
-Higher incidence of rashes
-Should not be given if pt with Infectious Mononucleosis or Leukemia– rashes
-N&V can be common

100
Q

What are the…
–> Indications
–>Action
–> Pharmacology details
–> Dose
–> Contraindications
for Flucloxacillin?

A

Indications:
Confirmed skin infections

Action:
Narrow spectrum antistaphylococcal penicillin
Relatively resistance to beta-lactamase produced Staphylococcus aureus.

Pharmocology:
Safe non-toxic even in high doses
MRSA strains emerging widely– so some resistance issues.

Dose:
500mg QDS

Contraindications:
Allergy
Diagnosis must be confirmed.

101
Q

Do we usually use Cephalosporins in dentistry? (Yes/No)

A

No

102
Q

What are the…
–> Indications
–>Action
–> Pharmacology details
–> Dose
–> Contraindications
for Cephalosporins?

A

Indications:
Few in dentistry
Used to be used as alternative for Penicillin resistant patients
Phased out in dentistry, maybe in hospital if MC&S sensitive

Action:
Broad spectrum
Active against both G+ve and G-ve bacteria

Pharmocology:
~10% penicillin sensitive patients demonstrate cross-sensitivity
Allergic reactions (urticaria, rashes)
Nephrotoxicity
Oral bacteria inc streptococci can develop cross-resistance to both penicillin and cephalosporins

Dose:
e.g. Cefalexin 500mg TDS

Contraindications:
Allergy
Diagnosis must be confirmed

103
Q

Name 2 Macrolides

A

Erythromycin
Clindamycin

104
Q

What is good about Erythromycin and Clindamycin?

A

Suitable as an alternative if pt allergic to penicillin

105
Q

What are the…
–> Indications
–>Action
–> Pharmacology details
–> Dose
–> Contraindications
for Erythromycin?

A

Indications:
Second line in oral infections
As obligate anaerobes are not particularly sensitive

Action:
Bacteriostatic

Pharmacology:
Similar to penicillin- suitable as an alternative for penicillin allergy pts
Haemophilus influenzae, Bacteroides, Prevotella and Porphyromonas spp. are sensitive.
Active against beta-lactamase producing bacteria.

Dose:
250-500mg QDS

Contraindications:
High doses can cause hepatotoxicity.

106
Q

What are the…
–> Indications
–>Action
–> Pharmacology details
–> Dose
–> Contraindications
for Clindamycin?

A

Indications:
Second line in oral infections
As obligate anaerobes are not particularly sensitive

Action:
Inhibits protein synthesis by binding to bacterial ribosomes.

Pharmacology:
Similar to erythromycin- suitable as an alternative for penicillin allergy pts.
Haemophilus influenzae, Bacteroides, Prevotella and Porphyromonas spp. are sensitive.
Active against beta-lactamase producing bacteria.

Dose:
150mg QDS

Contraindications:
Mild GI disturbances are common- DIAORRHOEA!!!!
Be aware of antibiotic associated colitis (pseudomembranous colitis)— can be fatal.

107
Q

If pts are on Clindamycin, what should they be aware of?

A

If got bowel issues, then stop!

108
Q

Why is there a decrease in use of Tetracyclines?

A

Increase in bacterial resistance

109
Q

What are the…
–> Indications
–>Action
–> Pharmacology details
–> Dose
–> Contraindications
for Tetracycline?

A

Indication:
Some evidence for use in periodontics– localised aggressive

Action:
Bacteriostatic– interfere with protein synthesis by binding to bacterial ribosomes

Pharmocology:
Wide range of spectrum of activity against oral flora inc Actinomyces, Bacteroides
Distributed widely in body tissues inc bone and developing teeth
Particularly concentrated in gingival fluid
Absorption of the drug is reduced by antacids, calcium, iron and magnesium salts

Dose:
250mg TDS

Contraindications:
Avoid in children up to 8yrs due to absorption into developing teeth, pregnancy, lactating women
D&V sometimes after oral absorption due to disturbance in bowel flora
Hepatotoxicity with high IV doses

110
Q

Why should we not give Metronidazole as first line of medication as an alternative to penicllin?

A

Metronidazole is only specific for ANAEROBIC bacteria, so not target any aerobes.

111
Q

What are the indications for Metronidazole?

A

Effective against anaerobic infections
Acute necrotising ulcerative gingivitis (ANUG)

112
Q

What is the action of Metronidazole?

A

Bactericidal– converted by anaerobic bacteria into a reduced active metabolite which inhibits DNA synthesis

113
Q

What is the Pharmacology of Metronidazole?

A

All strict anaerobes

114
Q

What is the dose of Metronidazole?

A

200mg/400mg TDS
Usually 400mg TDS

115
Q

What are the contraindications for Metronidazole?

A

GI upset, sometimes metallic taste in the mouth
Interferes with Alcohol metabolism– and if taken together can cause disulfiram reaction
Potentiates anticoagulants (Warfarin)
Long term can cause peripheral neuropathy

116
Q

Why should you NOT have Alcohol with Metronidazole?

A

It makes you Vomit

117
Q

Give some examples of Antifungals

A

Polyenes:
Nystatin/ Amphotericin

Azoles:
Miconazole/ Fluconazole

118
Q

What is usually the first line antifungal medication?

A

Nystatin

119
Q

What is the Indication for Nystatin?

A

Fungal infections of skin/ GI tract
Superficial fungal infections
Not suitable for chronic hyperplastic candidiasis

120
Q

What is the Action of Nystatin?

A

Fungistatic and Fungicidal
Disruption of the fungal cell membrane

121
Q

What is the Pharmocology of Nystatin?

A

Polyene macrolide
Limited absorption from mucous membranes or skin

122
Q

What is the Dose of Nystatin?

A

Oral suspension 100,000 units/ml
1ml QDS after food for 1/52

123
Q

What are the Contraindications for Nystatin?

A

Nausea and Vomiting are rare
No adverse effects reported with topical route

124
Q

What should you prescribe for Angular Chelitis?

A

Miconazole

125
Q

Miconazole should NOT be prescribed with…..

A

Anticoagulants

126
Q

What are the…
–> Indications
–>Action
–> Pharmacology details
–> Dose
–> Contraindications
for Miconazole?

A

Indications:
Dual action against yeast and staphylococci

Action:
Fungicidal and bacteriostatic for some Gram +ve cocci (inc S. aureus)

Pharmacology:
Synthetic antimycotic agents
Broad spectrum of activity
Block synthesis of ergosterol- altering fluidity of membrane and enzymes.
Inhibits transformation of candidal yeast cells into hyphae

Dose:
Gel- 20mg/g (80g tubes)
Apply pea sized amount after food QDS for 1/52

Contraindications:
Anticoagulants and Statins– DO NOT PRESCRIBE!

127
Q

What are the…
–> Indications
–>Action
–> Pharmacology details
–> Dose
–> Contraindications
for Fluconazole?

A

Indications:
Triazole- wide spectrum of activity on yeasts and other fungi.
Specifically used to prevent Candida infection in HIV-infected individuals
Generally 2nd line

Action: same as miconazole

Pharmacology: same as miconazole

Dose: 50mg OD for 1/52

Contraindications: Anticoagulants and Statins- DO NOT PRESCRIBE!!
Minor GI irritation, allergic rash, elevated LFTs.

128
Q

Is Aciclovir an Antibiotic, Antifungal or Antiviral medication?

A

Antiviral

129
Q

What is the Indications for Aciclovir?

A

Primary and Secondary herpetic stomatitis
Herpes labialis

130
Q

What is the Action and Pharmocology for Aciclovir?

A

Blocks viral DNA production

131
Q

What is the dose for Aciclovir?

A

Topical 5% cream
Start in ‘prodromal phase’
Oral tablets for severe infections 200mg 5 x per day for 5/7.

132
Q

What are the contraindications for Aciclovir?

A

Nephrotoxicity with other drugs- check BNF

133
Q

Odontogenic Bacterial Infection– if causing airway/respiratory distress, what should you do?

A

Call 999/ Emergency Hospital Refer

134
Q

Odontogenic Bacterial Infection– if no airway/respiratory distress, what should you do?

A

Local measures where appropriate

135
Q

Odontogenic Bacterial infection with spreading infection/ systemic involvement, what should you do?

A

Antibiotics:
Amoxicillin 500mg TDS
or Pen V 500mg QDS

Metronidazole 400mg TDS

136
Q

Odontogenic Bacterial infection with spreading infection/ systemic involvement, what should you do if pt allergic to penicillin?

A

Clindamycin 150mg QDS
or Clarithromycin 250mg BD

137
Q

Angular Cheilitis, what should you give?

A

Miconazole cream
or Sodium Fusidate

138
Q

How do you manage Acute Necrotising Ulcerative Gingivits?

A

Local measures
Metronidazole 400mg TDS 3-5/7
Amoxicillin 500mg TDS 3-5/7

139
Q

How do you manage Herpes Simplex?

A

Local measures: Hydration, CXD m/w, soft diet, analgesia

Aciclovir 200mg 5x day

140
Q

What is the big risk for Varicella- Zoster Virus?

A

Risk of blindness

141
Q

State and describe the two ways of managing an OAC?

A

1) Monitor
Either the OAC will heal spontaneously or it will not heal. If it does not heal, it is an OAF.

2) Closure
This involves closure of the OAC via four different ways.
These include:
- buccal advancement flap
- palatal advancement flap
- buccal fat pad
- P.R.F. Membrane closure

142
Q

How do you manage an OAF?

A

1) Excision and histopathology
2) closure

143
Q

How many closure techniques is there when managing and OAC and OAF?

A

4

144
Q

Name the closure techniques when managing an OAC and OAF.

A

Buccal advancement flap
Palatal advancement flap
Buccal fat pad
P.R.F. Membrane closure

145
Q

What are the advantages of a buccal advancement flap?

A

Procedure can be relatively straight forward if well trained.
Heals well but can be thin tissue
Easy to perforate

146
Q

What are the disadvantages of a buccal advancement flap?

A

Technique sensitive - the first shot is the best shot.
Limited mobility sometimes
Difficult to get good closure with large OAC
reduction in sulcus depth - issues with restorative

147
Q

What are the advantages of a palatal advancement flap?

A

Harbours palatine vessels, good blood supply
Little shrinkage
More tissue with less tension
Thicker - more resistant to trauma.
Preserves sulcus depth

148
Q

What are the disadvantages of a palatal advancement flap?

A

Granulating palatal bone (palatal bone exposed)

149
Q

What is a disadvantage of a buccal fat pad?

A

Technique sensitive.
It is often used for large defects in combination with others

150
Q

What are the advantages and disadvantages of a P.R.F. (Platelet rich fibrin) membrane closure?

A

Optimum technique, no local flap required
Good healing, but requires training and kit. This is not freely available on NHS

151
Q

What are the three type of maxillary sinus cysts?

A

Mucous retention cysts
Odontogenic cysts
Non-odontogenic cysts

152
Q

What can cause an acute odontogenic maxillary sinusitis?

A

Periapical infection/ abscess
Periodontitis
Peri-implantitis
Post-extraction infection
Trauma
Odontogenic cysts
Osteomyelitis
Displacement into sinus

153
Q

What are the signs and symptoms of acute Odontogenic maxillary sinusitis?

A

Pain and systemic upset
Dull or intense pressure-like pain, erytheme, swelling of the cheek and anterior maxilla.
Pressure or fullness in maxillary sinus, headache, malaise, fever, halitosis, mucopurulent rhinorrhea, nasal congestion/onstruction, nasal discharge/post-nasal drip.

154
Q

What are the signs and symptoms of chronic Odontogenic maxillary sinusitis?

A

Often little or no systemic upset.
Local signs and symptoms can be subtle but persistent pus or discharge are not uncommon.
Toothache during chewing, mobility of teeth, migraine, dull headache

155
Q

What can you use a good tool to assess maxillary sinusitis?

A

OPT imaging is useful
CBCT is a gold standard for assessment - gives much more reliable information

156
Q

What are the characteristics of sinus cysts?

A

Variate in normal anatomy
Radiographic changes are common e.g. 1/3rd have mucosal thickening and 8.5% have cysts
Well circumscribed and asymptomatic unlikely to be sinister

157
Q

Where do radicular cysts originate from?

A

Carious maxillary tooth

158
Q

What is a keratocystic Odontogenic tumour?

A

Rare, painless expansion of maxillay

159
Q

What are the steps in diagnosing a patient with sinusitis?

A

1) exclude or confirm Odontogenic cause. If excluded, GP/ENT referral
2) Is it acute maxillary sinusitis or chronic Odontogenic maxillary sinusitis?

160
Q

What are the management techniques for a displaced root?

A

1) Gentle suction
2) Leave it (this poses a risk of a foreign body entering so the patient might get an infection)
3) Refer patient
4) Antral regime

161
Q

What does the Antral Regime procedure involve?

A

This procedure is aimed at ensuring a disease-free sinus. The steps involve the following:
- analgesia
- no nose blowing
- sneeze like a horse
- no straws
- decongestants
- broad spec antibiotic

C A D (17 decks)

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