Exodontia (1)

Question 1

Name 5 indications for extraction

Answer 1

1. Severe caries
2. Pulpal necrosis
3. Severe periodontal disease
4. Impacted teeth
5. Orthodontic requirement

Question 2

Describe the contraindications to exodontia

Answer 2

• Contraindications are relative and tend not to be absolute
• It is more about minimising risk
• Systemic contraindications usually relate to medical history
• Local contraindications tend to be radiotherapy, bisphosphonate use or relation to tumours

Question 3

What is the function of a preoperative assessment?

Answer 3

Assess how difficult the extraction is going to be

Question 4

Describe 5 components of a general preoperative assessment

Answer 4

1. Age
2. HPC
3. PMH
4. PDH
5. Examination

Question 5

Describe how age can affect the difficulty of an extraction

Answer 5

• Children may be unable to co-operate

- Elderly patients have less elastic bone and co-morbidities

Question 6

Name 3 complicating factors for an extraction with regards to HPC

Answer 6

1. Pain
2. Swelling
3. Limited opening

Question 7

Name 5 ways PMH can affect exodontia

Answer 7

1. Access
2. Cooperation
3. Procedure
4. Post operative complication
5. Risk of systemic complications

Question 8

Name 4 ways access may be affected by PMH

Answer 8

1. Limited mouth opening due to radiotherapy
2. Neck or back problems making positioning difficult
3. Syndromes
4. Obesity

Question 9

Name 4 ways cooperation may be affected by PMH

Answer 9

1. Movement disorders
2. Behavioural problems
3. Learning difficulty
4. Dementia

Question 10

Name 2 ways the procedure may be affected by PMH

Answer 10

1. Osteogenesis imperfecta

2. McCabes disease

Question 11

Why does McCabes disease affect exodontia?

Answer 11

In McCabes disease means teeth are more prone to fracture and turn into surgical extractions

Question 12

Name 3 ways PMH may affect post operative complications

Answer 12

1. Liver problems
2. Diabetes
3. Previous radiotherapy

Question 13

Name 5 patient groups at risk of systemic complications following exodontia

Answer 13

1. Cardiovascular disease
2. Asthma
3. Epilepsy
4. Addisons disease
5. Diabetes

Question 14

Name 5 types of medications which can have an effect on exodontia

Answer 14

1. Warfarin / NOACs (bleeding risk)
2. Aspirin / Antiplatelet drugs (bleeding risk)
3. Steroids (post op infection)
4. Chemotherapy drugs (post op infection)
5. Bisphosphonates (ONJ)

Question 15

Describe 4 general components during an examination for exodontia

Answer 15

1. Demeanour
2. Swelling
3. Problems with access
4. Problems with position

Question 16

Name 3 main aspects of the assessment of the tooth

Answer 16

1. Crown integrity
2. Root size and morphology
3. Condition of surrounding bone

Question 17

Why is crown integrity important during an assessment of a tooth for exodontia?

Answer 17

• Important as this is where the forceps are applied

- Difficult to position forceps correctly if tooth carious or broken down

Question 18

Why is root size and morphology important during an assessment of a tooth for exodontia?

Answer 18

• Large root surface means more difficult extraction

- Roots which diverge tend to be more difficult

Question 19

Why is the condition of the surrounding bone important during an assessment of a tooth for exodontia?

Answer 19

• Teeth affected by periodontal disease will be easier to remove
• Palpate for thickness
• Bone density and elasticity will play a role but difficult to assess

Question 20

What must always be done before exodontia?

Answer 20

A radiograph (usually IOPA or OPT) must be taken

Question 21

Name 3 things a pre operative radiograph must show

Answer 21

1. Root numbers, shape and orientation
2. Associated local structures (sinus / IDN)
3. Condition of surrounding bone

Question 22

Name 6 intra operative complications of exodontia

Answer 22

1. Root fracture
2. Fracture of alveolar bone
3. Fractured tuberosity
4. OAC
5. Root displaced into antrum
6. Damage to mental or ID nerve

Question 23

Describe the complications with a root fracture during exodontia

Answer 23

• Decision to leave or remove (can leave smaller usually)
• Any infection risk
• Reason for initial exodontia will matter e.g pre radiotherapy
• Proximity to important anatomical landmarks

Question 24

Describe the complications with a fracture of the alveolar plate during exodontia

Answer 24

• Leave or remove depending on size and blood supply
• Usually seen as a tear in mucosa and bone moving with the tooth
• Large bodies can be left unless there is poor blood supply

Question 25

Name 5 common risk factors for a fractures tuberosity

Answer 25

1. Long or bulbous roots 2. Hypercementosis 3. Multi rooted teeth 4. Lone standing upper molars 5. Pneumatized sinus / sinus pathology

Question 26

Name 4 signs a fractured tuberosity has occured

Answer 26

1. Crunch or loud crack of bone breaking 2. Sudden loosening of tooth and bone together 3. Bone comes away with tooth during extraction 4. Tear in mucosa

Question 27

Describe 3 ways to diagnose a fractured tuberosity

Answer 27

1. Confirmed mobility of fracture fragments 2. Radiographic evidence of fracture 3. Determine size and if sinus involvement

Question 28

Describe how to manage a fractured tuberoisty

Answer 28

- Small fragments without sinus involvement can be dissected out - Large fragments, sinus involvement or multiple tooth involvement will need to be left in situ, 1st stage endo and onward referral for surgical removal

Question 29

What is an oro-antral communication?

Answer 29

Communication between maxillary sinus and oral cavity

Question 30

What is an oro-antral fistula?

Answer 30

If an OAC is not treated it can become lined with epithelium and is termed a fistula

Question 31

What is the major issue with an OAC?

Answer 31

Allows the flow of food, fluid, bacteria etc from the mouth the maxillary sinus and the nose

Question 32

Name 4 predisposing factors of OAC

Answer 32

1. Lone standing molars 2. Pneumatisation of the sinus 3. Proximity of molar roots to maxillary antrum 4. Difficult extractions

Question 33

Name 4 ways to diagnose an OAC

Answer 33

1. Sinus lining visible 2. Air bubbles in socket 3. Change of tone in the suction 4. Very gentle probing with blunt instrument

Question 34

Name 5 ways to manage a patient with an OAC

Answer 34

1. Small fistulae may close spontaneously but will need follow up 2. Large fistulae require buccal advancement flap ASAP 3. Sinus regimen 4. No nose blowing 5. If unable to advance flap, pack and refer ASAP

Question 35

What is the most common cause of root displacement into the antrum?

Answer 35

Usually due to injudicious use of elevators (operator error)

Question 36

Describe the management of a root being displaced into the antrum

Answer 36

- Needs removed and resultant OAC closed - Specialist referral - Better to be done ASAP before cilia in sinus brush root towards top

Question 37

When is damage to ID or mental nerve most likely to occur?

Answer 37

Extractions of lower 8s

Question 38

Name 3 post operative complications

Answer 38

1. Bleeding 2. Infection 3. Dry socket

Question 39

Name 3 types of haemorrhage following extractions

Answer 39

1. Primary (during surgery) 2. Reactionary (within 24 hours due to failure to follow post op instructions) 3. Secondary (days later due to infection)

Question 40

Describe how to manage a haemorrhage during exodontia

Answer 40

- Reassure patient and make them comfortable - Check medical history - Identify the cause of bleeding - Damp gauze and biting will usually stop bleeding - Surgicel and sututre (possible antibiotics)

Question 41

Describe dry socket as a post operative complication of exodontia

Answer 41

- Blood clot fails to form or breaks down - Extremely painful - Debris found in the socket with no clot - Reassure, irrigate and sedative dressing eg alvogel