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Oral Surgery > Exodontia > Flashcards

Exodontia Flashcards

1
Q

Describe the process of exo socket healing

A
  1. Socket filled with a blood clot
  2. Demolition phase
  3. In growth of granulation tissue
  4. Epithelial growth
  5. Formation of woven bone
  6. Formation of lamellar bone
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2
Q

The palatal mucosa of the incisors, canines and premolars in the maxilla is innervated by the:

A

Incisors and canines - nasopalatine

Premolars and back - Greater palatine

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3
Q

If a pathological condition has eroded the buccal bone, incisions must be mm away from this area.

A

6-8mm

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4
Q

Why do incision lines need to be supported?

A

If not they can collapse leading to wound dihescence

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5
Q

What vital structures are most important to be aware of in the maxilla whe making incisions?

A

Greater palatine arteries

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6
Q

What are the two most implant vital structures to be aware of when making incisions in the mandible?

A

Lingual nerve

Mental nerve

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7
Q

The most common flap design is the two sided flap

True or false

A

False. Envelope flap

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8
Q

What type of bleeding occurs hours after procedure?

A

Reactionary. Local rise in blood pressure following resolution of LA

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9
Q

What type of bleeding occurs 2-3 days after procedure

A

Secondary.

Due to infection destroying the blood clot or trauma to vessel wall.

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10
Q

What is the preferred analgesic in asthmatics?

A

Paracetamol

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11
Q

Is paracetamol safe for pregnant and breastfeeding women?

A

Yes

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12
Q

Why are NSAIDS unsafe for asthmastic?

A

Can get NSAID induced bronchospasm

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13
Q

Is codein safe for pregnant women?

A

Yes

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14
Q

list 4 radiographic features which indicate the nerve is in close relation to the root

A
  1. Constriction or narrowing of the canal
  2. Deviation of the canal
  3. Cenal is obscured or indeterminable
  4. Apex of third molar indeterminable
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15
Q

When is the ideal time to remove third molars?

A

When roots are 1/2 to 2/3 developed

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16
Q

What ASA is this?

A pt with mild to moderate systemic disease

A

ASA II

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17
Q

What ASA grade is this?

A patient with severe systemic disease that limits activity but not incapacitation

A

ASA III

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18
Q

What ADA grade is this-

A patient with severe systemic disease that limits activity and is a threat to life

A

ASA IV

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19
Q

What ASA is this?

A morbid patient not expected to live long without an operation

A

ASA V

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20
Q

3 symptoms and signs of a fresh OAC

A
  • Sinus fistula or lining visible
  • Bubbling of blood from the socket
  • Hollow sound during suction
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21
Q

4 signs/symptoms of an old OAC

A
  1. Water runs from the nose when drinking
  2. Sinusitis symptoms
  3. Unhealed socket with prolapsed antral polyps
  4. Radiographic changes
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22
Q

Management for OAC:

A
  • If less than 2mm, spongostan and mattress sutures
  • Other surgical options - buccal advanced flap
  • Post op antibiotics and other medications
  • Post op instructions and follow up.
  • Suture over bone - not over socket!
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23
Q
A
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24
Q

Prevention of OAC:

A
  • Assess radiographs
  • Care when exo of isolated upper molar
  • Surgical exo of suspected teeth with a planned flap design to close the communication
  • Suture plan
  • Pt education
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25
Q

Why should isolated upper molars be removed surgically?

A

To prevent the floor of the sinus from coming with it

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26
Q

Clinical signs of a fractured maxillary tuberosity

A
  • Tooth suddenly gives way with a noise
  • Tooth mobile with the surrounding tissue
  • Tear of the palatal mucosa
  • Bubbling of blood near the mobile tooth
  • Tooth removed with a large bone piece attached, and the antrum opened or lining can be seen
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27
Q

How should a small fracture of maxillary tuberosity be managed (no antrum involvement)

A

Remove tooth with segment

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28
Q

How should a large fracture of maxillary tuberosity be manged - antrum involved

A
  • Remove tooth
  • Close OAC

OR

  • Remove the pulp
  • Reduce the crown
  • Fix to the next teeth with circumferential wire
  • Surgically remove after about 4 months.
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29
Q

Where will a fracture of the alveolus likely occur?

A

Upper posterior or lower anterior

30
Q

How should you manage an alveolar fracture?

A

Reduce tooth, splint, clear occlusion

Then surgical extraction in 4 months

31
Q

Two methods of preventing TMJ dislocation/damage during exodontia :

A
  • Support mandible
  • Bite block
32
Q

List 7 POST exo complications:

A
  • Pain, swelling, trismus
  • Bruishing and haematoma formation
  • Prolonged bleeding
  • Dry socket
  • Soft tissue infection and abscess formation
  • Fascial space infection
  • Osteomyelitis/RONJ/MRONJ/BRONJ
33
Q

8 ways of minimizing POST exo complications

A
  • Check med hist
  • Haemostasis
  • Proper handling of tissue
  • Minimal trauma
  • Adequate cooling
  • Aseptic technique
  • Avoid injection into infected regions
  • Antibiotic prophylaxis for immune compromised
34
Q

What demographic has a high incidence of Dry socket

A
  • Smokers
  • Women on OC
35
Q

Clinical features of dry socket:

A
  • Severe pain one to three days after exo
  • Socket full of food with foul smell
36
Q

Tx for dry socket

A
  • Irrigate with saline or chlorhex
  • Pack with sedative dressing eg alvogyl
37
Q

You have a patient who needs an exo, but they have a history of dry sockets. What do you do/

A
  • Pre-operative metronidazole
  • Pack socket with alvogyl immediately after exo
38
Q

Whats Alvogyl?

A

Zinc oxide Eugenol

39
Q

3 reasons for primarily bleeding (bleeding at time of surgery)

A
  • Abnormal blood vessels
  • LA without vasoconstrictor
  • Bleeding disorder
40
Q

Management of reactionary bleeding (few hours after)

A
  • Pressure for 14 mins

If persistent:

  • Get pt in
  • Clean mouth and reassure
  • Infiltrate with LA wround socket
  • Clean socket and assess site.
  • Assess MH to eliminate bleeding disorders
  • If soft tissue - horizontal mattress sutures
  • Bony socket - Haemostatic agent and sutures (spongostan or surgical)
  • Anti-fibrinolytic agents as required eg tranexamic acid
41
Q

Management of secondary bleeding:

A

Clean socket, local measures, prescribe ABs

42
Q

5 possible complications of implant SURGERY

A
  • Unable to gain primary stability
  • Lack of osseointegration
  • Damage to vital structures
  • Component aspiration
  • Mandible fracture
43
Q

List 8 complications which can occur during exo

A
  1. Exo wrong tooth
  2. Tooth fracture
  3. Damage to adjacent teeth
  4. Tooth goes missing
  5. Fracture of bone
  6. Nerve damage
  7. Soft tissue damage
  8. OAC
  9. Damage to TMJ
44
Q
A
45
Q

What is the bony barrier which prevents OACs when maxillary molar roots extend into the sinus?

A

Intact lamina dura (though pathology may erode this)

46
Q

Healing of OAC is influenced by:

A
  • Diameter of defect
  • Dept of socket
  • Presence of pre-existing sinus disease
  • Home care
47
Q

In the absence of pre-existing sinus disease, a communication of less than mm will likely close spontaneously.

A

5mm

48
Q

Example of pre-existing sinus disease which might affect healing of OAC:

A

Hayfever

49
Q

What should socket be packed with following OAC?

A

Gel foam (spongostan)

50
Q

List the sinus precautions given to pt to facilitate healing:

A
  • Dont blow nose or sniff vigorously
  • Dont block nose when sneezing
  • Avoid smoking
  • Keep head elevated
  • Avoid drinking through straws
51
Q

What is it called when an OAC doesn’t heal on its own because it becomes epithelialised:

A

Oro-antral fistulae

52
Q

As a general rule, what roots ay be left in situ:

A

Less than 3mm, no pre-existing periapical infection.

53
Q

What to do if you have pushed a tooth or root into antrum:

A
  1. Confirm
  2. Close socket with gelfoam and sutures
  3. Advise sinus precautions
  4. Prescribe antibiotics
  5. Inform pt and document
  6. Urgent referral to specialist.
54
Q
A
55
Q

Which o the following is NOT a radiographic indication of close association between the apex of teeth and the IAC:

a) Deflection of roots
b) Narrowing of roots
c) Dark and bifid apex of roots
d) Darkening of the canal
e) Narrowing of the canal

A

d) Darkening of the canal

56
Q
A
57
Q
A
58
Q

6 aetiologies of pericoronitis

A
  • Trauma from opposing tooth
  • Upper resp tract infection
  • Debilitating disease
  • Stress
  • Fatigue
  • Pregnancy
59
Q

Signs and symptoms of acute pericoronitis:

A
  • Sudden onset throbbing pain back of jaw
  • Trismus and pain when swallowing
  • Unable to fully close mouth due to biting over the pericoronal flap
  • Halitosis and foul taste
  • Swelling over pericoronal flap
  • Fever, malaise, lymphadnopathy
  • In some patients infection can spread to fascial planes
60
Q

Signs and symptoms of chronic pericoronitis

A
  • Halitosis
  • Bad taste
  • Inflammaed pericoronal flap
  • Deep pocket distal to second molar and pus discharge
  • Radiographic evidence of bone loss around impacted tooth
61
Q

Tx for pericoronitis:

A
  • Relieve trauma from opposing teeth
  • Irrigate with chlorhexidine and apply antiseptic to pocket
  • Analgesics and chlorhex mouthwash
  • ABs if needed
  • Exo when acute infection subsides
62
Q

List tooth level and patient level factors which affect assessment of wisdom teeth for exo

A
  • Impaction type
  • Depth from alveolar margin
  • Distance from ramus
  • condition of crown and roots
  • Relationship with maxillary antrum, ID canal and adjacent teeth
  • Type and extent of pathological changes
  • Anxiety/stress of patient
  • Extent of mouth opening
  • TMJ disorders
  • Increased gag reflex
  • Available space between coronoid process and maxilla
63
Q

List indications for removal of wisdom teeth

A
  • Recurrent pericoronitis
  • Caries
  • Trauma to cheek or alveolus
  • Pathological lesions
  • Food impaction, perio or root resorption of adjacent tooth
  • Prior to radio/chemo therapy
  • Non functional
  • Pre-orthognathic surgery
  • Pros indications
  • Traveling overseas
  • Involved in professional contact sports
    *
64
Q

What are 6 advantages of exos at an early age

A
  • Wide pericoronal space
  • Straight or incomplete roots
  • Infrequent contact with IDC and antrum
  • Less danger of jaw fracture
  • Less medical problems usually
65
Q

When might you use a donovans view of a wisdom tooth?

A

Transverse impaction (occlusal view)

66
Q

List 7 radiographic features which indiacte close association of the IDB

A
  1. Darkening of apex
  2. Narrowing of roots
  3. Deflection of roots
  4. Dark and bifid apex of roots
  5. Interruption of the white line of the canal
  6. Deviation of the canal
  7. Narrowing of the canal
67
Q

When might you opt for a coronectomy?

A
  • Extreme surgical difficulty
  • Surgical removal can lead to severe post op complications
68
Q

When might you opt for an operculectomy as tx of pericorontis?

A
  • Tooth favourably placed
  • No more than 1 attack of pericoronitis
  • Missing teeth in arch
69
Q

How to create space between maxilla and coronoid process:

A

Get patient to open halfway and deviate jaw to the same side

70
Q
A

Oral Surgery (7 decks)

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