Extractions and Minor Oral Surgery

Question 1

Over view information

Answer 1

Simple ext-roots teeth no soft tissue or bone

Surgical ext-roots tooth soft tissue or bone to be again access to get to the tooth

Operculectomy-surgical removal flap partial erupted

Alveolectomy- surgical adjustment bone removal alveolar ridge crest a smooth base dentures after extract

Gingivetomy and gingivoplasty helps for OH periodontal to tissues adjusted

Periodontal flap surgery-surgical raising replacing enable subgivgival debridement carried out

Soft tissue biopsi-pathology investigation diagnosis partial or complete removal of oral tissue lesion

Extraction-
Pontic of a bridge,denture,implant

Question 2

Reason for tooth extraction

Answer 2

Pain infection
Position for denture prosthesis Poor aligned, ortho failed root canal pericoronitis food trapping deciduous tooth favourable positions

Question 3

No reason and has to extract

Answer 3

Continual infection in mouth infection can spread to blood stream repeat prescriptions is poor practice

Question 4

Different extraction categories

Answer 4

*Simple extraction

*Surgical extraction involving soft
tissues removal to expose an unerupted tooth or buried root

• surgical extraction Involving dissection tooth socket in sections
• surgical extraction involving raising mucoperiosteal flap and bone removal gain full access root or tooth

Question 5

Deciduous tooth points considered

Answer 5

Resorption-attached to gingivae
Permenent successor- underlying tooth Attached damaged?
Infection makes procedure unnecessary painful
Age cooperation
Medical history
Tooth status if surgical extraction lots of caries differcutl to sit thru

Question 6

Permanent tooth points considered

Answer 6

Infection
Medical history
Medications hospitalisation because of their side effects
Co operation may need anxiety control
Age older patients jaw brittle and damaged tissues
Tooth status grossly carious=surgical extraction
Cost implications after missing tooth

Question 7

Simple extractions instruments

Answer 7

Forceps-grip from neck of tooth applying wrist action
Luxators-used to widen socket serve periodontal ligaments
Elevators-prise the tooth and root of the socket-winters cryers Warwick James
Fine bore aspirator-disposable suction tip all blood sucking tooth debris
Haemostats-gelatine sponges or oxidised cellulose packs inserted into socket after extraction aid blood clotting

Question 8

Special precautions

Answer 8

Sterile bagged instruments individually
PPE for dental team prevent blood contamination
Disposable items cross infection scopale blades needle aspirators sutures
Contamination policy not used must be thrown anways
Suction equipment-run through inner workings
Operative field-sodium hypochlorite blood wiped down
Equipment coverage-dental chair covered before procedure
Sterile field-no touch technique

Question 9

Pre op

Answer 9

Local anaesthesia will nessary
Not be painful once that’s given
Surgical extraction suture be required
Take all meds before unless dentist says not to no aspirin
Light snap before procedure 2h avoid fainting
Full post of given I’m writing
Child patient or adult nervous accompy adult

Question 10

Post op

Answer 10

Pain swelling bruising occur
Analgesics expect aspirin
Alcohol hot drinks excercise avoid 24 hr
No mouth rinsing the day of procedure
Hot salt water rinses after meal for a week
Bleeding occur bite cotton pack 30 mins
Give emergency telephone number advise problems
Further appointments of suture to be removed

Question 11

Surgical extraction reasons
Will call into categories
Extraction sectioning or raising mucoperiosteal flap

Answer 11

Roots left retained in alveolar bone small lives left in situ can come to the
bone later on and be a normal extraction

Too rotten held by forceps

Curved roots impossible for normal extraction

Tooth is partially erupted or impacted tooth becomes a stagnation

Tooth unerupted has association to pathology cyst

Can cause problems prosthesis or ortho treatment
Deciduous tooth fails to exfoliate because roots cemented to bone -ankylosed

Question 12

Tooth Sectioning extraction

Answer 12

Multirooted teeth root that is curved or gross carious

Maybe necessary sometimes to remove septal bone lies between root and socket wall

High speed turbine diamond bur usually for crown prep bur

Use of couplands chisel achieve final separation of roots twist to snap them apart

High speed suction remove water

Careful retraction of soft tissues

Question 13

Extractions invoking mucoperiosteal flap

Answer 13

Unerupted tooth or impacted
Buried retained root
Root curved=extensive bone removal
Gross root

Question 14

Role as a dental nurse flap procedures

Answer 14

Correct suction and irrigation solution
Correct and accurate fine bore asipirator

Careful retraction without being forceful
Cutting suture or assistant keeping it taut
Prep bite pack assist placement of gelatine sponge

Question 15

SURGICAL INSTRUMENTS FOR FLAP PROCEDURE

Answer 15

• scalpel blade and handle-create flap incision thru full thickness
• Osteotrimmer-raise corner flaps- Mitchell’s trimmer
• periosteal elevator-elevation flap over bone surface peeling it off the bone
• hand piece surgical bur-remove alveolar bone gain access
• irrigation syringe-irrigate surgical field sterile saline or sterile water
• austin and Kilner retractors-protect check and lips and tongue
• rake retractor-retract mucoperiosteal it self
• bone rongeurs-nibble away Bony spicules smooth base
• dissecting forceps-holds loose flap taut during sutures
• needle holder-pre threaded needle Firm suturing
• suture pack-half moon needle silk black Vicryl Suture bad into position alveolar bone
• suture scissors-cut suture end

Question 16

Tooth impaction

Answer 16

Vertical impaction impacted to the ramps of the mandible

Horizontal impaction slacker sidewards

Mesio angular impaction titled side ways into second molar

Disto angular backwards into Ramus

Question 17

Risk of extraction

Answer 17

Extensive bone removal weaken mandible

Pain and swelling

Inferior dental nerve and lingual dents nerve close to operation damage temp or perm

Eating and talking diffecult
Limited mount opening

Question 18

Complications of extractions

Answer 18

Orantral fistulas - maxillary sinus extracting upper premolar and molar lies of those roots so it can cause infection or trauma pushed into the root=oral specialist..long rooted can leave a hole for a week antrum and oral cavity told not to blow their noses week..air bubbles in socket confirmed pinches nose and blows.. large openings direct suturing or gingival flap off palate across seal fistula

Unexpected tooth fracture it it has been heavy or root filled grossly carious if roots are fine and curved can cause a fracture can be left in situ to rise to alveolar ridge over time then remove

Loss of tooth-respiratory or digestive inhaled sent immediately hospital chest X-ray abdominal radiographs cause cause infection respiratory one can be removed in the use of a bronchoscope if lodged inside main bronchi if not then further has to be thru thoracic surgery

Question 19

Left surgery

Answer 19

Bleeding

Within 1-23 hours REACTIONARY HAEMORRHAGE

After24 hours SECONDARY HAEMORRHAGE due to infection at site

INFECTION
2-4 days loss blood clot boney socket walls infected LOCALISED OSTEITIS

Question 20

Bleeding

Answer 20

Blood vessels in the periodontist are torn during procedure

Usually stops 5 mins after PRIMARY HAEMORRHAGE

if extensive bleeding can use sutures

TORN blood vessels constrict blood flow
Then platelets come help with air and create sticky clump together
Clotting mechanisms-protein fibrinogen converted =fibrin= chemically seals cut vessels haemorrhage ends

INR international normalised ratio indicate whether done in the practice or hospital setting Score more then 4 out to hospital
Haemostatic sponge solve problem

Question 21

Infection

Answer 21

Painful 2-3 days after cute inflammation bone(osteitis) socket cause by a micro invasion the blood clot is the protection but it ain’t there

Infection of blood clot
Failure of formation
Disturbance of blood clot

Microorganism invade socket overwhelms the defending white blood cells
And disingets it more common in mandible then upper thick bone

TREATING —irrigation use tweezers sedative dressing alvogyl socket anti inflammatory analgesic and hot water rinses

Question 22

DENTAL nurse role

Answer 22

Dental nurse duty reassure patient
Give a pad to bite down
Awaiting arrival of dentist Mouth wash for unpleasant taste or go to dental hospital

Question 23

Accidental extraction

Answer 23

Replanting premolar back in don’t allow periodontal ligament infected or dried

Same with little children insicsal teeth come out avulsed as long as periodontal membrane remains vital

Reassure patient treatment might be possible
Hold tooth my crown warm water
Don’t disinfect
They can put it back inside immerse in milk come surgery straight away
Splint needed to mobilise for a week or so

Question 24

Antibiotics MOS

Answer 24

Back up to treatment
Evidence of infection only
Evidence symptoms raised body temp

Better removed form extraction
Resistant to bacteria
Long term affects to body bacteria
Dangerous antiolgant drugs have on antibiotic don’t stop bleeding
Other drugs conception and alcohol
Hypersensitivity for the use of antibiotic
All drugs avoid when pregnant

FIRST CHOICE-amoxicillin 250 mg 4 times for 5 days
SECOMD CHOICE-metronidazole 200 mg 3 day or 3 days
THIRD CHOICE-erythromycin 250mg 4 times 5 days allergic penicillin
Serve 1/2 given together

Question 25

Operculectomy

Answer 25

Surgical removal gingival flap partially erupted

Cause cause pericoronitis and then trismus
Treatment
Mouth wash called peroxyl mouthwash (oxygen realising solution)
Irrigation under flap remove debris cholorhexidine
OHI
Ibruprofen
Surgical removal using electrical cautery unit controls bleeding
3 days course of mertrondizole

Question 26

Alveolectomy and alveoplasty

Answer 26

A mucoperiosteal flap raised to gain access to ridge the. Bone rongeurs nuts used to remove help sit denture not make bone sharp

Question 27

Gingivectomy gingivoplasty

Answer 27

Helps with Oral health measures more better to remove plaque
Excess gum removed with gingivectomy knife Blake’s most common
Removed with tweezers RAW AREA covers with ZINC OXIDE EUGENOL periodontal pack=Coe-park
Rapid painless healing
Removed a week later thru scaling
Used for crown lengthening
Gingivoplasty carried out using electro surgical unit
Given analgesics Drugs soft diet mourn wash

Question 28

Periodontal flap surgery

Answer 28

Performed under local Anastasia And refer to a periodontal specialist

Helps for plaque control sub gingival
Incision made through the gingival palatal of the tooth down to the surface
piece of tissue is removed from the area
Then plaque calculus
Removed ultra sonic scaler
Antibiotics- gengigel dentomycin periochip used healing
Then put back into place sutures
But gingival margin repositioned
Exposing more of the route to make cleaning easy in the future

Question 29

Soft tissue biopsies

Answer 29

Large lesions are called incisor biopsies

Whole tissue removed and small lesions are referred to as excisions biopsies

Could be cancer

Question 30

Cyst removal

Answer 30

is a fluid filled sac combine with soft tissue lining

It can happen when the tooth is dead apex apical cyst or preventing a eruption dentigerous follicular cyst
If left it can displace of a tooth and it should be removed in oral surgeon hospital

Question 31

Frenectomy

Answer 31

Removal frenum fibrous tissue muscle membrane

Wide gap upper central Invisalign median diastema affect denture fit upper