Final Exam Study Guide

Question 1

OMS training is vastly different from most of the dental specialty training and education. What are the significant differences compared to general dentist education?

Answer 1

1. Extensive hospital, medical & surgical trainings
2. 100% US accredited OMS training programs incorporates advanced general anesthesia training for maximum patient comfort and safety in office setting
3. Bridge the gap between dentistry & medicine

Question 2

List some examples of various OMS treatments:

Answer 2

1. removal of teeth
2. exposure of impacted teeth for orthodontic treatment
3. recontour the jaw bones
4. preparation of jaws prior to XRT or placement of cardiac or orthopedic prosthetics
5. reconstructive surgery

Question 3

What are some reasons for an OMS to remove teeth?

Answer 3

a) malposed/impacted
b) non salvageable teeth

Question 4

What are some of the reasons an OMS may perform reconstructive surgery?

Answer 4

a) restoring form and function from avulse traumatic events, pathology removal & physiologic atrophy

b) restoration of continuity

c) restoration of alveolar bone height & width

d) restoration of osseous bulk

Question 5

Give examples of some events that may cause an OMS to have to perform reconstructive surgery to restore form and function:

Answer 5

i) Avulsive traumatic events
ii) Removal of pathology
iii) physiologic atrophy

Question 6

When writing a patient’s note, what type of patient record format is needed and is recognized in the medical profession worldwide?

Answer 6

SOAP note

Question 7

The very first thing about writing this format as well as what you need to ask the patient when you first meet them is:

Answer 7

Chief Complaint

Question 8

What do you need to ask the patient when you first meet them for a soap note?

Answer 8

Chief complaint

Question 9

Describe an ASA I:

Answer 9

Normal, healthy patient, no systemic disease

Question 10

Describe an ASA II:

Answer 10

Patient with mild systemic disease which is well controlled

Example: well controlled HTN

Question 11

Describe an ASA Class III:

Answer 11

Patient with significant systemic disease which limits activity but is not incapacitating

Example: CHF

Question 12

Describe an ASA IV:

Answer 12

Patient with an incapacitating systemic disease which is a constant threat to life

Example: Unstable angina pectoris

Question 13

Describe an ASA V:

Answer 13

Moribund patient not expected to survive more than 24 hours

Example: End stage kidney disease

Question 14

Classify the following based on the ASA parameters:

Patient with significant systemic disease which limits activity but is not incapacitating

Answer 14

ASA III

Question 15

Classify the following based on the ASA parameters:

Normal, healthy patient, no systemic disease

Answer 15

ASA I

Question 16

Classify the following based on the ASA parameters:

Moribund patient not expected to survive more than 24 hours

Answer 16

ASA V

Question 17

Classify the following based on the ASA parameters:

Patient with mild systemic disease which is well controlled

Answer 17

ASA II

Question 18

Classify the following based on the ASA parameters:

Patient with an incapacitating systemic disease which is a constant threat to life

Answer 18

ASA IV

Question 19

Classify the following based on the ASA parameters:

38yo female with controlled HTN

Answer 19

ASA II

Question 20

Classify the following based on the ASA parameters:

Patient with unstable angina pectoris

Answer 20

ASA IV

Question 21

Classify the following based on the ASA parameters:

55yo male with CHF

Answer 21

ASA III

Question 22

Classify the following based on the ASA parameters:

40yo female with end stage kidney disease

Answer 22

ASA V

Question 23

What are some ways to reduce patient fear & anxiety? (6)

Answer 23

1. Hand holding (non-pharmacological method)
2. N2O/O2
3. Oral medications/oral pre-meds
4. Intravenous medications
5. General anesthesia
6. Combination of all of the above

Question 24

How to correctly write the medical consultation? What components need to be IN the consult? What are the “STEPs”?

Answer 24

STEP 1: Write an abbreviated SOAP note
STEP 2: Brief anticipated procedure
STEP 3: Ask the focused question and what you want to know
STEP 4: Print & fax

Question 25

What’s the potential oral surgical patient logistic flow chart for UMKC dental school system?

(In other words, once a patient has been screened in DXR, what are the next few potential steps?)

Answer 25

Indication for tooth removal –> assessment of factors —> decision to treat or refer

Question 26

What’s the potential oral surgical patient logistic flow chart for UMKC dental school system for referrals?

(In other words, once a patient has been screened in DXR, what are the next few potential steps IF YOU DECIDE TO REFER)

Answer 26

Refer to specialist —> follow up to manage potential complications

Question 27

What’s the potential oral surgical patient logistic flow chart for UMKC dental school system for treating patient yourself?

(In other words, once a patient has been screened in DXR, what are the next few potential steps IF YOU DECIDE TO TREAT YOURSELF)

Answer 27

Treat yourself –> with or without flap –> follow-up to manage potential complications

Question 28

In the pre-surgical evaluation, how do you assess tooth mobility?

How would this be documented?

Answer 28

Assessment:
4) No mobility (high potential for ankylosis)
3) No mobility but ankyloses not a problem
2) Normal tooth mobility
1) Greater than normal mobility

Documented through miller classification

Question 29

Tooth mobility that is assesses as Stage 4: No mobility (high potential for ankylosis) includes teeth such as:

Answer 29

1. primary molars
2. endo treated teeth
3. erupted 3rd molars

Question 30

What is miller classification used to describe?

Answer 30

Tooth mobility

Question 31

Describe Miller Classification for tooth mobility:

Answer 31

Class 1: Less than 1mm horizontal
Class 2: Greater than 1mm horizontal
Class 3: Greater than 1mm horizontal and vertical mobility

Question 32

The following describes:

Class 1: Less than 1 mm horizontal
Class 2: Greater than 1mm horizontal
Class 3: Greater than 1mm horizontal and vertical mobility

Answer 32

Miller classification for tooth mobility

Question 33

Classify the following based on the Miller Classification for tooth mobility:

Less than 1 mm of horizontal mobility

Answer 33

Class 1

Question 34

Classify the following based on the Miller Classification for tooth mobility:

Greater than 1 mm of horizontal mobility

Answer 34

Class 2

Question 35

Classify the following based on the Miller Classification for tooth mobility:

Greater than 1 mm of horizontal and vertical mobility

Answer 35

Class 3

Question 36

What is physiologic tooth mobility?

Answer 36

0.25mm

Question 37

Extraction forceps has handle, hinge & beaks. When dealing with the handle, what are the different way that a clinician can hold (grasp) on to it?

Answer 37

Horizontal grasp & Vertical grasp

Question 38

What style of forceps are used when an operator is using a horizontal grasp?

Answer 38

American style forceps

“America is on the HORIZON”

Question 39

Describe horizontal grasp with extraction forceps:

Answer 39

-American style forceps
-Handles are horizontal to the floor

Question 40

When using a horizontal grasp with extraction forceps, the handles are always _____ to the floor

For a maxillary extraction, the palm should face _____

For a mandibular extraction the palm should face _____

Answer 40

horizontal
maxillary –> palm up
mandibular –> palm down

Question 41

What position should a right-handed operator be in, when using a horizontal grasp with extraction forceps?

Answer 41

7-9 O’clock

Question 42

What style of forceps are used when an operator is using a vertical grasp?

Answer 42

European style forceps

“Europe is VERY fashionable”

Question 43

Describe vertical grasp with extraction forceps:

Answer 43

-european style forceps
-handles in vertical plane
-used for removable of mandibular teeth

Question 44

When would an operator use a vertical grasp with extraction forceps?

Answer 44

for removal of mandibular teeth

Question 45

Based on the following clinical situation, determine:

a) Elevator:
b) Action:

-Removal of sectioned roots following sectioning:

Answer 45

a) #30 & #31 (cryer)

b) wheel and axel - use with or without purchase point

Question 46

Based on the following clinical situation, determine:

a) Elevator:
b) Action:

-Removal of tooth or portion of tooth:

Answer 46

a) #41 (Crane pick)

b) wheel and axel - use with or without purchase point

Question 47

Based on the following clinical situation, determine:

a) Elevator:
b) Action:

-Removal of maxillary 3rd molars both erupted & impacted:

Answer 47

a) #73 & #74 (Miller) Potts

b) wheel and axel

Question 48

Based on the following clinical situation, determine:

a) Elevator:
b) Action:

-Removal of larger single roots when forceps aren’t preferred:

Answer 48

a) #34-S & #46

b) displacement

Question 49

Based on the following clinical situation, determine:

a) Elevator:
b) Action:

-Luxating teeth prior to forceps application:

Answer 49

a) #34-S, #46 & #301 sometimes

b) lever action, fulcrum placed on interseptal bone

Question 50

Based on the following clinical situation, determine:

a) Elevator:
b) Action:

-Removal of medium roots or medium size root tips when #34-S or #46 elevators are too large:

Answer 50

a) #301, #302 & #303

b) displacement

Question 51

Based on the following clinical situation, determine:

a) Elevator:
b) Action:

-Removal of small root tips when tips have unobstructed pathway and are loose:

Answer 51

a) apex elevators (root picks)

b) displacement

Question 52

List the mechanical motions of extractions:

Answer 52

1. Lever
2. Widge
3. Wheel & axel

Question 53

What mechanical motion is being described below?

“prying the tooth root tip from its socket”

Answer 53

Lever

Question 54

Describe how to “lever” during extraction:

Answer 54

1. engage a purchase point (groove or hole in tooth)
2. gripping the edge of the blade and use bone as fulcrum

Question 55

Describe how to “wheel & axel” during extraction:

Answer 55

1. engage purchase point
2. use bone as fulcrum to rotate the tip out

Question 56

For maxillary extractions, what is the angle of the maxillary occlusal plane to the floor?

Answer 56

45 to 60 degrees

Question 57

When performing maxillary extractions, the patients shoulders are at the level of:

Answer 57

the surgeons elbow

Question 58

When performing maxillary extractions, the operator should be standing at the _____ position

Answer 58

7 or 8 o’clock

Question 59

When performing maxillary extractions, what provides stability to the operator?

Answer 59

feet spaced apart

Question 60

When performing maxillary extractions, what is the function of the nondomimant hand?

Answer 60

provides stability and counters traction of force

Question 61

For mandibular extractions, what is the angle of the mandibular occlusal plane?

Answer 61

parallel to floor

Question 62

When performing mandibular extractions, the patients shoulders are at the level of:

Answer 62

surgeons elbow or lower

Question 63

When performing mandibular extractions, the operator should be standing at the _____ position

Answer 63

7 to 8 o’clock

Question 64

What provides stability when performing mandibular extractions?

Answer 64

Feet spaced apart

Question 65

What is the function of the non dominant hand when performing mandibular extractions?

Answer 65

provides stability and counters traction force

Question 66

Another popular OMS position for maxillary extractions is when the operator is standing at _____ o’clock instead of 7 to 8 o’clock. The patient should be in a ______ position. The surgeon should grasp the forceps with the palm _____. The _____ is kept close to the body to reduce ____.

What is the downfall to this alternative position?

Answer 66

12 o’clock ; fully reclined; up; arm; fatigue

Downfall: way easier got object to get into airway; throat pack necessary

Question 67

List all the possible forcep movements:

1. ____ pressure
2. _____ serves as fulcrum of rotation
3. the more _____ the forceps adaptation, the shorter the fulcrum distance
4. ______ movement

Answer 67

1. BUCCAL pressure
2. MIDDLE OF SOCKET serves as fulcrum of rotation
3. the more APICAL the forceps adaptation, the shorter the fulcrum distance
4. FIGURR 8 movement

Question 68

What forcep movement is being described below?

-expand socket on buccal side
-detach PDL on lingual side

Answer 68

Buccal pressure

Question 69

What is an advantage to adapting the forceps more apically and therefore shortening the fulcrum distance?

Answer 69

More uniform dilation of socket –> reduces root fracture

Question 70

What forcep movement is being described below?

-combination of buccal pressure, lingual pressure and rotation

Answer 70

Figure 8 movement

Question 71

Give an example of how to use figure 8 movement on the central incisor:

Answer 71

basic movement is rotation because round/ovoid & conical shaped structure

Question 72

What may also be used to help with the figure 8 movement:

Answer 72

unscrew fashion

Question 73

Correct forceps will:

Answer 73

1. more apical position
2. tends to displace tooth with tearing up PDL with socket expansion at same time

Question 74

When performing an extraction, what should your non-dominant hand be doing?

Answer 74

The non-dominant hand should hold the jaw/alveolar process- detecting alveolar process movement

Question 75

How do you detect alveolar process movement during an extraction in the maxillary arch?

Answer 75

pinch grasp

Question 76

Describe what pinch grasp means

Answer 76

A way to detect alveolar process movement during a maxillary arch extraction

Thumb and index finger on either side of the alveolar process adjacent to the tooth

Question 77

The pinch grasp should be used in the ____ arch

Answer 77

maxillary

Question 78

Thumb and index finger on either side of the alveolar process adjacent to the tooth

Answer 78

Pinch grasp (detection of alveolar process movement in maxillary arch extraction)

Question 79

How do we detect alveolar process movement in the mandibular arch?

Answer 79

1. Mandibular sling grasp
2. Pinch grasp AND bite block

Question 80

What is the purpose of the mandibular sling grasp used to detect alveolar process movement in mandibular extractions?

Answer 80

1. Counteracts forces of extraction
2. prevents injury to the TMJ

Question 81

What is the purpose of the pinch grasp and bite block used to detect alveolar process movement in mandibular extractions?

Answer 81

1. support TMJ
2. Bite block on opposite side

Question 82

A common oral surgery lingo “____ flap –> _____ mistake”

Answer 82

small flap –> big mistake

Question 83

What can occur if the flap is too small?

Answer 83

Tearing of the tissue

Question 84

A mucoperiosteal flap needs to have a ______ to assure adequate blood supply

Answer 84

broad base

Question 85

A mucoperiosteal flap needs to have a broad base, this accomplished by making the:

Answer 85

apical portion wider than the coronal portion

Question 86

A mucoperiosteal flap needs to be large enough to provide:

Answer 86

Both visual access & instrument access

Question 87

T/F: With a mucoperiosteal flap, a large flap heals as rapidly as a small flap

Answer 87

true

Question 88

How does a mucoperiosteal flap heal (direction)?

Answer 88

Side to side (NOT end to end)

Question 89

In regards to a mucoperiosteal flap, post surgical pain does not correlate with ____ but rather ____

Answer 89

does NOT correlate with size of the flap, but rather the amount of bone removed

Question 90

A mucoperiosteal flap needs to be repositioned and sutured over ____

Answer 90

solid bone

Question 91

Why does a mucoperiosteal flap need to be repositioned and sutured over solid bone?

Answer 91

increases the healing rate and decreases wound dehiscence

Question 92

A mucoperiosteal flap needs to avoid:

Answer 92

major anatomical structures such as nerves & blood vessels

Question 93

Mucoperiosteal flap full thickness =

Answer 93

skin + subQ tissue + CT + periosteum

Question 94

For a mucoperiosteal flap, the margin of the flap should be atleast ____ from the margins of a ___

Answer 94

5mm; bony defect

Question 95

Common flap designs include: (2)

Answer 95

1. envelope flaps
2. vertical releasing incision flap

Question 96

Describe an envelope flap:

Answer 96

one tooth distal & one tooth mesial

Question 97

Describe a flap with a vertical releasing incision:

Answer 97

one tooth distal, one tooth mesial & includes papilla

Question 98

When creating a flap with a vertical releasing incision, the vertical releasing incision must be originating from either:

Answer 98

mesial or distal line angle