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Final state exams key topics Flashcards

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1
Q

Which cranial nerve supplies the main sensory innervation of teeth and jaws?

A

Trigeminal nerve (CN V).

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2
Q

What are the three divisions of the trigeminal nerve (CN V)?

A
  • V1 ophthalmic
  • V2 maxillary
  • V3 mandibular.
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3
Q

Which trigeminal division supplies maxillary teeth and maxillary gingiva?

A

V2 (maxillary nerve).

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4
Q

Which trigeminal division supplies mandibular teeth and mandibular gingiva?

A

V3 (mandibular nerve).

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5
Q

Which trigeminal division carries motor fibres to muscles of mastication?

A

V3 (mandibular nerve).

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6
Q

Name the muscles of mastication innervated by V3.

A

Masseter, temporalis, medial pterygoid, lateral pterygoid.

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7
Q

What is the key sensory nerve for mandibular teeth?

A

Inferior alveolar nerve (IAN).

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8
Q

From which nerve does the inferior alveolar nerve arise?

A

Mandibular nerve (V3), posterior division.

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9
Q

Where does the inferior alveolar nerve enter the mandible?

A

Through the mandibular foramen on the medial surface of the ramus.

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10
Q

What bony canal does the inferior alveolar nerve travel within?

A

Mandibular canal.

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11
Q

What does the inferior alveolar nerve supply?

A

Pulpal sensation of all mandibular teeth on that side (via dental branches in the canal).

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12
Q

What are the terminal branches of the inferior alveolar nerve?

A

Mental nerve and incisive nerve.

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13
Q

What is the incisive nerve and what does it supply?

A
  • Continuation of IAN anteriorly in the mandible=>
  • supplies mandibular incisors and canine region.
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14
Q

Where does the mental nerve exit the mandible?

A

Mental foramen (commonly near apices of premolars, often second premolar region).

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15
Q

What does the mental nerve supply?

A
  • Skin and mucosa of lower lip
  • skin of chin
  • labial mucosa/gingiva in anterior premolar–incisor region (variable distribution).
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16
Q

What clinical symptom strongly suggests IAN or mental nerve involvement?

A

Numbness/paraesthesia of lower lip and chin.

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17
Q

Which procedures commonly risk IAN injury?

A
  • Mandibular third molar surgery;
  • deep lower molar extraction;
  • implant placement in posterior mandible;
  • mandibular fracture;
  • apicectomy near canal.
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18
Q

What are typical signs/symptoms of inferior alveolar nerve injury?

A
  • Paraesthesia, hypoesthesia, dysesthesia of lower lip/chin;
  • altered sensation
  • possible neuropathic pain;
  • sometimes altered tooth sensation.

Paraesthesia=>an abnormal spontaneous sensation like tingling or pins and needles.
Hypoesthesia=>decreased sensitivity to sensory stimuli.
Dysesthesia=>unpleasant abnormal sensation, often painful
neuropathic pain=>Pain caused by a lesion or disease affecting the somatosensory nervous system.

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19
Q

How do you perform a basic chairside sensory test for IAN/mental nerve deficit?

A
  • Compare both sides=>
  • light touch (cotton)
  • pin-prick
  • two-point discrimination
  • document baseline.
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20
Q

What is the medico-legal priority if a patient reports numbness after extraction?

A
  • Document immediately (symptoms, sensory tests, distribution)
  • inform patient
  • provide review plan
  • refer if persistent.
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21
Q

What is the lingual nerve a branch of?

A

Mandibular nerve (V3), posterior division.

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22
Q

Where does the lingual nerve run in the mandible clinically (key viva point)?

A
  • Medial to mandible
  • very close to lingual plate in lower third molar region;
  • can lie at or above crest in some cases.
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23
Q

What does the lingual nerve supply (general sensation)?

A

General sensation from anterior two-thirds of tongue, floor of mouth, and lingual gingiva.

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24
Q

What does the lingual nerve supply (taste) and via which nerve?

A

Taste from anterior two-thirds of tongue via chorda tympani (CN VII) fibres that join the lingual nerve.

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25
What additional fibres travel with lingual nerve to salivary glands?
Parasympathetic secretomotor fibres to submandibular and sublingual glands (via chorda tympani → submandibular ganglion).
26
Which dental procedure most commonly risks lingual nerve injury?
Mandibular third molar surgery (especially lingual flap/retraction and lingual plate instrumentation).
27
What symptoms suggest lingual nerve injury?
* Numbness/paraesthesia of tongue; * altered taste; * burning/tingling; * possible speech or chewing discomfort.
28
Why is lingual nerve injury particularly important in a viva?
* High-risk complication; * affects taste/sensation ## Footnote requires clear documentation, counselling, and referral plan.
29
How should you reduce risk of lingual nerve injury during third molar surgery?
* Avoid unnecessary lingual flap; * gentle controlled retraction; * keep instruments on buccal side where possible; * avoid deep lingual curettage; * careful bone removal and sectioning.
30
If a patient reports tongue numbness post-op, what is your immediate management answer in a viva?
* Assess and document sensory deficit; * reassure; * explain possible nerve bruising; * review regularly; * refer to OMFS if persistent or severe; * do not dismiss.
31
What is the long buccal nerve (buccal nerve) a branch of?
Mandibular nerve (V3), anterior division.
32
What does the long buccal nerve supply?
Sensation to buccal mucosa/cheek and buccal gingiva adjacent to mandibular molars.
33
Why is the long buccal nerve clinically important for mandibular molar extraction?
IAN block does not anaesthetise buccal soft tissues of mandibular molars; need buccal nerve infiltration for painless flap/gingival manipulation.
34
What is the auriculotemporal nerve clinically associated with in dentistry?
* V3 branch; * supplies sensation to auricle/temple and carries parasympathetic fibres to parotid gland; * sometimes discussed with TMJ pain referral.
35
Which nerve supplies the upper lip?
Infraorbital nerve (branch of V2).
36
Which nerve supplies the lower eyelid?
Infraorbital nerve (branch of V2).
37
Which nerve supplies the cheek (midface)?
Infraorbital nerve (branch of V2).
38
Which nerve supplies the side of the nose?
Infraorbital nerve (branch of V2).
39
From which nerve does the infraorbital nerve arise?
Maxillary nerve (V2).
40
Through which canal/foramen does the infraorbital nerve emerge onto the face?
Infraorbital foramen (after passing through infraorbital canal).
41
Which teeth/regions are relevant to infraorbital nerve in oral surgery?
* Maxillary canine/premolar region; * midface trauma; * infraorbital nerve block for anterior maxilla/upper lip region.
42
Which nerve supplies maxillary teeth (general principle)?
Superior alveolar nerves (branches of V2).
43
Name the superior alveolar nerves.
Posterior superior alveolar nerve (PSA); middle superior alveolar nerve (MSA, variable); anterior superior alveolar nerve (ASA).
44
What does the posterior superior alveolar nerve supply?
Maxillary molars (often except mesiobuccal root of first molar in some patterns) and buccal gingiva over molars.
45
What does the middle superior alveolar nerve supply (when present)?
Maxillary premolars and sometimes mesiobuccal root of first molar.
46
What does the anterior superior alveolar nerve supply?
Maxillary incisors and canine and often premolar contribution via plexus.
47
What is the greater palatine nerve clinically associated with?
* Sensation to posterior hard palate and palatal gingiva * relevant for palatal injections and surgery.
48
What is the nasopalatine nerve clinically associated with?
Sensation to anterior hard palate (incisive papilla region); relevant for palatal anaesthesia.
49
Does the facial nerve (CN VII) supply teeth sensation?
No; facial nerve is primarily motor to facial expression.
50
Why is facial nerve relevant during dental local anaesthetic injections?
Incorrectly placed posterior injection into parotid region can anaesthetise facial nerve causing transient facial paralysis.
51
What are the signs of transient facial nerve palsy after LA?
* Inability to close eyelid on injected side; * facial droop; * asymmetrical smile; * patient may report ‘face feels strange’.
52
How do you manage transient facial nerve palsy after LA in a viva?
* Reassure; * protect eye (lubrication/patch if needed); * explain it resolves as LA wears off; * document.
53
What is the typical cause of trismus after injection?
* **Trauma/haematoma** in **muscles** of **mastication** (**medial** **pterygoid**) or **infection**; * **pterygoid** **plexus** involvement can contribute.
54
What are key landmarks for an inferior alveolar nerve block (IANB)?
Coronoid notch; pterygomandibular raphe; occlusal plane; needle insertion lateral to raphe at correct height to reach mandibular foramen region.
55
Why must you aspirate before injecting local anaesthetic for IANB?
To avoid intravascular injection (inferior alveolar vessels) and reduce toxicity/complications.
56
If lip is numb but tooth is not numb after IANB, what is the viva explanation?
Soft tissue anaesthesia (mental nerve) occurred but pulpal anaesthesia failed due to incorrect deposition/insufficient diffusion/accessory innervation.
57
What is accessory innervation that can cause failed mandibular molar anaesthesia?
* Mylohyoid nerve accessory fibres; * cross-innervation; * cervical plexus contributions; * central core theory/variable anatomy.
58
Which artery is the main arterial supply to the jaws and deep face?
Maxillary artery.
59
The maxillary artery is a terminal branch of which artery?
External carotid artery.
60
Name the two terminal branches of the external carotid artery.
Maxillary artery and superficial temporal artery.
61
Which artery supplies the mandibular teeth and mandible?
Inferior alveolar artery (branch of maxillary artery).
62
Which artery travels with the inferior alveolar nerve?
Inferior alveolar artery (and accompanying veins).
63
Through which foramen does the inferior alveolar artery enter the mandible?
Mandibular foramen.
64
What does the inferior alveolar artery supply?
* Mandibular teeth and mandible=> * gives mental branch via mental foramen to lower lip/chin region.
65
Which arteries supply maxillary teeth?
Superior alveolar arteries: posterior superior alveolar artery; middle superior alveolar artery (variable); anterior superior alveolar artery.
66
Which artery is classically associated with upper molar injections and possible hematoma?
Posterior superior alveolar artery (and pterygoid venous plexus region).
67
Why can a hematoma occur after posterior superior alveolar (PSA) nerve block?
Puncture of posterior superior alveolar vessels or pterygoid venous plexus leading to bleeding into tissues.
68
What are the immediate clinical signs of a hematoma after injection?
* Rapid swelling; * bruising/ecchymosis; * pressure discomfort; * sometimes trismus.
69
What is the first-line management of a post-injection hematoma?
* Stop injection; * apply firm pressure; * ice/cold pack initially; * reassure; document; * advise expected bruising.
70
What is the facial artery a branch of?
External carotid artery.
71
Where does the facial artery cross the inferior border of the mandible?
Just anterior to the masseter muscle (palpable pulsation).
72
Why is the facial artery clinically important in oral surgery?
* Potential for significant bleeding with laceration or surgical trauma; * important landmark in submandibular region.
73
What is the lingual artery a branch of?
External carotid artery.
74
What does the lingual artery supply?
Tongue and floor of mouth.
75
Why is bleeding in the floor of mouth potentially life-threatening?
Hematoma/bleeding can elevate tongue and compromise airway.
76
Name a high-risk scenario involving floor of mouth swelling/bleeding after dental procedures.
* **Sublingual hematoma** after implant surgery or trauma=> * potential **airway compromise** requiring emergency action.
77
What is the pterygoid venous plexus?
A network of veins in the **infratemporal fossa** around **pterygoid muscles.**
78
Why is the pterygoid venous plexus important in dental injections?
It can be punctured during posterior maxillary or deep mandibular injections causing hematoma.
79
Which deep facial vein connection links pterygoid plexus to cavernous sinus (conceptually)?
Emissary veins (via foramen ovale/foramen lacerum region pathways) provide potential intracranial communication.
80
What is the 'danger triangle' of the face?
Region from the bridge of the nose to the corners of the mouth.
81
Why is the danger triangle clinically important?
* **Facial venous drainage** can communicate w/ **cavernous sinus** * infections can spread **intracranially.**
82
Why can infection spread retrograde through facial veins?
* Facial veins are valveless; * flow can reverse depending on pressure gradients.
83
Give the superficial venous route from face to cavernous sinus.
Facial vein → angular vein → superior ophthalmic vein → cavernous sinus.
84
Give the deep venous route from face/oral region to cavernous sinus.
Deep facial vein → pterygoid venous plexus → emissary veins → cavernous sinus.
85
Which cranial nerves are associated with the cavernous sinus (viva list)?
CN III, CN IV, CN V1, CN V2, CN VI (plus internal carotid artery nearby).
86
Which cranial nerve is often affected early in cavernous sinus thrombosis and why?
CN VI (abducens) because it runs more centrally and is vulnerable.
87
What are key signs of cavernous sinus thrombosis (CST) an examiner expects?
* Fever; severe headache; * periorbital edema/chemosis; proptosis * ophthalmoplegia/diplopia; * possible reduced corneal reflex (V1) and facial sensation changes.
88
Why can cavernous sinus thrombosis become bilateral?
Cavernous sinuses **communicate across midline via intercavernous sinuses**, allowing spread.
89
What is the correct management statement for suspected cavernous sinus thrombosis?
Medical emergency: urgent hospital referral for IV antibiotics and specialist management.
90
What is the most common complication after tooth extraction in exams?
Bleeding (and pain/dry socket commonly discussed).
91
What is the first step in managing post-extraction bleeding?
Firm pressure with gauze pack for 10–20 minutes (continuous pressure).
92
If bleeding continues after pressure, what are escalation steps (viva sequence)?
Inspect socket; remove loose clot; local anaesthetic with adrenaline; pack with hemostatic agent; suture; consider systemic factors; arrange review/referral if uncontrolled.
93
Why does local anaesthetic with adrenaline reduce bleeding?
Adrenaline causes vasoconstriction of local vessels.
94
Name local measures to control socket bleeding an examiner expects.
Pressure; LA with adrenaline; sutures; socket packing (oxidized cellulose/collagen); tranexamic acid mouthwash/soaked gauze (where used); avoid disturbing clot.
95
What medical history points increase bleeding risk for extraction?
Anticoagulants (warfarin/DOACs), antiplatelets, bleeding disorders, liver disease, uncontrolled hypertension, alcohol misuse, thrombocytopenia.
96
In a warfarin patient, what must be checked before extraction?
INR (and timing relative to test per local protocol).
97
What INR is commonly considered acceptable for simple dental extraction (general exam answer)?
Usually INR ≤ 4.0 under appropriate local guidance and local hemostatic measures.
98
What is the typical viva answer about DOACs (general principle)?
* Assess bleeding risk and renal function; * follow local guidelines; * often avoid stopping for low-risk procedures and time procedure at trough; * use strong local hemostasis (exact protocol varies).
99
What causes immediate swelling after a dental injection?
Hematoma from vessel puncture (arterial/venous).
100
How do you differentiate allergic reaction vs hematoma (viva line)?
Hematoma is rapid localized swelling with bruising; allergy often includes urticaria, itching, generalized swelling, respiratory symptoms.
101
Why is aspiration essential before injecting local anaesthetic?
To reduce risk of intravascular injection and systemic toxicity.
102
What are signs of accidental intravascular injection of local anaesthetic with adrenaline?
Palpitations, tachycardia, anxiety, tremor; possible dizziness; symptoms occur rapidly.
103
What is the immediate management of suspected local anaesthetic systemic toxicity (LAST) (high-level viva)?
Stop injection, call for help, airway/breathing support, oxygen, monitor vitals; follow emergency protocol; hospital referral; lipid emulsion in severe cases (advanced management).
104
What nerve injury causes lower lip numbness after mandibular extraction/third molar surgery?
Inferior alveolar nerve injury (or mental nerve involvement).
105
What nerve injury causes tongue numbness after lower third molar surgery?
Lingual nerve injury.
106
What is the key 'safe dentist' statement when asked about nerve injuries?
* Pre-op risk explanation; * careful technique; * post-op sensory assessment; * document; review and refer early if persistent.
107
Which artery is palpated at the lower border of mandible anterior to masseter?
Facial artery.
108
What is the key vascular reason to avoid uncontrolled deep instrumentation in the floor of mouth?
Risk of significant bleeding/hematoma near lingual vascular structures and airway compromise.
109
How can infection from upper lip/face reach intracranial structures (one-line viva answer)?
Via valveless facial venous connections to the cavernous sinus.
110
List the key vascular structures examiners commonly connect to dental LA complications.
* Posterior superior alveolar vessels; * inferior alveolar vessels; * pterygoid venous plexus; facial vessels (hematoma/bleeding).
111
List the key nerves examiners commonly connect to dental LA complications.
* Inferior alveolar nerve; * lingual nerve; * long buccal nerve; * facial nerve (transient palsy).
112
What determines the direction of spread of odontogenic infection?
* Relationship of **root** **apex** to cortical bone=> * and **muscle** **attachments** especially **mylohyoid** and **buccinator**.
113
Which muscle is most important in determining mandibular molar spread?
Mylohyoid muscle.
114
If mandibular molar apex lies above mylohyoid attachment where does infection spread?
Sublingual space.
115
If mandibular molar apex lies below mylohyoid attachment where does infection spread?
Submandibular space.
116
Give the six boundaries of the sublingual space.
* Superior: Oral mucosa of **floor** of **mouth** * Inferior: **Mylohyoid** **muscle** * Medial: **Genioglossus** and **geniohyoid** * Lateral: **Mandible** * Anterior: **Symphysis** region * Posterior: Communicates around **posterior** **border** of **mylohyoid** w/ submandibular space.
117
Which teeth commonly cause sublingual space infection?
**Mandibular** **premolars** and **molars** w/ apices **above** mylohyoid.
118
What are clinical signs of sublingual space infection?
Floor of mouth swelling and elevation of tongue.
119
Why is sublingual space infection dangerous?
Tongue elevation may obstruct airway.
120
Give the six boundaries of the submandibular space.
* Superior: **Mylohyoid** muscle; * Inferior: **Platysma** and **superficial** **fascia**; * Medial: **Digastric** and **floor** **muscles**; * Lateral: **Mandible** * Anterior: **Anterior** **belly** of **digastric**; * Posterior: **Hyoid** and **posterior** **mylohyoid** border communicating w/ parapharyngeal space.
121
Which teeth commonly cause submandibular space infection?
**Mandibular** **molars** w/ apices **below** mylohyoid.
122
What are clinical signs of submandibular space infection?
Firm swelling **below** mandible w/ **dysphagia** and **fever**.
123
Why is submandibular space infection dangerous?
Risk of **airway** **compromise** and spread to **deep neck spaces.**
124
Give the six boundaries of the submental space.
* Superior: **Mylohyoid** muscle; * Inferior: **Platysma** and **skin**; * Medial: **Midline** **raphe**; * Lateral: **Anterior** **bellies** of **digastric** * Anterior: **Symphysis** **menti** * Posterior: **Hyoid** **region**.
125
Which teeth commonly cause submental space infection?
**Mandibular** **incisors** w/ apices **below** mylohyoid.
126
What is a key clinical sign of submental infection?
Midline submental swelling or double chin appearance.
127
Define Ludwig’s angina.
* Rapid bilateral cellulitis=> * involving submandibular, sublingual and submental spaces w/ airway risk.
128
What are the key signs of Ludwig’s angina?
* Bilateral neck swelling * raised tongue * drooling * dysphagia * airway compromise.
129
What is immediate management of Ludwig’s angina?
* Emergency referral * airway management * IV antibiotics and surgical drainage if required.
130
Give the six boundaries of the buccal space.
* Superior: **Zygomatic** **arch** region * Inferior: **Mandibular** **border** * Medial: **Buccinator** muscle; * Lateral: **Skin** and **superficial** **fascia** * Anterior: **Corner** of **mouth** region * Posterior: **Parotid** and **masseteric** region.
131
Which teeth commonly cause buccal space infection?
Maxillary or mandibular molars.
132
What are clinical signs of buccal space infection?
Cheek swelling externally.
133
Is buccal space infection usually life threatening?
No airway risk is generally low.
134
Give the six boundaries of the canine space.
* Superior: **Infraorbital** region * Inferior: **Upper** **lip** **muscles** * Medial: **Lateral** **nose** * Lateral: **Buccal** **space** * Anterior: **Facial** **soft** **tissues** * Posterior: **Maxilla**.
135
Which tooth commonly causes canine space infection?
Maxillary canine.
136
What are signs of canine space infection?
* Swelling beside nose * upper lip swelling * loss of nasolabial fold.
137
Why is canine space infection dangerous?
Risk of spread to cavernous sinus via facial veins.
138
Give the six boundaries of the pterygomandibular space.
* Superior: **Lateral** **pterygoid** region * Inferior: **Mandibular** **angle** region * Lateral: **Mandibular** **ramus** * Medial: **Medial** **pterygoid** muscle * Anterior: **Pterygomandibular** **raphe** * Posterior: **Parotid** **region**.
139
Why is pterygomandibular space important in dentistry?
Site of inferior alveolar nerve block.
140
What is the key clinical sign of pterygomandibular space infection?
Severe trismus.
141
Give the six boundaries of the submasseteric space.
* Superior: **Zygomatic** **arch** * Inferior: **Mandibular** **angle** * Lateral: **Masseter** muscle * Medial: **Mandibular** **ramus** * Anterior: **Ramus** **anterior** border * Posterior: **Parotid** **region**
142
Which teeth commonly cause submasseteric infection?
Mandibular molars especially third molars.
143
What is a key sign of submasseteric infection?
Marked **trismus** w/ **lateral facial swelling.**
144
Give the six boundaries of the parapharyngeal space.
* Superior: **Skull** **base** * Inferior: **Hyoid** bone * Medial: **Pharynx** * Lateral: **Medial** **pterygoid** and **parotid** region * Anterior: **Pterygomandibular** region * Posterior: **Prevertebral** **fascia**.
145
Why is parapharyngeal space infection dangerous?
Contains major vessels and may compromise airway.
146
Give the six boundaries of the retropharyngeal space.
* Superior: **Skull** **base** * Inferior: **Upper** **mediastinum** * Lateral: **Carotid** **sheath** regions * Medial: **Midline**. * Anterior: **Pharyngeal** **wall** * Posterior: **Prevertebral** **fascia**
147
Why is retropharyngeal infection life threatening?
Risk of **airway obstruction** and **mediastinal spread**.
148
What is the danger space?
Potential space behind **retropharyngeal** region allowing spread to **mediastinum**.
149
Why is the danger space clinically important?
Infection can descend to **mediastinum** causing **severe** **sepsis**.
150
What type of sinus is the maxillary sinus?
* A **pyramidal**-**shaped** * **paranasal** **sinus** within the body of **maxilla**.
151
What is the shape of the maxillary sinus?
Pyramid-shaped.
152
Where is the base of the maxillary sinus?
**Medial** **wall** forming the **lateral** **wall** of the **nasal** **cavity**.
153
Where is the apex of the maxillary sinus?
**Zygomatic** **process** of the maxilla.
154
Give the superior boundary of the maxillary sinus.
Floor of the orbit.
155
Give the inferior boundary of the maxillary sinus.
**Alveolar** **process** of **maxilla** roots of posterior teeth.
156
Give the medial boundary of the maxillary sinus.
**Lateral** **wall** of the **nasal** **cavity**.
157
Give the lateral boundary of the maxillary sinus.
**Zygomatic** **process** and **lateral** **maxillary** **wall**.
158
Give the anterior boundary of the maxillary sinus.
**Facial** **anterior** surface of maxilla.
159
Give the posterior boundary of the maxillary sinus.
* **Infratemporal** **surface** of **maxilla**=> * adjacent to **pterygopalatine** **infratemporal** region.
160
Which teeth are most closely related to the maxillary sinus?
* Maxillary first molar=> * especially mesiobuccal root * second molar * sometimes premolars.
161
Why is the first molar commonly associated with sinus perforation?
Its roots often project close to or into the sinus floor.
162
Can roots project into sinus without perforating mucosa?
Yes separated only by thin bone or mucosa.
163
What is the name of the mucosal lining of the maxillary sinus?
Schneiderian membrane.
164
What type of epithelium lines the maxillary sinus?
* Pseudostratified ciliated=> * columnar respiratory epithelium.
165
What arteries supply the maxillary sinus?
* Posterior superior alveolar artery * infraorbital artery branches of maxillary artery.
166
Venous drainage of maxillary sinus?
Pterygoid venous plexus.
167
What nerve supplies sensation to the maxillary sinus?
Superior alveolar nerves branches of V2.
168
Which trigeminal division innervates the sinus?
Maxillary nerve V2.
169
Where does the maxillary sinus drain?
Into the **middle** **meatus** of the **nasal** **cavity** via the **ostium**.
170
Is the ostium located superiorly or inferiorly?
Superiorly on the medial wall.
171
Why is maxillary sinus prone to infection?
* **Drainage** **opening** is **high**=> * making **gravity** **drainage** **poor**.
172
What is an oroantral communication?
An **abnormal** **opening** between oral cavity and maxillary sinus.
173
Most common cause of oroantral communication?
Extraction of maxillary molars.
174
Signs of oroantral communication?
* Air escape * fluid from mouth to nose * nasal regurgitation.
175
What is the Valsalva test?
* Patient gently blows nose=> * while clinician observes for air passage into socket.
176
Why should forceful nose blowing be avoided?
It can create or worsen communication.
177
When does oroantral communication become oroantral fistula?
When epithelialised and persists over time.
178
How can dental infection cause sinusitis?
Periapical infection can spread through sinus floor.
179
Why can sinusitis cause toothache?
Inflammation irritates **superior** **alveolar** **nerves**.
180
What is odontogenic sinusitis?
Sinusitis originating from **dental** **infection**.
181
Why is sinus floor lowest near first molar?
**Pneumatisation** of sinus extends **downward** into alveolar process. ##Footnote Pneumatisation=>presence or development of air-filled cavities in a bone
182
What happens to sinus after extraction over time?
Further pneumatisation may occur.
183
Why is sinus lift surgery needed?
* **Insufficient** **bone** **height**=> * due to sinus **pneumatization**
184
What space lies posterior to the maxillary sinus?
Infratemporal fossa.
185
Why is posterior sinus wall important surgically?
* Close to pterygoid plexus * maxillary artery branches.
186
What are red flags after upper molar extraction?
* Persistent bleeding * air passage * sinus symptoms.
187
What instructions should be given after suspected OAC?
* Avoid nose blowing * sneeze with mouth open * no straws * soft diet.
188
Why is the ostium position clinically significant?
* It lies high on **medial** **wall**=> * so **fluid** **accumulates** **inferiorly** **predisposing** to **infection**.
189
Define oroantral fistula.
* A **persistent** **epithelialised** **communication**=> * between oral cavity and maxillary sinus.
190
What are the clinical signs of an oroantral communication?
* Air passage between mouth and nose * nasal regurgitation of fluids * sinus symptoms.
191
Through which wall is the maxillary sinus accessed in a Caldwell-Luc procedure?
* Through the **anterior** **wall** of the **maxilla**=> * via canine fossa.
192
Why is the canine fossa important surgically in maxillary sinus access?
* It is a relatively **thin** area of bone=> * allowing surgical entry into the sinus.
193
What structure lies superior to the maxillary sinus and why is it clinically important?
* The **orbit** lies superiorly=> * infection may spread causing **orbital** **cellulitis**.
194
What **structures** lie posterior to the maxillary sinus and why is this clinically important?
* The **infratemporal** and **pterygopalatine** **fossae** lie posteriorly=> * creating risk of **vascular** **spread** and **deep** **space** **infection**.
195
How can maxillary sinus infection spread toward the cavernous sinus?
* Via **venous drainage** connections=> * through **pterygoid** **venous** **plexus** and **ophthalmic** **veins**.
196
Why is fluid typically seen at the floor of the maxillary sinus on imaging in sinusitis?
* Because the sinus **ostium is positioned superiorly**=> * so fluid accumulates **inferiorly** due to **gravity**.
197
What is the primary function of lymph nodes?
* **Filtration** of **lymph** * **activation** of the immune response
198
Why are lymph nodes clinically important in oral surgery?
They indicate **spread** of **infection** or **malignancy**.
199
What are the two main groups of cervical lymph nodes?
* **Superficial** **cervical** lymph nodes * **deep** **cervical** lymph nodes.
200
Where are the submental lymph nodes located?
* In the **submental** **triangle**=> * between **anterior** **bellies** of the **digastric** **muscles**.
201
What anatomical areas drain into the submental lymph nodes?
* Lower lip * mandibular incisors * anterior floor of mouth, and tip of the tongue.
202
Which oral cancer sites commonly metastasize first to the submental lymph nodes?
* Anterior tongue lesions * lower lip lesions near midline.
203
Where are the submandibular lymph nodes located?
* Along the **inferior** **border** of **mandible**=> * near the **submandibular** **gland**.
204
What anatomical areas drain into the submandibular lymph nodes?
* Upper lip and lateral lower lip * buccal mucosa * maxillary teeth, mandibular premolars and molars * lateral anterior tongue.
205
Which dental infections commonly cause enlargement of the submandibular lymph nodes?
Posterior mandibular dental infections.
206
Where are the preauricular lymph nodes located?
* **Anterior** to **ear**=> * near the **parotid** **gland**.
207
What anatomical areas drain into the preauricular lymph nodes?
* Lateral face * eyelids, and conjunctiva.
208
Where is the jugulodigastric lymph node located?
* **Below** **angle** of **mandible**=> * along the **internal** **jugular** **vein**.
209
What anatomical areas drain into the jugulodigastric lymph node?
* Tonsils * posterior tongue, and oropharynx.
210
Why is the jugulodigastric lymph node commonly enlarged?
* Because of **tonsillitis** * posterior **tongue** **infections**.
211
What is the jugulo-omohyoid lymph node primarily associated with?
Drainage of the tongue.
212
Why is the jugulo-omohyoid lymph node important in oral cancer?
Because **tongue** **carcinoma** may **metastasize** to this node.
213
Where are the deep cervical lymph nodes located?
* Along the **internal** **jugular** **vein**=> * deep to the **sternocleidomastoid** **muscle**.
214
Why are deep cervical lymph nodes clinically significant?
* They receive lymph from most **superficial** **head** and **neck** **lymph** **nodes**=> * are often involved in **metastatic** **disease**.
215
Where does the tip of the tongue primarily drain lymphatically?
Submental lymph nodes.
216
Where does the lateral anterior two-thirds of the tongue primarily drain lymphatically?
Submandibular lymph nodes.
217
Where does the posterior third of the tongue primarily drain lymphatically?
* Jugulodigastric * deep cervical lymph nodes.
218
Why is carcinoma of the tongue particularly dangerous in terms of lymphatic spread?
* tongue has a **rich** **lymphatic** **supply**=> * leading to **early** **metastasis**
219
To which lymph nodes does the lower lip primarily drain?
Submental and submandibular lymph nodes.
220
To which lymph nodes does the upper lip primarily drain?
Submandibular lymph nodes.
221
To which lymph nodes do the maxillary teeth primarily drain?
Submandibular lymph nodes.
222
To which lymph nodes do the mandibular molars primarily drain?
Submandibular lymph nodes.
223
How should cervical lymph nodes be examined clinically?
* By **systematic** palpation * w/ patient’s head slightly **flexed**=> * assessing **size**, **tenderness**, **mobility**, and **consistency**.
224
What lymph node characteristics suggest infection?
* Tender * soft * mobile, and warm nodes.
225
What lymph node characteristics suggest malignancy?
* Hard * non-tender * fixed, and irregular nodes.
226
What does a rubbery lymph node consistency suggest?
Possible lymphoma.
227
What is the most common type of oral cancer?
Squamous cell carcinoma.
228
What is the most common anatomical site for oral squamous cell carcinoma?
**Lateral** **border** of the tongue.
229
Which lymph node groups are first commonly involved in lateral tongue carcinoma?
**Submandibular** or **deep** **cervical** lymph nodes depending on lesion location.
230
Why can oral cancers spread bilaterally in the neck?
Because of **lymphatic** **crossover** near the midline.
231
Why can a small tongue lesion cause significant cervical lymph node enlargement?
* Because early lymphatic metastasis can occur even w/ small primary tumors.
232
Why are deep cervical lymph nodes more concerning than superficial lymph nodes?
Because involvement often indicates **deeper** or **metastatic** **disease**.
233
What is the clinical significance of a fixed cervical lymph node?
It suggests possible **extracapsular** **spread** or **malignancy**.
234
Why can infection of mandibular incisors cause midline neck swelling?
Because lymphatic drainage goes to the submental lymph nodes.
235
What is the most common **malignant tumour** of the oral cavity?
Oral squamous cell carcinoma (OSCC). ## Footnote OSCC is a significant concern in oral health due to its prevalence and potential severity.
236
From which type of **cells** does oral squamous cell carcinoma arise?
Stratified squamous epithelium. ## Footnote This type of epithelium is found in various areas of the oral cavity.
237
What is the most common **anatomical site** for oral squamous cell carcinoma?
Lateral border of the tongue. ## Footnote This area is particularly vulnerable due to its exposure and cellular characteristics.
238
What are other **high-risk anatomical sites** for oral squamous cell carcinoma?
* Floor of mouth * Lower lip * Retromolar trigone ## Footnote These sites are also frequently examined for potential malignancies.
239
What are the major **risk factors** for oral squamous cell carcinoma?
* Tobacco use * Alcohol consumption * HPV infection ## Footnote These factors significantly increase the likelihood of developing OSCC.
240
Why do **tobacco and alcohol** together significantly increase the risk of oral cancer?
They act synergistically, greatly increasing carcinogenic potential. ## Footnote The combination enhances the harmful effects on oral tissues.
241
Which **HPV subtype** is most associated with oropharyngeal squamous cell carcinoma?
HPV-16. ## Footnote This subtype is particularly noted for its role in head and neck cancers.
242
What is **leukoplakia**?
A white patch that cannot be clinically characterised as another disease. ## Footnote It can be a precursor to malignancy.
243
What is **erythroplakia**?
A red patch with a high risk of dysplasia or carcinoma. ## Footnote Erythroplakia is considered more concerning than leukoplakia.
244
Which lesion has a higher **malignant transformation risk**: leukoplakia or erythroplakia?
Erythroplakia. ## Footnote Its appearance is often indicative of more serious underlying pathology.
245
What is **oral submucous fibrosis** associated with and why is it important?
Areca nut chewing and increased risk of oral cancer. ## Footnote This condition can lead to significant oral health issues.
246
What is the typical **clinical appearance** of oral squamous cell carcinoma?
* A **non-healing ulcer**=> * w/ **indurated** and possibly **rolled margins**. ## Footnote This presentation is a key indicator for further investigation.
247
What does **induration** of an oral lesion suggest?
Invasion into deeper connective tissues. ## Footnote Induration=>deep, thickening of skin from edema, inflammation, or infiltration, including cancer
248
Why is **pain** often a late sign in oral squamous cell carcinoma?
Because early lesions may not invade or involve sensory nerves. ## Footnote This can delay diagnosis and treatment.
249
What are **red flag signs** of possible oral cancer?
* A non-healing ulcer lasting more than 2 weeks * Unexplained lump * Persistent red or white patch * Unexplained tooth mobility * Dysphagia ## Footnote These signs warrant immediate medical evaluation.
250
What is the clinical significance of a lesion persisting longer than **2 weeks**?
It requires urgent referral or biopsy to exclude malignancy. ## Footnote Timely intervention is crucial for better outcomes.
251
Why does carcinoma of the **tongue** metastasise early?
Because the tongue has a rich lymphatic supply. ## Footnote This anatomical feature facilitates the spread of cancer.
252
Which **lymph node levels** are commonly first involved in oral cavity cancers and why is this significant?
* **Levels I–III (submental, submandibular, and upper to middle deep cervical nodes)** are commonly first involved=> * they receive **primary** lymphatic drainage from oral cavity=> * involvement indicates regional metastasis and significantly worsens prognosis. ## Footnote Understanding lymphatic drainage patterns is vital for staging and treatment planning.
253
What is **Level I lymph node classification** divided into?
* Level IA (submental nodes) * Level IB (submandibular nodes) ## Footnote This classification helps in understanding the spread of oral cancers.
254
What anatomical structures typically drain to **Level I lymph nodes**?
* Lips * Anterior tongue * Floor of mouth * Most oral cavity structures ## Footnote This drainage pattern is crucial for assessing cancer spread.
255
What is **Level II lymph node classification**?
Upper deep cervical lymph nodes including the jugulodigastric node. ## Footnote These nodes are often involved in the metastatic process.
256
What is **Level III lymph node classification**?
Middle deep cervical lymph nodes along the internal jugular vein. ## Footnote Their involvement indicates further progression of disease.
257
Why does **lymph node involvement** worsen prognosis in oral cancer?
Because it indicates regional metastatic spread. ## Footnote This is a critical factor in determining treatment and survival outcomes.
258
What does the **T category** represent in TNM staging?
**Size** and **local extent** of the primary tumour. ## Footnote This classification is essential for treatment planning.
259
What does the **N category** represent in TNM staging?
Regional lymph node involvement. ## Footnote This is a key factor in assessing the spread of cancer.
260
What does the **M category** represent in TNM staging?
Presence of distant metastasis. ## Footnote This indicates the most advanced stage of cancer.
261
Why is **N-stage** particularly important in oral squamous cell carcinoma?
Because lymph node metastasis significantly reduces survival rates. ## Footnote This highlights the importance of early detection and treatment.
262
What is the **gold standard** for diagnosis of oral squamous cell carcinoma?
Histopathological examination following biopsy. ## Footnote This method provides definitive diagnosis.
263
When is an **incisional biopsy** indicated in suspected oral cancer?
* For **large** or **suspicious** lesions=> * where complete removal is not feasible. ## Footnote This approach allows for diagnosis while preserving tissue.
264
When is an **excisional biopsy** appropriate?
* For **small** lesions=> * can be completely removed safely. ## Footnote This method is often curative.
265
From where should a **biopsy** be taken in a suspected malignant ulcer?
From the edge of the lesion including both normal and abnormal tissue. ## Footnote This ensures a representative sample for diagnosis.
266
Why should the **necrotic centre** of an ulcer be avoided during biopsy?
Because necrotic tissue may not provide diagnostic cellular material. ## Footnote This can lead to false-negative results.
267
What is a **selective neck dissection**?
Surgical removal of specific lymph node levels at risk of metastasis. ## Footnote This procedure aims to minimize morbidity while addressing cancer spread.
268
What is a **radical neck dissection**?
* Removal of **cervical** **lymph** **nodes** along w/=> * **sternocleidomastoid** muscle, **internal** **jugular** **vein**, and **spinal** **accessory** **nerve**. ## Footnote This is a more extensive procedure often required for advanced disease.
269
Which **lymph node levels** are commonly removed in oral cavity cancers?
Levels I–III. ## Footnote This removal is crucial for managing the spread of cancer.
270
What are the major **prognostic factors** in oral squamous cell carcinoma?
* Tumour size * Depth of invasion * Lymph node involvement * Extracapsular spread ## Footnote These factors significantly influence treatment decisions and outcomes.
271
What is **extracapsular spread** in the context of lymph node metastasis?
Extension of tumour cells beyond the lymph node capsule into surrounding tissues. ## Footnote This is associated with a poorer prognosis.
272
Why is **extracapsular spread** associated with poor prognosis?
It indicates aggressive disease and higher risk of recurrence. ## Footnote This necessitates more aggressive treatment strategies.
273
Why can a small primary oral lesion cause significant **cervical lymph node enlargement**?
Because early lymphatic metastasis may occur even when the primary tumour is small. ## Footnote This highlights the importance of monitoring lymph nodes in oral cancer.
274
Why is carcinoma of the **floor of the mouth** often aggressive?
* mucosa is **thin** and has **rich lymphatic drainage**=> * allowing **early** invasion and spread. ## Footnote This anatomical feature contributes to its aggressive nature.
275
Why must every **non-healing oral ulcer** be biopsied?
To exclude or confirm malignancy. ## Footnote Early diagnosis is critical for effective treatment.
276
How are salivary glands classified?
* classified into **major** salivary glands and **minor** salivary glands.
277
How many major salivary glands are there in total in the human body?
* **six major salivary glands**=> * two parotid, two submandibular, and two sublingual glands.
278
Why are there six major salivary glands instead of three?
each type of major salivary gland is **paired** on the left and right sides of body.
279
Approximately how many minor salivary glands are present in the oral cavity?
There are **hundreds** of minor salivary glands scattered throughout the oral mucosa.
280
In which areas of the oral cavity are minor salivary glands not found?
* Minor salivary glands are **not** **found** in the **gingiva** * or **anterior** **midline** of the **hard** **palate**
281
Where is the parotid gland located?
* **Anterior** and **inferior** to **ear**=> * between **mandible** and the **sternocleidomastoid** **muscle**.
282
What type of secretion does the parotid gland produce?
The parotid gland produces **serous** secretion.
283
What is the name of the duct of the parotid gland?
The duct of the parotid gland is called **Stensen’s duct.**
284
Where does Stensen’s duct open into the oral cavity?
Stensen’s duct opens opposite **maxillary second molar**.
285
Which important cranial nerve passes through the parotid gland?
The **facial** **nerve** (cranial nerve VII) passes through the parotid gland.
286
Does the facial nerve provide secretomotor supply to the parotid gland?
**No**, the facial nerve passes through the parotid gland but **does** **not** supply it.
287
Which cranial nerve provides parasympathetic secretomotor supply to the parotid gland?
The **glossopharyngeal** **nerve** (cranial nerve IX) provides parasympathetic supply=> * via **otic** **ganglion**.
288
Where is the submandibular gland located?
* In the submandibular triangle beneath the mandible.
289
What type of secretion does the submandibular gland produce?
The submandibular gland produces mixed **serous** and **mucous** secretion.
290
What is the name of the duct of the submandibular gland?
The duct of the submandibular gland is called **Wharton’s duct.**
291
Where does Wharton’s duct open into the oral cavity?
* Wharton’s duct opens at the **sublingual** **caruncle** => * beside **lingual** **frenulum**.
292
Which cranial nerve provides parasympathetic secretomotor supply to the submandibular gland?
* The **facial** **nerve** (cranial nerve VII)=> * via **chorda** **tympani** and **submandibular** **ganglion**.
293
Which nerve is closely related anatomically to Wharton’s duct?
The **lingual** **nerve** is closely related to Wharton’s duct.
294
Where is the sublingual gland located?
**Beneath** mucosa of **floor** of **mouth** above **mylohyoid** **muscle**.
295
What type of secretion does the sublingual gland produce?
The sublingual gland produces predominantly **mucous** secretion.
296
How does the sublingual gland drain into the oral cavity?
Through **multiple** **small** **ducts** directly into the floor of the mouth.
297
Which salivary gland is most commonly affected by sialolithiasis?
The **submandibular gland** most commonly affected by salivary stones.
298
Why is the submandibular gland particularly prone to salivary stone formation?
* Has a **long** duct=> * saliva flows **upward** against gravity * its secretion is **thicker** and more **mucous**.
299
What is the classic clinical symptom of salivary duct obstruction by a stone?
**Pain** and **swelling** of the gland during **meals**.
300
What is sialadenitis?
Sialadenitis is inflammation of a salivary gland.
301
What are common causes of sialadenitis?
Common causes include duct **obstruction** and **bacterial** **infection**.
302
Which major salivary gland most commonly develops tumours?
The **parotid** **gland** most commonly develops salivary gland tumours. ## Footnote -largest salivary gland and contains the greatest amount of glandular tissue, increasing the probability of tumour formation. -Increased cell proliferation in glandular tissue increases the chance of DNA damage and accumulation of oncogenic mutations.
303
What is the most common benign salivary gland tumour?
**Pleomorphic** **adenoma** is the most common benign salivary gland tumour.
304
What is the most common malignant salivary gland tumour?
**Mucoepidermoid** **carcinoma** is the most common malignant salivary gland tumour.
305
Which salivary gland has the highest proportion of malignant tumours?
The **sublingual** **gland** has the highest proportion of malignant tumours. ## Footnote * small gland w/ fewer benign tumour types, and tumours arising in it are more likely to be malignant=> * particularly due to its predominantly mucous glandular tissue.
306
Why is facial nerve weakness in a patient with a parotid mass concerning?
Facial nerve weakness suggests possible **malignant invasion.**
307
Where are minor salivary glands commonly located in the oral cavity?
* LIps, buccal mucosa * soft palate, posterior hard palate * floor of mouth, and ventral tongue.
308
What type of secretion do most minor salivary glands produce?
Most minor salivary glands produce **mucous secretion.**
309
What is a mucocele?
**mucus**-**filled** lesion caused by **rupture** or **blockage** of a minor salivary gland duct.
310
What is the most common site of a mucocele?
The **lower** **lip** is the most common site of a mucocele.
311
Where do most minor salivary gland tumours occur?
Most minor salivary gland tumours occur on the **hard and soft palate**.
312
Compared to parotid tumours, are minor salivary gland tumours more likely to be malignant?
* **Yes**, minor salivary gland tumours have a higher proportion of malignancy=> * compared to parotid tumours.
313
What type of joint is the temporomandibular joint (TMJ)?
**synovial** **joint** of the modified hinge (ginglymoarthrodial) type. ## Footnote Unique among other synovial joints as=> contains fibrocartilage, an articular disc, and functions as both a hinge and gliding joint.
314
Which bones form the temporomandibular joint (TMJ)?
* The **condyle** of the mandible articulates w/ **mandibular** (**glenoid**) **fossa** of the **temporal** **bone**.
315
What structure divides the temporomandibular joint into two compartments?
* The **articular** **disc** divides the joint=> * into **upper** and **lower** compartments
316
What type of cartilage covers the articular surfaces of the temporomandibular joint?
**Fibrocartilage** covers the articular surfaces of the temporomandibular joint. ## Footnote when compared to hyaline cartilage=>**fibrocartilage** is more resistant to shear forces and better adapted to high mechanical stress.
317
What is the articular disc of the temporomandibular joint composed of?
The articular disc is composed of **dense fibrous connective tissue.**
318
What are the three anatomical parts of the temporomandibular joint articular disc?
The anterior band, intermediate zone, and posterior band.
319
Which part of the temporomandibular joint disc is the thinnest?
The **intermediate** **zone** is the thinnest part of the disc.
320
Which muscle attaches to the anterior part of the temporomandibular joint disc?
The **lateral** **pterygoid** **muscle** attaches to the anterior part of the disc.
321
What structure lies posterior to the articular disc in the temporomandibular joint?
* The **retrodiscal** **tissue**=> * also known as the **bilaminar** **zone**.
322
What movement occurs in the lower compartment of the temporomandibular joint?
**Rotation** (**hinge** **movement**) occurs in the lower compartment.
323
What movement occurs in the upper compartment of the temporomandibular joint?
**Translation** (gliding movement) occurs in the upper compartment.
324
During mouth opening, which movement occurs first in the temporomandibular joint?
Rotation occurs first, followed by translation.
325
Which muscle is primarily responsible for initiating mouth opening at the temporomandibular joint?
* The **lateral** **pterygoid** **muscle**=> * assisted by the **suprahyoid** **muscles**.
326
What is the main stabilising ligament of the temporomandibular joint?
The lateral (temporomandibular) ligament.
327
What are the accessory ligaments of the temporomandibular joint?
* Stylomandibular ligament * Sphenomandibular ligament.
328
Which nerve provides sensory innervation to the temporomandibular joint?
* The **auriculotemporal** **nerve**=> * a branch of **mandibular** **division** of the **trigeminal** **nerve** (V3).
329
Why can temporomandibular joint disorders cause ear pain?
Because the auriculotemporal nerve supplies both the TMJ and the external ear region.
330
Which arteries supply the temporomandibular joint?
Branches of the **superficial** **temporal** artery and the **maxillary** artery.
331
What is the most common direction of temporomandibular joint dislocation?
**Anterior** dislocation is the most common direction.
332
Why does anterior temporomandibular joint dislocation occur?
Because the mandibular condyle moves anterior to the articular eminence and **cannot** **return** to the mandibular fossa.
333
What is a common cause of temporomandibular joint dislocation?
* Excessive mouth opening=> * such as during yawning or dental procedures.
334
What is internal derangement of the temporomandibular joint?
Internal derangement is **abnormal** **positioning** or **function** of the articular disc.
335
What is disc displacement with reduction in the temporomandibular joint?
* The disc is **displaced** but **returns to normal position during mouth opening**=> * often producing a clicking sound.
336
What is disc displacement without reduction in the temporomandibular joint?
* The disc **remains displaced** during mouth opening=> * leading to **limited** mouth opening and possible **locking**.
337
What does TMD stand for in relation to the temporomandibular joint?
Temporomandibular disorder.
338
What are common symptoms of temporomandibular disorder (TMD)?
* Pain, clicking, locking * limited mouth opening * muscle tenderness.
339
What is trismus in the context of temporomandibular joint disorders?
Trismus is restricted mouth opening.
340
What is osteoarthritis of the temporomandibular joint?
* Osteoarthritis is a **degenerative joint disease**=> * affecting the **articular** surfaces of the TMJ.
341
What are common radiographic signs of temporomandibular joint osteoarthritis?
* Flattening of condyle * osteophyte formation * joint space narrowing.
342
Why does clicking occur in disc displacement with reduction in the temporomandibular joint?
Clicking occurs because the mandibular condyle **snaps back** onto the displaced disc during mouth opening.
343
Why is the intermediate zone of the temporomandibular joint disc functionally important?
It is the **load-bearing region** of the disc during joint movement.
344
What is the immediate management of a patient who collapses during dental treatment?
* Stop treatment, assess responsiveness * call for help, and assess airway and breathing.
345
What should be done if a collapsed patient is unresponsive and not breathing normally?
* Call emergency services immediately=> * begin CPR (30:2), and use an AED as soon as available.
346
What should be done if a collapsed patient is unconscious but breathing normally?
* Place in recovery position * maintain airway, monitor vitals * identify the cause.
347
What are common causes of collapse in dental practice?
* Vasovagal syncope * hypoglycaemia, anaphylaxis, myocardial infarction * stroke, seizure, and cardiac arrhythmia.
348
What is first-line management of vasovagal syncope in the dental clinic?
* Lay the patient supine with legs elevated * maintain airway, monitor vitals * give oxygen if needed.
349
What is the first-line drug for anaphylaxis in adults?
Intramuscular adrenaline (epinephrine).
350
What is the adult dose of intramuscular adrenaline for anaphylaxis?
* 500 micrograms (0.5 mL of 1:1000 solution)=> * injected into anterolateral thigh.
351
How often can intramuscular adrenaline be repeated in anaphylaxis?
Every 5 minutes if there is no improvement.
352
What additional medications may be given after adrenaline in anaphylaxis?
* Antihistamines and corticosteroids=> * but only after adrenaline.
353
What supportive measures are essential in anaphylaxis?
* Call emergency services * lay patient flat * give high-flow oxygen, and monitor continuously.
354
What is the first-line medication for an acute asthma attack in the dental clinic?
Salbutamol inhaler (short-acting beta-agonist).
355
What is the typical adult emergency dose of salbutamol in asthma?
* 2 puffs initially * may repeat up to 10 puffs via spacer.
356
When should emergency services be called for asthma in the dental clinic?
* If there is poor response to inhaler=> * exhaustion, cyanosis, or worsening symptoms.
357
What blood glucose level defines hypoglycaemia?
Less than 4.0 mmol/L.
358
What is first-line treatment for mild hypoglycaemia in a conscious patient?
* 15–20 grams of fast-acting carbohydrate=> * glucose tablets, gel, or juice.
359
What medication is used for severe hypoglycaemia with unconsciousness?
Glucagon 1 mg intramuscularly.
360
What must be done after hypoglycaemia resolves?
* Give a longer-acting carbohydrate=> * monitor patient
361
What should be done if diabetic ketoacidosis (DKA) is suspected in dental practice?
Stop treatment and call emergency services immediately.
362
What is first-line management of a seizure in the dental clinic?
* Protect patient from injury * do not restrain * do not place objects in mouth, and time the seizure.
363
When is medication required during a seizure in dental practice?
If the seizure lasts longer than 5 minutes.
364
What is the first-line medication for prolonged seizure in adults?
Buccal midazolam 10 mg.
365
What is an alternative medication for prolonged seizure if midazolam is unavailable?
Rectal diazepam 10 mg.
366
What is first-line medication for stable angina in the dental clinic?
Glyceryl trinitrate (GTN) spray.
367
What is the typical dose of GTN spray for angina?
1–2 sprays sublingually (400 micrograms per spray).
368
What medication should be given in suspected myocardial infarction if not contraindicated?
Aspirin 300 mg to chew.
369
What is the most important action in suspected myocardial infarction in dental practice?
Call emergency services immediately.
370
What medication should be given in suspected stroke in dental practice?
* No medication * call emergency services immediately.
371
What blood pressure is considered acceptable for routine dental treatment?
Below 160/100 mmHg.
372
At what blood pressure should elective dental treatment be postponed?
Persistently above 160/100 mmHg.
373
At what blood pressure should urgent medical assessment be sought before treatment?
Above 180/110 mmHg.
374
What INR level is considered safe for most simple dental extractions in patients on warfarin?
INR below 4.
375
Should warfarin usually be stopped for simple extraction if INR is below 4?
No, it should not be stopped if INR is below 4.
376
What medication is used to treat seizures caused by local anaesthetic toxicity?
Benzodiazepines such as midazolam.
377
What advanced medication may be required in severe local anaesthetic toxicity?
Intravenous lipid emulsion therapy in hospital setting.
378
What medication is required in adrenal crisis?
Hydrocortisone (administered in hospital setting). ##Footnote Adrenal crisis is a life-threatening condition caused by a sudden severe deficiency of cortisol (and sometimes aldosterone) from the adrenal glands. -Normally the adrenal cortex releases cortisol, which helps regulate: Blood pressure Blood glucose Stress response Electrolyte balance
379
What is the immediate action in suspected adrenal crisis in dental practice?
Call emergency services and manage ABCDE.
380
What local haemostatic agents may be used to control post-extraction bleeding?
* Oxidised cellulose * collagen sponges(gelaspon) * sutures, and pressure packs. ##Footnote -Gelaspon-Purified gelatin (usually derived from porcine collagen) -Highly porous sponge structure -structure allows it to absorb blood and promote clot formation.
381
What HbA1c level is considered well-controlled diabetes for invasive dental procedures in Bulgarian data?
Up to 7.5%. ## Footnote -HbA1c is a blood test that shows the average blood glucose level over previous 2–3 months. -It measures how much glucose has attached (glycated) to hemoglobin in red blood cells.
382
What HbA1c level is considered moderately controlled diabetes in Bulgarian data?
7.6% to 9%.
383
At what HbA1c level should routine invasive dental treatment be postponed according to Bulgarian data?
Above 9%.
384
What preoperative blood glucose level is generally acceptable for dental surgery in controlled diabetic patients?
Up to approximately 9 mmol/L.
385
When should diabetic patients ideally be scheduled for dental surgery?
Morning appointments after eating and taking usual medication.
Oral surgery
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