Final Study Guide Flashcards
(122 cards)
1
Q
OMS training is vastly different from most dental specialty training and dental school education. What are the significant differences compared to general dentist education? (Lec 1)
A
- Extensive hospital, medical, surgical trainings
- 100% US accredited OMS training programs incorporates advanced general anesthesia training for maximum patient comfort and safety in office setting
- Bridge the gap between dentistry and medicine
2
Q
What type of tx does OMS offer?
A
- Removal of teeth
- Exposure of impacted teeth for ortho tx
- Recontour jaw bones
- Prep of jaws prior to XRT of placement of cardiac or orthopedic prosthetics
- Preprosthetic surgery for prosthesis - removal of tori
- Management of odontogenic and facial space infections due to tooth origin (ludwigs, I&D of abscess)
etc
3
Q
What are the types of reconstructive surgery that an OMS does?
A
- Mandible reconstruction
- Palatal reconstruction after melanoma removal
- Restoration of continuity, restoration of alveolar bone height and width, and restoration of osseous bulk
4
Q
What are the goals of reconstructive surgery?
A
Restore function and form from:
- Alvusive traumatic events
- Removal of pathology
- Physiologic atrophy
5
Q
Where can bone be harvested from?
A
around body (iliac crest, rib, and cavalier -skull )
intraorally (ramus, symphysis, max tuberosities)
6
Q
When writing patient’s note. What type of patient record format is needed and recognized by all the medical professional worldwide? (Lec 2)
A
SOAP
Subjective → CC, ROS, Meds (also OTC and herbs), Allergies (discriminate from side effects), HPI (History of present illness), past dental tx, medical hx, social hx (drugs and alcohol), assessment of anxiety
Patine interview is important in assess anxiety, ability to tolerate tx, health issues that alter tx, consultations needed, and RISK of tx
Objective → Physical exams, vital signs, x-rays, labs (INR, BG, A1C, CBC), dental exam
Assessment → Dx, create problem list first addressing medical problems first
Plan → Tx to address problem list
No Tx is always an option, referral is an option
7
Q
The very first thing about writing this format as well as what you need to ask the patient when you first meet them is… (Lec 2)
A
Chief complaint → why are they there? What do they want? → write down in their exact words
8
Q
What is ASA I?
A
normal healthy patient, no systemic disease, on NO meds
9
Q
What is ASA II?
A
patient with mild systemic disease which is well controlled (well controlled hypertension)
10
Q
What is ASA III?
A
patient with significant systemic disease which limits activity but not incapacitating (CHF)
11
Q
What is ASA IV?
A
patient with an incapacitating systemic disease which is a constant threat to life (unstable angina pectoris)
12
Q
What is ASA V?
A
moribund patient not expected to survive more than 24 hours (end stage kidney disease)
13
Q
6) What are the ways to reduce patient fear and anxiety? (Lec 2)
A
- Hand holding (non-pharmacological methods) → have them hold onto arm rest
- N2O/O2
- Oral medications/oral premeds
- Intravenous medications
- General anesthesia Combinations of the above
14
Q
What is the first definitive thing done with a new patient?
A
Med consult
15
Q
What are med consults used to evaluate?
A
ability to tolerate tx, medical clearance, modify medications prior to procedure
16
Q
What are the dos and don’ts of writing a med consult?
A
NOT asking for a start check
NOT asking for permission to initiate dental care
ARE communicating with other health care professions
17
Q
What are the steps to writing a med consult?
A
- Write abbreviated SOAP note
- Brief anticipated procedure
- Ask the focused question and what you want to know
- Print and FAX (NOT email)
18
Q
What are the steps of a patient that has been screened in DXR?
A
DXR → go to OMS faculty → SOAP presentation and discussion with OMS Faculty (with recommendation written in Axium)
a. Student /Honors Student Case → secure OMS chair → SOAP presentation and perform surgery → 7-10 day post-op to receive credit
b. OMS resident → schedule and take care → refer patient back
19
Q
What is a presurgical assessment?
A
determines how hard it will be to remove and what surgical approach you will need to take based on medical risk, emotional condition, clinical eval (infection, mobility, mouth opening, caries/fx, alignment in arch), rx eval (relationship to structures, number of roots, extent of caries, root shape, bone amount and density)
20
Q
Is TE easier or harder with mobility due to perio bone loss?
A
easier
21
Q
Describe the tooth mobility assessment numbers (1-4)
A
1: greater than normal mobility = EASY
2: normal tooth mobility
3: no mobility
4: no mobility and high potential for ankylosis
- Primary molars, endo tx, erupted M3s
(the lower number (1) is better and higher number (4) means it will be harder)
22
Q
What are the miller classifications for class 1-3?
A
Class 1: < 1 mm (horizontal)
Class 2: > 1 mm (horizontal)
Class 3: > 1mm (horizontal and vertical)
23
Q
What is the amount of normal tooth mobility?
A
.25mm due to PDL
24
Q
What teeth are high risk for sinus exposure?
A
All max molars and max 2PM
25
What are the functions of the handle, hinge, and beak?
Handle - allows instrument to be grasped and leverage/pressure to be delivered to beak
Hinge - transfer and amplifies force from handle to beak
Beak - adapts to tooth below cervical line
- Parallel or offset at 45 degrees for maxillary
- Right angle for mandibular
26
What are the different ways to grasp onto extraction forceps?
Horizontal grasp and vertical grasp
27
What is the maxillary universal forcep?
150
28
What is the mandibular universal forcep?
151
29
What force is used for mandibular molars when the tooth is "squeezed" out of the socket?
#23 (crowhorn)
Crownhorn also good for furcation
30
What tools are used for an alveoplasty?
Rongeurs
31
What are periosteal elevators (#9) used for?
Reflect full thickness mucoperiosteum flap
32
What is the standard blade of a #3 bard-parker?
#15 blade
33
What are tapered surgical burs?
701
702
703 (biggest taper)
34
Why can a high speed air rotor be dangerous for OS?
Impact air = air comes out the back and can lead to air embolism in surgical wound = swelling in face
35
What are the motions done for an extraction with a elevator?
1. Wedge
2. Lever
3. Wheel and axle
36
What is a displacement/wedge motion?
Insert into PDL space to dislodge root tip
- Can NOT use when close to max sinus = oro-antral communication
37
What is a lever motion?
prying tooth root tip from its socket
- Engage in groove/hole of tooth
- Use bone as fulcrum and grip edge of blade
38
What is a wheel and axle motion?
Engage purchase point and use bone as fulcrum to ROTATE the tip out
39
Why is chair and patient position important when performing extractions?
Chair position is important NOT for better vision (only need to see for adaptation unless root tip removal), but for better adaptation and leverage
40
Where is the maxillary occlusal plane for extractions? And where should the operator stand?
Maxillary occlusal plane is 45 degrees to 60 degrees to the floor
- Patients shoulders are at level of surgeons elbow
- Standing at 7 or 8 o’clock position
- Non dominant hand need to provide stability and counter traction of force
41
Where is the mandibular occlusal plane for extractions? And where should the operator stand?
Parallel to the floor
At the level of surgeon’s elbow or lower
- Standing at 7 or 8 o’clock
- Feet spaced apart for stability
- Non dominant hand need to provide stability and counter traction force
42
What are all the possible forcep movements?
1. Apical pressure: seat forceps as apical as possible to prevent crown fracture, acts as a wedge between tooth root and bony socket
2. Buccal pressure: expand socket on buccal side and detach PDL on lingual side
3. Lingual/ Palatal Pressure: do the same on lingual
Combo of Buccal-Lingual always will work
4. Rotation: twist, NOT on max molar because 3 roots = break it
5. Traction: vertical pull
6. Figure 8 Movement: combo of B, L, and rotation → good for central incisors because round-ovoid, conical root
43
When performing extraction, what should you non-dominant hand doing?
Non-dominant hand needs to provide stability and counter traction to force by holding the head of part of the alveolus
44
What are the specific names of the grasp that our non-dominant hand can be doing when extracting?
**1. “Pinch grasp”: for extraction in MAX arch, thumb and index on either side of alveolar process adjacent to tooth**
2. Mandibular sling grasp: For MAND arch, Hand underneath jaw
- Counteracts forces of extraction
- Prevents injury to TMJ
3. “Pinch grasp” + bite block
- Support TMJ with hand
- Bite block on opposite side to minimize trauma to TMJ
45
What are the principles of a flap design?
1. Broad base for adequate blood supply
2. Large enough for visiual and instrument access
3. Reposition and sutured over solid bone
4. Avoid major structures (nerves and BVs)
5. Full thickness NOT partial
46
Describe the base of a flap
Apical portion is WIDER than coronal portion
47
Why is it important to have a large flap?
- Large heals just as quick as small
- Flap heals side-to-side NOT end-to-end
- Pain does not correlate with size of flap but how much bone is removed
48
Why should a suture be sutured over solid bone?
Increases healing rate and decreases wound dehiscence
49
Where should the margin of flap be from margins of bony defect?
5mm
50
Describe the thickness of the flap
FULL thickness not partial
Full: Skin, subcutaneous tissue, AND periosteum
Partial: does not include periosteum
51
What are the 2 common flap designs?
1. Envelope flaps
2. Flaps with vertical release incision
52
What is the design of an envelope flap?
1 tooth distal and 2 mesial (at least)
- Full thickness flap withOUT vertical release
- Can modify by adding 1 or 2 vertical releases
53
What is the design of a flap with vertical release incision?
1 tooth distal and 1 mesial, includes papilla
- Vertical release originates from mesial or distal line angles
- Incision must be over sound bone
- NEVER from middle of papilla or mid-facial
54
What is a main contraindication of vertical release incision lines?
1. Canine prominence
2. Mental foramen
3. Palate -> do NOT do
4. Incisive papilla
5. Bony lesion
6. Major frena
**7. Lingual side of mandibular arch
- NEVER place vertical incision on lingual side of the mandibular arch**
55
Where are mandibular flaps made?
from tip of one coronoid process down the anterior border of the ramus and along the crest of the alveolus to the tip of the coronoid process on the opposite side without cutting any major structures except the buccinator artery and long buccal nerve, also watch for the mental foramen
56
What are hazard areas of mandibular flaps?
**1. Lingual region of 3rd molars
- damage to lingual nerve = permanent anesthesia and loss of taste**
2. Premolar buccal vestibular region
- damage to mental nerve = loss of labial sensation
3. Improper incision/scalpel slip to depth of vestibular near M2
- damage to facial artery/vein
57
What are the differences between full and partial thickness flaps?
Full thickness
- Mucosal tissue and periosteum
- Preserve periosteum
- Most popular in dentistry
Partial Thickness
- Periosteum Is left attached to bone
- Able to apically reposition flap (Increases amount of attached gingiva)
- Special OMS/perio procedures
58
What are curved flaps used for?
PA endo surgery - smiley face shaped
59
How does needle and diameter size correlate?
Higher number of needle = smaller diameter = less tensile strength
ex: 3-0 is bigger than 5-0
60
What sizes are used for microsurgery, skin closure, and muscle/deep skin/intra oral mucosa?
9-0 or 10-0 for microsurgery
5-0 or 6-0 facial skin closure
3-0 or 4-0 for muscle, deep skin, intra oral mucosa → what we use in OS
61
What are the types of sutures?
- Absorbable or Non Absorbable
- Monofilament or Braided
- Natural or Synthetic
62
What is a non-absorbable suture?
Must physically remove it
63
What is a resorbable suture?
Over time it will break down and resorb
- ideal for deep wound so you don't have to re-enter to remove
64
What are downsides of braided sutures? Monofilament?
Braided: Could draw oral flora into the wound
Monofilament: decreased flexibility and increased tendency to untie
65
What are downsides of resorbable sutures?
Unknown time of wound support
66
Describe the type of sutures we use at the school
Absorbable natural: plain gut, chromic gut
67
What sutures are most frequently used?
Interrupted sutures
Adv: if one suture is untied, others can still support wound
Disadv: time consuming
68
What is a vertical mattress suture?
Interrupted suture but doubled
**Used when more tension is needed **
69
What is a horizontal mattress suture?
Suture line parallel to incision line
Adv: better wound compression
Disadv: not as effecient as vertical mattress
70
What is a continuous mattress suture and continuous locking mattress suture?
Zig-zaggy, one continuous suture
Used for long incisions
71
What are figure-eight sutures used for?
Hold gel-foam or materials in socket (i.e., grafting)
72
When surgically sectioning and removing a molar with a broken crown, how should you do it?
Sectioned and remove one root at a time --> Y-shape
- specifically useful for a damaged crown
- - create flap, remove buccal bone, section 3 roots in Y pattern, remove each root
73
How does penicillin work?
Penetrates transpeptidase (or penicillin binding protein) and inhibits it
- basically inhibits bacteria from creating cell walls by inhibiting transpeptidase
74
What are the types of penicillin?
1. Penicillin G
2. Aminopenicillin
3. Penicillinase-resistant PCN
4. Antipseudomonal PCN
5. Cephalosporins
75
What are beta-lactamase inhibitors?
Add-ons to penicillin to make it more effective
76
What is an anti-ribosomal abs common in dentistry?
Clindamycin
77
What are post-op pain medications?
Ibuprofen
Acetaminophen (tylenol)
78
What is the max dose of ibuprofen a day?
3200 mg/day
79
What are disadvantages of ibuprofen?
decreases platelet aggregation = increasing in bleeding time
Problem for patient with bleeding disorders, not normal patients
80
What is the maximum dose of tylenol a day?
4000 mg/day
81
What are benefits of tylenol over ibuprofen?
Does NOT interfere with platelet function of bleeding so can be used on pts with platelet defects
82
How are schedule 1 drugs classified by the DEA?
- high abuse potential
- not accepted medical use in the USA
- CANNOT prescribe
ex: heroin, LSD, marijuana
83
How are schedule 2 drugs classified by the DEA?
- High abuse potential
- Severe psychic/physical abuse liability
- Require written Rx can be faxed and NO refill
EX: oxycodone, morphine, fentanyl, hydrocodone, meperidine
84
How are schedule 3 drugs classified by the DEA?
- Significant abuse potential
- Written Rx not required → can be called in
- Refill up to 5 times
EX: Codeine + acetaminophen and hydrocodone combos (Tylenol #3)
85
How are schedule 4 drugs classified by the DEA?
- Lower abuse liability
- Written Rx not required → can call in
- 5 refills in 6 months
EX: phenobarbital, diazepam (Valium), propofol, tramadol
86
How are schedule 5 drugs classified by the DEA?
- Very low abuse potential
- Written rx not required → does NOT even need to be prescribed
- 5 refills within 6 months
EX: robitussin
87
How to protect foreign object from going into patient’s lung when doing dental work? Specifically a tooth lost in pharynx?
1. PREVENT this using a throat screen ALWAYS
2. Turn patient to the side
3. Encourage to cough
4. Suction
5. Can only tell swallowed vs aspirated based on two X-rays or CT scan
88
How are oroantral fistulas created?
between mouth and max sinus usually due to removal of max molars when there is extensive pneumatization of max sinus and little to no bone between roots and sinus floor OR if bone is adhered to roots
- Can lead to postop max sinusitis (infection) or formation of chronic OA fistula (drinking OJ and it comes out through the nose)
89
How do you prevent an oroantral fistula?
- Preop rx exam → explain it is a possibility BEFOREhand
- Surgical extraction and section roots
- Avoid extensive apical pressure
90
How do you know there is an oroantral fistula?
Nose blowing test = gently blow and will see bubble form
91
What do you do if you have an oroantral fistula less than 2mm in size?
no additional tx is needed
- Sinus precautions: no blowing of nose, sneeze with mouth open, no straws, no smoking for minimum of 2 weeks
92
What do you do if you have an oroantral fistula >2 and <6mm in size?
gelfoam to plug hole, figure 8 of suture, sinus precautions
- Antibiotics, nasal spray, oral decongestant
93
What do you do if you have an oroantral fistula greater than 7mm in size?
consider referral to OMS → they will use one of these 4 places to take tissue from to cover up the exposure
1. Buccal advancement of flap → take tissue from buccal
2. Palatal flap → from hard palate
3 Tongue flap
4. Buccal fat pad
94
What is post-op bleeding caused by?
- Due to tissue of mouth and jaw being HIGHLY vascular
- Extraction sites leave open wounds
- Pts explored surgical sites with tongue
- Salivary enzymes lyse blood clot
95
How do you prevent post-op bleeding?
1. Medical and family history of bleeding
Need to know if they have a bleeding disorder and if they are on any blood thinners
If bleeding disorder, need an INR of < 2.5
Any history of chemotherapy, alcoholism, liver disease (makes clotting factors)
2. Atraumatic surgical technique
3. Good hemostasis at surgery
4. Provide patient instructions
96
How do you manage post-op bleeding?
**- Direct pressure: gauze pack -> for at least 5 minutes (#1 way)**
- Tea bag for 30 min (must contain tannic acid -> natural tea)
**- Gelfoam with figure 8 of sutures**
- Collaplug
**- Local anesthesia with epi**
97
What is alveolar osteitis?
- Moderate to severe pain without s/s of infection such as fever, swelling and erythema occurring 2-3 days later
- Results from high fibrinolytic activity around extraction socket
98
What is tx for alveolar osteitis?
pain relief: irrigation and insertion of a medicated dressing (gelfoam and eugenol)
- Pack straight into socket and they will feel immediate relief
- Do NOT induce bleeding/scraping of wall
- They must come back every day to get it packed to feel better
99
What are risk factors of alveolar osteitis?
- Smoking and tobacco use
- Oral contraceptives
- Improper home care
- Having dry socket in the past
- Tooth or gum infection → Ex) pericoronitis
Use of corticosteroids
100
What are mandibular fractures almost exclusively associated with?
Surgical removal of mandibular 3rd molars due to excessive force to mandible
101
What is tx for mandibular fracure associated w tooth extraction?
Reduction and fixation stabilized with a plate
102
What is the tx for fibrous enlargement of tuberosity?
Soft tissue surgery due to fibrous tissue accumulation in tuberosity
- results in reduction of vertical interocclusal space (need minimum of 6mm)
103
How do you reduce the fibrous enlargement of a tuberosity?
1. An elliptical incision is made down to bone and the ellipse of soft tissue is excised
2. The scalpel creates an oblique cut, as seen in cross section
3. The underlying submucosa is filleted to reduce the bulk of the tuberosity
4. The wound edges are apposed and sutured
104
How do max labial frenum cause problems in dentate and edentulous patients?
In a dentate patient it causes diastema between central incisors = really just an esthetic concern
In edentulous patients it interferes with peripheral seal = need t remove to properly seat denture
105
How do you remove a frenum?
Cannot just go in and clip, need to remove ALL the irregular tissue behind it so it does not recur again
106
What are the two techniques to remove a max frenum?
Diamond technique
Z-plasty technique
107
What is the diamond technique for frenum removal?
- Use two mosquito hemostats used to clamp on frenum and pull towards you
- Incision made along the outside of hemostat
- Closed with interrupted sutures
- Drawback: linear contraction of resulting scar tissue
108
What is the z-plasty technique used for?
- 30, 45, and 60 degree angle Z-plasty
**60 degree allows for most movement after suturing**
- Less scar contracture
- Angle of incision matters
109
What can lingual frinum cause?
Ankyloglossia (tongue tie)
110
What is an indication for tx for lingual frenum?
significant tongue immobility (can cause speech and mastication issues) or unable to seat denture
111
What is tx for lingual frenum?
Z-plasty - to allow for tongue to stick out
- outside the scope of a general dentist - refer to OMS
112
When should tori be removed?
When prosthesis is involved (instability) or ulcerated often due to thin mucosa
113
When should palatal tori be removed?
Greater than 3mm in height
114
What incision technique is used in palatal tori removal?
Single Y or double Y incision and then reflect tissue
115
How should tori be removed?
1. single Y or double Y incision
2. reflect tissue
3. cut tic tac toe grooves using #6 round bur
4. Remove bone segment using osteotome (hammer and chisel) or acrylic bone
116
Where should incisions be made for mandibular tori in a dentate and edentulous patient?
Expose on edentulous by making incision at height of alveolar crest
Expose on dentate by making incision around lingual gingival sulcus
117
How are tori removed on the mandible?
1. Incision
2. Insert Seldon elevator at base of tori to prevent accidental puncture or cutting into floor of mouth
Also to protect the soft tissue because it is need to close to wound
3. Score the bone with a drill
4. Remove bone and gradually reduce its size
Use acrylic bur and or mono bevel chisel
118
What are the types of suction tips used in OS?
Yankeur - general
Frazier - precision surgical
Coupland - 2 piece with variable size
119
What are vertical grasps on forceps used for?
For European forceps
Removal of mandibular teeth only
120
What causes trismus?
Trismus: limiting in mouth opening
Usually due to multiple injections of LA around medial pterygoid muscle
121
When does swelling occur?
Max size in 36-48 hours and subsides on 3rd and 4th day
Manage:
- sleep w elevated head
- ice pack to face and warm compress by 3rd day
122
What instrument is used to disrupt PDL?
#9 peri-osteal elevator
