Little Birdie Flashcards
(143 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?
A
a. 1 year internship is desired.
b. 4 year dental school then a 4-6 year residency program
i. DDS/DMD = 4 years = certificate
ii. DDS/DMD + MD = 6 years (2 years in medical school)
c. 36 months of OMS + 12 months of surgical/medicine rotations
d. Differences:
- extensive hospital, medical, and surgical trainings
- incorporated advanced general anesthesia training
- bridges the gap between dentistry and medicine.
2
Q
What is dentoalveolar surgery?
A
Remove teeth (impacted/malposed/non-salvageable). Expose impacted teeth
for ortho. Recontour jaw bones. Prepare jaws for radiation therapy/cardiac or
orthopedic prostheses.
3
Q
What is preprosthetic surgery?
A
preparing the max/mand to accept a dental prosthesis.
- Palatal torus removal.
- Mandibular tori removal.
4
Q
What is management of odontogenic and facial space infections?
A
i. Ludwig’s angina - bilateral - submandibular, sublingual, and submental spaces.
ii. facial abscesses - can get so big that they swell eyes shut.
iii. Treatment = I&D
5
Q
What is orthognathic surgery?
A
evaluate and treat dentofacial deformities
i. facial asymmetries, dental/skeletal malocclusions, congenital deformities,
abnormal jaw relationships
1. Mandibular advancement. Reduction of chin protuberance. LeFort 1
fractures +/- concurrent mandibular advancement.
6
Q
What is craniofacial surgery?
A
Treat craniofacial syndromes. Skull base access surgery.
1. distraction osteogenesis
7
Q
What is treatment for obstructive sleep apnea?
A
Treat via maxillomandibular advancement = move max/mand forward together
= larger airway.
8
Q
What is management of traumatic injuries?
A
Soft tissue trauma. Dentoalveolar trauma. Fractures of the maxillofacial skeleton
(mand/max/midface/nose, orbit, and ethmoid/frontal sinus).
Combinations/panfacial fractures (like occur due to airbags).
9
Q
What is treatment for TMD?
A
Artificial joint, disc replacement. replacement of a displaced disc.
10
Q
What is implant surgery?
A
i. Intraoral - replace missing teeth, implant retained prosthesis, implant supported
prosthesis, and fixed/removable work.
ii. extraoral - retention of facial prosthesis, improved cosmetics.
11
Q
What is management of odontogenic pathologic conditions?
A
odontogenic cysts/tumors, or neoplastic lesions.
1. ameloblastoma - may have to resect part of the mandible.
2. mandibular reconstruction - take bone from hip/fibula - place implants
12
Q
What is management of non-odontogenic pathologic conditions?
A
salivary gland/mucous membrane disorders, epithelial
lesions.
1. Palatal melanoma - may have to resect the WHOLE maxilla and place a
denture.
13
Q
What is reconstructive surgery?
A
i. Restore form and function from - avulsed tooth trauma events, remove
pathology, physiologic atrophy. Restore continuity. Restore alveolar bone height
and width. Restore osseous bulk.
1. oral bone harvesting sites - symphysis, ramus, tuberosities…
2. extraoral bone harvesting sites - skull cortex, ribs (for TMJ), hip (for mandible), skin from thigh.
ii. Alveolar distraction osteogenesis - for alveolar deficiency - body will fill in bone
14
Q
What is cosmetic surgery?
A
Botox, septoplasties, rhinoplasties, blepharoplasties (removal of additional
tissue above eyes), laser facial resurfacing, liposuction, osteotomies, combo of
these.
15
Q
When writing patient notes. What type of patient record format is needed and recognized by all
medical professionals worldwide?
A
SOAP note
16
Q
What is the S in SOAP?
A
S - subjective
i. chief complaint - written word for word - is why the patient came to see us.
ii. history of present illness
1. describes, supports, provides info about the CC. What treatment has
been completed relating to this CC.
2. Pain involved - where, when, what causes, what resolves, what is the
character (sharp or dull).
iii. med hx (past and current), past social history, past dental history
1. medications, allergies, tobacco/alcohol/recreational drug use
2. past dent. history = where, what did they do, what was their experience
3. family history - if contributory
4. PATIENT INTERVIEW is the best way to get an accurate med hx
iv. assessment of anxiety - see question 7
v. review of systems
17
Q
What is the O in SOAP?
A
O - objective
i. Physical assessment
1. examine intra/extra-oral areas + x-rays + labs
18
Q
What is the A in SOAP?
A
A - assessment
i. diagnosis
1. create a problem list
2. medical needs first
a. Most dental procedures are elective so control med. issues first
19
Q
What is the P in SOAP?
A
P - plan
i. How is this going to be treated/addressed?
20
Q
The very first thing about writing this SOAP format as well as what you need to ask the patient when
you first meet them is…
A
Chief Complaint/why are they here.
21
Q
ASA 1
A
i. normal, healthy patient.
ii. Ex) No systemic disease. No medications.
22
Q
ASA 2
A
i. Mild systemic disease that is well controlled.
ii. ex) well controlled hypertension OR taking allegra for allergies
23
Q
ASA 3
A
i. significant systemic disease that limits activity, but isn’t incapacitating.
ii. ex) congestive heart failure
24
Q
ASA 4
A
i. incapacitating systemic disease that is a constant threat to life.
ii. ex) unstable angina pectoris
25
ASA 5
i. moribund patient NOT expected to survive more than 24 hours
ii. ex) end stage kidney disease
26
identify meds that may alter dental treatment
monoclonal antibodies, bisphosphonates, or coumadin.
27
What are the ways to reduce patient fear and anxiety?
a. Hand holding = non-pharmacologic - NOT your hand
b. N2O/O2 = good choice, used by many general dentists
c. Oral medications/pre-meds
d. intravenous medications = used in many OS offices
e. general anesthesia = OR/hospital dentistry
f. refer out the care
g. combination of the above
28
How to correctly write the medical consultation? What components need to be IN the consult?
Requesting evaluation of patient regarding
i. ability to tolerate treatment
ii. medical clearance to proceed with treatment
iii. modification of existing medications before the procedure (ex - INR or insulin)
29
What are the “STEPs” for medical consultation?
- 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 and fax (no email)
30
What’s the potential oral surgical patient logistic flow chart for UMKC dental school system? In
other words, Once a patient had been screened in DXR. What’s the next few potential steps.
31
Pre-surgical evaluation. How do you assess tooth mobility? How would you document mobility?
4- no mobility & high potential to be ankylosed
3- no mobility, but not ankylosis
2- normal tooth mobility = 0.25mm = can barely feel the movement
1- greater than normal mobility
32
Miller Class I
less than 1mm horizontal mobility
33
Miller Class II
more than 1 mm horizontal mobility
34
Miller Class III
more than 1 mm horizontal AND vertical mobility
35
Extraction Forceps has handle, hinge, and beaks. When dealing with handle, What are the
different ways that a clinician can hold (grasp) on to it?
horizontal grasped = American style forceps
i. handle is horizontal to the floor
1. palm down = mandibular extraction
2. palm up = maxillary extraction = 7-9 o’clock position (right handed)
vertical grasped = european style forceps
i. The handle is vertical to the floor. For removal of mandibular teeth.
36
maxillary anterior teeth - forceps
i. #1 & #99-C
1. extraction of canine usually involves buccal bone removal
ii. #150 (good alternative)
37
maxillary premolars - forceps
i. #150 = “universal”
1. Good for oval shaped/conical roots. Beak migrates toward the apex of
anterior teeth when proper forces are applied.
ii. #150-A
1. Conform to premolar crowns. Poorer adaptation. Less beak migration
toward the apex.
38
maxillary first and second molars - Forceps
i. Pairs of forceps are required - one for the right side, one for the left side.
ii. #89/#90 - palatal beak adapts to palatal root, NOT enter furcation.
1. use when) extensive coronal caries and large coronal restorations.
iii. #88R/#88L - “upper cowhorn”
1. 2 palatal prongs slide to either side of the palatal root. Buccal prong
enters the furcation.
2. ***reckless use leads to) alveolar fracture, crushing gingival tissue,
damage to adjacent teeth.
3. use when) extensive coronal caries and large coronal restorations.
iv. #53R/#53L
1. For trifurcated roots. Not used when coronal structures are
compromised.
39
erupted maxillary 3rds - forceps
#210-S) short beak for the short crown
40
maxillary root fragments - forceps
#286) long and slender beak
41
maxillary primary teeth - forceps
#150-S) smaller version of the #150. Good for ALL maxillary primary teeth
42
mand. anteriors and premolars - forceps
i. #74, #74-N, #74-extra-N
1. Vertical beaks. Continually seating beaks (continue to go as far apical as
possible) to prevent crown fracture.
ii. #151 = lower universal
iii. #151-A = grasp premolar but not adapt well to other anterior teeth.
iv. #203 = thinner beak for better adaptation.
43
mand. molars - forceps
i. #23 (cowhorn)- MOST popular- properly adapted to tooth = "squeeze" tooth out of socket
ii. #17 - bifurcated molars - not adapted to conical-rooted molars.
44
most popular mandibular forceps
"squeeze the tooth out"
#23
45
mand. 3rd molars - forceps
i. #222 - can also be used for conical-rooted 2nd molars.
46
primary mand. teeth - forceps
#151-S = scaled down version of #151.
47
#30 & #31 (Cryer) elevator
1. Wheel and Axle. Use with or without purchase point.
2. Remove root with adjacent empty socket
48
#41 (Crane Pick) elevator
1. MOST dangerous elevator - fulcrum on buccal bone & sharp point buried
into cementum = drags the root out
2. uses a “purchase point.” Wheel and axle.
49
#73 & #74 elevators
50
Potts elevator
1. Used as a corkscrew. T-handle which delivers more force.
2. Impacted maxillary 3rds = use
51
#301, #302, #303- small elevators
301 = MOST commonly used elevator
52
34-S and 46 - large elevator
1. 2nd most commonly used. Into PDL space parallel to tooth. Grasp
properly and not to slip.
2. start with 301 → #34-S/#46.
53
Apex elevators (root picks)
1. Straight or angled shank. Essential in small detached root tips. Sharp end
goes into PDL space.
2. root tip still attached to PDL, use #301 and not a root pick.
54
periosteal elevator - #9 (molt), Hopkins (less popular)
1. reflect full thickness mucoperiosteum
a. easily end up with supraperiosteal flap
2. prevent splitting or tearing of the flap
3. push/pry motion = sever attachment of gingiva
4. pull motion = loosely reflect attached gingiva
55
#5 Rongeurs
1. Large-bladed. Side-cutting. “Bone forceps” cuts not pinching.
Alveoplasty with good access. ***pinch/cut lip or cheek***
56
#4A Rongeurs & Blumenthal Rongeurs
Side and end cutting. Cut bone by “pinching”. Minor alveoplasty with
limited access. MOST popular by dentists.
57
mallet
nylon head - softens the blow
58
chisels
i. section teeth or remove bone
ii. bibevel #2 chisel = split teeth
iii. monobevel #52 chisel = remove bone, hand pressure along can remove bone
59
curettes
Curettage a granuloma. Enucleate small cysts. Debride sockets. Assorted
sizes/shapes
60
bone file - #12
Smooth bone. Not for gross reduction. Pull stroke only.
61
Kelly
| scissors
1. universal-type scissors
2. trimming of wound margins
3. cutting sutures
62
Dean
| scissors
long curved handle
63
needle holder
i. thumb and ring finger in the holes
ii. index finger along the shaft
64
bard parker
i. #3 bard parker knife handle.
ii. blades - place with other instruments
1. #15) standard blade
2. #11 - pointed) for I&D
3. #12 - “hooked”) reach inaccessible regions
4. #12b) incises on both sides
5. #10) not for intraoral surgery
65
Adson tissue forceps
1. tissue forceps with “teeth”
2. support flap, enable suture needle to penetrate the flap at 90-degrees.
3. avoid crushing tissue when performing biopsy
66
mouth prop
minimizes TMJ trauma
67
Minnesota and Austin retractors
1. hold mucoperiosteal - flaps, cheeks, lips, tongue
2. improves visibility and protects tissues
68
yankauer suction
general suction
69
frazier suction
precision surgical suction
70
coupland suction
1. 2 piece design, various tips.
2. tip width varies
71
tapered fissure burs - 701, 702, 703
removes bone, sections teeth, place purchase point.
| 703 biggest
72
round burs - 2, 4, 6, 8....
place purchase point = where the forces will be delivered = 3 mm apical
to CEJ and 3 mm deep.
73
acrylic burs - football, pear shaped
remove exostoses, tori, and alveoplasty
74
electrical drill
No need for an air compressor. VERY expensive. proper maintenance = MUST.
75
high speed air rotors
i. impact-air) attach something to old handpiece and get impact-air
ii. exhaust air to rear
1. regular dental handpieces exhaust air into surgical wounds and may
cause **air embolism** to the surgical site.
76
Mechanical Motions of Extractions are....
a. **Wedge/displacement**
i. Insert into PDL space to dislodge root tip.
ii. ***Cannot use for maxillary roots (sinus). May cause an oro-antral
communication.
b. **lever action**
i. “Pry” tooth root tip. Engages a purchase point (groove or hole). Gripping the
edge of the blade and using the bone as a fulcrum.
c. **wheel and axle**
i. Engage a purchase point. Use bone as a fulcrum to rotate the tip out.
77
Chair and patient position when performing maxillary or mandibular extractions.
Chair position
i. Correct - Better adaptation of forces. Wrist kept straight, arm close to body.
ii. incorrect - severe discomfort and muscle strain caused by inappropriate arm
position or force.
iii. Only time we need to see during an extraction is to confirm which tooth,
otherwise it is just feeling.
78
Chair and patient position when performing maxillary extractions
i. Occlusal plane 45-60 degrees to the floor. Patient shoulder at surgeon’s elbow.
Stand at 7-8 o’clock. Feet apart. Non-dominant hand counters traction force.
ii. 12 o’clock. Patient fully reclined. Forceps grasped PALM UP. Arm close to body
(reduce fatigue). Easier for object into airway. Throat screen necessary.
79
Chair and patient position when performing mandibular extractions
i. Occlusal plane parallel to floor and at surgeons elbow or lower. Stand at 7-8
o’clock. Feet apart. Non-dominant hand counters traction force.
80
All the possible Forceps Movements are
a. Buccal pressure
i. Expands socket on buccal side. Detaches PDL on lingual side.
b. apical pressure
i. more apical the forceps = shorter fulcrum = uniform socket dilation = reduced
root fracture risk.
c. lingual pressure
i. Expands socket on lingual side. Detachees PDL on buccal side.
d. rotation
e. traction
i. Delivers tooth out of the socket.
f. figure 8 movement
i. Combination of buccal, lingual, and rotation.
81
When performing extraction, what should you non-dominant hand doing?
a. Non-dominant hand provides stability and counter traction force. It holds the mandible
or the head. Also helps to apply the force more apically.
b. Maxillary arch
i. “pinch-grasp” - thumb and index finger on either side of the alveolar ridge to
feel the movement. DO NOT put fingers in the patient’s eyes.
c. Mandibular arch
i. sling grasp - counteract forces of extraction - prevent injury to TMJ.
ii. “pinch-grasp” + bite block - support TMJ while the bite block is on the opposite
side.
82
principles of flap design
i. Broad base for adequate blood supply - **wider apically than coronally.**
ii. Large enough to provide visual and instrument access - heals as rapidly
iii. repositioned and sutured over solid bone
iv. avoid major anatomical structures
v. full thickness = skin, subcutaneous tissue, connective tissue, periosteum)
83
common designs of flaps
i. Envelope
1. 1 tooth distal and 2 teeth mesial = sulcular incision.
ii. flaps with releasing incision
1. 1 tooth distal and 1 tooth mesial + papilla = MINIMUM size. MUST
originate from mesial or distal line angle.
iii. Margin MUST be at least 5 mm from margins of the bony defect.
iv. Flaps should be repositioned over an adequate margin of solid bone to increase
healing and decrease dehiscence.
84
Contraindications for placing vertical release incisions
i. Canine prominence
1. soft tissue defect due to frequent bone fenestration... the tissue is tight.
ii. mental foramen
1. avoid vertical incision in this proximity
iii. palate
1. avoid vertical incision on the palate to avoid severing the greater
palatine vasculature and nerve
2. NEVER do this (he said)
iv. incisive papilla
1. avoid unnecessary incisions here
v. bony lesion
1. avoid placing incisions over bony lesions - dehiscence could result in
delayed healing b/c won’t heal over weird tissues
vi. major frena
1. avoid incisions here
vii. lingual side of mandibular arch
1. NEVER place vertical incision on the lingual side of the mandibular arch
85
Mandibular flap + hazards
i. incision made from coronoid process down anterior border of the ramus along
the crest of the alveolus to the opposite coronoid process WITHOUT cutting any
major structures except buccinators artery and long buccal nerve.
ii. hazards
1. Lingual region of 3rd molars - nerve damage causing permanent
anesthesia and loss of taste.
2. premolar buccal vestibular region - sever mental nerve/vessel = loss of
labial sensation - recovery of sensation is possible by proliferation of
collateral innervation from C2/C3/contralateral mental nerve
3. improper incision/scalpel slip to depth of vestibule near 2nd molar
a. facial artery/vein - crosses mandible at anterior edge of
masseter→ MUST ligate or prolonged firm pressure if cut
b. prevention - buccal releasing incision directed UP TOWARD the
crest of the alveolar ridge
86
summary of concerning structures for mandibular flap
lingual nerve, facial artery, mental nerve, long buccal nerve, buccal artery
87
Maxillary flap and hazards
i. from one tuberosity to the other along alveolar ridge cuts nothing larger than a
capillary
ii. hazards
1. greater palatine artery - goes anterior toward the incisive foramen - runs
b/t palatal gingiva and midline of the palate - if artery is cut, direct
pressure at the PROXIMAL end of the vessel
2. nasopalatine nerve - avoid incision through incisive papilla
88
summary of concerning structures for maxillary flap
greater palatine vasculature, nasopalatine nerve
89
Full thickness flap
1. mucosal tissue + periosteum
2. preserve periosteum
3. MOST popular flap
90
Partial thickness flap
1. periosteum left attached to the bone
2. able to apically reposition the flap - increase amount of attached gingiva
3. OMS/Perio procedures
91
envelope flap
1. flap of choice for MOST procedures
2. full thickness - sulcular incision without vertical releasing incision
3. 1 tooth distal, 2 teeth mesial - extend “coverage” as clinically indicated -
add 1-2 vertical releases based on clinical indicators.
92
modified envelope - vertical release incision flap
1. 2nd most useful flap for exodontia
2. greater access + proximity to apex + deeply impacted teeth
93
modified envelope - 2 vertical release incisions flap
1. rectangular flap
2. 1 distal and 1 mesial to surgical site
94
Semilunar flap
1. curved flap
2. Full thickness. Doesn’t involve gingival sulcus. Placed partially in
attached gingiva and goes into mucosal tissue
3. utilization - periapical periodontal surgery - retrieval of small root tips
4. Should be AT LEAST 2 mm apical to the base of gingival sulcus - probe
before incising.
95
pedicle flap
1. Long, narrow flap. Used to cover osseous cavities.
2. Perio - corrects gingival recession
3. OMS - closure of oro-antral fistula
4. high potential for necrosis and rejection = technique sensitive to
maintain adequate blood flow in the flap
96
suture overview
If margin tissue turns white, it’s too tight. Bleeding NOT controlled by sutures. Intra-oral
sutures left in the mouth for 4-7 days. Suture needles should be 3mm from flap margins.
Always move from mobile tissue to non-mobile tissue.
97
Suture size = diameter
i. the more 0s there are = the smaller the diameter
ii. smaller size = less tensile strength
1. 9-0 or 10-0 = microsurgery = vessels sewn together
2. 5-0 or 6-0 = facial skin closure
3. 3-0 or 4-0 = muscle, deep skin, intraoral mucosa
## Footnote
bigger number = smaller diameter
3-0 bigger than 5-0
98
nonabsorbable sutures
examples - silk = natural. Nylon, propylene, polyester, SS, titanium =
synthetic.
99
absorbable sutures
1. ideal for deep closures. Made from gut. Gradually dissolved by
proteolytic activity.
2. Downside - unknown time of wound support
3. examples - Plain cut, chromic gut = natural. Vicryl, PDS = synthetic.
100
braided sutures
1. Multiple filaments braided together. Increased flexibility. SUTURE
MATERIAL OF CHOICE for intraoral surgery.
2. downside - draw oral flora into the wound → may or may not be
clinically relevant.
101
monofilament sutures
1. Single fiber material
2. downside - decreased flexibility and increased tendency to untie
102
sutures at UMKC
silk, nylon, propylene, plain gut, chromic gut, Vicryl.
103
interrupted sutures
i. Most frequently used. If 1 unties, the others can still support the wound.
ii. advantage) good wound approximation
iii. disadvantaged) time consuming
iv. How to tie
1. wrap twice, clockwise (or CCW).
2. wrap once, CCW (or CW).
3. wrap once, CCW (or CW).
104
vertical mattress sutures
i. Used when more tension is required. Seldom used for intra-oral surgery.
ii. Advantage) Frequently useful for oro-antral fistulas.
105
horizontal mattress sutures
i. Better wound compression.
ii. Advantage) Good wound approximation.
iii. Disadvantage) Not as efficient as a vertical mattress suture.
106
continuous mattress sutures
i. Used for long incisions.
ii. Disadvantages) Not always accurately approximate wound margins. Suture may
unwind if one knot is untied or cut.
107
continuous locking mattress sutures
i. Used for long incisions.
ii. Advantages) Better wound margin proximation. Less prone to unwind if one gets
untied.
108
figure eight sutures
i. For socket grafting
ii. Advantage) Holds gel-form or materials in socket.
109
Post-Op Pain medication. What’s the maximum dose for ibuprofen/Acetaminophen? What’s the
difference between these 2 OTC medications?
Acetaminophen = Tylenol
i. Advantage
1. does not interfere with post-op bleeding and platelet function
2. good for pt with platelet defects.
ii. MAX dose = 4000 mg/day
Ibuprofen
i. Advantage = effective for post-op pain
ii. Disadvantage
1. decreased platelet aggregation = thinner blood.
2. increased bleeding time = not important in avg. patient.
iii. MAX dose = 3200 mg/day
110
Schedule I drugs
- high abuse potential
- no accepted medical use in USA
- simply CANNOT prescribe
- example: Heroin, LSD, marijuana
111
Schedule II durgs
- high abuse potential
- severe psychic/ physical abuse liability
- require written Rx, can be faxed, NO refill
- example: oxycodone, morphine, fentanyl, hydrocodone, meperidine
112
Schedule III drugs
- significant abuse potential
- written Rx not required
- refill up to 5 times
- example: hydrocodone combo (Vicodin), codeine + acetaminophen
113
Schedule IV drugs
- lower abuse liability
- written Rx not required
- 5 refills within 6 months
- example: phenobarbitol, diazepam, propofol, tramadol
114
Schedule V drugs
- very low abuse potential
- written Rx not required
- 5 refills within 6 months
- example: robitussin
115
How to protect foreign objects from going into a patient's lung when doing dental work?
Treatment
i. Turn patient to their side
ii. encourage coughing
iii. use suction
iv. try to determine if swallowed or aspirated.
Prevention
i. use a throat pack OR use a gauze screen (cotton 4x4)
116
How oroantral fistula happens
i. Occurs during removal of maxillary molars.
ii. Pneumatization of maxillary sinus, little or no bone b/w roots and sinus floor =
bone adhered to roots
117
Prevention of oroantral fistula
i. Conducting a thorough pre-op radiographic exam
ii. Use surgical extraction early, section roots
iii. avoid excessive apical pressure on maxillary posterior teeth
118
How to determine treatment for oroantral fistula
Determine size to determine treatment
- <2 mm no additional treatment in necessart
- Sinus precautions: No blowing of nose, sneeze with mouth open,
no straws, and no smoking
- >2 and <6 mm: gelfoam, figure 8 suture, sinus precautions, antibiotics,
nasal spray, oral decongestant
- >7mm consider referral to OMS for a flap
119
Sinus precautions
i. No blowing nose
ii. Sneeze with mouth open
iii. No straws
iv. No smoking
120
sequalae of oroantral fistula
2 sequelae) post-op maxillary sinusitis and formation of a chronic oroantral fistula.
121
Management of fibrous enlargement of Tuberosity.
c. How to
i. elliptical full-thickness incision made - creates an oblique cut
ii. underlying submucosa fileted to reduce tuberosity bulk
iii. wound edges are apposed and sutured - trim the edges to get nice wound
approximation
122
Why remove fibrous enlargement of tuberosity?
a. Fibrous or bony accumulation at tuberosity - usually mobile - causing **denture instability**
b. **Causes a reduced vertical interocclusal space** = minimum of 6mm of space
123
Post-op bleeding dependent upon
a. Dependent upon:
i. Medical history, family history, current medications, chemotherapy, alcoholism,
severe liver disease, anticoagulation
124
Prevention of Post-Op Bleeding
b. Prevention:
i. Obtain a history of bleeding
ii. Use atraumatic surgical techniques
iii. Obtain good hemostasis at surgery
iv. Provide excellent patient instructions
125
Management of Post-Op Bleeding
c. Management:
i. Direct pressure with gauze
ii. Gelfoam with figure 8 sutures
iii. Surgicel reserved for more persistent bleeding
iv. Thrombin
v. Microfibrillar collagen
vi. collatape/collaplug
vii. Local anesthesia and epinephrine*
1. *as long as pt is not limit epi
viii. Monitor for hemostasis for at least 30 minutes before D/C
126
Alveolar Osteitis. What is it?
dry socket
127
How to recognize alveolar osteitis
i. moderate to severe pain w/o signs and symptoms of infection (fever, swelling,
erythema)
ii. results from high fibrinolytic activity around extraction socket
128
treatment of alveolar osteitis
pain relief - irrigation and insertion of medicated dressing (gelfoam + eugenol) in socket
129
Risk factors for alveolar osteitis
i. smoking and tobacco use
ii. oral contraceptives
iii. improper at-home care
iv. history of dry sockets
v. tooth or gum infections
vi. use of corticosteroids
130
Mandibular fracture associated with tooth extraction
Rare complication - almost exclusively associated with surgical 3rd molar extractions -
due to excessive force - appropriate reduction and fixation is required
131
Maxillary Frenum frenectomy
i. Dentate patients - cause diastema b/t central incisors = esthetic issue
ii. Edentulous patients - interfere with peripheral seal = physical issue
iii. diamond technique
1. double mosquito hemostats clamp the frenum
2. incision made along the outside of the hemostats
3. closed with interrupted sutures
4. Drawback - linear contraction w/ resulting scar
iv. Z-plasty technique
1. less scar contracture
2. the angle of the cut matters - bigger the angle = longer length (60
degree cut = ideal = 75% gain in length)
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Mandibular Frenum frenectomy
i. Correct ankyloglossia
ii. indications) significant tongue immobility OR unable to seat denture
iii. Treatment
1. Z-plasty - if possible - 60 degree = better ability to stick the tongue out
2. Generally outside the scope of general dentist —> refer to OMS
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What is tori?
i. Dense cortical bone growths
ii. Indications) ulcerations or instability for dentures
1. Palatal torus > 3mm height = removed
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Palatal torus/torus palatinus treatment
i. surgical exposure - single or double Y incision - reflect thin-easily teared palatal
tissue
ii. removal of bone - #6 round bur/cross-cut fissure bur
1. Score the bone - remove each piece with osteotome or acrylic bur -
TAKE care with the depth → easily create oro-antral fistula b/c the
palatal shelf = very thin
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Mandibular tori removal
i. edentulous - mid-crestal incision made at the height of the alveolar crest - place
Seldon elevator apical to the bottom of the tori
ii. dentate - incision made around lingual gingival sulcus
iii. removal of bone
1. gradual reduction in size - acrylic bur +/- monobevel chisel
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Surgical extraction of maxillary first molar
a. Alveoplasty following the removal of a supraerupted isolated tooth
b. goal is to provide sufficient interocclusal space
| section into Y shape
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How does penicillin work?
i. It is a cell wall synthesis inhibitor = BACTERICIDAL
ii. Beta-lactam ring structure **penetrates transpeptidase**
1. penetrates all cell layers in order to expose fragile inner membrane
iii. What can bacteria do?
1. penicillinase = beta-lactamase
2. alter transpeptidase such as MRSA
3. gram negative bacteria have porins to prevent PCN from passing
through
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Penicillin G
Pen V (oral) vs Pen G (IM or IV)
139
Aminopenicillin
better coverage for gram negative bacteria
1. examples) ampicillin (IV) or Amoxicillin (oral or IV)
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Penicillinase-resistant PCN
for MRSA
IV examples) methicillin, nafcillin, oxacillin
oral examples) cloxacillin, dicloxacillin
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Antipseudomonal PCN
expanded gram negative coverage
1. carboxypenicillins - carbenicillin, ticarcillin
2. Ureidopenicillins - piperacillin, mezlocillin
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Beta-Lactamase inhibitors
i. Clavulanic acid
1. Not effective by itself. Suicide inhibitor to B-Lactamase, deactivates the
enzyme.
2. Examples) Clavulanic acid + amoxicillin = Augmentin; Clavulanic acid +
ticarcillin = Timentin
ii. Sulbactam
1. bind to enzyme and protect degradation of antibiotic
2. ex) sulbactam + ampicillin = Unasyn (IV equivalent)
iii. Tazobactam
1. Sodium salt
2. Ex) tazobactam + piperacillin = Zosyn (for nosocomial pneumonia)
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Anti-ribosomal Antibiotics (buy AT 30, CELL 50 - 30S: Aminoglycoside/Tetracycline - 50S:
chloramphenicol, erythromycin, lincomycin, clindamycin)
i. Tetracycline
1. chelates with milk/Ca2+/Mg = combines with the ABX and passes
through intestine without absorption
2. ex) tetracycline, doxycycline, demeclocycline, minocycline
ii. Erythromycin
1. treats legionnaire’s disease and chlamydia
2. Ex) erythromycin, clarithromycin, azithromycin (z–pack)
iii. Clindamycin
1. for anaerobic bacteria coverage - FREQUENTLY used in dentistry
2. if have pseudomembranous colitis treat with vancomycin or
metronidazole
