Munk Review Flashcards
(149 cards)
1
Q
MX forceps and what teeth to use them on
A
- #210 - M3s
- #88 - M1, M2 cowhorns
- #150 - universal; PMs, anteriors
- #65 - MX root tips
2
Q
Deep sedation
A
- Pt cannot be easily aroused; responds purposefully to repeated or painful stimulation
- Independent, spontaneous ventilation may be impaired
3
Q
What are aveolar housing fractures and how do we tx them?
A
- Teeth displaced as a group
- Tx
- LA
- Reposition tooth/teeth into normal position
- Consider splinting together for stability
4
Q
What is the superscription?
A
- Date when the prescription was written
- Name, address, age of pt
- R/ or Rx
5
Q
What facial subunit is the zygomatic arch a part of?
A
Zygomaticomaxillary complex (ZMC)
Has 4 bony fusions w/ the skull
6
Q
What are the 4 components of risk assessment evaluation?
A
- Nature, severity, stability of the pt’s medical condition
- Functional capacity of pt
- Emotional status of pt
- Type & magnitude of planned procedure (invasiveness)
7
Q
What is azotemia?
A
- Loss of glomerular filtration fcn = build up of non-protein nitrogen cmpds in the blood (mainly urea)
- Basically urea in the blood
8
Q
Can you use N2O/O2 in combination w/ a single enteral drug in minimal sedation?
A
Yes, but not 3 (unless it’s Benadryl)
9
Q
ESRD medical tx’s. What’s the difference between them?
A
- Hemodialysis: More commonly used; method of choice for long-term
- Peritoneal dialysis: Can be done anywhere
10
Q
What conditions increase risk of infective endocarditis?
A
- Prosthetic heart valve
- Previous IE
- Congenital heart disease (CHD)
- Unrepaired CHD
- 6mo post complete CHD repair
- Repaired CHD w/ residual defects
- Cardiac transplants that develop cardiac valvulopathy
11
Q
What are normal values for hemostasis?
A
- Bleeding time: 2-8min
- Platelet Function Analyzer (PFA): Closure time <175s
- Prothrombin Time (PT): 10-12s
- Activated Partial Thromboplastin Time (aPTT): 25-35s
12
Q
What is infective endocarditis?
A
- Microbial infection of endocardium or heart valves
- Often near heart defects
13
Q
How does blood supply affect flap design?
A
- Base must be broader than the FGM/coronal
- If the base of the flap is too narrow, blood supply may not be enough (ischemia) which can lead to flap necrosis
14
Q
O.D.
A
Right eye
15
Q
How does the center of rotation of a tooth effect its extraction?
A
- If the center of rotation is not positioned far enough apically, excessive force is placed on the apical portion of the tooth, increasing the chance of root fracture at the apex
16
Q
What is Grave’s? What is Hashimotos?
A
Graves = hyperthyroidism
Hashimotos = hypothyroidism
17
Q
O.U.
A
Both eyes
18
Q
What is the most common odontogenic deep fascial space infection?
A
Vestibular space abscess
19
Q
q.d.
A
1x/day
20
Q
Lateral pharyngeal space infection boundaries
A
- Superior: Sphenoid bone (cone base)
- Inferior: Hyoid bone (cone apex)
- Lateral: Fascia covering medial pterygoid m., parotid, MN
- Medial: Buccopharyngeal fascia on lateral surface of superior constrictor mm.
- Anterior: Pterygomandibular raphe
- Posterior: Extends to prevertebral fascia
Morbid complications if not tx’ immediately! Deep neck.
(Inverted cone or pyramid shape)
21
Q
ASA Classification
A
- ASA I: Healthy
- ASA II: Mild systemic disease, no functional limitations
- ASA III: Severe systemic disease, definite functional limitations
- ASA IV: How are you even alive bruh
22
Q
With what trauma would you see sublingual ecchymosis as a clinical finding?
A
Submandibular fractures
- Most common areas of fracture
23
Q
Minimal sedation/anxiolysis
A
- Independently and continuously maintain airway
- Normal response to tactile & verbal commands
- When intent is minimal sedation for adults, initial dosing is never past MRD
24
Q
What is anesthesia?
A
Loss of sensation resulting from pharmacologic depression of nerve function or from neurologic dysfunction
25
What are the different T stages in TNM Staging?
* **TX:** Primary tumor cannot be assessed; information not known
* **T0:** No evidence of primary tumor = carcinoma in situ; disease is still localized in the top layers of cells lining the oral cavity & oropharynx
* **T1:** Tumor is **\<2cm** across
* **T2:** Tumor is **\>2cm** but **\<4cm** across
* **T3:** Tumor is **\>4cm**
* **T4:**
* **T4a:** Tumor is growing into nearby structures; **_moderately_ advanced local disease**
* **T4b:** Tumor has grown through nearby structures and into deeper areas or tissues; **_very_ advanced local disease**
26
q.h.s.
before bed
27
What is axonotmesis?
* Injury to nerve that causes **loss** of axonal continuity, but **preserves the endoneurium**
* Caused by **crushing injury**
28
What are the most common causes of ESRD?
1. Diabetes mellitus
2. HTN
3. Chronic glomerulonephritis
29
Dialysis pts: Dental appt considerations
* Potential for bleeding problems, should have pre-tx labs done
* Peritoneal dialysis: Tx as normal
* Hemodialysis: Tx pts day after hemodialysis
30
Surgical vs. Non-surgical extractions
* **Surgical:** Cutting tooth or bone
* **Non-surgical:** Not cutting tooth or bone
31
Duration of anesthesia
* 0.5% Marcaine: 6-10hr
* 2% Lidocaine: 2-3hr
* 3% Carbocaine: 0.5-2hr
* 4% Septocaine: 3-4hr
32
b.i.d.
2x/day
33
What are the two types of zygoma fractures?
* Arch fractures - Most common
* Tripod (malar) fractures - Most serious
34
Large and small straight elevators #'s
* Small: #301 \*\*Your go to\*\*
* Large: #34
35
Palatal space infection boundaries
* **Inferior:** Cortical plates of hard palate
* **Superior:** Overlying periosteum
* **Lateral:** Alveolar process of MX & teeth
36
What is analgesia?
Neurologic or pharmacologic state in which painful stimuli are **moderated**
37
How many mg of anesthetic in 2% lido?
2% = 20 mg
20mg x 1.7mL = **34mg**
38
LeFort III - What's fractured? Clinical findings? Radiographic findings?
* Fractures through the **MX, zygoma, nasal bones, ethmoid bones, base of skull**
* Clinical findings
* **Dish faced deformity**
* Epistaxis & CSF rhinorrhea
* **Mobility of MX, nose, zygoma**
* **Severe airway obstruction**
* Rad findings
* Fractures through zygomaticofrontal sutures, zygoma, orbital walls, nasal bone
39
What is diabetes? What is the goal HbA1c for diabetics?
* Chronic disease characterized by **hyperglycemia** and complications (microvascular disease of kidney, eye) and variety of clinical neuropathies
* Goal for pts in general is HbA1c \<7% and goal for each individual is as close to 6% as possible w/o hypoglycemia
40
What is Cushing's Syndrome?
Making too much cortisol
* Long-term effective use of glucocorticoids can bring on Cushing's Syndrome (mimicks Cushing's disease)
* Secondary adrenal insufficiency results from hypothalamic or pituitary disease or from administration of exogenous corticosteroids
* Adrenal crisis is rare and not as severe bc aldosterone (regulates Na & K) secretion is normal
41
What is uremia?
* Retention of excretory pdts and interference w/ endocrine & metabolic fcn caused by renal failure
* Basically pee in the blood
42
What is avulsion and how do we tx it?
* **Tooth is completely out of the socket**
* Transport immediately in saliva or milk and re-implant w/in 20-30 min
* Tx
* Place into correct position
* Splint
* F/u - 10-14 days may need endo depending on pulp test
* Remove splint in 6wk
43
Can you use epi in HTN pts? What is the max epi you can give HTN pt in 1 session?
* In moderation
* Use cautiously in pts on non-selective beta blockers
* Normal
* 200mcg in 1 session
* 11 carps of 1:100K = 298mcg
* Heart disease
* **40mcg in 1 session**
* **2 carps of 1:100K = 36mcg**
44
p.c.
after meals
45
What are elevated creatinine levels an indication of?
* Impaired kidney function or kidney disease
* As kidneys become impaired, clearance decreases = elevated creatinine
46
Pts on what drugs may experience toxic rxn to LAs if injected intravascularly? What else should be avoided with these pts?
* GI diseased pts
* Pts on H2 blockers
* Should also avoid aspirin & NSAIDs and use abx judiciously
47
t.i.d.
3x/day
48
Steroid supplementation protocol
* Minor stress - take usual AM steroid dose
* \<7.5mg? No supplementation
* \>7.5 mg? Double the dose day of procedure
* Moderate stress
* 10-15mg prednisone for 1-2 days and taper to normal daily dose
* Major stress
* 20-25mg prednisone for 1-2 days and taper to normal daily dose
49
What is Addison's?
Primary adrenal insufficiency = Not making enough cortisol
* Adrenal crisis is possible
50
What is the suggested instrumentation sequence for extractions?
* #15
* #9 periosteal elevator
* Elevator
* Forceps
* Debride w/ double ended curette
* Bone file or rongeur
* Alveoloplasty - digital compression
51
What is luxation and how do we tx it?
* **Displacement of teeth; similar to alveolar housing fractures, but involving less teeth**
* Tx
* Place into correct anatomical position and splint
* F/u - will likely need endo in 10-14 days depending on pulp test
* Remove splint in 6wk
52
What are the 4 stages of odontogenic infections?
* **Inoculation**
* **First 3 days** of symptoms
* **Mildly** tender, soft, doughy swelling
* This stage is the easiest to tx
* **Cellulitis**
* After **3-5 days**, swelling becomes hard, red, indurated, and **acutely** tender as the **infecting mixed flora** stimulates intense inflammatory response
* **Dangerous because you don't know where it will go and it spreads rapidly**
* **Abscess**
* **5-7 days** after onset, **anaerobes predominate**, causing liquified abscess in the center of the swollen area
* Acute abscess is a more mature infection w/ more localized pain, less swelling, nice borders
* Chronic abscess is slow growing and less serious than cellulitis
* **Resolution**
* When the abscess drains, immune system destroys the infecting bacteria; healing and repair begin
53
q.t.t.
drop
54
What is the inscription?
Name & strength of medication
55
What is ACTH stimulation test for?
Adrenal hypofunction screening; directly evalutes the level of adrenal reserve
56
T1 diabetes
Regular insulin. Neutral Protamine Hagedorn (NPH) and Ultralente
* Less common than T2
* Younger and rapid onset
* Normal, thin body build
* Severity is extreme
* Almost no insulin
* Plasma glucagons are high, suppressible
* Few respond to oral hypoglycemics
* Ketoacidosis is common
* Complications are common
* Unstable
* Genetic locus: Chromosome 6
* Autoimmune rxn
* No insulin receptor defects
57
Retropharyngeal space infection boundaries
* **Superior:** Skull base
* **Inferior:** Mediastinum
* **Lateral:** Lateral pharyngeal space
* **Anterior:** Posterior pharyngeal wall
* **Posterior:** Prevertebral fascia
58
Prevention & Tx of Alveolar Osteitis
* Prevention
* Aseptic technique
* Atraumatic technique
* Thorough irrigation and wound debridement
* Primary closure of wound if possible
* Adequate hemorrhage
* Abx
* Gentl antimicrobial rinse
* Tx
* Gentle irrigation, place medicated dressing on gelfoam
* Medicated dressings
* BIPP
* ZOE cotton pellets
* Eugenol, iodoform, butamen
* Metronidazole, lidocaine ointment
* Sultan dry socket paste
* F/u w/ pt 24hr later
* No improvement? Repack and f/u 24hr later
59
T2 diabetes
Lifestyle changes. Metformin, Avandia, etc. Control of risk factors for CV disease.
* More common than T1
* Older, slower clinical onset
* Obese body build
* Severity is mild
* 25-30% of insluin
* High, resistant plasma glucagons
* 50% respond to oral hypoglycemics
* Ketoacidosis is uncommon
* Complications are less common
* Stable
* Genetic locus: Chromosome 11?
* Autoimmune rxn not present
* Insulin receptor defects often found
60
What is neuropraxia?
* Injury to nerve that causes **no loss** of continuity of the axon or endoneurium, but **disrupts myelin sheath**
* Caused by **compression** of the nerve or **ischemia**
* No long term effects
61
Submandibular space infection boundaries
* **Superior:** Mylohyoid m., inferior border of MN
* **Inferior:** Anterior & posterior belly of digastric
* **Lateral:** Deep cervical fascia, platysma, superficial fascia & skin
* **Medial:** Hyoglossus, styloglossus, mylohyoid m.
* **Anterior:** Submental space
* **Posterior:** To hyoid bone
62
Over which structure do the condyle and disk translate anteriorly and inferiorly over in TMJ?
Articular eminence of the temporal bone
63
What BP is hypertensive?
\>140/90
64
What is incremental dosing?
Giving a little bit until you reach MRD, but you don't exceed it
Titrating N2O is an example of this
65
Stages of genera anesthesia
* Analgesia
* Excitement/delirium
* Surgical - IDEAL
* Medullary depression
66
What do you Rx a pt at risk of infective endocarditis?
Abx prophylactically to be taken PO **30-60 min before the procedure**
* **Amoxicillin 2g PO**
* If allergic to PCN,
* **Cephalexin/Clindamycin 2g**
* **Clindamycin/Clarithromycin 500-600mg**
67
LeFort I - What's fractured? Clinical findings? Radiographic findings?
* **Horizontal** fracture of the MX at **nasal fossa level**
* MX moves, nose doesn't
* Clinical findings
* Facial edema
* Malocclusion
* MX moves; nose doesn't
* Rad findings
68
What is the BP cut off in real life for dental tx?
180/110
69
What is functional capacity?
Ability of pt to perform normal physical activity
70
What does TNM stand for in TNM Staging? What is TNM Staging?
* **T:** Tumor
* **N:** Node
* **M:** Malignancy
TNM Staging is cancer staging.
71
What is the tx for aphthous ulcers?
* Empirical and palliative only
* No cure, you can only relieve symptoms
* Steroids in severe cases
* **Xylocaine**
72
What are normal values for complete blood count?
* **WBCs:** 4400-11K/mL
* **RBCs****:** 3.5-4x10^6/mcL
* **Platelets:** 150K-450K/mcL
* **Hematocrit:**
* **Male:** 41-50%
* **Female:** 35-44%
* **Hb:**
* **Male:** 13-17 g/dL
* **Female:** 12-15 g/dL
73
Name the instruments in this set up
* Weider/Sweetheart retractor
* Austin retractor
* Minnesota retractor
* #15 blade
* #9 periosteal elevator
* #2 Molt curette
* Bone file
* Anesthetic syringe
* Bite block
* Suction tip
* Needle holders
* Hemostats
* Scissors
74
How many mg of anesthetic in 0.5% marcaine?
0.5% = 5mg
5mg x 1.7mL = **8.5mg**
5mg x 1.8mL = **9mg**
75
Cavernous sinus thrombosis
* Formation of blood clot w/in the **cavernous sinus** (cavity @ base of brain which drains deO2 blood from the brain back to the heart)
* Cause is usually spreading infection from nose, sinuses, ears, or teeth
76
What is TMJ
Articulation of MN condyle w/ the glenoid fossa of temporal bone
77
q.o.d.
every other hour
78
What is the signatura?
Directions for the pt, written in English or Latin abbreviations
79
How do you tx submandibular fracture?
* **Closed Reduction Maxillomandibular Fixation (CR-MMF)**
* Wiring the jaws together
* **Open Reduction/Internal Fixation (ORIF)**
* Opening the wound to place fixation plate, screwing it down on both sides of the fracture to stabilize the MN
80
What BZD would be indicated for a short procedure? Intermediate? Long?
* Short (1-2hr): **Triazolam (0.25mg)**
* Intermediate (1/2 day): **Apprazolam (0.5mg)**
* Long (full day): **Lorazepam (2g)**
81
How do you tx MN dislocation?
* Muscle relaxation
* May need sedation
* Closed reduction
* Analgesics
* Soft diet
* Avoid excessive mouth opening
* Pop back into place
* Place thumbs on lower Ms or on the ridge of MN IO, posterior to Ms, with your fingers wrapped externally around the MN. Apply firm, slow, and steady pressure in a downward and posterior direction
82
What are BUN values an indication of?
Kidney & liver function
83
What are dental implications of uncontrolled hyperthyroidism?
* Using epi in local or gingival retraction cords MUST BE AVOIDED in untx'd or poorly tx'd thyrotoxic pts
* Well-managed pts can have normal concentrations of epi vasoconstrictors
84
a.c.
before meals
85
How much epi in 1:50K? 1:100K? 1:200K?
* **1:50K = 34mcg**
* 0.02mg x 1.7mL = 0.034 = 34mcg
* **1:100K = 17mcg**
* 0.01mg x 1.7mL = 0.017 = 17mcg
* **1:200K = 8.5mcg**
* 0.005mg x 1.7 = 0.0085 = 8.5mcg
86
MN forceps and what teeth to use them on
* **Ash****:** MN anteriors
* **#151:** universal; anteriors & PMs
* **#23:** M1, M2 cowhorns
* **#222:** M3
87
Why are pts w/ uncontrolled diabetes more susceptible to infection and have slower wound healing?
* Hyperglycemia, Ketoacidosis, Vascular wall disease
88
How many mg of anesthetic in 3% carbo?
3% = 30mg
30mg x 1.7mL = **51mg**
89
q.4h and q.6h
every 4hr; every 6hr
90
How does diffusion hypoxia happen?
* N2O diffuses out of the blood into the alveoli upon termination of flow
* N2O can dilute O2 = hypoxia
* Symptoms
* Nausea
* Lethargy
* Headache
* Syncope
91
What are the different M stages in TNM Staging?
* **M0:** No distance spread
* **M1:** Cancer has spread to distant sites outside the head and neck region
92
Infective endocarditis prevention
* Maintain good OH \*more important than abx prophylaxis\*
* Abx prophylactically 30-60 min pre-procedure
93
What is the tx for herpes?
Acyclovir
94
Submental space infection boundaries
* **Superior:** Mylohyoid m.
* **Inferior:** Deep cervical fascia, platysma, superficial fascia & skin
* **Lateral:** Anterior body of digastric
* **Posterior:** Submandibular space
95
By which intention do sockets heal?
Secondary
96
Where do condyles articulate in TMJ?
Base of cranium w/ **squamous** portion of the **temporal bone** in the **glenoid fossa**
97
General anesthesia
* Not arousable, even by repeated painful stimulation
* Independent airway often impaired
* CV can be impaired
98
Sensory innervation of MX & MN
99
What would elevated K+ levels be an indication of?
* Kidney disease
* High or low K+ = heart problems
* Low K+ = muscle cramps
100
prn
as needed
101
Steroids: Anti-inflammatory potencies
Cortisone \< Prednisone \< Methylpredinsone \< Dexamethasone
102
How many mg of anesthetic in 4% septo?
4% = 40mg
40mg x 1.7mL = **68mg**
103
What are the two types of stroke? If stroke is coming on, do we give aspirin? Why or why not?
* **Hemorrhagic:** Cerebral BV rupture
* **Ischemic:** Cerebral BV blockage
* Don't give aspirin b/c you cannot clinically tell which of these strokes someone is experiencing
104
LeFort II - What's fractured? Clinical findings? Radiographic findings?
* **Pyramidal** fracture of **MX, nasal bones, medial aspects of orbits**
* Clinical findings
* Marked facial edema
* **Nasal flattening**
* **Traumatic telecanthus**
* **Epistaxis or CSF rhinorrhea**
* Rad findings
* Fracture involving nasal bones, medial orbit, MX sinus, frontal processes of MX
105
Alveoloplasty
* Digital compression post-extraction
* Bony areas that need recontouring should be exposed using a flap if there are gross irregularities of bone contour post-extraction
106
Ellis Fracture - Class III
**Fractures w/in the pulp**
* Vitality testing
* **Direct pulp cap procedures**
* Repair w/ composite
* **Endo tx indicated**
* If no endo, f/u w/ vitality testing @ 2wk, 3mo, 6mo, 1yr
* Watch for color change
107
Cornerstones of pt evaluation & risk assessment?
* Med hx
* Med consult as needed
* Physical exam
* Lab tests
108
What is neurotmesis?
* Injury to nerve that causes **loss** of axonal and endoneurium continuity,
* Caused by **severe contusion, laceration, stretching, LA toxicity**
* BLOCKING WITH SEPTO CAN CAUSE THIS!!!
* **DO NOT BLOCK W/ SEPTO!!!!**
109
What INR ranges are ok for us to do OS on?
* **INR 2-3: Normal**
* Can do extractions on pts w/o reducing the anticoagulant dose
* **INR 3**
* W/ special precautions, it is reasonably safe to do minor amounts of surgery in pnts up to INR 3 if **special local hemostatic measures are taken**
* **INR \>3:** Physician should be contacted to lower anticoagulant dose to allow for surgery
110
Primary concern when tx'ing pts w/ HTN?
Increased BP = stroke or MI
111
Dean's Technique
Intraseptal Alveoloplasty
* Alternative; not used often
* Removing intraseptal bone and repositioning labial cortical bone, rather than removing excessive/irregular areas of labial cortex
* Useful in MX if removing a significant amount of facial bone
112
What information needs to be on a prescription?
* Superscription
* Inscription
* Subscription
* Signatura
* Name of prescriber
113
Accessory ligaments of TMJ
* Sphenomandibular
* Stylomandibular
114
Alveolar osteitis
**Dry Socket**
* Delayed healing, not assoc w/ infection
* Describes appearance of the socket when pain begins
* Pain starts 3rd or 4th day after extraction, always MN M
* Socket looks empty w/ partial or completely missing blood clot; some bony surfaces exposed
* Sensitive and the source of the pain
* Smells bad, tastes bad
Pain after extraction is not always dry socket
115
Steroid supplementation
* Most pts w/ adrenal insufficiency can have routine dental tx w/o supplemental steroids
* Pts on cortcosteroids have enough exogenous & endogenous cortisol to handle dental procedures if normal dose is taken w/in 2hr of surgery
* Cortisol increases about 1-5hr post-op
* Steroids post-op and tapering off decrease swelling, pain, trismus
* Medrol (21-4mg pills for 6 days)
116
Why is it important that we assess pt's general appearance (inspecting exposed body areas like skin, nails, face, eyes, nose, ears, neck)?
Irregularities can be an indication of underlying systemic disease
117
What are the two major components of the zygoma?
* Zygomatic arch
* Zygomatic body
118
What is the normal range for K+?
3.8-5 mEq/L
119
Sublingual space infection boundaries
* **Superior:** FOM mucosa
* **Inferior:** Mylohyoid m.
* **Medial:** Geniohyoid, styloglossus, genioglossus mm.
* **Anterior & Lateral:** Inner aspect of MN body
* **Posterior:** Body of hyoid bone
120
What is eAG (estimated avg glc) at 5%? 6%? Etc.
* 5% = 95
* 6% = 126
* 7% = 154
* 8% = 183
* 9% = 212
* 10% = 240
* 11% = 269
* 12% = 298
eAG increases by about 30 per 1% increase.
121
How is azotemia measured?
BUN
122
What is supplemental dosing?
* After the half life of the initial dose has passed, giving another dose that doesn't exceed 1/2 the initial dose amount.
* Should not have an aggregate 1.5x the MRD
123
Buccal space infection boundaries
* **Superior:** Zygomatic arch
* **Inferior:** Inferior border of MN
* **Lateral:** Skin & subQ tissue
* **Medial:** Buccinator m.
* **Anterior:** Posterior border of zygomaticus major & depressor anguli oris
* **Posterior:** Anterior edge of masseter m.
124
Do antiresorptive medications (bisphosphonates) work on osteoblasts or osteoclasts?
* Stimulates osteoclast activity
* In the MX & MN, it causes ischemia and therefore, osteonecrosis
* MRONJ
* It's important to know if pts are taking bisphosphonates before doing extractions because they are at risk for MRONJ which doesn't heal
125
What structures would be fractured in zygoma tripod (malar) fractures? What are clinical features?
* Fracture through the
* Zygomatic arch
* Zygomaticofrontal suture
* Infraorbital rim & floor of the orbit
* Clinical features
* Periorbital edema & ecchymosis
* Hyperesthesia or paresthesia of the infraorbial n.
* Palpatioon may reveal step off
126
q.i.d.
4x/day
127
What are the INR targets?
* **INR 1:** Normal, healthy pt
* **INR 2:** A-fib target (2-3)
* Most common
* **INR 3:** Mechanical heart valve target
* **INR 4:** Risk for uncontrolled bleeding
* **INR 5:** Uncontrolled bleeding
128
What are METs? What is the MET threshold and what is notable about it?
**Metabolic Equivalent Levels**
* Measurement that pt's ability to perform normal daily tasks is expressed in****
* **1 MET = 1 O2 unit**
* 1 MET= 3.5 ml/kg/min @ rest
* **4 MET** is the threshold
* Risk of a serious perioperative event (MI, heart failure) increases in pts who can't meet a 4 MET
129
Pulse oximetry. Sexy Darling mnemonic
* Measures oxygenated and non-oxygenated RBCs and then spits out a ratio
* Normal O2 saturation is 96%
130
HTN: Dental appt considerations
* Short, AM appt
* Stress/anxiety support
* Establish good rapport
* Consider sedation
* Obtain excellent LA
* Intraop monitoring
* Slow position changes to prevent orthostatic hypotension
131
What is the BP cut off in the Roseman Clinic?
160/100
132
Steps in administering N2O
* Review med hx
* Pre-op vitals
* Place nose
* Establish base line tidal volume
* Titrate N2O to effect - increase 0.5L every 1min
* Usually between 30-50% but must determine for each pt individually
* Don't go above 50% w/o faculty approval
* Titrate down
* 5 min of O2
* Post vitals
* Assign discharge score
133
What is the subscription?
Directions for the pharmD, usually short sentences
134
What is MRD?
Maximum recommended dose
## Footnote
Max FDA recommended dose of a drug for unmonitored home use
135
Stages of Wound Healing
* **Inflammatory** - begins moment that injury occurs and lasts **1-5 days**
* **Vascular:** Vasoconstriction and vasodilation
* **Cellular:** PMNs diapedesis to remove gross stuff
* **Fibroplastic** - lasts **2-3wks;** fibrin strands criss cross and form latticework, on which fibroblasts begin laying down ground substance and tropocollagen
* **Migratory:** Epithelial migration continues; capillary ingrowth; fibroblasts travel into found along fibrin strands
* **Proliferative:** Increase in epithelial thickness; collagen fibers laid down; budding capillaries establish contact w/ counterparts
* **Remodeling** - **70% of wound healing time; several months**
* Initial collagen replaced by new collagen
* Increase in tensile strength
* Stronger wound
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What is the protocol if a MX tooth or root is displaced in the sinus?
**Caldwell luc**
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O.S.
Left eye
138
What are primary, secondary, tertiary intentions?
* **Primary intention:** Wound edges are placed together anatomically
* **Secondary intention:** Gap is left between edges of wound (heals through clot formation)
* **Tertiary intention:** Healing of wounds through tissue grafts bridging the wound edges together
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Moderate sedation
* Independent, spontaneous ventilation
* Pt responds purposefully to verbal commands and tactile stimulation
* Titrating refers to moderate sedation; cannot titrate minimal
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Curved elevator #'s
* #190, 191
* Cryer East, West
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Ellis Fracture - Class II
**Fractures w/in dentin**
* Vitality testing
* **Indirect pulp cap**
* Repair w/ composite
* F/u w/ vitality testing @ 2wk, 3mo, 6mo, 1yr
* Watch for color change
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True ligaments of TMJ
* Temporomandibular ligament
* Fibrous capsule of the joint
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What does INR stand for? What is it used for?
* **International Normalized Ratio**
* Anti-coagulation indication (1 is normal, 5 is uncontrolled bleeding)
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What are some things that may cause ischemia in wound healing?
* Suture tension
* Poor flap design
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Ellis Fracture - Class I
**Fractures w/in enamel**
* Vitality testing
* Repair w/ composite
* F/u w/ vitality testing @ 2wk, 3mo, 6mo, 1yr
* Watch for color change
146
What is HbA1c? What HbA1c %s are normal, increased risk for diabetes, and diabetes?
* HbA1c: Glycolated Hb levels
* Found in normal people too
* HbA1c increases in the presence of hyperglycemia and reflects blood glc levels over the **6-12wk** preceding the test
* 4-6%: No diabetes
* **5.7-6.4%:** Increased risk for diabetes
* \>6%: Diabetes
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What are the different N stages in TNM Staging?
* **NX:** Nearby lymph nodes cannot be assessed; information unknown
* **N0:** Cancer has not spread to nearby lymph nodes
* **N1:** Cancer has spread to **one** lymph node on the same side of the head or neck as the primary tumor; **\<3cm** across
* **N2:**
* **N2a:** Spread to **one** lymph node on the **same side** as the primary tumor; **3-5cm** across
* **N2b:** Spread to **two or more** lymph nodes on the **same side** as the primary tumor; no lymph nodes are \>6cm across
* **N2c:** Spread to **one or more** lymphon nodes on **both sides of the neck** on the side **opposite** that of the primary tumor; no lymph nodes are \>6cm across
* **N3:** Cancer has spread to a lymph node that measures **\>6cm**
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What are normal serum chemistry values?
* **Glc, fasting:** 70-110 mg/dL
* **BUN:** 8-23 mg/dL
* **Creatinine:** 0.6-1.2 mg/dL
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