omfs 2 Flashcards

Question

MX of pt weak, dizzy, with the peripheries turning cold and clammy.-- Basic life support resuscitation guideline

Answer 1

alert staff to emergency medical services (EMS) immediately due to potential severity. 1) Position: lay pt supine+ elevate legs if no aspiration risk-inc cerebral perfusion 2) Airway and Breathing: Ensure patent airway, adequate breathing, administer oxygen if available and indicated. monitor vital signs (RR, temp). 3) Circulation [HR, pulse rate, BP] Check pulse and BP. Consider IV access for fluid resuscitation if hypotensive. 4)if conscious-Monitor: Continuously monitor consciousness, pulse, and BP. Provide oxygen at 5-6L/min. M/H Review:Quickly review patient's medical history for relevant medications or conditions. reassurance if conscious, while giving cup of warm Milo/sugary drink 5) if unconscious and no pulse:-CPR Ensure an automated external defibrillator (AED) is accessible. adrenal crisis (may require IV hydrocortisone 200mg STAT if confirmed). Documentation: Document all observations, actions taken, and patient's responses. Reassurance: Keep the patient calm and reassured throughout the episode. Follow-Up: Ensure follow-up for underlying cause, consider liasing with physician and omfs referral.

Answer 2

12-20 breaths per minute. 94-98% sit them upright

Answer 3

fixed ..dilated

Answer 4

lay pt supine and remove object in mouth loosen tight clothings First-line treatment for seizures involves the use of benzodiazepines such as: IV diazepam 0.1mg/kg to abort seizure/IM midazolam * Turn victim to recovery position as soon as seizure stops o Helps open and maintain a clear airway, also avoiding aspiration Dose reductions are often required for elderly patients. Failure to respond to first-line treatment requires referral to hospital.

Answer 5

CPR using chest compressions and mouth-to-mouth breathing at a ratio of 30:2 compressions-to-breaths. In adult victims of cardiac arrest, perform chest compressions at a rate of 100 to 120/min and to a depth of at least 2 inches (5 cm) for an average adult, while avoiding excessive chest compression depths (greater than [6 cm]).

Answer 6

Purpose: Prevent complications during surgery by Identifying and tx sources of infection; remove loose teeth to prevent aspiration or airway obstruction. Objectives: Ensure no oral infections that could spread systemically during surgery; ensure a safe airway for intubation and ventilation.

Answer 7

Purpose: Necessary due to increased risk of oral infections becoming systemic and life-threatening under immunosuppression medication post BM transplant. BM transplant dt M. Myeloma / leukemia pt meaning more susceptible to infections. How: Eliminate infection sources such as carious lesions or periodontal disease. Objectives: Reduce risk of post-transplant complications; ensure optimal oral health and patient education on meticulous oral hygiene as pt may need to defer any elective dental tx 6mo-1yr post transplant and only be treated if ANC is SUFFICIENT.

Answer 8

Purpose: Assess dental health due to risks of medication-related osteonecrosis of the jaw (MRONJ) associated with therapies like bisphosphonates/RANKL -or. Objectives: Address dental issues and Prevent the need for invasive procedures (e.g., extractions) post-medication commencement which pose higher risks of MRONJ; educate on oral hygiene; establish a dental care plan to minimize MRONJ risk.

Answer 9

1 Difficult Surgery/ prolonged procedure time. 2 Postoperative Care: Inadequate care like not following post-surgery instructions, vigorous rinsing. 3 Smoking impairs healing and promotes infection. 4 poor OH 5 oral contraceptive 6 Previous occurrence of dry socket

Answer 10

Pathogenesis of dry socket is not completely understood Failure of blood clot to form or its premature loss at the extraction site, before wound healing occurs. This exposing bone and nerves to oral environ-> inf and pain. Theories: Fibrinolytic Theory: Excessive fibrinolytic activity leads to clot disintegration. Bacterial Theory: Bacterial contamination causes clot breakdown.

Answer 11

1Pain Control: Use of analgesics or obtundant dressings. 2Socket Care: Gentle irrigation to remove debris; placement of medicated dressing (e.g., Alvogyl/bipp) to protect the area and promote healing. 3Patient Instructions: Maintain oral hygiene, avoid smoking and using straws. 4Follow-Up: Important for monitoring healing and replacing dressings as needed.

Answer 12

1Condition Severity: Osteomyelitis involves infection and inflammation of bone, potentially with suppuration and pain. 2 Symptoms: Osteomyelitis shows more systemic symptoms like fever and malaise. D.S limited to the alveolar bone at the extraction site, osteomyelitis can involve any of the bones and may spread beyond the initial site and sometime cause swelling. 3 Onset: Dry socket occurs a few days post-extraction, whereas osteomyelitis has a more insidious/gradual onset. 4 Diagnostic difference: Radiographic changes are more apparent in osteomyelitis; dry socket is a clinical diagnosis with typically normal early radiographic appearance. 5. Treatment: More aggressive treatment with antibiotics and possibly surgical debridement.

Answer 13

differential Diagnosis of the White Lesion: 1 . Oral Lichen Planus: A chronic inflammatory condition that can present as white, lacy patches on the mucosa, potentially linked to systemic conditions like DM; HTN;SLE GVHD; stress,liver not renal diseases. 2. Candidiasis: Especially in immunocompromised patients, such as those with diabetes, presenting as a white plaque that may be wiped off to reveal a red base. 3. Frictional Keratosis: Chronic irritation from the denture could cause a white callous-like lesion.[MEANS thickened] 4. Squamous Cell Carcinoma: A malignant tumor that can present as a white or red-and-white lesion and should always be considered, especially in patients with a history of smoking. 5 Nutritional Deficiencies: Deficiencies in iron, folic acid, or vitamin B12 can lead to mucosal changes, including white patches. 6 Oral Hairy Leukoplakia: Although primarily associated with immunocompromised states such as HIV infection, it could be considered given the patient’s compromised systemic health. 7 Leukoplakia: A premalignant lesion often associated with tobacco use, which can present as a white patch that cannot be scraped off. Diagnosis by exclusion. **Sublingual keratosis is subtype of leukoplakia**

Answer 14

1. Elimination of Irritants: If the lesion is due to the denture, adjusting or remaking the denture to eliminate irritation may resolve the lesion. 2. Biopsy: Any unexplained white lesion that does not resolve on its own or after the elimination of potential causes should be biopsied to determine its nature. 3 Monitoring: If HP results are benign; no dysplasia, close follow-up is necessary to monitor the lesion for any changes, especially given the patient's history of smoking and systemic conditions. 4. OHE 5 Antifungal Treatment: If candidiasis is suspected or confirmed, topical or systemic antifungal medications would be indicated. 6 Topical Corticosteroids: For oral lichen planus, topical corticosteroids may be used to reduce inflammation. If Contraindicated for systemic steroids; topical tacrolimus/ topical retinoids 7 Laser Ablation or Cryotherapy: These may be options for lesions that are resistant to other treatments or where malignancy is a concern. 8 Vitamin Supplementation: If the lesion is due to nutritional deficiencies, supplementation may be indicated. 9 Smoking Cessation: Although the patient has quit smoking, reinforcement of the benefits of cessation is important. 10 Surgical Excision: If the lesion is confirmed to be malignant or shows severe dysplasia, surgical excision would be necessary. 11 Management of Systemic Conditions: Optimal control of diabetes and monitoring of renal function are important for overall health and may influence the healing of oral lesions. 12 Regular f/up

Answer 15

1 Patient Medical History: Assess for systemic diseases (e.g., cardiovascular, respiratory, endocrine disorders-DM), allergies, and current medications. 2 Anatomical Considerations: Understand the relevant anatomy for effective administration, including nerve locations and variations- in geriatric and children. Aspiration before injection. 3 Expected Duration of Procedure will influence the choice of anaesthetic and whether additional doses may be required. 4 Pharmacology: Choose the appropriate local anaesthetic agent based on its onset, duration, and potential for toxicity. Consider the patient's weight for appropriate dose. 5Technique: Select the proper technique (infiltration, block, field block-max teeth) based on the procedure and the area to be anaesthetized. 6 Presence of Infection: Inflamed tissues can alter the pH, affecting the efficacy of the anaesthetic. 7 Patient Factors: Age, weight, anxiety level, and cooperation should be considered to tailor the approach and manage expectations. 8 Clinic Setup: Ensure an aseptic technique to prevent complications. 9 absolute CI for Adrenalinex6 1. <6/12 MI 2. <6 CVAccident 3. <6/12 CABG 4. uncontrolled HTN > 200mg/115mmHg 5. unstAble Angina pectoris 6. uncontrolled thyrotoxicosis 7. Congestive heart failure

Answer 16

repeated injections of drug- [loss of response dt repeated dose admins]

Answer 17

Local Factors delayed-Trismus/hematoma [dt nick bld vsl], -cold packs/warm towel massage+reassurance facial paralysis MoFE-symptomatic mx-eye patch + eye drop, dt loss of blinking/corneal reflex; 24-72 hr of symptoms start on acyclovir and oral CCS paresthesia--neurobion OD 2/52 and referral omfs [delayed presentation] needle breakage, failure to achieve anesthesia- anatomy well/defer tx. Patient Factors =Trauma (e.g., lip/c cheek biting)-mx POIG/orocort E, =psychogenic/fear-induced to needles- Vasovagal Syncope leading to bradycardia and hypotension. Management: Position patient supine with legs elevated, ensure airway patency /recovery is fast systemic factors: CVS/CNS allergic reaction: PABA from Ester LA Symptoms: Skin rashes, bronchospasms, ranging from mild to anaphylaxis. mx: Discontinue offending agent. Administer antihistamines for mild reactions. For severe reactions (e.g., anaphylaxis): STop procedure, alert EMS, Position patient supine-raise legs if low BP, establish airway, give high-flow oxygen, administer **IM adrenaline 1:1000 0.5ml stat**, repeat every 5 minutes, and give IV hydrocortisone 200mg stat. Monitor vitals (pulse oximetry, BP). IV diazepam/ IM midazolam if seizures is noted.

Answer 18

Idiopathic peripheral facial CN VII palsy The most common cause of facial paralysis. Caused by a lower motor neuron lesion. Upper motor neuron lesion leads to paralysis of the contralateral lower face. Lower motor neuron lesion results in total ipsilateral facial paralysis. Unilateral facial sag and forehead weakness (e.g., inability to raise eyebrows, decreased forehead wrinkling). Hyperacusis and changes in taste can also occur.

Answer 19

[1] Idiopathic (most common cause of peripheral facial nerve palsy) known as Bell palsy. [2] Secondary reasons:- i. Trauma (e.g., temporal bone fracture) ii.Tumors (parotid gland tumors, acoustic neuroma) iii. Infection- Herpes zoster (Ramsay Hunt syndrome) ivOtitis media v. Stroke

Answer 20

Symptomatic therapy - Incomplete eye closure: Initiate eye care (e.g., eye drops and eye patch). -Incomplete mouth closure: Advise freq vaseline application on lips and stay hydrated Bell palsy is self-limiting, but early treatment is recommended to improve recovery time and prevent incomplete recovery. Targeted treatment Oral glucocorticoids: Start early (i.e., within 48–72 hours of symptom onset) -prednisolone Antivirals-acyclovir 400 mg orally 5 times daily for 10 days Follow up with specialist consult if the patient has any of the following: No signs of improvement in 2–3 weeks

Answer 21

1. Bell's Palsy: Idiopathic condition where the exact cause is unknown; could be triggered by factors changes in atmospheric pressure (diving/flying). 2. Trauma: Facial nerve damage due to fractures of the temporal bone. 3.Tumors like parotid gland neoplasms or acoustic neuromas exerting pressure on the facial nerve. 4. Herpes Zoster Oticus : Affects cranial nerves VII and VIII, managed with antivirals; characterized by facial palsy with an ear rash(Ramsay Hunt Syndrome) 5. Otitis Media (Acute and Chronic): Swelling or infection spread that puts pressure on the facial nerve. 6.Stroke: Can lead to facial palsy due to brain injury affecting the neural pathways.

Answer 22

metabolite of prilocaine [O-toluidine] ->reduces available Hb [methemoglobin] for 02 -> hypoxia Mx: continuous infusion of methylene blue or ascorbic acid for 5 minutes to reduce methemoglobin back to Hb Methemoglobinemia occurs in G6PD/ cardiac and pulmonary diseases.

Answer 23

1. Preemptive Analgesics to Reduce postoperative pain, eg NSAIDs or acetaminophen administered before the procedure. 2. Topical Anesthetics-eg Benzocaine applied prior to dental local anesthetic administration. 3. Oral Sedatives: Such as diazepam. Inhalation Sedation: Nitrous oxide to reduce anxiety. Intravenous Anxiolytics: Midazolam for deeper sedation. 4. General Anesthesia- Indicated for: Extensive procedures/patients who are uncooperative or medically compromised. 5. Acupuncture: More studies needed to fully understand efficacy 6. Psychological Support Techniques: Guided imagery, relaxation, deep breathing, and distraction to reduce anxiety and pain perception. 7. Postoperative Care mx: Pain management instructions, including analgesics and cold packs. Advice: Recommendations on diet and activity restrictions to aid recovery. 8 Alternative Techniques Articaine: Used for better diffusion into bone and soft tissue; >effective LA. Synergistic Effect: Often used in conjunction with lidocaine for enhanced efficacy.

Answer 24

Cerebrex Arcoxia Avoid in those at risk of thrombotic events Avoid in pregnancy, nursing (can go into breast milk) Avoid in patients taking ACE inhibitors

Answer 25

1. History of Symptoms (H/O)-Pain and a sensation of weight in the cheek, especially noticeable when bending down. 2. Clinical Examination Facial Assessment: Check for swelling or redness of the face and intraoral vestibule. Palpation: Assess tenderness in the maxillary sinus area. 3. Nasal Examination-nasal discharge, potentially more pronounced on the affected side. 4. Intraoral Examination - extraction site for signs of infection (purulent discharge, malodour, redness, tenderness). -Sinus Communication: Perform the Valsalva maneuver or have the patient gently blow their nose with nostrils pinched to check for air/bubbles at the extraction site /misting of a mirror placed at the site. 5. Radiographic Examination Imaging: dental panoramic tomogram (DPT) or cone-beam computed tomography (CBCT) to view the maxillary sinus and extraction site for any retained roots or bone fragments. 6. Transillumination to Assess the patency of the sinus by shining a light through it to check for fluid levels or opacification. 7. Vitality Testing-Test adjacent teeth to rule out periapical pathology contributing to sinus symptoms. 8. Laboratory Tests Full Blood Count (FBC): Check for signs of infection through changes in neutrophil counts and WBC count, and monitor blood glucose levels. 9. Review of Other Comorbidities/medical conditions, medications, and allergies.

Answer 26

1. Initial Findings Symptoms: Facial swelling, nasal stuffiness, oroantral communication following tooth extraction. Diagnostic Results: Clinical and radiographic evidence of acute maxillary sinus infection. 2. Immediate Management Antibiotics: Begin Augmentin and metronidazole to cover both aerobic and anaerobic organisms, considering the patient's diabetic status. Decongestants and Antihistamines: Prescribed to alleviate nasal stuffiness and promote sinus drainage. 3. Supportive Care-Advise against creating negative pressure in the oral cavity (no straw use, no forceful nose blowing/sneeze with mouth closed) for 10-14 days. [<2mm can heal spontaneously] Irrigation: Perform frequent gentle irrigation of the fistula to keep the area clean. 4. Temporary Measures Fistula Coverage: Construct a temporary appliance to cover the fistula, preventing contamination from food and other oral debris. 5. Surgical Intervention Indications: Persistent oroantral communication, evidence of retained dental roots. Procedures: Surgical closure of the chronic fistula and removal of epithelium from bony walls and any foreign material. Possible use of buccal advancement flap or palatal rotation flap with or without alloplastic membrane. Caldwell-Luc procedure for diseased tissue removal if conditions persist. 6. Medical Management Chronic Conditions: Ensure optimal control of hypertension and diabetes to support healing and infection response. 7. Follow-Up Monitoring: Close monitoring of the patient’s response to treatment and healing progress. Further Imaging: May be required to assess resolution of the sinus infection. 8. Patient Education Complications: Educate on signs of complications such as increasing pain, fever, or spreading infection, and when to seek immediate care. 9. Documentation Record Keeping: Document all findings, discussions, and management plans in the patient's medical/dental record.

Answer 27

1. Detailed History-comprehensive dental and medical history, including family history. 2. Clinical Documentation - Note any facial asymmetry, freckles, and mobility of posterior teeth along with other relevant clinical findings. 3. Radiographic Analysis Tools: Utilize radiographs and supplement with CBCT for a detailed assessment of radiolucencies, impacted teeth, and root resorption. 4. FNAC- Aspirate thick yellow fluid to analyze and rule out infection or other pathology. 5. Referral +Multidisciplinary Approach Specialists: Refer the patient to an Oral and Maxillofacial Surgeon and a dermatologist for further evaluation and management. 6. Biopsy of the radiolucent areas to provide a definitive diagnosis. 7. Genetic Counseling When Suspected: Refer for genetic counseling and testing if a genetic syndrome is suspected. 8. Patient Education Communication: Inform the patient and their family about the findings, potential diagnoses, and the need for further investigations and management. 9. Follow-Up to monitor the patient’s condition and response to treatment/ EARLY DETECTion of recurrance

Answer 28

1. Gorlin-Goltz Syndrome (Nevoid Basal Cell Carcinoma Syndrome) Indicators: Multiple odontogenic keratocysts, facial asymmetry, skin findings (e.g., freckles). Most Plausible Diagnosis: Given the presentation. 2. Ameloblastoma Characteristics: Benign, locally aggressive odontogenic tumor. Radiographic Signs: Similar to Gorlin-Goltz but typically singular and less likely systemic. 3. Dentigerous Cyst Typical Feature: Envelops the crown of an impacted tooth; generally does not cause root resorption/ large radiolucency to coronoid process. 4. Central Giant Cell Granuloma Presentation: Benign lesion; causes radiolucencies and root resorption. 5. Odontogenic Myxoma: Rare, presents with multilocular radiolucencies and tooth displacement.

Answer 29

1Demographic: Often young patients. 2. Skin: Multiple basal cell carcinomas resembling freckles. 3. Jaw: Presence of odontogenic keratocysts. 4. Hands/Feet: Palmar or plantar pits. 5. Neurological: Calcification of the falx cerebri. 6. Skeletal: Abnormalities like bifid ribs or elevated scapula. 7. Facial Structure: Asymmetry and mandibular prognathism. Genetic and Chromosomal Defect 1.Condition: Autosomal dominant. 2. Gene Involved: PTCH1 gene on chromosome 9q 22.3. 3. Function: Tumor suppressor gene; mutation leads to syndrome manifestations.

Answer 30

Contributions of Medical Conditions to Oral Problems 1. Atrial Fibrillation and Antithrombotic Medications Impact: Increased risk of bleeding, complicating periodontal treatments and other dental procedures. 2. Medication Effects: Beta-blockers and ACE inhibitors for HTN may cause dry mouth (xerostomia), increasing the risk of root caries and periodontal disease. 3. Type 2 Diabetes Mellitus: Greater susceptibility to periodontal disease, xerostomia, burning mouth syndrome, and infections due to altered immune response and impaired wound healing. 4. Stroke: Decreased manual dexterity and potential cognitive impairment, making oral hygiene maintenance challenging. 5. Osteoporosis and Related Medications Concerns: Medications like Alendronate increase the risk of osteonecrosis of the jaw MRONJ; osteoporosis may worsen periodontal disease due to bone loss. 6. Depression and Cognitive Impairment Effects on Oral Health: Potential neglect of oral hygiene and decreased ability toreport, manage oral pain and discomfort.

Answer 31

1. Preoperative Assessment: Consultation with the patient's physician to evaluate medical stability and medication adjustments before dental treatment./ check platelet level on day of exo>4 teeth. 2. Bleeding Risk Management: <2 catridge of LA, Local hemostatic measures (e.g., tranexamic acid mouthwash, suturing techniques); coordinate with physician on antiplatelet+ AOC management. 3. Infection Control: Enhanced aseptic techniques , defer if >10%; 15mmol/L 4. AVOID NSAIDS, AZOLE ANTIFUNGALS, CARBAMAZEPINES FOR RIVAROXABAN/dabigatran 4. Dry Mouth Management Solutions: Use saliva substitutes, pilocarpine, xylitol gum, and recommend frequent water intake. F-varnish. 5. Gentle Handling Consideration: Minimize discomfort due to the patient's frailty; use stress reduction techniques and ensure short, efficient appointments. 6. Osteonecrosis Prevention Strategies: Avoid bone-impacting procedures when possible; consider conservative approaches. Drug holiday is controversial- depend on duration if >3-4yrs/ IV 7. Stress and Endurance Management Techniques: Clear procedure explanations, potential sedation, and keeping appointments short. 8. Supportive Care Involve caregivers in postoperative care; use tools like electronic brushes for easier oral hygiene-stroke. Regular follow-ups to adjust care plans and manage complications.

Answer 32

TMJ Symptoms Management 1. Evaluation of Clicking Noises Context: Clicking alone, without pain or functional limitations, typically warrants conservative management and monitoring. Action: If accompanied by pain or dysfunction, assess further and consider treatment to prevent progression of TMJ disorders. 2. History of Trauma Importance: Trauma to the chin linked to the onset of clicking suggests a need for a detailed TMJ examination. Examination Includes: Palpation of TMJ area. Assessment of mandibular range of motion. Observation of jaw functions (any deviations, crepitus, or tenderness). Additional Checks: Inspect for occlusal discrepancies, step deformities, or fractures. 3. Imaging for TMJ Assessment Recommended Modalities: MRI for soft tissue, disc position, and integrity. Bony Structures: Panoramic, reverse Towne’s view, and CT scan for potential fractures or bony changes due to trauma.

Answer 33

2. History of Trauma to the chin linked to the onset of clicking suggests a need for a detailed TMJ examination. Examination Includes: Palpation of TMJ area. Assessment of mandibular range of motion. Observation of jaw functions (any deviations, crepitus, or tenderness). Additional Checks: Inspect for occlusal discrepancies, step deformities, or fractures. 3. Imaging for TMJ Assessment Recommended Modalities: MRI for soft tissue, disc position, and integrity. Bony Structures: Panoramic, reverse Towne’s view, and CT scan for potential fractures or bony changes due to trauma.

Answer 34

1. Nature: Describe the pain (aching, throbbing, sharp). 2 .Timing: When does the pain occur (at rest, during movement, chewing, sleeping at the sides)? Gradual/sudden? 3. Duration: How long does the pain last? Does it resolve on its own? 4 Triggers: Any exacerbating factorsor 5. alleviating factors? 6 Associated Symptoms: Any headaches, earaches, or neck pain? 7 Any medications used and their effectiveness?

Answer 35

Criteria for Pain Complexity 1.Duration and frequency of pain episodes.[>3months CHRONIC vs acute] 2. Intensity and nature of the pain (e.g., mild, moderate, severe; constant, intermittent). 3. Presence of associated symptoms such as headaches, earaches, or neck pain. 4. Response to previous treatments or medications. 5. Impact on daily activities and quality of life; LMO MX: Education and Self-care: Initial approach for simple pain cases. -Further Interventions: Consider physical therapy/occlusal appliances based on diagnostic results.

Answer 36

1. Duration of Onset 4x Acute Onset: May suggest trauma, acute infection, recent occlusal changes, or an exacerbation of existing TMJ disorder. 4x Chronic Onset: Could indicate degenerative changes in the TMJ, TMD, arthritic changes, or effects of long-term habits like bruxism or systemic conditions affecting the jaw.

Answer 37

2. Severity of Pain on Mouth Opening 3x Mild Pain: Often related to muscle strain from parafunctional habits, minor soft tissue injuries, or early-stage TMD. 3xSevere Pain: Could be indicative of acute infection, advanced TMD, or neoplastic processes.

Answer 38

3. Tenderness at Muscles of Mastication 4x Indications: Suggests a musculoskeletal origin such as myofascial pain syndrome, myositis, muscle overuse, or trauma.

Answer 39

4. Asymmetry and Deviation of Chin 3xObservations: may signal a displaced fracture of the mandible, unilateral condylar hyperplasia or hypoplasia, or TMD with possible internal derangement like disc displacement.

Answer 40

5. Long-term Use of Fosamax Effects: Associated with osteonecrosis of the jaw (ONJ), especially after invasive dental procedures. Can contribute to pain and difficulty in mouth opening if ONJ develops. History taking-any recent dental tx

Answer 41

6. Chewing Betel Nut/Quid Habit Consequences: Associated with submucous fibrosis leading to trismus + PAIN on mouth opening. Chronic use may cause fibrotic changes in the oral mucosa+ submucosa and increase the risk of oral cancer, potentially involving masticatory muscles or TMJ.

Answer 42

Managing a 47-year-old Chinese male smoker with a buccal swelling in the left mandibular premolar-molar region: History Taking 1.Onset and Duration: Note when swelling started, changes in size, and outcomes of any previous treatments. 2 .Pain Description: Type (dull, sharp, throbbing), timing (intermittent, constant), onset [gradual/sudden], duration, radiation of pain 3. exacerbating/relieving factors, and medication used. 4. Systemic Symptoms: Fever patterns, weight loss, night sweats. 5. Tobacco Use: no. of packs/ smoking history due to malignancy risk. 6. Dental History: Past dental treatments, perio/endo issues, and oral hygiene practices. 7. Medical History: General health, systemic diseases (e.g., diabetes), medications (e.g., immunosuppressants), allergies. 8. Family and Social History: Family similar issues, lifestyle factors affecting health (alcohol, betel nut chewing, etc.). 9. Nutritional and Social History: Assess for any factors that may impact healing and immune status. [alcohol/betel nut chewing/sunlight exposure/multiple partners]

Answer 43

2. Clinical Examination Extraoral Examination: Check facial asymmetry, skin changes, lymphadenopathy (size, tenderness, consistency, fixation). Intraoral Examination: Assess swelling for size, consistency, borders, color changes, ulceration, and effects on teeth (displacement, mobility). Occlusion and Function: Examine bite and jaw function, check for TMJ issues (range of motion, deviation, pain). 3. Clinical Tests Palpation: Evaluate if swelling is hard/soft, fixed/mobile, and pain response. Percussion: Test teeth in affected area for tenderness or ankylosis. Vitality Testing: Conduct tests on adjacent teeth for necrosis or periapical infection.

Answer 44

Special Investigations:- Radiographs: Obtain periapical and panoramic images to view lesion extent, effect on bone, and tooth relationship. CT Scan: Detailed bony architecture and lesion extent. MRI: Assess soft tissue involvement. Biopsy: Incisional for larger lesions or excisional for smaller, defined lesions. Cytology: Consider FNAC to investigate uncertain lesions and rule out malignancy. Histopathology: Send biopsy for examination to determine tumor nature. Blood Tests: Complete blood count, ESR, CRP to evaluate general health and infection signs. Benign Odontogenic Tumor Confirmation: Utilize a thorough evaluation strategy to exclude malignancy, particularly considering the patient’s smoking history and symptoms.

Answer 45

Action Mechanism: Local anesthetics inhibit sodium channels in neuronal cell membranes. Process: LA drugs diffuse into the nerve, bind to intracellular receptors on sodium channels, **stabilize** the membrane, and prevent sodium ion influx necessary for action potentials--> prevents the nerve from transmitting pain signals to the brain, resulting in loss of sensation in the targeted area.

Answer 46

1. Oral Lichen Planus Chronic inflammation, painful, bleeding gums, ulcerative lesions with Wickham’s striae. 2.Pemphigus Vulgaris Autoimmune, painful oral ulcers, bleeding gums. 3. Mucous Membrane Pemphigoid Autoimmune blistering, painful ulcers, red patches. 4 Candidiasis Opportunistic fungal infection, red patches, ulcers,common in immunocompromised pt 5 Drug-Induced Mucosal Reactions Oral ulcers and erythema from medication side effects. 6 Squamous Cell Carcinoma Chronic lesions, induration, fixed lesions; malignancy should be considered, especially with chronicity and patient's age. Management of Oral Lichen Planus Topical Treatments: Corticosteroids (first-line), antifungal agents like Nystatin. Severe Cases: Systemic corticosteroids, immunosuppressive agents, topical tacrolimus or cyclosporine, PUVA. Lifestyle: Good oral hygiene, avoid irritants (spicy foods, tobacco). Monitoring: Regular due to a small risk of malignant transformation.

Answer 47

First line Topical Treatments: Corticosteroids f/by antifungal agents like Nystatin 100,000 U/mL suspension-Swish and spit (or swallow if esophageal lesions) for 1–2 min 2-3x/day. Continue until lesions resolved Severe Cases: Systemic corticosteroids, immunosuppressive agents, topical tacrolimus or cyclosporine, PUVA. Good oral hygiene, avoid irritants (spicy foods, tobacco) ; SRP with antibiotic prophylaxis Monitoring: Regular due to a small risk of malignant transformation.

Answer 48

Topical Antifungals: Nystatin antifungal agents 100,000 U/mL suspension-Swish and spit (or swallow if esophageal lesions) for 1–2 min 2-3x/day. Continue until lesions resolved. Clotrimazole lozenges- avoid in atorvastatin Systemic Antifungals: Fluconazole, itraconazole for severe or widespread cases- need to see if can stop meds or change if not risk of muscle pain/rhabydomyolysis. Combine with topical triamcinolone acetonide (corticosteroid) - beware of CHX interaction -complex formed is ineffective Systemic: Fluconazole [x warfarin] -risk of bleeding

Answer 49

Pre-Treatment Stage Medical Consultation: Confirm stability of medical conditions; dental treatment planning. Medication Review: Note antiplatelet and antihypertensive medications; manage bleeding risks. Informed Consent: Discuss risks, benefits, alternatives. Preoperative Instructions: Maintain stable medical condition, continue regular medications. Intra-Operative Stage Bleeding Management: Minimally invasive techniques, local hemostatic measures. ABX? presence of aortic valve stenosis and regurgitation, unless the valve has been replaced with a prosthetic valve, does not warrant the use of prophylactic antibiotics according 2007 AHA guidelines LA Selection: Prefer no VC or lowest epinephrine concentration; consider patient's cardiac conditions. Stress Reduction, short, LATE morning as asthmatic pt cortisol level is lower Monitoring: Continuous monitoring of vital signs. Postoperative Care Instructions: Clear postoperative guidelines, signs of complications. Medication: Prescribe appropriate painkiller -PCM considering patient’s health. No indication for antibiotics unless have systemic symptoms.

Answer 50

damage....collagen on endothelium+plasma proteins =HMWK/Kallikrein XII, XI, IX, and VIII

Answer 51

external trauma that escape from the III [TISSUE factor] and interaction with F VII

Answer 52

X, formation of thrombin stable fibrin clot X, V, II-thrombin, I-fibrin, and XIII-fibrin stabilizing factor.

Answer 53

1Presentation: Slow-growing, painless swellings in the jaw, often incidental findings. 2Location: Commonly in the mandible, especially molar and ramus areas. 3 Symptoms: Can cause cortical bone expansion and thinning, facial asymmetry, tooth displacement, occasionally pain or paresthesia. Distinctive Pattern: Multilocular radiolucencies with "soap bubble" or "honeycomb" appearance. Other Features: Possible root resorption. 1Common Patterns: Follicular and plexiform. 2 Characteristic: Islands and strands of odontogenic epithelium, peripheral palisading of columnar basal cells, central stellate reticulum-like cells.

Answer 54

1. Growth Behavior: Aggressive, high recurrence rate post-enucleation. 2. Often associated with impacted teeth and derived from dental lamina 3. Symptoms: Typically asymptomatic until large; may cause cortical expansion, tooth displacement, and pain if infected. Radiographic Appearance Typical Presentation: Well-defined radiolucent lesion, often unilocular with a smooth and corticated outline. -May scallop around tooth roots. Histologic Appearance Characteristics: Distinctive thin, uniform parakeratinized epithelium; Corrugated surface, palisading basal cell layer. Nevoid Basal Cell Carcinoma Syndrome (Gorlin Syndrome)

Answer 55

Manifestations: Multiple basal cell carcinomas, bifid ribs, calcification of the falx cerebri, palmar or plantar pits, frontal bossing, and mandibular prognathism, okc. Genetic Defect Gene Involved: PTCH1 on chromosome 9q22.3. Pathway Affected: Hedgehog signaling pathway.

Answer 56

1. prosthetic heart valves; 2.history of IE 3.CHD-Esp those cyanotic chd unrepaired/repaired with with residual shunts or valvular regurgitation 4. valvulopathy in cardiac transplant recipients

Answer 57

Manipulation of gingival tissues or periapical regions, or mucosal perforations THAT MAY cause bacteremia.

Answer 58

Dosing for Adults: Amoxicillin 2g or Doxycycline 100mg [>45kg] or Azithromycin 500mg -1 hour before procedure. C'ren: Amoxicillin 50mg/kg Doxycycline 2.2mg/kg [<45kg] Azithromycin 15mg/kg

Answer 59

1 Existing Infections: Treat conditions like abscesses, cellulitis, or post-operative infections. 2.Acute onset infections, systemic involvement, osteomyelitis, severe pericoronitis, and those who are medically compromised. 2 Typically 5-7 days to ensure adequate bacterial eradication. 1 Empirical Therapy: Based on suspected organisms, considering patient allergy history and resistance patterns. 2 Cultures: Ideal for tailoring therapy to specific organisms in complex cases.

Answer 60

Interaction: Metronidazole potentiates warfarin effects, increasing bleeding risks. Management: Monitor INR closely, adjust warfarin dosage as necessary, educate patient on bleeding signs.

Answer 61

Interaction: Fluconazole increases simvastatin levels, raising risks of myopathy and rhabdomyolysis[muscle death]. Management: Consider alternative antifungal or discuss to chg or adjust simvastatin; monitor for muscle pain or weakness.

Answer 62

an SSRI + NSAID Interaction: Increased risk of gastrointestinal bleeding and potential for serotonin syndrome. Management: Use gastroprotective agents or alternative pain medications, monitor for gastrointestinal symptoms. antacids such as Famotidine (20mg BDS 5/7) Omeprazole PPI (40mg OM 5/7) for patients with gastritis related to NSAIDs

Answer 63

1. Decay and Gum Disease: Difficult to clean due to positioning. 2. Cysts/Tumors: Development can lead to jawbone damage and affect surrounding teeth. 3 Infection- Pericoronitis: Infection of the gum tissue around the tooth crown, causing painful swelling and potentially leading to systemic infections. 4 Surgical Complexity: Delayed decision to remove can result in more complex, risky surgical procedures due to increased complications over time. 5 Crowding: Can cause displacement or damage to adjacent teeth.

Answer 64

1.Tobacco use, including cigarettes, cigars, pipes, chewing tobacco, and snuff. Reverse smoking 50% on hard palate 2. Heavy alcohol consumption. 3. Betel nuts 4. Human Papillomavirus (HPV) infection, particularly high-risk strains HPV 16, 18 OR /Candida infection/Syphilis/HIV 5. Prolonged sun exposure to the lips without protection.[actinic radiation] 6. Immunodeficiency or immune suppression. 7. Chronic irritation from rough teeth, dentures, or fillings. 8 LOW SES 9 Poor nutrition, especially diets low in fruits and vegetables; high in red meat and processed foods.IRON DEFICIENCY/ VIT A DEFICIENCY 10. Genetic predisposition- HEREDITARY oncogene, p53/ tumor suppressor gene mutation 11. Pre-existing diseases 12. increasing age 13. h/o of PML

Answer 65

1 Location and size of the tumor. 2 Stage of the cancer at diagnosis: earlier detection generally leads to better outcomes- T4-spread to other tissues 3 LN-mobile/fixed LN>6cm 4 Presence of distant metastasis [TMN staging system] 5 Patient’s age, overall health and presence of co-morbidities. 6 Histopathological results- dysplasia 7 Quality and timeliness of medical and surgical intervention. 8 Patient's adherence to treatment and follow-up care.

Answer 66

1 Early Detection-Routine Screenings 2 Education: Inform patients about the risks and signs of oral cancer recurrence, especially high-risk individuals. 3 Prompt Referrals: Send patients for further evaluation if suspicious lesions are detected. 4 Multidisciplinary Approach: Work closely with oncologists and other healthcare providers. 5 Dental Care Throughout Cancer Treatment Pre-Treatment: Clear any infections and perform necessary dental work (restorations, extractions, periodontal and endodontic treatments) ideally one month prior to cancer treatment to allow healing. During Treatment: Manage symptoms like mucositis and hyposalivation; focus on maintaining oral health to prevent complications like xerostomia, oral mucositis, and root caries. Post-Treatment: Continue supportive dental care and monitor for any long-term effects such as osteonecrosis of the jaw (ONJ), particularly in patients who have received radiation doses >60 Grays. 6 Rehabilitation and Support ->Prosthetics: Help fabricate dental prosthetics for patients who have undergone surgical resections. 7 Nutritional Counseling: Assist with challenges like dysphagia and taste loss. 8 Support Services: Offer emotional support and connect patients with support groups to help cope with their condition. 9 Engage in public health initiatives to raise awareness about the importance of early detection and prevention of oral cancer.

Answer 67

1) Check recent cardiovascular interventions; defer treatment if within 6 months or refer. Antibiotic Prophylaxis: Required if prosthetic heart valves are present due to stenosis. 2) Medication Review Types: Anticoagulants, antiplatelet agents, antihypertensives, cholesterol-lowering drugs, Alzheimer's medications. Purpose: Anticipate drug interactions with LA and assess bleeding risks. 3) Consultation with Medical Providers / cardiologist and primary care physician for health status and dental treatment clearance. 4) Medication Adjustments: Possible dose adjustments required. 5 ) Vital Signs Monitoring: Ensure blood pressure and heart rate are within safe limits (<180/100mmHg) for dental treatment. 6) Dental Examination Focus: Assess caries, periodontal disease, prioritize treatment considering patient's health and cooperation abilities. 7) Cognitive Assessment-Evaluate the patient's understanding and ability to cooperate during treatment. 8) Treatment Plan Discussion Informed Consent: Include the patient and caregiver, considering cognitive status.

Answer 68

Intra-Operative 1 LA Selection: Use anesthetic with minimal VC due to cardiac risks. [<2catridges] 2 Continuous Monitoring: Vital signs must be monitored, specifically ensuring BP <180/100mmHg. 3 Stress Reduction: Implement techniques to maintain a calm environment. 4 Appointment Length: Keep appointments short to minimize stress and fatigue. 5 Bleeding Management: Prepare for potential bleeding due to anticoagulant or antiplatelet use. 6 Post-Operative Pain Management: Prescribe suitable analgesics, avoiding NSAIDs if on anticoagulants. 7 Postoperative Instructions: Clear guidance for patient and caregiver on care and signs of complications; due to Alzheimer's impact. 8 Follow-up: Schedule to monitor healing and manage complications.

Answer 69

1 Fluoroquinolones (norfloxacin and ciprofloxacin), 2 third-generation cephalosporins (G3) (ceftriaxone and cefotaxime) 3 trimethoprim–sulfamethoxazole (SXT) are recommended for preventing infections in patients with cirrhosis or liver failure.

Answer 70

Macrolide , tetracycline and clindamycin ==> hepatoxic

Answer 71

1 Increased Bleeding Risk-clotting factors 2 Infection Risk: Elevated due to immunosuppression associated with chronic liver disease-reduction in complement proteins and acute phase proteins needed for Immune system. 3 Drug Metabolism Issues: Altered liver function affects drug metabolism and clearance [Amide LA, metronidazole] Management Strategies: 1Preoperative Assessment: Collaborate with hepatologist to evaluate liver function and coagulation status PT/aPTT. 2Anesthetic Considerations: Opt for the lowest effective dose[ <2] 3Bleeding Precautions: Check clotting factors and platelets, have blood products ready, use tranexamic acid mouthwash postoperatively. PCC on standby. 4Antibiotics: Use to prevent infections; consider cephalosporin and avoid NSAIDs.

Answer 72

1. Bleeding risk - depend type of AOCoagulant for dialysis.+platelet is destroyed during hemodialysis. 2 Nutritional Concerns: Malnutrition and compromised immune state from dietary restrictions. 3 Hemodynamic Changes: Blood pressure fluctuations due to dialysis;hypotensive* 4 Infection and Electrolyte Risks: Higher infection risk; dialysis affects potassium [hyperkalemia-> arrhythmia] and calcium levels[hypocalcemia-bone disorder] 5. Anemia: -↓ synthesis of erythropoietin → ↓ stimulation of RBC production → normocytic, normochromic anemia 6. DRUG metabolism and excretion is impaired

Answer 73

1 Increased Bleeding Risk: From aspirin and clopidogrel. 2 Cardiac Events Risk: Surgery stress may precipitate cardiac events.

Answer 74

Management Strategies: 1Timing of Surgery: Perform surgery on a non-dialysis day, soon after dialysis session. 2 Blood Pressure Monitoring: Monitor closely, especially avoiding measurements on the arm with AV shunt. 3 Bleeding Management: Consult with nephrologist about platelet function, aPTT +INR if on warfarin and possible use of prothrombin complex concentration/desmopressin. 4 Avoid NSAIDS,

Answer 75

1 Cephalosporins - Generally, cephalosporins are considered safe for the kidneys, but certain ones can be nephrotoxic in those with renal impairment. 2 Aminoglycosides - nephrotoxic 3 Penicillins - While penicillins are generally safe, high doses or prolonged use can sometimes lead to interstitial nephritis. 4 Tetracyclines- slightly 1 NSAIDs - These are known to be nephrotoxic due to their effect on kidney prostaglandins, which are crucial for maintaining renal blood flow, especially in patients with compromised kidney function. 2 Paracetamol (Acetaminophen) - It's generally safe in therapeutic doses; however, chronic high doses can indeed be hepatotoxic and potentially nephrotoxic.

Answer 76

1 Cardiac Clearance: Obtain clearance and guidance from a cardiologist regarding antiplatelet therapy management. Possible continuation, modification, or temporary cessation as advised. 2 Stress Reduction: Implement stress reduction protocols and consider sedation. 3 Bleeding Control: Use local hemostatic measures and prepare for potential prolonged bleeding.

Answer 77

over 200 types of HPV, 12 are considered high-risk due to their ability to cause several types of cancer. High-risk HPV types include 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, and 59. Most attributed to HPV-related cancers are HPV-16 and HPV-18. Low-risk types rarely cause cancer and include both HPV-6 and HPV-11. These types can cause warts on or around the genitals, mouth, and throat.

Answer 78

HPV-positive cancers predominantly affect the **palatine or lingual tonsils**. The base of the tongue and tonsillar site tumors show a 62% HPV-positivity rate vs other oropharyngeal sites show a 25% HPV-positivity rate. may appear with areas of dysplasia, inflammation, or superficial spreading; may appear as exophytic or ulcerative. Can spread across a broad region, including the tonsillar fossa, lateral soft palate, retromolar trigone, and buccal mucosa.

Answer 79

TRUE . The risk is related to the amount of nicotine consumed per day. “The influence of smoking on the host immune response has revealed that **nicotine impairs neutrophil bactericidal activity against oral pathogens** by **inhibiting the production** of **superoxides and hydrogen peroxide**, which are responsible for bacterial death.”

Answer 80

Periodontitis Leukoplakia Leukoedema Necrotizing gingivitis Oral cancer

Answer 81

TRUE. Neglected oral hygiene that may occur due to alcohol abuse may lead to the formation of periodontopathogenic biofilm, which exacerbates the inflammatory response and increases cytokines. Alcohol intake can also cause changes in saliva and decrease salivary flow+ xerostomia, making oral tissues more susceptible to **periodontal diseases,gingival recession and caries**.

Answer 82

The overall risk of developing osteoradionecrosis of the jaw from therapeutic radiation is estimated to be 2%. Certain factors increase this risk, including invasive dental procedures (primarily tooth extraction), tumor location and area of irradiated bone, oral hygiene, periodontal health, smoking and alcohol consumption, and uncontrolled diabetes. The risk of developing osteoradionecrosis after an extraction is 7%. This risk gradually increases for extractions between the second and fifth years postradiation, reaching a peak risk of 22.6%. After the fifth year postradiation, the risk decreases to 16.7%. Vindiš, E., et al. Osteonecrosis of the Jaw. Dentistry Journal. 2023; 11(1): 23. https://doi.org/10.3390/dj11010023

Answer 83

false- Most amide anesthetics (except for articaine) are metabolized by the liver by a microsomal enzyme system whereas **90%** of articaine is metabolized by **esterase in the plasma** and **excreted via the kidneys**. The remaining 10% is metabolized in the liver. Articaine has a ester side chain allowing it to be quickly metabolized systemically by hydrolysis.

Answer 84

Bidigital palpation using the index finger and thumb to press against the tissue is used to palpate the lips, labial and buccal mucosa, and tongue.