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Oral Med and Oral Surg Flashcards

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1
Q

What is an OAC?

A

Oro-antral communication. It is an unnatural communication between the oral cavity and the maxillary sinus that is not yet epithelial lined. IMMEDIATE

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2
Q

Management of an OAC

A

Buccal advancement flap - with vertical mattress suture
Buccal fat pad
Palatal rotation flap

Give antibiotics (tetracyclines), analgesics and decongestants (ephedrine, xylometazoline)

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3
Q

What is ANUG?

A

acute necrotising ulcerative ginigivitis. Loss of interdental papillae and halitosis, painful and bleeding gums

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4
Q

Causes of ANUG

A

Mixed bacterial infection that includes anaerobes. Spirochetes, Fusobacterium nucleatum, Prevotella intermia, Treponema, Borellia vincentii

Predisposing factors - Smoking, stress, poor OH, immunodeficiency, viral respiratory conditions

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5
Q

Treatment for ANUG

A

OHI, debridement,Short course of systemic antiobiotics - Metronidazole

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6
Q

How does Metronidazole work?

A

Bacteriacidal against protozoa and anaerobic bacteria. Inhibits DNA synthesis by causing strand breakage of bacterial DNA.

200mg TDS

Disulphuriam like reaction with alcohol

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7
Q

Principles of flap design

A 
Broad base
incision on sound bone
avoid vital structures
full thickness flap
include the interdental papillae
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8
Q

What is desquamative gingivitis?

A

erythematous, shedding, ulcerated appearance of gums. Associated with pemphigus, pemphigoid, lichen planus, dermatitis hepetiformis

NOT PLAQUE INDUCED

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9
Q

What is muscous membrance pemphigoid?

A

autoimmune Primary vesiculo-bullous disorder. Sub-epithelial. Auto antibodies against the epithelial basement membrane. (IgG and c3 along the basement membrane) Conjunctiva involvement

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10
Q

What is pemphigus

A

Most common vulgaris. Autoimmune primary vesiculo bullous disorder. Intra-epithelial. IgG mediated against desmoglein 1 + 3

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11
Q

What is an OAF

A

Or-antral fistula - epithelium lined tract which forms within 48 hours of extraction

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12
Q

What is dysplasia?

A

Abnormaltiy of development. expansion of immature cells and reduction in mature cells. Moderate and severe dysplastic changes should be excised due to the risk of malignant change

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13
Q

Pathological, microscopic changes in dysplasia?

A
  1. Anisocytosis - cells of unequal size
  2. Poikilocytosis - cells of abnormal shape
  3. Hyperchromatism
  4. Increase in mitotic figures
  5. Drop shaped rete ridges
  6. lack of cell polarity
  7. increase in nucleus to cytoplasmic ratio
  8. loss of intercellular adhesion
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14
Q

When do you extract 8’s?

A

Evidence of pathology (caries, periapical pathology, abcess, internal/external resporption of adjacent teeth.

Impeding jaw surgery
greater than 2 episodes of pericoronitis

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15
Q

Types of lichen planus

A

Reticular, erosive, atrophic, plaque-like, papular, bullous

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16
Q

Which types of lichen planus have the worst prognosis

A

erosive and plaque-like (atrophic)

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17
Q

Points of note when looking at a radiograph showing wisdom teeth

A

1/ Angluation of tooth

  1. proximity to the ID neve
  2. shape of the root
  3. position of the second molar
  4. texture of surrounding bone
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18
Q

Differentials of a non-healing socket

A

SCC, BRONJ, osteoradionecrosis, dry socket

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19
Q

What is chronic erythematous candidosis

A

Chronic form of candidosis, most commonly seen in denture wearers. Mucosa is erythematous and the mucosa may become nodular –> papillary hyperpalasia

Diagnois - seperate smear/swab of denture and mucosa,

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20
Q

Where do you give an ID block

A

in the pterygomandibular space. You palpate for the external oblique ridge and advance the needle into the raphe. Usually approach from the opposite premolar area

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21
Q

What is the nerve pathway for the trigeminal nerve

A

Opthalmic - Superior orbital fissure (sensory)
Maxillary - Foramen Rotundum (sensory)
Mandibular - foramen ovale (Sensory and motor)

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22
Q

Differentials for a unilocular radiolucency in the angle of the mandible

A
  1. Radicular cyst - unilocular, well defined at the apex of a non-vital tooth. can displace teeth
  2. Residual cyst - a remaining radicular cyst after tooth removal
  3. Dentigerous cyst - remenants of the reduced enamel epithelium after tooth formation, the crown is unerrupted.
  4. Odontogenic keratocyst - usually associated with an unerupted tooth. Tooth displacement and extensive expansion with cancellous bone
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23
Q

are lesions above the ID canal odontogenic or non-odontogenic

A

odontogenic

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24
Q

What is a mucocele

A

an accumulation of mucous either in the connective tissues (extravastation) or in the salivary duct (retention)

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25
What is a ranula
a mucocele inthe floor of the mouth
26
Herpes labilais
Herpes infection caused by HHV 1 AND 2. Very infectious - symptoms usually begin as a burning/tingling sensation in a localized region
27
Factors which predispose you to herpes labialis
``` immunosuppression sunlight hormonal changes stress trauma fever menstruation ```
28
What is median rhomboid glossitis
It is an erythematous rhomboid area of depapillation on the dorsum of the tongue in the midline, anterior to the circumvallate papilla, Treatment is by the use of antifunglas
29
Predispositions to candida
``` immunosupression systemic steriods diabetes anaemia poor intra-oral appliance hygiene extremes of age malnutrition smoking ```
30
What is angular chelitis?
erythema +/- yellow crusting at one or both corners of the mouth, Associated with candidal or staph aureaus infection.
31
Side effects of systemic steriods
``` Cushingoid features buffalo hump moon face diabetes hypertension thin skin central obestity fragile hair immunosuppression glaucoma huirsutism gastric ulceration -- DONT GIVE NSAIDS osteoperosis ```
32
Geographic tongue
mucosal condition resembles psoriasis histpathologically irregular depapillated erythematous areas surrounded by pale well-demarcated margins on the dorsal surface and lateral borders of the tongue unknown aetiology
33
Herpes zoster
childhood- chicken pox adulthood - shingles VZV progresses along the sensory nerves to the nerve ganglia where tit resides in the latent form. Reactivation characteristically follows suppression due to malignancy, drug administration or HIV infection ZOSTER DOES NOT CROSS THE MIDLINE
34
Sialadentis
Viral - Mumps (paramyxovirus) Bacterial - usually caused by reduced salivary flow - staph aureas, strep viridans and strep pneumoniae. Strictly anaerobes
35
Dermatitis herpetiformis
primary vesiculo-bullous disease. RELATIONSHIP WITH COELIACS disease. Development of blisters on the skin and oral mucosa, Granular deposition of IgA along the basement membrane Treatment - dapsone
36
What is HIV
human immunodeficiency virus that causes AIDS. Transmission through blood semen and breast milk. Lentivirus/ retrovirus Attaches to gp120 on cells Lowers CD4 t-cell numbers
37
Haemophilia A
Factor viii deficiency
38
Haemophilia B
Factor IX deficiency
39
What is Sjogrens
chronic autoimmune disease in which the bodies white cells destroy the exocrine glands Primary - dry eyes and dry mouth Secondary - CT disorder in addition to suffering from dry eyes/dry mouth (rhematoid arthritis, SLE, systemic sclerosis, primary biliary cirrhosis)
40
Histology of lichen planus
Linear deposition of fibrinogen along the basement membrane but no deposition of Igs or complement (with direct immunofluoresence) Hyperkeratinized epithelium, basal cell destruction and band-like infiltration of t lymphocytes
41
What is eccymosis
subcutaneous purpura greater than 1cm. ie a bruise not caused by trauma
42
What is azathioprine
Purine analogue and is an immunosupressive drug. Inhibits DNA synthesis of rapidly diving cells and so strongly affects cells such as B and T cells. Main adverse effect is bone marrow supression.
43
What blood test do you do before giving dapsone
Glucose 6 phosphate dehydrogenase
44
What blood test do you do before giving azothioprine
TPMT - Thiopurine methyl transferase
45
What is the relevance of TPMT
Patients are tested for it prior to the use of thioprine drugs. Low TPMT increases the risk of drug-induced bone marrow toxicity due to the accumulation of unmetabolised drug
46
What can you do to test for Candida
1. Swab to culture 2. take a smear and histologically stain with a PAS stain - stain the carbohydrate in the fungal cell wall magenta 3. You can also do a rinse of phosphate-buffered saline 4. Mucosal biopsy for chronic hyperplastic candidiosis
47
What are the indications for prescribing antibiotics
Systemic involvement such as fever, lymphadenopathy, pyrexia. Pus and trismus
48
Where can the spread of infection go?
Direct spread -- through facial planes/ muscles. ie the path of least resistance Lymphatics Veins -- cavernous sinus thrombosis
49
What is a cavernous sinus thrombosis
Formation of a blood clot in the cavernous sinus, which is a cavity that drains deoxygenated blood from the brain back into the heart Staph aureas and streptococcus are usually the causative agents
50
Signs and symptoms of a cavernous sinus thrombosis
Decrease loss of vision, drooping or bulging eyes, headaches, paralysis of the cranial nerves (II,IV, V1, V2, VI)
51
Why do you get a chin point/sub metal swelling when there is pathology associated with the mandibular incisors
There is a thin labial cortical plate and the mentalis attaches above the apices
52
What is Ludwigs angina
Spreading of infection of the sublingual and submental spaces bilaterally. Occurs bilaterally due to the lack of posterior border of the mylohyoid. The swelling forces the tongue up against the palate which causes airway obstruction
53
Spread of infection of pericoronitis
1. Buccal space 2. Cheek space 3. Pterygomandibular space 4. Tonsilla space 5. Retropharyngeal 6. lateral pharyngeal 7. Sub masseteric
54
What is pericoronitis
Infection of the operculum or the soft tissues overlying a partially erupted tooth
55
What is in LA
``` LA base HCL Salt vasoconstrictor buffering agent preservatives ```
56
in which direction should you suture
from free to fixed
57
Indications for surgical endodontics in the presence of periradicular disease
(with or without symptoms) 1, non-surgical root treatment has failed 2. trauma 3. perforations 4. re-root treatment cannot be undertaken due to obliterated canals, very curved canals, fractured instrument. 5. where a biopsy of the periradicular tissue is needed
58
What do bisohosphonates do?
They have an affinity for hydroxyapetite crystals and are absorbed by the bone. They inhibit osteoclast mediated bone resorption
59
What radiographic features show an intimate relationship of the IDN with a wisdom tooth?
1. Loss of tramlines 2. Narrowing of tramlines 3. sudden change in the direction of tramlines 4. Radiolucent band across the root
60
Why does LA work less well in patients with acute infection
1. inflammed tissues are acidic and therefore LA is ionised in tissues before it can cross the neural cell. 2. Increased vascualrity of tissues - solution is removed more quickly 3. Prostaglandins increase the threshold of nerves thus a higher concentration of LA is needed to anaesthetise
61
Frey's syndrome
occurs due to surgeries in the parotid gland or due to injury of the auriculotemporal nerve (V3) which passes through the parotid gland Severence of the nerve can cause inappropriate regeneration of parasympathetic nerve fibres --gustatory sweating
62
Bacteriocidal antibiotics
Penicillins, metronidazole, cephalosporins
63
Bacteriostatic drugs
erythromycin, tetracyclines, clindmycin
64
Allodonyia
Pain caused by a stimulus that doesn't normally cause pain
65
Paraethesia
Spontaneous and subjective altered sensation that a patient doesn't find painful
66
Dysaethesia
Spontaneous and subjective altered sensation that a patient finds painful
67
Where are you most likely to come across FNAC
Ultrasound guided in a neck lump clinic enables you to examine cell structure and morphology. NOT TISSUE
68
Stages of tooth development
bud, cap bell
69
Potentially malignant lesions in the oral cavity
Oral lichen planus, erythroplakia, leukoplakia, dyskeratosis congentia, submucous fibrosis, acitinic chelitis
70
What would increase the risk profile of leukoplakia?
``` Location - FOM, retromolar pad, tongue Colour - mixed red and white Texture - raised and non-homogenous Induration Presence of ulceration ```
71
What is leukoplakia
A white patch that cannot be identified clinically or pathologically. It cannot be rubbed off
72
What is erthyroplakia
A red patch that cannot be identified clinically or pathologically. It has a high risk of malignant transformation.
73
Causes of SCC
Smoking, genetic, alcohol, betel quid, HPV
74
Histological features of SCC
Dysplasia, invasion through the basement membrane, perineural and vascular invasion
75
What is an odontogenic tumour?
A group of heretogenous diseases (benign or malignant) derived form elements of the tooth forming apparatus that contain odontogenic epithelium and/ or odontogenic connective tissue
76
Odontogenic cysts
Radicular cyst, residual cyst, dentigerous cyst and lateral periodontal cyst
77
Non-odontogenic cysts
Nasopalatine Nasolabial Bone cysts - aneurysmal or solitary bone cyst
78
Where is the most common place to have a radicular cysts?
Upper laterals. A radicular cyst is in continuity with the lateral periodontal ligament of the affected tooth
79
What is a residual cyst
A radicular cyst that remains once the causative tooth has been removed
80
What is a dentigerous cyst?
Remnants of the reduced enamel epithelium after tooth formation. From the crown of and unerupted and displaced tooth
81
Where does the nasolabial cyst originate
remnants from the embryonic nasolacrimal duct
82
Multilocular radiolucencies
Odontogenic tumours and giant cell lesions
83
Giant cell radiolucencies
Aneurysmal bone cyst Browns tumour of hyperparathyroidism Cherubism Central giant cell granuloma
84
Multilocular odontogenic tumours
``` Odontogenic keratocyst Ameloblastoma odontogenic myxoma ameloblastic fibroma odontogenic fibroma sialo-odontogenic tumour ```
85
Where do odontogenic keratacysts usually occur
Posterior/body of the mandible anterior maxilla in the canine region Smooth, scalloped, well defined and corticated Present commonly in patients with Gorlin-goltz syndrome.
86
Ameloblastoma
Multilocular. Soap bubble effect. Benign but very aggressive. disfiguring
87
cysts vs tumour
cysts displace teeth and tumours resorb teeth/roots project into the tumour
88
Central giant cell granuloma
Occur in the mandible and the main feature is that it crosses the midline. It is multilocular and has a honeycomb appearance
89
Cherubism
multilocular, bilateral giant cell lesion
90
Odontomes
odontogenic tumour
91
Compound odomtome
organised mass of dental tissue. More common in the anterior maxilla. Superficial resemblance to teeth
92
Complex odontome
unrecongizable as dental tissues, Usually appears in the posterior mandible
93
Osteomyelitis
Bone infection and inflammation usually caused by bacteria, It can be chronic or acute and the bone has a moth eaten appearance.
94
What conditions can cause opactities of the antrum
``` Thalassemia Sickle cell anaemia Fibrous dysplasia Pagets disease of the bone osteopetrosis ```

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