Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

BDS5 OSCE NR > Oral Surgery > Flashcards

Oral Surgery Flashcards

(59 cards)

Start Studying
1
Q

GDC sedation definition

A

drugs used to produce depression of the CNS
communication maintained
pt will respond to command throughout period of sedation
margin of safety wide enough to render unintended loss of consciousness unlikely

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

components of sedation assessment

A

History: establish nature of fear/phobia/anxiety (cant do IV sedation for people with needle phobia)

Explain to patient:
* Escort
* No alcohol before
* No responsibilities or work following day
* No driving for 12hours

MH: drug interactions – alcohol, opioids, erythromycin, antidepressants, antihistamines, antipsychotics, recreational
drugs
ASA Classification

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

ASA Classifications

A

ASA Class I: Normal healthy patients
ASA Class II: Mild systemic disease (amber light for practice) BP< 160/95
ASA Class III: Severe Systemic Disease
ASA Class IV: Incapacitating disease which is a constant threat to life
ASA Class V: Moribund pt’s not to expected to live >24hrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

indications for sedation

A

MH aggravated by stress: IHD,Hypertension, Asthma, IBS, Epilepsy
Handicap/Parkinsons/learning difficulties
Phobia/Gagging/Fainting
Procedure – long, difficult, unpleasant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

contraindications for sedation

A

COPD
hepatic insufficiently
pregnancy
severe special needs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

drug used in IV sedation

A

midazolam 5mg/ml

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

reverse drug for IV sedation

A

flumanenil 200ug

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

indications for inhalation sedation

A

Anxiety
Needle fear
Gagging
Traumatic treatment
MH that increases stress
Unnacompanied adults needing sedation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

contraindications for inhalation sedation

A

Common Cold
Enlarged tonsils/adenoids
COPD
1st trimester pregnancy
Limited understanding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

pre op instructions for inhalation sedation

A

Light meal pre-appt
Routine meds
Children accompanied by adult
Adults need accompanied at 1st appt only
no alcohol
sensible clothing
arrange childcare post-appointment
plan to remain in clinic 30mins post appt.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what to include in GA referral letter

9

A
  1. Pt name and address
  2. Parent/Guardian name
  3. contact no.
  4. Treatment plan
  5. Justification (SIGN 47)
  6. radiographs
  7. Medical History
  8. GP details
  9. My details
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

TMD history

A

SOCRATES

MHx and SHx markers:Unusual posturing – chin holding, wind instrument, singer, Stressful event in life

e/o
* Mouth opening
* Palpate masseter + temporalis
* Test opening against resistance (test pterygoids by placing gentle pressure under chin)
* Listen for click
* crunch - crepitus

I/o:
* Interincisal mouth opening – normally 40-55mm
* Parafunction: Linea Alba
* Tongue Scalloping
* Cheek biting
* Occlusal, non carious TSL
* Enamel Hairline Fracture

Differential Diagnosis: Dental Pain, Sinusitis, Trigeminal Neuralgia, Referred neck pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

reversible TMD management

A

CONSERVATIVE - no actual pathology of joint

Pt education – explain nature of problem, why its happened, what will make it better,
how long it’ll take,

Reassure
Soft Diet - Dont incise/cut into small bits
Break Habits
Supported mouth on opening (yawn)
no wide opening
No chewing gum
Chew on both sides
stop parafunctional habits
stop postural habits – phone, resting chin on hand
Hot or cold packs
Scarf cold day
Analgesia – Paracetamol + Ibuprofen (max. respectively 1g every 4hrs, 600mg every 4 hours.. alternate)

Can also advise: Physio, massage, acupuncture, hypnotherapy

Conservative advice for 8 weeks before Rx of Hard Splint - bite raising appliance
- also protects teeth from grinding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

SPLINT for TMD

A

after trying conservative advice for 8weeks

Won’t feel affects for several weeks – persevere
Problems wont go away without it
Cleaning – fairy liquid warm water soft bristled brushing
Excess saliva and bulkiness for 24hrs
Wear at times of parafunction activity – at work, driving, sleeping, studying.

Works by stabilising occlusion and improving function of MoM, decreasing abnormal acivity and also protects the teeth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

irreversible TMD management

A

pathology of joint causing discomfort - crepitus; anterior disc displacement without redction

REFER
Arthrocentesis
Arthroscopy
Disc-repositioning surgery
Disc repair/removal
High condylar shave
Total joint replacement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Cranial nerve exam

A

Olfactory – sense of smell

Optic - Visual acuity - ask pt to count fingers; read print on Snellen chart; visual field;

Occulomotor – shine light and assess pupil size, shape and symmetry

Trochlear – move eye

Trigeminal – clench jaw muscles. touch skin, ask about altered sensation. Check all 3 branches.

Abducens – move eye in all directions

Facial – muscles of facial expression, smile, frown, rais eyebrows, screw up eyes, pout, whistle

Vestibulocochlear – whisper in one ear

Glossopharyngeal -assess pupil size, shape and symmetry

Vagus – look for deviation of uvula when saying ahh

Accessory nerve – shrug shoulders

Hypoglossal – look for any wasting/limp areas on tongue, protrude see if symm/deviation, ask to move to either cheek

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

lymph nodes names

A

Occipital
Retro Auricular
Pre- Auricular
Buccal
Submental
Submandibular
Superficial Cervical Nodes
Jugulodigastric
Deep Cervical
Jugulo-omohyoid
Supraclavicular

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

OAC dx

A

Radiographic position of roots in relation to antrum
Bone at trifurcation of roots?
Visual with direct light - bubbling of blood
Listen for echo w/ suction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

management of OAC

A

Inform pt
IF: SMALL <2mm/ sinus lining intact:
* Encoruage clot
* Suture margins Vicryl Rapide 4.0 (resorbable)
* Amoxixillin 500mg 7 days
* Post-op instructions: reg. Meds
* refrain from nose blowing/stifling sneeze
* avoid straws
* refrain from smoking
* steam inhalation

LARGE >2mm/ lining torn: Buccal advancement flap w/ non-resorbable sutures Prolene 7.0

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

dx OAF

A

fluid coming out nose when drinking
problems with speaking, smoking using a straw
bad taste/pus
pain/sinusitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

management OAF

A

Excise sinus tract
B.A.F/Buccal fat pad with B.A.F/Palatal flap/Bone graft

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

aetiology of maxillary tuberosity fracture

A

Single standing molar
XLA in wrong order 678, where it should 876
Unerupted/unknown wisdom toothbrush
Inadequate alveolar support

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

dx of maxiallary tuberosity #

A

Multiple tooth movement
Noise
Tear on palate
Feel and see movement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

management of maxillary tuberosity #

Study These Flashcards
A

Mgmt Option 1: Dissect out + close wound

Mgmt Option 2:
Reduce & Stabilise (Hold in place with fingers + Ortho buccal arch wire welded with composite)
* Teeth involved: RCTx; remove from occlusion; amoxicillin + chx; instructions post-op; SR XLA tooth 8 weeks later

25
management root in maxillary sinus
1. Confrim radiographically 2. Decision on retrieval * Caldwell Luc approach – through buccal sulcus, cut window into bone * OAF type approach through socket, suction, small curettes, irrigation, close. 3. Refer if in doubt
26
sinusitis what is it symptoms differential dx
cant evacuate contents: build up of pressure and bacterial overgrowth. Congestion, fever, headache, Discomfort on palpation of infraorbital, diffuse pain max.teeth, worse pain on head movement. Differential: Abscess, infection, caries, xla site, MFPDS, Neuralgia, Atypical Facial pain
27
management sinusitis
Self limiting, lasts 2.5wks Local measures: Steam inhalation Ephidrine Nasal Drops 0.5% (not for patients with high BP) If persistent: Amox 500, 7days.
28
trigeminal neuralgia management
Ensure pain is not odontogenic Urgent referral to OM/GP for FBC, LFT, assess response + titrate dose Carbamazepine tabs 100mg Send: 20tabs Label: 1 tab twice daily Positive response to drug confirms diagnosis
29
29
how to name mandib #
1. Type Simple/Compound/Communited 2. Number Single/Double/Multiple 3. Side Unilateral/Bilateral 4. Site Symphyseal, Parasymphyseal, Body, Angle, Ramus, Coronoid, Subcondylar, Condylar 5. Direction Fav/Unfav (increased risk of displacement) 6. Specifics Green Stick (children, incomplete separation) or Pathological – BONJ, Osteomyelitis, KcOT 7. Displacement- Displaced or Undisplaced (may require no tr)
30
30
possible post op complications
Trismus – monitor, gentle mouth opening excersizes, wooden spatulae, trismus screw Soft Tissue bleeding – pressure, suture, LA, Diathermy, Haemostatic forceps, if severe A&E Bone bleeding – Pressure, LA, Surgicel/Kaltostat/Bone wax, Pack Dry socket Osteoradionecrosis
31
how to manage post op bleeding
Calm pt Clean pt Take a history – rule out bleeding disorder or meds. (warf/aspirin/anti-platelets) * Contact haematologist if bleeding disorder * If warfarin – do INR; * Hospital if large volume of blood loss, medical problems, extremes of age Vision + suction Remove large jelly clot Identify site Pressure LA with adrenaline Surgicel (oxidised celulose) Suture Ligation If you cant arrest haemorrhage then refer to hospital Give pt contact no. Review Haemostatic agents: LA w/ adrenaline, Surgicel, Gelatin Sponge, Thombin powder, fibrin foam Systemic – Vit K, Tranexamic Acid (anti-fibrinolytic) Missing Clotting factors
32
dry socket what is it
starts 3-4 days postXLA 1-2wks to resolve mod-severe dull throb/ache can radiate to ear bad smell/taste no fever or pus 'clot fails to form or breaks down' due to smoking; contraceptive pill; Local Anaesthetic F>M Molars excessive rinsing/traumatic xla previous dry socket/FH
33
dry socket management
Reassure + Analgesia LA block Saline, check for bony fragments Alvogyl (LA+antiseptic) to soothe pain and prevent food packing Advise analgesia + hot salty mouthwash Review and change dressing every 2 days
34
osteomyelitis what is it
inflammation of bone marrow 'infection of the bone' Rare, mandible fever, may have altered sensation Predisposed by: mandibular fracture or odontogenic infection No radiographic changes until 10-12 days, increased radiolucency – uniform/patchy with a moth-eatenappearance.- areas of radiopacitity within sequestrae
35
osteomyelitis management
FBC, Glucose, seek medical consult Up to 6months of high dose antibiotics Severe – may need hospital admission and IV abx Drainage Remove non-vital teeth @ site of infection remove loose bone Excise necrotic bone
36
osteroradionecrosis what is it
radiation causes bone's blood supply to be reduces, doesnt heal well after xla so need to prevention
37
prevention for osteoradionecrosis
prevent need for XLA- dentally fit prior to radiotherapy; OHI, Scaling, Chx Antibiotics post xla Hyperbaric O2 Refer for extraction
38
tx for osteoradionecrosis
Irrigation of necrotic debris Loose sequestrae removed Small wounds <1mm heal over 1month Larger ones need bone resection and suturing Hyperbaric O2
39
signs and symptoms of severe orofacial infection
Swelling/fluctuant/induration Airway Compromise Fevere Lethargy Malaise Dehydration Induration Trismus Dysphagia Sytemic Inflammatory Response Syndrome: 2 out of 4 needed for Sepsis Syndrome: Urgent referral * Temp <35ºC or >38ºC * Heart Rate >90bpm (tachycardia) * Resp Rate >20 breaths per minute or PaCO2 <4.3kPa * (WBC count <4, >11)
40
cellulitis Vs abscess
Cellulitis: warm, diffuse, erythematous, indurated and painful swelling. * Acute * Large * Diffuse borders * Doughy/induration * No pus * Greater degree of seriousness Abscess: pocket of necrotic tissues, bacterial colonies, dead white cells * Chronic * Small * Well circumscribed * Fluctuant * Pus * Less degree of seriousness
41
SIRS
Sytemic Inflammatory Response Syndrome: 2 out of 4 needed for Sepsis Syndrome: Urgent referral * Temp <35ºC or >38ºC * Heart Rate >90bpm (tachycardia) * Resp Rate >20 breaths per minute or PaCO2 <4.3kPa * (WBC count <4, >11)
42
principles of management of dental infection
1. Drainage – xla/endo/incision I/o or e/o 2. Remove cause – xla/endo/periradicular surgery 3. Supportive antibiotic therapy – severe spreading infection/ systemic involvement/ medically compromised. REVIEW 24hrs
43
4 indications for culture and sensitivity testing for infection
rapidly progressing non responisve previous antibiotics therapy recurrent infeciton
44
indications for antiobiotics | 4
trismus lymphadenoapthy temp >38 severe periocorontitis
45
cyst
pathological cavity containing fluid, semi-fluid or gaseous contents & not formed by accumulation of pus.
46
odonotgenic cysts types | 2 categories
Inflammatory - * Radicular: Apical * Lateral * Residual Developmental * Keratocystic Odontogenic Tumout (kcot) * Dentigerous cyst * Eruption cyst * lateral periodontal cyst * gingival cyst
47
non-odontogenic cysts
nasopalatine duct cysts
48
special investigations for cysts
Vitality testing (teeth associated with radicular cysts are non-vital) Radiology: Panoramic, PA, Sinus views Aspiration Biopsy of cyst lining
49
reasons for endo failure
Misdiagnosis Inadequate cleaning - not using NaOCl, not under rubber dam Inadequate shaping
50
aim of peri radicular sugery
apical seal remove existing infeciton
51
indications for peri-radicular surgery
Failure of endodontics due to 1. Nerves left in lateral canals near apex, leading to chronic irritation 2. Obstruction to instrumentation (instrument, root fracture, dilaceration) 3. RCT underfilled, overfilled, open apex 4. Poor host tissue response 5. Poor natural drainage of infection
52
TMD signs/symptoms
click of joint sore muscles hypertrophic MOM sore in AM tongue scalloping cheek biting wear facets
53
prevalance of TMD
75% of population get it at some point in their life
54
explanantion of TMD
The jaw joint sits in base of skull and muscles control opening and closing. Now, like any muscle in the body, if overworked they get tired e.g. if you climb a mountain legs are sore for next few days.’ ‘However, as your jaw joint gets used all day everyday like for speaking and eating it never gets a rest. Muscles become inflamed and sore.’ ‘The fact that you’re sore in the morning also tells us that you clench or grind your teeth at night as well which puts more stress on those muscles and exacerbates the problem even more’ ‘The clicking by your ear is caused when the disc between your jaw and the skull gets trapped in front of the jaw bones and snaps in place’ Could draw a wee diagram to show disc and explain that when muscles not in harmony the disc is pulled at wrong time to create clicking noise or disc trapped in front of jaw bones crushing the tissue that can cause pain.
55
management of TMD
reassurance resting theh join - soft food, cut in small pieces, chew on both sides, avoid chewy stikcy foods, avoid wide opening, support jaw when yawn, avoid habits (nail biting) analgesia heat packs stress reduction bite splint for night time
56
summary for TND
Reassurance - common condition with simple conservative management Important to reduce stress Inform that other symptoms like tongue scalloping and linea alba are caused by the clenching and also go away on management of condition. Ask if any questions Actor marks for communication, simplicity of language and empathy
57

BDS5 OSCE NR (11 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions