Oral Surgery Flashcards
(31 cards)
Describe pulp hyperaemia
- Reversible pulpits
- Pain stimulated by hot/cold or sweet and lasts a few seconds
- Pain resolves after removal of stimulus
- Sharp pain
(caries is approaching the pulp but the tooth can still be restored without treating the pulp)
Describe acute pulpitis
- irreversible pulpitis
- severe constant pain, worsens with thermal stimuli
- Poorly localised, pain may be referred
- Poor/minimal response to analgesics
- Symptoms less severe if there is a release of pressure (crown so carious its broken off)
- Negative TTP (PDL not inflamed as infection in pulp chamber)
Describe acute apical periodontitis
- Tooth is TTP
- Pain very well localised
- Tooth non vital (unless traumatic)
- Radiograph may show loss of lamina dura
- May be slightly mobile
Discuss the treatment of an acute apical abscess
- drain infection via intra or extra oral soft tissue incision
- Remove source - RCT (pulp extirpation), extraction or peri-radicular surgery
- Prescribe antibiotics if patient is systemically unwell
- If infection is causing difficulty with anaesthesia, prescribe antibiotics and get patient back to remove source at future date (5 days time)
what are the 5 cardinal signs of inflammation
- heat
- redness
- swelling
- pain
- loss of function
Describe upper teeth areas of spread
- Buccally > buccal space
- Palatally > unlikely due to dense palatal bone
- Buccally below buccinator > drains into mouth
- Maxillary sinus > unusual, would develop into sinusitis
Describe lower teeth areas of spread
- lingually above mylohyoid line > sublingual space under tongue
- lingually below mylohyoid line > submandibular
- buccally above buccinator > drain into mouth
- buccally below buccinator > drain into buccal space
whether infection spreads to sublingual or submandibular space depends on what
The tooth in relation to the mylohyoid line. Premolars are more likely sublingual, molars more likely submandibular
What are the primary fascial spaces
- vestibular
- palatal
- canine
- buccal
- submental
- sublingual
- submandibular
what are posterior spaces filled with and why does infection spread there
connective tissue, because infection follows areas of less resistance
what are the posterior potential spaces
- pterygomandibular space
- infra-temporal space
- deep temporal space
- superficial temporal space
- masseteric space
what is Ludwig’s angina
life threatening cellulitis involving bilateral submental, submandibular and sublingual swelling
What are the features of Ludwig’s angina
- Diffuse redness and swelling bilaterally in submandibular region
- Raised tongue
- Difficulty breathing
- Difficulty swallowing
- Drooling
- Systemic - increased heart rate, respiratory rate, temperature and white cell count (SIRS)
- Compromised airway
What is SIRS
Systemic inflammatory response syndrome
Diagnosed when a patient has 2 or more from the following
- temperature <36 or >38
- heart rate >90 beats per minute
- respiratory rate > 20 breaths per minute
- WBC <4000/mm3 or >12,000/mm3
What is sepsis
life threatening condition caused by an over-reaction of the body’s immune system response to infection. Diagnosed when SIRS criteria is met and infection is present
What is the sepsis six treatment of sepsis
- Give high flow oxygen
- Take blood cultures
- Give IV antibiotics
- Give a fluid challenge
- Measure lactate
- Measure urine output
What is the prescription for first line antibiotics for a periapical abscess
- Phenoxymethylpenicillin 250mg (send 40 tablets, 2 tablets 4 times a day for 5 days)
- Amoxicillin 500mg (send 15 tablets, 1 tablet 3 times a day for 5 days)
- Metronidazole 400mg (send 15 tablets, 1 tablet 3 times a day for 5 days)
why would you prescribe amoxicillin over phenoxymethylpenicillin
if you are concerned about someone actually taking the entire prescription/ remembering to take 8 tablets per day (3 tablets per day easier to remember)
What nerves are at risk during mandibular third molar surgery
- inferior alveolar nerve
- lingual nerve
- long buccal nerve
- nerve to mylohyoid
what are 3 consequences of third molar impaction
- caries
- pericoronitis
- cyst formation
what is the inferior alveolar nerve and what does it supply
- peripheral sensory nerve arriving from mandibular division of trigeminal nerve
- supplies all mandibular teeth and mucosa/skin of the lower lip and chin on that side
what is the lingual nerve and what does it supply
- branch of mandibular division of trigeminal nerve
- supplies sensory innervation to anterior 2/3rd of Doral and ventral tongue mucosa
- gives off branch which supplies lingual gingival and floor of the mouth
name three guidelines relating to third molar surgery
- NICE guidance on extraction of wisdom teeth 2000
- SIGN publication 43 management of unerupted and impacted third molar teeth 2000
- FDS RCS 2020 parameters of care for patients undergoing mandibular third molar surgery
Discuss all the indications for third molar extractions
- Therapeutic indications - infections (caries, pericoronitis, periodontal disease), periapical abscess, cysts, tumours, external resorption of 7 or 8
- Surgical indications - if the M3M is present within perimeter of surgical field, consideration can be taken for removal
- High risk of disease - mesioangular or horizontally impacted 8 has high caries risk for the 7 and periodontal detriment for the 7
- Medical indications - pt awaiting cardiac surgery, immunosuppressed or to prevent osteonecrosis, MRONJ before starting bisphosphonate medication
- Accessibility - limited access to restore
- Patient age - complications increase with age
- Autotransplantation
- Pt undergoing general anaesthetic
