Oral Surgery Flashcards
(55 cards)
common perioperative complications
difficult access, fracture of crown/root/alveolar bone/jaw/tuberosity, broken instrument, damage to soft tissue/nerve/adjacent teeth, haemorrhage, abnormal resistance, involvement of maxillary antrum, loss of tooth, dislocation of TMJ, wrong tooth, extraction of permanent tooth germ
part of root is missing when extracting 2nd premolar
what radiograph to assess
periapical
anatomical structures supplied by mental nerve
lower lip, chin, mucosa of anterior teeth
correct terminology of dry socket
alveolar osteitis
signs/symptoms of alveolar osteitis
dull, aching pain
pain radiating to ear
kept up at night
bad odour/taste
how to manage alveolar osteitis
reassure pt, give analgesia
give LA and irrigate socket to remove debris
curettage and debridement of socket to encourage bleeding and new clot formation
give antiseptic pack
alveogyl dressing
check socket to ensure no remaining debris/tooth
what type of drug is warfarin and what is the mechanism of action
vitamin k antagonist anticoagilant
inhibits vitamin k production which is responsible for production of clotting factors, therefore clotting synthesis does not occur
what type of test must be carried out when pt on warfarin
INR
what guidance to refer to for advice on dealing with pt on warfarin
what time frame should this be carried out prior to XLA
SDCEP
ideally no more than 24hrs, can be 72hrs
below what INR level would it be safe to continue with extraction
less than 4
outline options to carry out clinically to deal with post-op bleeding
reassure and support pt
administer LA, debridement of socket, surgicel, bone wax, diathermy, pressure
suture wound closed
if you could still not stop bleeding after management, what would you do
refer to specialist, vitamin k injection, surgical injection
removal of 48
what nerves must be anaesthetised
inferior alveolar, lingual, long buccal
how to assess anaesthesia has been achieved
check for blanching, use a probe to poke around PDL, ask the pt if anything feels sharp or just pressure
ask pt if they feel numb [tongue/lip depending on where LA]
pins and needles feeling, or partial loss of sensation
paraesthesia
painful, unpleasant or neuralgic sensation that lasts for a fraction of a second
dysesthesia
total loss of sensation
anaesthesia
clinical reasons which account for neuro-sensory defecit such as loss of sensation, pins/needles feeling, painful sensation
damage to nerves due to crush injuries, stretching/cutting/shredding of nerves, transection, damage from surgery or LA administration
injection into parotid gland
how to achieve haemostasis after XLA
apply pressure by biting down on gauze/finger, sutures, LA with adrenaline, diathermy by cauterising/burning vessels to precipitate proteins to form plug in vessel, apply ligatures, bone wax, pack
aims for raising a flap in minor oral surgery
better access to tooth/roots
protection of soft tissues
things that influence flap design
procedure being done, surrounding nerves, how much access is required, personal preference, aim of procedure, minimal effect on gum recession, position of foramen, anatomical postion
type of handpiece used for bone removal
straight handpiece saline cooled with carbide/tungsten bur
why are highspeed handpieces not used for bone removal
push of air into soft tissues, creating surgical emphysema which can cause infection
methods of debridement
physical = mitchells trimmer, victoria currette, remove sharp
aspiration = under flap to remove debris
irrigation = saline
