Oral Surgery

Question 1

name the upper forceps and their uses

Answer 1

straight forceps - 13-23
universals (curved handle) - 15-25
molars - right vs left beak to cheek
upper root - identical to upper universals but with thinner beaks
3rd molar bayonets - straight handle bend in the tip and thicker beak than root forceps

Question 2

name the lower forceps and their uses

Answer 2

universals - 45-35
molar
cowhorn
root - identical to universals but smaller tip

Question 3

when is the only time you should stand behind a patient to take out a tooth as a right handed operator

Answer 3

when taking out teeth in lower right quadrant

Question 4

name extraction risks

Answer 4

pain, bleeding, bruising, swelling, infection, damage to adjacent teeth/ restorations, unable to extract, surgical extraction, root in situ, dry socket, temporary or permanent numbness, limited mouth opening, jaw stiffness

Question 5

what advice should you give for swelling after XLA

Answer 5

cold compress on and off for 15 minutes

Question 6

how would you describe pericoronitis to a patient

Answer 6

wisdom teeth partial erupt or become stuck under the gum which makes it difficult to clean
this can cause infection of soft tissue around the tooth leading to pain and swelling

Question 7

what are risk factors for pericoronitis

Answer 7

partial eruption and vertical/ distoangular impaction
opposing 7/8 causing mechanical trauma
upper respiratory tract infections
poor OH
stress

Question 8

what is treatment for pericoronitis

Answer 8

incision of localised pericoronal abscess
IDB given
irrigate with saline or chlorhexidine
XLA upper 3rd molar
antibiotics if severe - 400mg metronidazole TID for 3 days
discuss XLA of tooth

Question 9

how would you describe TMD to a patient

Answer 9

condition where adverse stress affects movement of jaw joint, ligament and muscles
associated with grinding habits
can be worse on wide opening and chewing
tends to get better on its own

Question 10

how would you examine a patient with TMD

Answer 10

e/o - palpate MOM, look for asymmetry, check joint for clicks, measure max jaw opening with willis bite gauge, check opening and side to side movement against hand resistance
i/o - atrrition, linea alba, wear facets, lost fillings, scalloped tongue

Question 11

what are the treatment options for TMD[

Answer 11

soft diet, masticate bilaterally, no wide opening, no chewing gum, cut food into small pieces, stop parafunctional habits, support mouth opening
soft splint

Question 12

what are the instructions of splint wear for patient with tmd

Answer 12

wear at time of parafunction (night)
demonstrate insertion and removal
may take months before benefit observed
teeth must be cleaned properly before splint wear
avoid consuming anything but water when splint in place
clean splint with cold water and soap over basin
place in sterilisation soln once a week

Question 13

how would you describe OAC or OAF to patients

Answer 13

a communication (hole) between mouth and air filled spaced either side of the nose in the cheekbones called the maxillary sinus
sometimes happens when an upper molar or premolar extracted
liquids move from mouth to sinus and through nose
if left untreated can turn into OAF and cause sinusitis

Question 14

what are risk factors for OAC

Answer 14

extraction of upper molars and premolars
last standing molars
close relationship of roots to sinus
older patient
previous OAC
recurrent sinusitis

Question 15

what are perioperative signs of OAC

Answer 15

bone at trifurcation of roots comes away
bubbling at socket
valsalva test
change in suction sound
direct vision - black hole

Question 16

what are post op signs of OAC

Answer 16

unilateral discharge
fluid from nose when drinking
difficulty smoking or drinking water through straw
non-healing socket
nasal sounding voice

Question 17

what is the management of OAC under 2mm

Answer 17

pack and monitor
review in 1 week
no nose blowing, sneeze with mouth openm chlorhexidine m/w, smoking cessation, steam inhalation
refer for closure if larger or not healing
antibiotics - penV 500mg QDS for 5 days

Question 18

what are risk factors for a tuberosity fracture

Answer 18

single standing molar
unknown unerupted molar wisdom tooth
XLA in wrong order
inadequate alveolar support

Question 19

what are signs of tuberosity fracture

Answer 19

noise
movement noted visually or with fingers
more than one tooth movement
tear on palate

Question 20

what is the treatment of tuberosity fracture

Answer 20

dissect out and close
reduce with fingers and fix with splint
treat/ remove pulp
antibiotics
remove tooth 8 weeks later

Question 21

how would you describe dry socket to a patient

Answer 21

normal clot fails to form properly or gets dislodged
this leaves exposed bone which gives intense pain
7-14 days to go away

Question 22

what is treatment for dry socket

Answer 22

reassure
analgesia
LA block
irrigate with saline
curettage and debridement
alvogyl pack

Question 23

what reasons are wisdom teeth extracted

Answer 23

caries, infection, pericoronitis, cyst formation, cheek biting, periodontal disease, 8 causing external resorption of 7

Question 24

how should you assess an OPT of impacted 8s

Answer 24

presence or absence of disease
anatomy of 8
depth of impaction
orientation of impaction
periodontal status

Question 25

what are signs roots of lower 8 are close to IDN

Answer 25

interruption of tramlines by tooth diversion/ deflection of canal deflection of roots darkening of roots where canal crosses narrowing of canal narrowing of roots dark bifid root

Question 26

how would you discuss risk of nerve damage to a patient getting lower 8 out

Answer 26

sensory damage rather than functional 2 nerves run close near third molar region (lingual and IAN) can be damaged usually temporary (10% fisk) and can take weeks/ months to recover permanent damage is less than 1% risk demonstrate lips, cheek, teeth and tongue on one side may be affected

Question 27

what are the steps of coronectomy

Answer 27

IDB 3 sided buccal mucoperiosteal flap transect tooth 3-4mm below enamel into dentine elevate and leave crown without mobilising roots if roots mobilised they must be removed due to infection risk leave pulp untreated irrigate replace flap suture HAPOIG

Question 28

what should you ask on initial exam of someone presenting with facial fracture

Answer 28

any headache hearing loss nausea or vomiting numbness or alteration of sensation police involvement

Question 29

what E/o features to look out for in mandibular fracture

Answer 29

check for lacerations, bleeding, swelling, facial asymmetry palpate mandible bilaterally check reduced incisal opening deviation on opening tenderness of TMJ sensation to lower lip/ chin region bleeding around ear (condylar fracture)

Question 30

what I/O features should you look out for in mandibular fracture

Answer 30

lacerations on gingivae bruising, swelling, sublingual haematoma occlusal derangement broken or mobile teeth paraesthesia of teeth in lower jaw AOB due to bilateral fracture

Question 31

how do you classify mandibular fractures

Answer 31

involvement of soft tissue - single/ compound number of fractures side site direction of fracture line displacement

Question 32

what is treatment for mandibular fracture

Answer 32

reassure explain numbness related to damage to IDN PA mandible and OPT NSAIDs and antibiotics LA refer to OMFS with phone call OMFS will do ORIF or closed reduction with IMF

Question 33

what is the E/O exam for midthird fractures

Answer 33

lacerations nasal bleeding/ deviation/ patency palpation of zygoma bilaterally orbital rims and zygomatic arch from behind facial asymmetry limitation of mandibular movement examine infraorbital nerve - upper lip, lateral nose, lower eyelid eye exam

Question 34

what is the eye exam for midthird fractures

Answer 34

eye movement - 6 points eye position pupil reaction to light diplopia periorbital ecchymoisis or subconjunctival haemorrhage

Question 35

what are signs and symptoms of midthird fractures

Answer 35

flattening of cheeks step deformities numbness in face pain swelling difficulty moving ete diplopia subconjunctival haemorrhage periorbital ecchymosis epistaxis (nosebleeding) LMO

Question 36

what is tx of middle third fractures

Answer 36

check for ocular injuries, prophylactic antibiotics, advise against nose blowing closed reduction with/ without fixation open reduction and internal fixation

Question 37

what two aspects would a patient have to present with to be diagnosed with SIRS

Answer 37

tachycardia - more than 90 bpm breathing rate less than 20 breaths per min fever of more than 38 or under 36

Question 38

what is the sepsis 6 - done within first hour of admission to hospital

Answer 38

give high flow O2 take blood cultures IV antibiotics give fluid challenge measure lactate measure urine output

Question 39

when would you send a patient to hospital

Answer 39

swelling floor of mouth rapidly progressing swelling fluctuation in pharyngeal area unable to move tongue trismus pyrexia low O2 saturation dehydration diplopia

Question 40

what is cellulitis

Answer 40

infection into deep layers of skin diffuse, red, indurated, no pus

Question 41

what is ludwig's angina

Answer 41

bilateral cellulitis of submandibular and sublingual space

Question 42

what are the types of sutures

Answer 42

resorbable non-resorbable monofilament polyfilament

Question 43

what are resorbable sutures

Answer 43

full resorbed by tissues used in areas where suture requires to be buried or difficult to remove useful for I/O wounds

Question 44

what are non-resorbable sutures

Answer 44

remain in tissue until removed used in areas that require suture remain for a long period of time OAC, skin closure, hold dressings when exposing canines

Question 45

what are monofilament sutures

Answer 45

single strand less likely to facilitate infection because difficult for bacteria to colonise a single strand

Question 46

what are polyfilament sutures

Answer 46

made from several smaller strands twisted together easier to handle contraindicated in contaminated wounds due to potential to absorb fluids and bacteria

Question 47

what is the wicking effect with sutures

Answer 47

sutures absorb fluid and bacteria enabling infection to penetrate the body along the suture tract seen with polyfilament sutures

Question 48

what are principles of flap design

Answer 48

big flaps heal as well as small ones wide base incisions aim for healing by primary intention cut flap down to bone awareness of adjacent anatomical structures keep papilla intact no sharp angles no crushing keep tissue moist flap margins lie on sound bone