Oral Surgery Flashcards
(272 cards)
1
Q
What are the reasons for failure of conventional RCT? (4)
A
- anatomical
- root obturation error/problem
- root perforation/fracture
- pathology
2
Q
What are the pathological indications for periradicular surgery? (4)
A
- chronic persistent periapical granuloma
- radicular cyst
- cementoma
- external root resorption
3
Q
What are the contraindications for periradicular surgery? (4)
A
- anatomical factors e.g proximity to neuromuscular bundles
- periodontal considerations e.g presence of defects
- medical factors e.g leukaemia, neutropenia
- skill and ability of surgeon
4
Q
What are the stages of periradicular surgery? (7)
A
- LA
- flap design
- bone removal
- curettage
- apicectomy
- retrograde preparation and filling
- closure
- POI
5
Q
What are the types of full mucoperiosteal flaps? (3)
A
- 2 sided
- 3 sided
- horizontal/envelope
6
Q
What is a full flap? (3)
A
- incisions through gingival margin
- papillae mesial and distal included
- relieving incision at 90* to tooth
7
Q
What is a mucogingival flap? (3)
A
- crowned anterior teeth
- scalloped incision in middle of attached gingiva at 45*
- vertical relieving incisions straight up and down
8
Q
Give an advantage of a submarginal flap
A
Avoids recession
9
Q
Give 2 disadvantages of a submarginal flap
A
Scarring
Painful post op
10
Q
How do you do a root end resection? (5)
A
- remove the apical 3mm to remove the apical delta
- slight bevel improves vision
- use fissure bur
- if post present do not section it
- all granulation tissue must be removed
11
Q
What is guided tissue regeneration?
A
When a barrier membrane is used to treat teeth with large periapical lesions in conjunction with periodontal defects or without cortical bone
12
Q
How do you do wound closure? (4)
A
- thorough irrigation before closure
- compression of flap to eliminate haematoma
- reapproximation of flap (suture papillae first)
- apply pressure +/- ice pack
13
Q
What are the success rates of non surgical re treatment?
A
56-98%
14
Q
What are the success rates of surgical treatment?
A
37-95%
15
Q
What are the properties of root end filling materials? (4)
A
- well tolerated by apical tissues
- bactericidal or bacteriostatic
- adhere to tooth
- dimensionally stable
16
Q
What are the disadvantages of amalgam? (4)
A
- sets slowly
- dimensionally unstable
- scatters
- leaks
17
Q
What are the contents of MTA? (5)
A
- tricalcium silicate
- tricalcium aluminate
- tricalcium oxide
- silicate oxide
- bismuth oxide
18
Q
What are the properties of MTA? (6)
A
- high pH
- good sealing ability
- hydrophilic
- radiopaque
- excellent biocompatibility
- regeneration of cementum
19
Q
What procedures are performed using a microscope? (7)
A
- osteotomy
- curettage
- root end resection
- inspection of resected root surface
- root end preparation
- root end filling
- examination of surgical site
20
Q
What are the valid causes of surgical failure? (4)
A
- failure to clean root canal throughly
- failure to seal root end
- tissue irritation
- failure to manage materials properly
21
Q
What are the uncertain causes for surgical failure? (4)
A
- infected dentinal tubules
- infected periradicular lesion
- accessory or lateral canals
- loss of alveolar bone
22
Q
What are the symptoms of sepsis in adults? (6)
A
- slurred speech
- extreme shivering
- passed no urine in a day
- severe breathlessness
- illness so bad they feel they’re dying
- skin mottled/discoloured/ashen
23
Q
What are the symptoms of sepsis in children? (4)
A
- no urine >12 hours
- skin abnormally cold
- rash not fade with pressed glass
- fever
- skin colour change
- difficulty walking
- vomiting
- fast breathing
24
Q
What are the clinical features of sepsis? (5)
A
- temp >38C or <36C
- heart rate >90
- respiratory rate >20
- WCC >12 or <4
- BP systolic <100
25
What bloods should you take for a patient with sepsis? (6)
- FBC
- U+E
- glucose
- CRP
- lactate
- cultures
26
What is the treatment of sepsis? (6)
- take blood cultures ideally before antibiotics
- take serum lactate
- give oxygen
- give empirical intravenous antibiotics
- give IV fluids
- monitor urine output
27
What are the synonyms for TMJ disorders? (4)
- TMJ pain dysfunction syndrome
- myofascial pain dysfunction
- facial arthomyalgia
- mandibular dysfunction
28
What are the types of TMJ classification? (3)
- no meniscal displacement
- anterior displacement of meniscus with reduction e.g clicks
- anterior displacement without reduction e.g locks
29
What is the management of TMJ disorders?(5)
- take time to explain and reassure patient
- remove the dental cause e.g traumatic occlusion
- advise soft diet/analgesics
- jaw exercises/physiotherapy/ice packs
- review 6 weeks
30
What could be the causes of TMJ pain? (6)
- arthritis
- pain of dental origin
- other systemic arthropathies
- atypical facial pain
- giant cell arteritis
- intracranial neoplasm
31
What are the classifications of oral ulceration? (6)
- traumatic
- iatrogenic
- idiopathic
- infective
- autoimmune
- neoplastic
32
What drugs can induce oral ulceration? (3)
- NSAIDs
- methotrexate
- nicorandil
33
What is methotrexate used for?
In the management of rheumatoid arthritis, lichen planus and skin conditions
34
Who is more likely to get RAs? (5)
- F>M
- childhood to 40 years
- white
- non smokers
- high socio economic status
35
What are the causes of recurrent apthous stomatitis? (4)
- stress
- menstrual cycle
- hypersensitivity to foods
- GI tract disease
36
Why does anaemia/haematinic deficiency predispose to mucosal disease? (3)
- epithelial atrophy
- compromised cell mediated immunity
- cytotoxity of leucocytes reduced
37
What investigations should you do for recurrent oral ulcerations? (3)
- full blood count
- haematinics
- immunology for coeliac disease
38
What is the oral presentation of crohns disease? (4)
- mucosal tags
- lip swelling
- full width gingival inflammation
- cobblestone mucosa
39
Why do you get recurrent oral ulceration in GIT disease in the stomach/small intestine? (2)
- chronic blood loss secondary to gastric/peptic ulceration
| - failure to absorb vitamin B12
40
What are the signs and symptoms of coeliac disease?(4)
- severe or persistent mouth ulcers
- unexplained iron, vitamin B12 or folate deficiency
- irritable bowel syndrome
- first degree relative of people with coeliac disease
41
What is the result of coeliac disease in infants 4-24 months? (3)
- reduced growth
- diarrhoea
- abdominal distension
42
What is the result of coeliac disease in adults? (4)
- abdominal discomfort
- bloating
- diarrhoea
- weight loss
43
What is the sequelae of coeliac disease? (5)
- anaemia secondary to iron deficiency and folate deficiency
- calcium deficiency
- vit D deficiency
- vit K deficiency
- GIT lymphoma
44
What is the treatment for coeliac disease?
Gluten free diet
45
How do you control ulceration in recurrent apthous stomatitis? (4)
- SLS free toothpaste
- chlorohexidine gluconate mouthwash
- hydrocortisone mucoadhesive buccal tablets 2.5mg
- doxycycline dispensable tablets as mouthwash
46
What are the investigations for cysts? (4)
- vitality test
- radiology
- aspiration of cyst contents
- biopsy
47
What are the contraindications for enucleation? (4)
- cyst is large
- involves a number of vital teeth
- difficult anatomical site
- involving a potentially useful unerupted tooth
48
Why do you need to eliminate dead space? (2)
- to reduce reactionary haemorrhage
| - to reduce post operative infection
49
How do you eliminate dead space? (4)
- drain placement
- procedures to collapse the walls of the cavity
- use of biological and other materials to fill the space
- use layered soft tissue closure or secondary intention
50
What are the disadvantages of enucleation? (4)
- infection
- incomplete removal of lining
- damages to adjacent teeth or antrum
- weakening of bone
51
What are the advantages of marsupialisation? (4)
- avoids pathological fracture
- treatment for medically compromised patients
- avoids damage to adjacent structures
- allows potentially useful teeth to erupt
52
What are the disadvantages of marsupialisation? (4)
- orifice closes and cyst reforms
- repeat visits
- manual dexterity and compliances
- complete lining not available for histology
53
Name 5 developmental epithelial odontogenic cysts
- dentigerous cyst
- eruption
- odontogenic keratocyst
- lateral periodontal
- gingival
54
What is the treatment for keratocysts? (4)
- enucleation
- curettage of cavity
- long term radiographic follow up
- en bloc resection
55
Name 2 epithelial non odontogenic cysts
- nasopalatine duct cyst
| - nasolabial cysts
56
What is the histopathology of aneurysmal bone cysts?
Consists of mass of blood filled spaces with scattered giant cells
57
What is an ameloblastoma?
Odontogeni tumour arising from a tooth forming structure. Essentially benign but can be locally aggressive and invasive
58
When would you do an excisional biopsy? (2)
- when there is small benign lesions
| - malignancies where primary repair is possible
59
What are the problems with biopsies? (4)
- inappropriate specimen
- specimen too small
- can't orientate specimen
- lab not informed for need for frozen section
60
What do frozen sections do?
Allow rapid diagnosis of malignancy within 1 hour
61
What is exfoliative cytology?
Removal of surface cells by scraping with a spatula or cytobrush
62
When would you do a labial gland biopsy?
Diagnosis of sjogrens syndrome
63
What is toluidine blue?
A cationic metachromatic dye that selectively binds in vivo to acidic tissue components of DNA and RNA
64
What is the vizilite system used for?
The vizilite system is used to detect the mucosal tissue undergoing metabolic or structural changes that by their nature have different absorbance and reluctance profiles when exposed to various forms of light sources
65
What concerns you about a lesion? (4)
- site
- size
- colour
- risk factors
66
Name 4 intra oral detection methods
- toluidine blue
- exfoliative cytology
- biopsy
- PDD
67
What are the changes in exfoliative cytology for oral cancer? (2)
- decreased CA
| - increased proliferation markers
68
What is the p53 wild type gene? (5)
- normal tumour suppressor gene
- half life 20 mins
- 393 amino acids
- cell cycle arrest
- repair or apoptosis
69
What is the p53 codon 72 gene? (3)
- loss of control
- no repair
- most common gene affected in cancer
70
How do you do a sentinel lymph node biopsy? (3)
- inject radioactive dye into cancer
- use device to identify radioactivity
- incise down onto node and remove for biopsy
71
What are synchronous 2nd primary tumours?
Within 6/12 index tumour
72
What are metachronous 2nd primary tumours?
More primary tumours >6/12
73
Name 4 potentially malignant lesions
- erythroplakia
- erythroleukoplakia
- leukoplakia
- erosive lichen planus
74
What is dyskeratosis congenital? (3)
- leukoplakia
- nail dystrophy
- increased skin pigmentation
75
What common pathology affect the salivary glands? (4)
- inflammatory disorders
- obstruction/trauma
- neoplasms
- autoimmune/degenerative
76
What are the systemic causes of bacterial sialadenitis? (4)
- immunosuppression
- medication
- dehydration
- irradiation
77
What is the acute management of sialadenitis? (4)
- antibiotics
- fluids
- sialogogues
- analgesics
78
What are the causes of sialolithiasis? (3)
- stasis of saliva
- mucous plug
- duct stricture
79
What are the symptoms of obstructive sialadenitis? (4)
- recurrent episodes of transient prandial salivary gland swelling
- no symptoms between attacks as saliva escapes from the gland
- the bigger the stone becomes the more severe the symptoms
- complete obstruction causes stasis of saliva and allows commensals from the oral cavity to enter the gland
80
What is the presentation of acute sialadenitis secondary to obstruction? (4)
- stasis allows ascending infection
- increasing painful swelling of 24-72 hours duration
- oral discharge of pus
- systemic manifestation
81
What are the investigations for salivary gland tumours? (4)
- radiographs
- FNA
- ultrasound
- CT/MRI
82
What are the indications for salivary gland surgery? (3)
- chronic pain
- repeated acute or chronic sialadenitis
- benign/malignant tumours +/- nerve reconstruction
83
What will the patient experience post removal of the submandibular gland? (4)
- pain, swelling, brusing
- scar
- numbness of tongue
- weakness of lower lip
84
What are the types of parotid surgery? (4)
- extra capsular dissection
- lobar resection
- superficial parotidectomy
- total parotidectomy
85
What are the post operative complications of salivary gland surgery? (4)
- facial nerve injury
- gustatory sweating
- numbness around ear lobe
- salivary fistula
86
How long does radiotherapy for oral cancer last?
Extends over 3-7 weeks with daily or week ends off
87
What are the side effects of chemotherapy?
- low rbc +/- abc +/- platelets
- mucositis
- impaired wound healing, bleeding, infection
- change in taste, tricky to swallow, halitosis
88
What are the side effects of radiotherapy? (4)
- osteoradionecrosis
- altered taste
- infection
- dental caries
89
What are the management strategies for oral mucositis? (4)
- bland rinses
- topical anaesthetics
- analgesics
- low level laser treatment
90
What are the management strategies for a sore mouth? (4)
- avoid strong foods
- eat bland, soft diet
- avoid alcohol MWs
- topical lignocaine, benzydamine HCL
91
What is the treatment for sialadenitis? (4)
- flucloxacillin or augmentin
- drain pus
- keep well hydrated
- encourage saliva flow
92
How does amifostine treat a painful mouth? (3)
- protects damage to salivary glands by radiotherapy
- promotes repair of damaged tissue
- bind to harmful free radicals
93
How does sucralfate treat a painful mouth?
Sucralfate treats a painful mouth as it is a sucrose sulphate aluminium complex that binds to the ulcer creating a physical barrier that protects the gastrointestinal tract and prevents the degradation of mucus
94
What does denosumab do?
Inhibits osteoclast function and bone resorption
95
What is osteoradionecrosis?
exposed irradiated bone that fails to heal over 3/12 without residual or recurrent cancer
96
What is the medical management of osteoradionecrosis? (4)
- 250mg tetracycline x4 day for 14 days
- then 250mg x2 for several months
- if severe infection add flagyl 200mg x3
- pentoxyfylline +tocopherol for 6/12
97
What does pentoxifylline do? (5)
- increases intracellular cAMP
- activates PKA
- inhibits TNF alpha and leukotriene synthesis
- reduces inflammation and innate immunity
- decreases blood viscosity and decreases potential for platelet aggregation and thrombus formation
98
What biological therapies can be used to treat oral cancer? (4)
- vaccines e.g perception
- anti angiogenic therapy
- anti p53 antibodies
- nivolumab immunotherapy
99
What does the biological therapy cetuximab do?
Blocks the surface of cancer cells that can trigger growth
100
How do biological therapies work? (3)
- stop cancer cells dividing
- seek out cancer cells and kill them
- get the immune system to attack the cancer cells
101
What are the indications for the use of foscan PDT? (4)
- licensed for palliative therapy
- failed or unsuitable for surgery
- failed or refused radiotherapy
- curative therapy
102
What are the potential problems of foscan PDT? (4)
- extravascular injection
- light deprivation
- immediate post operative pain
- depth of tumour necrosis limited
103
What are the potential benefits of foscan PDT? (4)
- possible under LA
- quick
- repeatable
- preserves aesthetics/function
104
In PDT how much foscan is given?
0.15mg/kg
105
What are the clinical effects of fiscal PDT? (4)
- impressive tumour reduction and necrosis
- marked reduction in trismus
- arrest of bleeding
- marked halitosis
106
What are the classifications of zygoma fractures? (7)
- type 1 undisplaced
- type 2 arch fracture only
- type 3 tripod fracture f-z suture intact
- type 4 tripod fracture f-z suture distracted
- type 5 blow out fracture only
- type 6 orbital rim fracture
- type 7 comminuted and other fractures
107
What are the symptoms of zygoma fractures? (4)
- pain
- numb cheek
- double vision
- restricted jaw movement
108
What are the signs of zygoma fractures? (5)
- swelling
- depressed cheek bone
- periorbital bruising
- surgical emphysema
- palpable deformity
109
What are the investigations for zygoma fractures? (5)
- radiographs 10 and 30 degrees
- CT
- ultrasound
- ophthalmology
- HESS chart
110
What are the advantages of CT scans over plain radiograms and tomograms? (4)
- no difficult positioning of patient
- no movement of cervical spine
- high quality images unaffected by soft tissue oedema and haemorrhage
- better definition of difficult to image areas
111
How do you tell if there is a blow out fracture of the orbital floor?
- diplopia test in 9 fields of gaze
- diplopia on upward gaze
- up gaze limitation on affected side
- pain on upward gaze
112
What is the classic presentation of orbital fractures in children?
Absence of subconjunctival haemorrhage with up gaze diplopia and general malaise
113
What are the radiographic features of a blow out fracture of the orbital floor? (4)
- step at infra orbital margin
- separation at f-z suture
- fracture at arch
- fracture at buttress
114
When do we do no treatment for fractures of the zygomatic complex? (4)
- no visual disturbance
- no restricted jaw movement
- no cosmetic problem
- patient refusal
115
When do we do treatment for fractures of the zygomatic complex? (4)
- displaced fracture
- trismus
- infra orbital nerve damage
- other injuries
116
Where is the location of open reduction and internal fixation? (5)
- fronto zygomatic suture
- infra orbital region
- zygomatic arch
- plates or wires
- antral pack
117
What post op instructions do you give for fractures of the zygomatic complex? (4)
- antibiotics
- avoid pressure to the face
- avoid contact sports
- avoid blowing nose
118
What are the complications of fractures of the zygomatic complex? (5)
- mal reduction or mal union
- asymmetry
- retrobulbar haemorrhage
- blindness
- infra orbital nerve damage
119
What is a le fort I classification?
Horizontal fracture of the maxilla immediately above the teeth and palate. It extends posteriorly to the pterygoid plate. It separates the dento alveolar complex from the nose and antrum
120
What is a le fort II classification?
Pyramidal fracture that passes across the bridge of the nose, through the infra orbital margin, around the zygomatic buttress to the pterygoid plate
121
What is a le fort III classification?
Separation of the entire mid face from the bones of the cranium. Extends from the nasal bone, through the bones of the orbit to the f-z suture. The zygoma also fractures. Fracture of the pterygoid plate
122
What are the clinical features of le fort I? (5)
- mobility of tooth bearing segment of the upper jaw
- crepitus in buccal sulcus
- palatal haematoma
- fractured teeth cusps
- bruising of upper lip and lower mid face
123
What are the clinical features of le fort II and III? (4)
- bilateral peri orbital bruising
- subconjunctival haemorrhage
- lengthening of face
- anterior open bite
124
What structures is the antrum of high more related to? (7)
- orbit
- infra orbital nerve
- nasolacrimal duct
- posterior teeth
- lateral wall of nose
- pterygopalatine fossa
- maxillary artery
125
What is the common pathology of the maxillary sinuses? (4)
- infective sinusitis
- non infective sinusitis
- fractures
- tumours/cysts
126
What is the presentation of acute infective sinusitis? (4)
- pain
- tenderness across area worsens on bending over
- posterior teeth TTP
- history of coloured discharge
127
What % of sinusitis is caused by a bacterial infection?
30-40%
128
What are the SDCEP guidelines for the management of sinusitis? (4)
- inhalations
- epinephrine nasal drops 0.5% tds for 1 week
- amoxicillin 250mg ads for 7 days
- doxycycline 100mg for 1 week (200mg on first day)
129
What are the causes of sinusitis? (2)
- mechanical obstruction of osmium
| - impaired mucous clearance
130
What is the treatment of chronic sinusitis? (2)
- drainage
| - metronidazole with amoxicillin/erythromycin
131
What are the complications of sinusitis? (3)
- brain abscesses
- orbital cellulitis
- cavernous sinus thrombosis
132
What are the causes of oro antral communication? (4)
- extraction of posterior teeth
- tuberosity fracture
- middle third fracture
- malignancy/pathology
133
What happens if oro antral communication is untreated?
A fistula develops which can cause persistent sinusitis, unilateral nasal discharge, intra oral antral polyp, caogausia and facial pain
134
What do you do if you create an oro antral communication? (5)
- close with a buccal advancement flap
- plate or modified denture
- antibiotics, ephedrine drops, mucolytic inhalations
- avoid nose blowing
- if communication of treated than 5mm spontaneous closure unlikely
135
What is non infective sinusitis?
Mucosal inflammation due to atopy, upper airway obstruction, undiagnosed foreign bodies, syndromes
136
Name 3 cell wall synthesis inhibitors
- cephalosporins
- carbapenums
- monobactums
137
What are the features of penicillins time dependant killing? (3)
- prefer dividing bacteria
- take time for the inhibition process and eventually microorganisms rupture
- high blood levels
138
What are the indications for penicillin? (4)
- spreading infection/cellulitis/lymphadenopathy/fever/malaise
- pen G reserved for severe infection
- oral route compromise
- beware beta lactamase producing
139
What are the immediate reactions to penicillin? (4)
- nausea/vomiting
- erythema
- wheeze
- hypotension
140
What are the delayed reactions to penicillin? (4)
- blood dycrasias
- haemolytic anaemia
- leukopenia
- thrombocytopenia
141
What are the autoimmune reactions to penicillin? (4)
- eosinophilia
- stevens johnson syndrome
- exfoliative dermatitis
- toxic epidermal necrolysis
142
What are the risk factors for a penicillin reaction? (3)
- multiple drug reactions
- atopic disease
- skin testing
143
Why is recurrent allergy for penicillin higher in those with repeated exposure short term or long IgE expression??
Because serum IgE antibodies are often retained for 10-1000 days
144
What is the dose of penicillin G?
1.2g
145
What is the resistance of penicillin? (3)
Reduced PBP- altered configuration
Beta lactamase- hydrolysis
Tolerance- disable autolysis mechanism
146
What are the common effects of penicillin? (3)
- diarrhoea
- nausea
- skin rash
147
What are the uncommon effects of penicillin? (2)
- vomiting
| - urticaria and pruritus
148
What are the very rare effects of penicillin? (4)
- diarrhoea
- black hairy tongue
- neutro/leuco/thrombocytopenia
- increased PT/INR/bleeding
149
What are the alternatives to penicillin? (4)
- metronidazole
- clarithromycin
- erythromycin
- clinamycin
150
What is amoxicillin associated with?
Diarrhoea and C diff associated colitis
151
What is the mechanism of action of metronidazole? (4)
- inhibits DNA replication
- fragment existing DNA
- penetrate cells equally
- enzymatic reduction
152
What is the spectrum activity of metronidazole? (3)
- obligate anaerobes
- gram -ve pathogens
- bactericides
153
What are the types of bacteria metronidazole has activity on? (4)
- clostridium
- fusobacterium
- prevotella
- peptostreptococcus
154
What is the distribution of metronidazole? (4)
- wide volume distribution
- penetrates saliva
- CNS penetration
- foetal circulation
155
What are the dental indications for metronidazole? (3)
- acute necrotising forms of gingivitis
- pericoronitis
- dental abscess
156
What are the interactions of metronidazole? (6)
- disulfiram
- phenytoin
- phenobarbital
- cimetidine
- lithium
- warfarin
157
What are the main adverse effects of metronidazole? (4)
- compulsive seizure
- nausea, vomiting, anorexia, diarrhoea
- peripheral neuropathy
- thrombocytopenia
158
What are the oral effects of metronidazole? (5)
- unpleasant taste
- furred tongue
- glossitis
- stomatitis
- candida
159
What is the half life of metronidazole?
8 hours
160
What things does the outcome of infection depend on? (4)
- virulence of organism involved
- host resistance to infection
- local anatomy
- treatment of infection
161
What local factors does host resistance depend on? (3)
- anatomical site
- mucosal barriers
- local immune response
162
What systemic factors does host resistance depend on? (6)
- age
- stress
- pregnancy
- underlying host pathology
- nutritional state of host
- type of drug therapy
163
What are the indications for antibiotics to be used with abscesses? (4)
- systemic involvement
- significant cellulitis
- compromised host defences
- involvement of fascial spaces
164
When should you refer an odontogenic infection? (6)
- rapidly progressing infection
- difficulty in breathing
- difficulty in swallowing
- involvement of fascial tissue spaces
- temp >39*C
- severe trismus
165
What are the symptoms of infection in the infra temporal space? (3)
- severe trismus
- bulging of the temporalis
- cavernous sinus thrombosis
166
What are the sites of drainage we would use local anaesthetic as opposed to general anaesthetic? (3)
- palate
- sublingual space
- buccal/labial sulcus
167
What is the result of ludwigs angina? (6)
- board like swelling floor of mouth
- elevation of tongue
- dysphagia
- dysarthria
- trismus
- glottal oedema
168
What nerves/arteries does an infected cavernous sinus affect? (5)
- internal carotid artery
- abducent nerve
- oculomotor nerve
- trochlear nerve
- trigeminal div I and II
169
What types of swelling can an upper 6 have? (4)
- palatal swelling
- maxillary sinusitis
- intra oral swelling
- facial swelling
170
How is pain detected? (4)
- nociceptors
- a delta and c fibres
- modulated a beta
- modulated spinal mechanisms
171
What is the definition of analgesia?
An insensibility to pain without loss of consciousness. A state in which painful stimuli are to perceived or interpreted as pain
172
What are the classifications of analgesics? (5)
- specific
- conventional analgesic
- unconventional analgesic
- analgesic adjuncts
- non pharmacological
173
Name 2 specific analgesics
- antacids
| - vasodilators
174
What should you consider when you prescribe? (5)
- diagnosis
- potency
- onset and duration
- patient and drug factors
- route of administration
175
What are the enteral routes of administration? (3)
- oral
- buccal/sublingual
- rectal
176
Name 4 topical routes of administration
- mucosal
- cutaneous
- nasal
- conjunctival
177
What is aspirins therapeutic activity? (4)
- anti pyrexic
- anti platelet
- anti inflammatory
- analgesic mild/moderate
178
What are the indications for aspirin? (4)
- acute pain
- dental pain
- rheumatic fever
- rheumatoid arthritis
179
What are the side effects of aspirin? (5)
- ulcerogenesis
- prostaglandin inhibition
- decreased mucous production
- decreased acid production
- influence cell permeability H+
180
What drugs do aspirin interact with? (7)
- anticoagulants
- antihypertensive
- antidepressants
- anti epileptics
- NSAIDs
- thrombocytes
- steroids
181
What is the standard adult dose of aspirin?
300-900mg 4-6 hourly with a max of 4g daily
182
What is the half life of paracetamol?
2-4 hours
183
What is the standard adult dose for paracetamol?
10/15mg/kg every 4-6 hours
184
What drugs can interact with paracetamol? (7)
- st johns wort
- carbamazepine
- rifampicin
- alcohol
- phenobarbital
- phenytoin
- primidone
185
How much paracetamol is needed to be fatal?
25 grams
186
What are the side effects of a paracetamol overdose? (4)
- nausea and vomiting
- haemorrhage
- hypoglycaemia
- cerebral oedema
- death
187
What are the indications for morphine use? (3)
- acute severe pain
- cough suppression
- touch, pressure, vision
188
What are the unwanted effects of morphine? (4)
- nausea
- respiratory depression
- constipation
- confusion in the elderly
189
What is the maximum daily dose of morphine?
100mg
190
What are the contraindications for prescribing morphime? (5)
- suspected head injury
- acute alcoholism
- reduced respiratory
- overdose
- hypersensitivity
191
What is the therapeutic activity of codeine?
agonist at opiod receptors
192
What is the standard adult dose for codeine?
30-60mg 4-6 hourly (max of 240mg in 24h)
193
How does codeine produce an analgesia effect?
By being metabolised in the liver to form morphine
194
What are the contraindications of codeine use?
NSAIDs
195
What is the half life of codeine?
3 hours
196
What are the side effects of codeine? (3)
- nausea
- hypotension
- urticaria
197
What are the interactions of codeine? (4)
- alcohol
- antihistamines
- anxiolytics and hypnotics
- antipsychotics
198
Deficiency in bleeding is due to what? (4)
- coagulation factor
- platelets
- vascular
- drug therapy
199
If bleeding continues when should you refer? (2)
- blood pressure decreases less than 100/60
| - heart rate >100bpm
200
What post op advice can you give in the 1st 24hours after extraction? (4)
- dont rinse
- start HSMW 24hrs later
- if bleeds put pressure with clean cloth
- avoid alcohol, strenuous exercise and smoking
201
What should you do if the tuberosity fractures? (3)
- if fragment is small, remove it
- if there is a pulpal infection, remove tooth and check for OAC
- if the tooth is not carious, splint and surgically remove
202
What are the risk factors for a dry socket? (6)
- the pill
- radiotherapy
- previous dry socket
- Md extractions
- smokers
- females
203
What can happen if a retained root is pushed into the Mx antrum? (4)
- may resorb
- may fibrose
- may cause infection
- may become and antrolith
204
Why would you get a false -ve to no response in pulp sensibility testing? (3)
- calcified canal
- immature apex
- recent trauma
205
What are the types of cold test? (3)
- ethyl chloride
- dichlorafluoromethane
- ice sticks
206
What are the types of heat test? (3)
- hot water
- gutta percha heated in flame
- rotation of rubber trophy cup
207
Why would you get a false positive to an electric pulp test? (4)
- electrode makes contact with gingiva or large amalgam restoration
- patient is anxious
- tooth is not dry or isolated well
- liquefaction necrosis
208
Why would you get false negatives to an electric pulp test?
- patient is premeditated
- inadequate contact with enamel
- trauma
- canal is calcified
- apex is immature
- partial necrosis
209
What is laser doppler flowmetry?
An objective test of the presence of mixing red blood cells within a tissue
210
What is the procedure for laser doppler flowmetry?
Laser light transmitted to the dental pulp by fibre optic against tooth structure
211
What are the uses of laser doppler flowmetry? (4)
- traumatic teeth
- pulp tyrosine on children
- revascularisation of replanted teeth
- differential diagnosis of periapical radiolucencies
212
Why is pulp capping less successful in older patients?
Because pulpal blood supply decreases reducing the regenerative capacity and response to pulp capping
213
What is condensing osteitis?
The tooth will have an etiological factor for low grade, chronic inflammation such as necrotic pulp, extensive restoration or crack
214
Give 5 indications for peri-radicular surgery
Under obturated canal, over obturated canal so excess material in the peri-apical tissues, fracture instruments in the canal, peri-apical pathology for biopsy, anatomically difficult root canals to obturate, correct procedural errors, exploratory surgery
215
Give 2 factors that have a direct effect on the success of peri-radicular surgery.
Quality of endodontic treatment and coronal seal
216
Why is the apical tissue removed in periradicular surgery?
Removes the apical delta area that harbours bacteria causing the infection
217
What effect does lateral canals have on the outcome of surgery?
Can have a detrimental effect if these are lower than the apical 3mm as bacteria can survive and cause persistent infection
218
Give 5 ideal properties of retrograde root filling materials
a. Well tolerated by apical tissues
b. Bactericidal or bacteriostatic
c. Adhere to tooth
d. Dimensionally stable
e. Easy to handle
f. Do not stain
g. Noncorrosive
h. Do not dissolve
i. Promote cementogenesis
j. Radiopaque
219
What type of flap is preferred for the best aesthetic outcomes in periradicular surgery?
Papilla sparing or Levart Flap
220
What kind of suture material is used for periradicular surgery?
Non-resorpable monofilaments like 4/0 or 5/0 prolene or ethilon
221
What should you warn your patient about when doing periradicular surgery around a crowned tooth?
Gingival recession and exposed roots – poor aesthetics
222
How successful is repeat peri-radicular surgery?
Not very about 33%
223
What is the commonest cause of osteomyelitis?
Spread of infection from an odontogenic focus
224
Other than odontogenic sources of infection how else could osteomyelitis develop?
Penetrating injuries, fractures of the mandible including pathological, anything that affects the blood supply like radiotherapy or metabolic bone diseases like Paget’s, MRONJ any immunocompromised condition e.g renal transplant case
225
What is a sequestrum?
A section of dead bone
226
What is an involucrum?
a layer of new bone growth outside existing bone
227
What is meant by a pathological facture?
A fracture in an area of diseased bone or in the presence of pathology that has weakened the architecture of the bone rendering more prone to fracture
228
What is the difference between acute purulent osteomyelitis and acute osteomyelitis?
The purulent form produces pus
229
How does chronic osteomyelitis differ from acute osteomyelitis?
Chronic OM has low grade symptoms of long duration with attempts being made at bone healing whereas the acute from present like an odontogenic abscess with significant pain and swelling and lack of mandibular function
230
How does radiotherapy cause necrosis of the jaw bone?
Damages the blood supply to the bone (endarteritis obliterans) and also suppression of osteoclasts and reduced ability of fibroblasts to produce collagen
231
How long after radiotherapy is complete does the risk of necrosis disappear?
it does not reduce over time or disappear
232
What 2 treatments can be offered to a patient who has had head and neck radiotherapy who needs a tooth extracted to try to reduce the risk of necrosis?
Medication – pentoxyphylline + tocopherol (+clodronate) or hyperbaric oxygen therapy
233
What is meant by a drug holiday?
When the patient stops taking the drug for a period of 3 months before the dental treatment
234
What epithelial remnants do cysts of the jaws develop from?
Remnants of the root sheath of Hertwig, the dental lamina and the reduced enamel epithelium
235
What 2 cysts are associated with vital teeth?
Periodontal cyst, paradental cyst, dentigerous cyst
236
On a radiograph what size does an apical area represent a cyst?
More than 6mm
237
Name 3 cyst like radiolucency’s commonly found at the angle of the mandible.
Dentigerous
Keratocyst
Ameloblastoma
238
What cyst has a potential for recurrence and why?
Keratocyst due to friable cyst lining, growth in an AP direction between the bone trabeculae making it difficult to remove, friable lining and the presence of daughters cysts in the lining
239
How does a keratocyst behave differently to a dentigerous cyst?
Keratocysts grow much faster with a high proliferative rate, generally grow in an AP direction with a thin friable membrane that is difficult to enucleate intact and may or may not involve a tooth. Dentigerous cysts always involve a tooth are attached at the ACJ and are slow growing in 3D and are easy to enucleate as the membrane is thick.
240
What area on a lesion would you take an incisional biopsy?
The worse looking part that is representative of the lesion
241
What lesions are treated by an excisional biopsy?
Simple small benign lesions like polyps
242
What is meant by mapping biopsies?
Taking multiple biopsies for the same lesion as the lesion is heterogeneous in appearance e.g speckled so one area does not represent the whole lesion
243
What is a punch biopsy?
An incisional biopsy taken using a circulate blade that punches out a circle of mucosa
244
When might a frozen section be required?
During surgery to establish if all of the tumour is removed and for immunofluorescence for vesiculo-bullous conditions
245
What is meant by the terms sessile and pedunculated?
Sessile means the lesion has a flat base whereas pedunculated means it has a small stalk at the base
246
What is meant by sensitivity and specificity of diagnostic tests?
sensitivity is the ability of a test to correctly identify those with the disease (true positive rate), whereas test specificity is the ability of the test to correctly identify those without the disease (true negative rate)
247
What suture material would you use to close a biopsy wound?
4/0 vicryl rapide
248
How quickly should a traumatic ulcer heal?
2 weeks
249
When does the maxillary antrum develop in the foetus?
3rd month intrauterine life
250
What volume is the average adult maxillary antrum?
3.5x2.5x3.2cm
251
What is the 3 dimensional shape of the maxillary antrum?
Pyramidal with the base forming the lateral wall of the nose
252
Where is the ostium of the maxillary antrum?
2/3rd up the medial wall of the antrum draining to the middle meatus measuring 2.4 mm
253
What type of lining has the maxillary antrum?
Respiratory ciliated columnar epithelium
254
What is the commonest infection of the maxillary antrum?
Respiratory viral infection
255
What percentage of antral infections are odontogenic in origin?
10%
256
What is the difference between an OAC and an OAF?
An AOC is a communication between the maxillary sinus and the mouth usually after the extraction of a molar tooth whereas an OAF is an OAC that has persisted so that there has been epithelial growth along the defect such that there is continuity between the lining of the mouth and the antrum and this is a fistula
257
What is the commonest site of fracture and why?
Condyle as it is a point of weakness designed to facture in preference to transmitting the force of the impact to the cranium
258
What factors determine whether a fracture is displaced?
Muscle pull and the pattern of fracture if it is favourable the muscles hold the two ends of the fracture together if it is unfavourable the muscle pulls the ends of the bone apart
259
What is a guardsman’s fracture?
Bilateral condylar fractures and a symphyseal facture caused by a direct impact on the chin
260
What is a bucket handle fracture?
Bilateral parasymphyseal fractures of an edentulous mandible
261
What does a lateral open bite indicate the pattern of fracture might be?
Displaced condylar fracture on the contralateral side
262
What does an anterior open bite indicate the pattern of fracture might be?
Bilateral displaced condylar fracture or a condyle and a contralateral displaced body or angle fracture
263
What is meant by management using a closed technique?
Inter maxillary fixation- wire the jaws together
264
When might you manage a fracture of the condyle with an open technique?
Fracture dislocation or a badly displaced condylar neck fracture or a bilateral fractured condyle
265
Who developed the principles that guide the placement of the plates?
Champs
266
What are 3 sequelae of delayed presentation of a displaced fractured mandible?
Infection, fibrous union, mal-union, non-union, malocclusion
267
What percentage of TMJ disease is treated surgically?
5%
268
What is the sensory innervation of the TMJ?
auriculotemporal and masseteric branches of V3 or mandibular branch of the trigeminal nerve.
269
Which joint space is accessed for arthrocentesis?
The superior joint space
270
What is the difference between arthroscopy and arthrocentesis?
Arthroscopy involves using endoscope to access the superior joint space to investigate it but when you wash out the joint to break down any fibrous adhesions this is arthrocentesis
271
List 3 indications for TMJ surgery
Degenerative TMJ conditions such as psoriatic arthropathy, recurrent dislocation, internal derangement without reduction, condylar hyperplasia
272
Give 3 signs that would indicate TMJ surgery would be beneficial.
Closed lock of the TMJ, chronic unmanageable pain, recurrent uncontrolled dislocation
