Oral surgery - All Flash Cards

Question 1

• What are the 4 wrong site surgery prevention protocol?

Answer 1

1. Confirm; I see you are here for an extraction today, is that correct?
2. Can you tell me which tooth it is?
3. Can you point to the tooth please?
4. Check accuracy with clinical records

Question 2

• During an extraction, you read on the pink sticker that the tooth to be extracted is grossly carious. How can this tooth cause problems when being extracted?

Answer 2

A tooth that is grossly carious will make it prone to breaking when force is applied to the forceps. This may require the use of other instruments to open pockets or the need of surgical intervention.

Question 3

• What must be completed before giving LA or sedation

Answer 3

the dental surgical safety checklist

Question 4

• What four details need to be written down on the x ray boards whilst setting up for an extraction?

Answer 4

1. Name
2. CHI Number
3. Tooth to be extracted
4. PMH

Question 5

• Why is the PMH so important before and extraction is carried out?

Answer 5

Patients PMH may influence treatment such as, Anticoagulants and bisphosphonates.

Question 6

• What would you want to look out for when reading through the PDH before doing an extraction?

Answer 6

Problems with previous extractions such as, difficult extractions, bleeding, infection and dry socket.

Question 7

• Describe the position of the dental chair when undergoing an upper tooth extraction?

Answer 7

Chair position between shoulder and elbow height, lying back 45 degrees.

Question 8

• Describe your position when performing an upper tooth extraction?

Answer 8

Infront, to right of patient (if right-handed)

Question 9

• Describe the position of the dentist when extracting a lower right tooth

Answer 9

Behind, right side for lower right (if right-handed)

Question 10

• What is the purpose of elevators?

Answer 10

To expand socket and loosen tooth

Question 11

• What are the ten post op instructions you would give to a patient after an extraction

Answer 11

1. Avoid rinsing mouth for 24 hours (establish a clot, prevent dry socket)
2. Avoid alcohol today – (increases bleeding)
3. Avoid smoking – (prevent dry socket)
4. Bite on clean cotton for 15 mins if bleeds
5. How to contact you for advice if problems
6. Explain use of HSMW
7. Don’t bite lip
8. Give analgesic advice
9. Avoid strenuous exercise
10. Need for review

Question 12

• What are the 6 potential post op problems expected?

Answer 12

1. Pain – to be expected
2. Bleeding
3. Bruising
4. Swelling
5. Infection
6. Dry sockets (alveolar osteitis)

Question 13

bone turnover is regulated by which hormones?

Answer 13

parathyroid hormone,

calcitriol,

calcitonin,

sex hormones,

growth hormone,

thyroid hormone,

and cortisol

Question 14

bone turnover involves which two cells

Answer 14

Involves osteoblasts and osteoclasts

Question 15

what are the 5 phases in remodelling

Answer 15

1. Activation
2. Osteoclast recruitment and resorption
3. Reversal
4. Osteoblast recruitment and bone formation
5. Termination – quiescence (stable)

Question 16

A genetic disorder causing an abnormality of the bone, in which results in a defect of collagen formation, affecting the whole skeleton is known as?

Answer 16

osteogenesis imperfecta

Question 17

a genetic disorder causing an abnormality of the bone that results in excess osteoclastic bone resorption is known as?

Answer 17

osteopetrosis

Question 18

which abnormality of the bone is common in women undergoing post-menopausal

Answer 18

osteoporosis

Question 19

what can the long term high dose of steroids such as prednisolone induce

Answer 19

glucocorticoid-induced osteoporosis

Question 20

which bone abnormality is a chronic problem in which scar-like tissue grows in place of normal bone?

Answer 20

fibrous dysplasia

Question 21

which condition of the thyroid results in the increase turnover of bone?

Answer 21

hyperparathyroidism

Question 22

which other group of drugs are known to cause abnormalities of the bone?

Answer 22

Bisphosphonates

Question 23

Following extractions there is a physiological osteoclastic bone resorption. When we extract a teeth, we rely on the alveolar bone which houses the bone to mobilised and used elsewhere.

The greatest amount of bone loss is in the horizontal dimension and occurs mainly on the facial aspect of the ridge.

There is also loss of vertical ridge height, which has been described to be the most pronounced on the buccal aspect.

This resorption process results in a narrower and shorter ridge and the effect of this resorptive pattern is the relocation of the ridge to a more palatal/lingual position

What is the clinical relevance?

Answer 23

• The remodelling process takes 6 months
• Provision and design of bridges
• The need for immediate dentures
• The timing of dental implant placement

Question 24

Drugs that affect bone remodelling

Answer 24

1. Bisphosphonates
2. Denosumab and anti-angiogenic drugs
3. Steroids
4. NSAID’s

Question 25

* Are a non-metabolised analogues of pyrophosphate that are capable of localizing to bone and inhibiting osteoclastic function which drug is being described

Answer 25

bisphosphonates

Question 26

why can high concentrations of bisphosphonates be maintained within bone for long periods

Answer 26

bisphosphonates are not metabolised therefore these high concentrations are maintained within bone for long periods of time (approximately 10 years)

Question 27

* What is the pathway of endochondral ossification?

Answer 27

Cartilage -\> calcified cartilage -\> bone

Question 28

* Which of the three bone cells is derived from a haemopoietic source and is large multinucleate cell

Answer 28

Osteoclasts

Question 29

* What is the name given to trapped osteoblasts?

Answer 29

Osteocytes

Question 30

* Bone turnover is a continuous remodelling cycle that involves resorption and deposition, which helps keep the skeleton effectively engineered for its use and helps maintain Ca2+ levels. How long does it take bone to be completely replaced?

Answer 30

10 years

Question 31

* How much calcium is in our body?

Answer 31

1kg calcium in body. 99% in bones and teeth and 1% in body fluids.

Question 32

* What are the 7 roles of calcium in our body?

Answer 32

1. Membrane permeability 2. Excitation – contraction coupling 3. Excitation – secretion coupling 4. Hard tissue formation 5. Blood clotting 6. Enzyme reactions 7. Secretions – e.g. milk

Question 33

* Which gland is stimulated by increasing plasma calcium?

Answer 33

Thyroid gland

Question 34

* What is the name of the hormone that is released when there is an increase in plasma calcium levels, which gland releases it and what is the function of the hormone?

Answer 34

Calcitonin Thyroid gland Kidney increased Calcium excretion and bone stimulates calcium deposition

Question 35

* Which gland is stimulated by decreasing plasma calcium?

Answer 35

Parathyroid gland

Question 36

* What is the name of the hormone that is released when there is a decrease in plasma calcium levels, which gland releases it and what is the function of the hormone?

Answer 36

Parathyroid hormone Parathyroid glands Kidney decreases Ca excretion Bone stimulates Ca release

Question 37

* which hormone is responsible for preventing HYPOCALAEMIA?

Answer 37

Parathyroid hormones

Question 38

* parathyroid hormones act quickly to breakdown small labile pools of CA2+ in bone, which involves osteocytes, the rapid breakdown in bone is known as?

Answer 38

Osteocytic osteolysis.

Question 39

* Which vitamin is essential for the absorption of Ca2+ in the intestine?

Answer 39

Vitamin D

Question 40

* Where would you be standing if you were extracting a lower right 6?

Answer 40

Standing behind the patient

Question 41

* What push must you apply before you apply any buccal and back movements to remove a tooth?

Answer 41

Apical push

Question 42

* What is the purpose of the upper cow horn/eagle beak forceps?

Answer 42

Designed for badly broken tooth, better engagement with the furcation of the roots.

Question 43

* Name the forcep and its function?

Answer 43

lower universal forcep - capable of removing all teeth from the lower quadrants.

Question 44

* Name the forcep and its function?

Answer 44

lower molar forcep - more specialised compared to the lower universal forcep through the conformation of the beaks.

Question 45

* Name the forcep and its function?

Answer 45

lower cow horn forcep - used to engage with roots of badly broken tooth

Question 46

which tooth would you typically use the lower universal forceps on

Answer 46

from 3- 3

Question 47

* Name the forcep and its function?

Answer 47

upper universal forcep - can be used to remove all upper tooth, if roots are well enegaged

Question 48

* Name the forcep and its function?

Answer 48

upper right and left molar forcep - used in correspondance for the extraction of upper molars. upper molars have two roots bucally and 1 root palatally.

Question 49

What is the term given for infections arising from tooth tissue

Answer 49

odontogenic infection.

Question 50

Caries, peri-apical periodontitis, periodontitis, pericoronitis, osteomyelitis, maxillary sinusitis are examples of what type of infection:

Answer 50

odontogenic infection.

Question 51

Osteomyelitis is more common in the mandible or the maxilla?

Answer 51

Mandible

Question 52

What is meant by sequelae:

Answer 52

a condition which is the consequence of a previous disease or injury. “the long-term sequelae of infection”

Question 53

What are collagenases:

Answer 53

collagenases are enzymes that break the peptide bonds in collagen.

Question 54

What is collagenases role in infection:

Answer 54

collagenase will help breakdown surrounding structures, to help facilitate spread

Question 55

What type of patients are more likely to get spread of infection orally:

Answer 55

immunocompromised and diabetic patients.

Question 56

How does someone having head and neck radiotherapy affect the spread of infection:

Answer 56

head and neck radiotherapy affects the local vasculature, which makes blood supply to the area compromised. Nutrients and host defence is delivered via the vasculature. If your vasculature is compromised then your most likely to have more significant infections, and consequence of infections.

Question 57

What is the significance of the buccal, lingual plate in relation to the apex of the tooth, and the spread of infection?

Answer 57

The buccal and lingual plate are relatively thin and in close proximity to the apex, making the spread of infection easier to pass.

Question 58

Why would antibiotic not work effectively when the source of infection is coming from a non-vital tooth?

Answer 58

The antibiotic needs to be delivered to the source of infection via blood vessels. A non-vital tooth will not have a vascular supply.

Question 59

How many potential routes are there for a maxillary tooths spread of infection?

Answer 59

5 routes 1. Buccal sulcus 2. Buccal space 3. Antrum space, maxillary sinus 4. Nasal passage 5. Palatal swelling

Question 60

How many potential routes are there for a mandibular tooths spread of infection?

Answer 60

4 routes 1. Buccal sulcus 2. Submandibular space 3. Sublingual space

Question 61

A patient presenting with a large facial swelling, with very minimal collection of pus can be diagnosed as which condition?

Answer 61

Cellulitis

Question 62

This patient Is showing symptoms of cellulitis, the spread of infection has spread to the orbital region, why is this worrying?

Answer 62

Patient Is showing signs of peri-orbital oedema, this will allow if not treated, the spread of infection to reach the cavernous sinus, which can result in cavernous sinus thrombosis.

Question 63

What is cavernous sinus thrombosis?.

Answer 63

Cavernous sinus thrombosis (CST) is the formation of a blood clot within the cavernous sinus, a cavity at the base of the brain which drains deoxygenated blood from the brain back to the heart

Question 64

Where would you expect to find the collection of pus, in this patient with cellulitis?

Answer 64

The swelling presented on the patient Is from the body’s reaction to the infection. The pus location in cellulitis patients is commonly localised to the tooth responsible for the initial infection.

Question 65

What would we be worried about if the spread of infection in the mandible was close to the laryngeal inlet?

Answer 65

The laryngeal inlet is the opening that connects the pharynx and the larynx. If the spread of infection was in this proximity, then we would be worried about asphyxiation.

Question 66

What can cause mediastinitis?

Answer 66

If the spread of infection caused in the mandible region progresses inferiorly towards the pharyngeal inlet, and passes through either the pretracheal, prevertebral, or the retropharyngeal space, which ultimately leads down to the chest.

Question 67

What Is Ludwig’s angina?

Answer 67

Ludwig's angina is a rare but serious bacterial skin infection that affects your mouth, neck, and jaw. Considered a type of cellulitis, Ludwig's angina spreads rapidly to infect the soft tissues underneath your tongue. This serious condition is more common in adults than children.

Question 68

Sepsis should be defined as life threatening organ dysfunction caused by a dysregulated host response to infection. What are the symptoms of sepsis (from the lecture)

Answer 68

1. Slurred speech 2. Extreme shivering 3. Passed no urine in a day 4. Severe breathlessness 5. Illness so bad they feel like they’re dying 6. Skin mottled/discoloured/ashen 7. Rash doesn’t blanch with pressure 8. Cyanosis of lip/skin/tongue

Question 69

Any patient presenting with sepsis will have a temperature of what?

Answer 69

Temp \>38 degrees or \<36 degrees

Question 70

Any patient presenting with sepsis will have a heart rate of what?

Answer 70

\>90 (high risk \>130/min)

Question 71

Any patient presenting with sepsis will have a respiratory rate of what?

Answer 71

Respiratory rate \>20 (high risk \>25 breaths /min)

Question 72

Any patient presenting with sepsis will have a WCC of what?

Answer 72

WCC \>12 or \<4

Question 73

Any patient presenting with sepsis will have a BP systolic of what?

Answer 73

BP systolic \<100 (high risk \<90)

Question 74

How would you manage sepsis before giving antibiotics?

Answer 74

Take blood cultures ideally before antibiotics to determine causative pathogen.

Question 75

What is a serum lactate test?

Answer 75

This test measures the level of lactic acid, also known as lactate, in your blood. Lactic acid is a substance made by muscle tissue and by red blood cells

Question 76

A lactate result of \>2mmol/l would indicate what?

Answer 76

Would indicate sepsis as the normal value is 1.5 mmol/l

Question 77

Principles of management of odontogenic infection: how would eliminate the cause of the infection ASAP?

Answer 77

Extirpate the pulp or extract the tooth.

Question 78

How would you provide a path of least resistance for pus?

Answer 78

Incision and drainage.

Question 79

How long would you weight to review your patient after local measures were practiced for an odontogenic infection?

Answer 79

48-72 hours.

Question 80

If you have eradicated the source of odontogenic infection, would it be appropriate to prescribe antibiotics for management?

Answer 80

No – unless patient is immunocompromised.

Question 81

If an odontogenic infection produces pus, and can track through the alveolus, it will eventually erupt through the mucosa causing a?

Answer 81

communication between the end of the tooth and oral cavity, allowing for pus to discharge from this tract.

Question 82

This communication is currently lined with granulation tissue, which is not yet epithelialized meaning it is a sinus. When a sinus is formed what does this tell us about the stage of the infection?

Answer 82

Because it has not epithelialized it is been there for a long time, therefore it is a chronic infection.

Question 83

Which tooth is responsible for the formation of the sinus?

Answer 83

The lateral incisor as the apex of the canine root is positioned much higher than the sinus.

Question 84

Due to the positioning of the apex of the tooth in relation to the bone and overlying muscles allows the pus to track back extra orally through the skin, this results in the formation of a?

Answer 84

orocutaneous fistula.

Question 85

What is a fistula?

Answer 85

Is an epithelial line tract connecting two body cavities.

Question 86

Erosion of bone caused by a build up of pus above the attachment to buccinator, most commonly maxillary molars result in what type of infection?

Answer 86

Buccal space infection.

Question 87

Which blade would be used for incising through mucosa and periosteum for pus drainage?

Answer 87

No 11 blade

Question 88

What is a culture sensitivity testing?

Answer 88

During the incision of a swelling, puss is drained and then collected and sent away for culture, to determine the pathogen responsible, so a specific antibiotic can be given for treatment.

Question 89

Most abscesses are anaerobic, which antibiotic would be recommended?

Answer 89

Metronidazole AB of choice.

Question 90

If there is a severe infection how would you prescribe antibiotic for general measures?

Answer 90

Combine metronidazole and penicillin V in severe infections.

Question 91

Why are we trying to move away from prescribing amoxicillin?

Answer 91

Because it is a broad-spectrum antibiotic. We tend to use a narrow spectrum antibiotic such as penicillin V.

Question 92

Which method is used to break down the locules of puss?

Answer 92

Hiltons method

Question 93

Elevators are known as?

Answer 93

Couplands

Question 94

How many sizes do couplands come in?

Answer 94

3 1 being the narrowest and 3 being the broadest

Question 95

What are couplands used for?

Answer 95

Used to facilitate extractions by widening the neck of the tooth, can also be used to elevate tooth as well.

Question 96

What is the difference between a couplands and a luxator?

Answer 96

A luxator is only used to facilitate extractions by widening the socket, through an axial movement.

Question 97

How many forms are there to warwick james?

Answer 97

Three forms, left right, straight.

Question 98

When would the removal of retained roots become a surgical procedure?

Answer 98

Retained roots below the alveolar bone, so no point of application for elevators.

Question 99

What is meant if you have an ectopic tooth?

Answer 99

A tooth that is in abnormal place.

Question 100

What is the definition: occurs when there is prevention of complete eruption into a normal functional position due to lack of space or development in an abnormal position. This predisposes to pathological changes. this can involve only soft tissues or hard and soft tissues.

Answer 100

– impaction.

Question 101

If a tooth is malpositioned due to congenital factors, then it is referred to as?

Answer 101

Ectopic

Question 102

If a tooth is malpositioned due to presence of pathology, then it is referred to as?

Answer 102

Displaced

Question 103

When a tooth is entirely covered by soft tissue and partially/totally covered in alveolar bone, it is referred as?

Answer 103

Completely unerupted.

Question 104

When a tooth does not erupt or fully erupt because it has fused with alveolar bone, this is known as?

Answer 104

Ankylosed.

Question 105

Arrange in order of commonest affected teeth that are impacted 1. Maxillary canines 2. Mandibular premolars/canines 3. Maxillary third molars 4. Mandibular third molars 5. Maxillary incisors

Answer 105

1. Mandibular third molars 2. Maxillary canines 3. Mandibular premolars/canines 4. maxillary incisors 5. maxillary third molars

Question 106

Which guidelines is used for the removal of third molars?

Answer 106

National institute of clinical excellence (NICE) 2000

Question 107

What is the most common indication found to remove mandibular third molars?

Answer 107

Pericoronitis (8-59%)

Question 108

Which tooth had a higher risk of unrestorable caries which justified the removal of the mandibular third molar the 8 or 7?

Answer 108

Unrestorable caries 8= 7% 7= 42%

Question 109

By allowing the mandibular third molar to erupt in its impacted position, can later result in what for the 7’s?

Answer 109

it can result in the development of unrestorable caries.

Question 110

In which situation would you have the mandibular third molars prophylactic removal in medically/surgically compromised patients?

Answer 110

Patients undergoing head and neck radiotherapy may want the third molars removed to prevent problems arising in the future.

Question 111

Why would having a transplant be an indication for the removal of third molars?

Answer 111

Being a transplant patient would make you immunocompromised, and having an impacted molar may result in pericoronitis, causing infection. For someone who is immunocompromised, pericoronitis needs to be prevented.

Question 112

Where is the third molar commonly transplanted after extraction?

Answer 112

1^st molar position

Question 113

What is orthognathic surgery?

Answer 113

an operation to reposition the jaws. The operation aims to correct imbalance between the upper and lower jaws which will enable the teeth to bite together correctly; this also has the benefit of balancing and enhancing the facial appearance.

Question 114

any tooth in the fracture line (fractured mandible) would be rendered as what?

Answer 114

Non vital

Question 115

what is an operculum?

Answer 115

Is a flap of gum tissue over a partially erupted tooth.

Question 116

Treatment of pericoronitis can involve local or general measures, if the patient is systemically well which measure would you use?

Answer 116

Local measures

Question 117

What would be the local measure treatment for pericoronitis for mandibular third molars?

Answer 117

1. Irrigation – warm saline water 2. Oral hygiene measures 3. Remove trauma if evident i.e. extract upper 8 or grind down cusps.

Question 118

What would be the general measure treatments for pericoronitis for the mandibular third molar?

Answer 118

1. Analgesics 2. Antibiotics if systematically unwell/immunocompromised 3. Admission in severe airway threating cases

Question 119

Is pericoronitis predominately anaerobic or aerobic disease?

Answer 119

Anaerobic

Question 120

Winters lines are used for radiographic assessment when removing impacted mandibular third molars. What do the colors of the of the winters line represent?

Answer 120

White = occlusal plane. Yellow = bone level Red = application point for elevator

Question 121

There are four possible angle of impaction of the mandibular third molars, what are they and which two are the most common?

Answer 121

* Vertical – 30-38% * Mesial – 40% * Distal – 6-15% * Horizontal – 3-15%

Question 122

radiographic signs of close relationship between the lower third molar and the IDC, can be identified name the 6 radiographic signs that determine a close relationship.

Answer 122

1. Diversion of IDC 2. Darkening of root as it is crossed by the IDC 3. Loss of Lamina dura of IDC 4. Narrowing of IDC 5. Deflection of roots of lower third molars as they approach the IDC 6. Juxta apical area

Question 123

Why does the darkening of the M3M root determine a close relationship with the IDC?

Answer 123

If the root has crossed the IDC then it has relatively less mineralized tissue, which would show as darken roots on the radiograph.

Question 124

a well-defined area of radiolucency that is apical or lateral to the roots of mandibular third molars is known as a?

Answer 124

juxta apical area.

Question 125

Which type of X-ray would you do, to determine the close relationship between the IDC and the M3M?

Answer 125

CBCT

Question 126

what would this image suggest in a radiographic assessment?

Answer 126

1. The yellow lines indicate the lamina dura of the roof and floor of the IDC. 2. both lines cross the roots of the 8’s 3. the yellow lines are uninterrupted and haven’t changed in their appearance, when they cross the roots and no change in radiolucency in the roots. 4. no narrowing or deviation of the canal. 5. in third dimension this would be demonstrated at as super imposition.

Question 127

what would this image suggest in a radiographic assessment?

Answer 127

You can see that there is a loss of lamina dura as it crosses the roots of the tooth. A loss of the lamina dura can indicate a close relationship Because of the close relationship, there is no/very little bone between the IDC and the M3M roots, and upon removal this can cause bruising/crushing of the canal, leading to altered sensation.

Question 128

What would this image suggest in a radiographic assessment?

Answer 128

Loss of lamina dura as they cross the canal Change in radiolucency in the roots, darkens where the canal crosses.

Question 129

what can you make out from this radiograph?

Answer 129

The third molar is impacted at the level of the alveolus The roots of the M3M are very bulbous. Adjacent tooth has very poor prognosis, due to poorly root treated. The relationship between the impacted M3M shows that the canal has become narrower and removing this tooth would suggest that there is a likely chance of altered sensation.

Question 130

How come not all IDC appear on a radiograph?

Answer 130

Due to the positioning of the IDC on the mandible 1. Lamina dura are visible when they sit in cortical bone and are formed through the cortex. 2. If the IDC was to sit in the medullary bone, then it won’t be as mineralised (centre of the mandible).

Question 131

What is the most common procedure that results in altered sensation of the lower lip and tongue?

Answer 131

Implant placement.

Question 132

Which nerve can you not see on a radiograph, thus not assess the risk of altered sensation?

Answer 132

Lingual nerve.

Question 133

Why do we have to give general figures for assessing risk of altered sensation for the tongue when compared to figures for altered sensation of the lip?

Answer 133

Because we cannot view the lingual nerve on a radiograph it is difficult to give a figure, so a general figure is given.

Question 134

Post-operative alteration in sensation: what are the short term and long-term figures for both lip and tongue altered sensation?

Answer 134

**Lower lip** Short term – 5% Long term – 1% **Tongue** Short term – 10% Long term – less than 1% Taste can be affected.

Question 135

Patients who under-go short term altered sensation of the lower lip are likely to return to sensation when?

Answer 135

A period of weeks and months

Question 136

In the long term of altered sensation of the lower lip, if a patient has not recovered from altered sensation within a 12-18 months, what is the likely hood of recovery?

Answer 136

Very unlikely.

Question 137

Which nerve branch is affected, if we lose the sensation of taste?

Answer 137

The chorda tympani branch on the lingual nerve.

Question 138

What was the main suggested reason for short term loss of sensation of the tongue, preoperatively?

Answer 138

The use of instruments such as lingual retractors, are known to cause bruising of the lingual nerve.

Question 139

Which alternative surgical procedure would you carry out, if there was a high risk to the IDN when extracting a M3M?

Answer 139

coronectomy.

Question 140

What are the complications of coronectomy?

Answer 140

1. If the roots are mobile at the time of coronectomy, they need to be removed. 2. Post op infection of the roots (2.9%) 3. Post operatively there is a risk of migration of the roots 14-81%.

Question 141

this is a post op radiograph of a coronectomy. It shows that the mesial aspect of the enamel has been left, why would this cause a problem?

Answer 141

Bone cannot form on enamel, as it cannot be rendered interalveolar. So, this will mean that the bone will not heal properly causing more problems.

Question 142

migration of retained roots has been reported in most coronectomy studies, and all patients should be warned of this phenomenon. The root may eventually erupt harmlessly to the mucosal surface. Current experience indicates that most roots migrate away from the IDN along the axis of the root. Neither migration nor eruptions are indications for surgical intervention unless?

Answer 142

The roots reach the mucosal surface and become symptomatic.

Question 143

A CBCT compared to traditional DPT has a higher radiation dose and financial cost, thus a CBCT should not be used routinely in the radiographic assessment of a M3M. when can they be used?

Answer 143

Where conventional imaging has shown a close relationship between the M3M and the IAN canal, CBCT may be considered in carefully selected cases where the findings are expected to alter management decisions.

Question 144

Verbal and written warnings should be entered into the notes before getting consent for a surgical procedure, who must witness this being done?

Answer 144

Nursing staff as witness

Question 145

If a patient decides to decline treatment, what must they be informed of?

Answer 145

Likely long-term problems.

Question 146

We must warn patients of post-operative complications with a greater than % incidence?

Answer 146

5%

Question 147

When removing a tooth, the general principle/assessment is made on the radiograph, what are the 5 points planned from a radiograph?

Answer 147

1. What would be the path of eruption (whats stopping the tooth from eruption) 2. Intrinsic (tooth morphology)/extrinsic (canal, tooth) obstacles to be removed 3. Required bone removal 4. Point of application 5. Flap design (the first thing you do)

Question 148

the path of withdrawal of this M3M is indicated by the blue arrow. What is indicated by the green x’s?

Answer 148

the green x’s represent the extrinsic obstacles. Which happen to be the adjacent tooth and the overlying distal buccal bone.

Question 149

The path of withdrawal of this M3M is indicated by the blue arrow. What is indicated by the blue dotted lines and the line?

Answer 149

Bone removal for the blue dotted line, this bone removal must be wide enough to remove the widest part of the tooth. The red line indicates the point of application for your elevators.

Question 150

The mucoperiosteal flap, is referred to as what type of flap?

Answer 150

Triangular flap based on its design.

Question 151

How many layers is the mucoperiosteal flap made of?

Answer 151

2 layers one is made of mucosa, which is very elastic vascular layer. Second is a periosteum layer which is an inelastic collagenous layer.

Question 152

This image shows the markings placed to perform a triangular flap, what do each number represent for this technique.

Answer 152

1. Distal reliving incision landmark = ascending ramus 2. Peri-coronal incision cutting through the alveolar crest fibres includes the papilla between the 3m and 2m 3. Mesial reliving incision down from the 2M to the depth of the sulcus

Question 153

What would be the indications for creating an envelope flap?

Answer 153

If you have a peri coronal pathology such as a cyst or if you are unsure about how much bone you have to remove to take the tooth out.

Question 154

This image shows the markings placed to perform an envelope flap, what do each number represent for this technique.

Answer 154

1. Distal reliving incision landmark = ascending ramus 1. Peri-coronal incision cutting through the alveolar crest fibres round the 3m and all around the 2m

Question 155

How does peri-coronal incision differ from a triangular flap to an envelope flap?

Answer 155

The peri-coronal incision for the triangular flap does not extend pass the 2M compared to the envelope flap where it extends pass the 2M.

Question 156

What would use so that bone does not overheat when using burs to surgically remove 3M?

Answer 156

saline

Question 157

What are burs used for, in the removal of tooth surgically?

Answer 157

1. To relive impaction 2. Create a point of application 3. Remove bone with round bur to create a narrow gutter mesiobuccally avoiding adjacent roots.

Question 158

If a tooth is horizontally impacted, what must you always do what when removing the tooth?

Answer 158

Section the crown off.

Question 159

Often, we must cut the crown off to disim-pact the tooth, what does this minimise?

Answer 159

Bone removal.

Question 160

If you have multirooted tooth, what must you do to the furcation in order to remove the individual roots?

Answer 160

Divide the furcation

Question 161

What is the ideal suture material to be used?

Answer 161

3/0 viceryl rapide

Question 162

Which is the most important to suture to place after removing m3m?

Answer 162

the most important suture is the one placed from the buccal tissues to the lingual tissues immediately distal to the second molar tooth to encourage good periodontal health

Question 163

What is the second most common impacted tooth?

Answer 163

Maxillary canines

Question 164

What is the prevalence of impacted maxillary canines?

Answer 164

1.7% – 2%

Question 165

80% of the impacted canines are found ectopically palatally or buccally?

Answer 165

Palatally

Question 166

Why is it more common for the impacted maxillary canine to ectopic palatally more than buccally?

Answer 166

That is because of the tooth germ of the permanent canine originates on the palatal aspect of the arch.

Question 167

At what age can you palpate the maxillary canines in the labial sulcus (before eruption)?

Answer 167

10-11 years

Question 168

The aetiology of canine impaction is ultimately a result of lack of space, there are two theories that suggest this. The guidance theory described by Becker et al, in 1981 suggests which tooth and aspect is the guide for canine eruption?

Answer 168

Becker et al suggests that the distal aspect of the lateral incisor is the guide for canine eruption.

Question 169

The aetiology of canine impaction is ultimately a result of lack of space, there are two theories that suggest this, the genetic theory described Peck et al, in 1994, considers the dental anomaly of impacted canines to be a product of what?

Answer 169

Polygenetic multifactorial inheritance.

Question 170

Canines have the longest path of eruption, how long is the path?

Answer 170

22mm

Question 171

Why would you use horizontal parallax?

Answer 171

You would use horizontal parallax to localise canines. This is done by taking periapical radiographs of the canine in question and positioning the beam in a different direction and the impacted canine would move in the same direction.

Question 172

What does this sectional DPT show?

Answer 172

1. Impacted upper right canine 2. Retained deciduous canine 3. The right canine seems to be overlapping to the root of the lateral incisor 4. Lateral incisor is rotated

Question 173

What is the follicular space?

Answer 173

The dental follicle is an ectomesenchymal tissue that surrounds the developing tooth germ. In a radiograph, it is seen as a normal homogeneous radiolucent space around the crown of a developing tooth and is known as the follicular space

Question 174

The follicular space in this radiograph suggest that It is bigger than normal, what can be deduced from this?

Answer 174

The increase size in the follicular space can suggest that the impacted canine tooth is undergoing cyst formation.

Question 175

What is a dilacerated tooth?

Answer 175

Dilaceration is an abnormal bend in the root or crown of a tooth. Although the root is affected most frequently, the bend may occur anywhere along the length of the tooth and has been noted in various teeth throughout the dentition.

Question 176

What is the treatment plan for a dilacerated tooth if it is pathology free?

Answer 176

Left alone

Question 177

Leaving the impacted canines alone is a possible treatment option, however this may cause complications later. How would leaving an impacted canine affect the roots of the lateral incisor?

Answer 177

Resorption of incisor roots – incidence unknown up to 12.5%

Question 178

Whenever we lift a mucoperiosteal palatal flap it is always a good idea to make what for the patient?

Answer 178

An acrylic palatal plate used as a dressing, held by an Adams cribs.

Question 179

How long is the acrylic palatal plate, used as a dressing kept in for?

Answer 179

1 week

Question 180

This is a canine from a buccal approach, for the purpose of aesthetics, a close technique is being used. This is the same style of flap that is raised as the palatal approach, once you expose the crown of the canine, you dry it and etch the surface and bond an orthodontic bracket. These gold orthodontic brackets commonly have a gold chain attached to them, and once the flap is sutured back on, the gold chain is visible from the wound. This will allow for the orthodontic to hook it up to the fixed appliance. What is the advantage of using this closed technique?

Answer 180

It makes the physiological eruption of the canine at the gingivae giving you a good contour.

Question 181

What is the third most impacted tooth?

Answer 181

Maxillary incisors

Question 182

Aetiology of delayed incisor eruption can be a result of either hereditary or environmental factors, which are the most common factors from both categories?

Answer 182

Hereditary = supernumeraries Environmental = trauma (common in children)

Question 183

When a patient presents with delayed incisor eruption, we would typically do a history and examination, what would be look for during the clinical examination?

Answer 183

1. Retained deciduous teeth 2. Palpable buccal/palatal mass 3. Lack of space 4. Erupted mesiodens/supernumeraries

Question 184

What are mesiodens?

Answer 184

Mesiodens is a supernumerary tooth present in the midline between the two central incisors. It usually results in oral problems such as malocclusion, food impaction, poor aesthetics, and cyst formation

Question 185

If you want to locate the impacted incisor in three dimensions, which radiographic technique would you use?

Answer 185

Parallax

Question 186

What are the 5 management options for impacted teeth?

Answer 186

1. Conservative – do nothing (not the best option when aesthetic is in question) 2. Interceptive – extract 3. Exposure 4. Removal 5. Transplantation – common for canines

Question 187

Which technique is preferred when managing the canines through the exposure procedure, the open or closed technique?

Answer 187

Closed technique.

Question 188

The open technique for incisor exposure relies on which type of flap?

Answer 188

Apically repositioned flap for incisor exposure

Question 189

How many flaps are there in a apically repositioned flap for incisor exposure?

Answer 189

3

Question 190

Where are the relieving incisions made for an apically repositioned flap for incisor exposure?

Answer 190

Mesial and distal reliving incisions are made and a peri coronal incision.

Question 191

Which technique is being demonstrated?

Answer 191

Closed exposure technique

Question 192

What are the fourth most impacted tooth?

Answer 192

Mandibular premolars

Question 193

Why do we approach mandibular premolars from a buccal aspect rather than lingually?

Answer 193

We always a buccal flap to getter better access, compared to lingual flap.

Question 194

what are the complications that can arise from this unerupted premolar?

Answer 194

1. If the premolar becomes superficial is creates a communication down the gingival crevices of the adjacent premolars to the crown of the impacted premolars, leading to caries. 2. Cystic transformation of the follicular tissue, causing external root resorption. 3. Caries

Question 195

How would you describe the follicular space of the severely ectopic mandibular premolar?

Answer 195

Normal

Question 196

what would be the treatment plan for the ectopic mandibular premolar?

Answer 196

Treatment plan would be a conservative approach 1. There is no pathology present 2. The follicular space is of normal parameters, so has not undergone cystic development 3. A bridge can be placed in the space available to create function

Question 197

these maxillary premolars may need to be extracted if oral hygiene is affected. Although they have fully erupted why can you not use forceps to extract them?

Answer 197

Elevators would need to be used to mobilise them to get them out because, you wouldn’t be able to get the beaks of the forceps on the labial surface of the tooth.

Question 198

What type of flap would be used in the mandibular premolar region, for an open/closed technique?

Answer 198

2 sided mucoperiosteal flap.

Question 199

Why would you want to be careful when doing the mesial relieving incision in to the sulcus?

Answer 199

So you can avoid the branches of the mental foramen.

Question 200

Supernumerary tooth come in how many forms?

Answer 200

3

Question 201

Supplemental tooth, is a form of supernumerary tooth, where is this tooth most found?

Answer 201

Commonly palatal in the maxilla.

Question 202

Often conical supernumeraries between central erupt, are known as?

Answer 202

Mesiodens

Question 203

How do Tuberculate supernumerary tooth cause problems?

Answer 203

Tuberculate tend not to erupt, but prevent eruption of adjacent teeth, therefore removal warranted often performed with incisor exposure.

Question 204

This is a supernumerary tooth erupting between the central incisors, what is the form of this supernumerary tooth?

Answer 204

Mesiodens

Question 205

Which form of supernumerary tooth look exactly like permanent tooth?

Answer 205

Supplemental tooth

Question 206

What are odontomes?

Answer 206

An odontoma, also known as an odontome, is a benign tumour linked to tooth development. Specifically, it is a dental hamartoma, meaning that it is composed of normal dental tissue that has grown in an irregular way. It includes both odontogenic hard and soft tissues.

Question 207

Odontomes come in the form of compound and complex what is the physiological differences between them?

Answer 207

Compound form is the result of a proliferation of the dental lamina, so compound odontomes look like a bag of teeth. Complex form tends to be a disordered aggregation of dentine, enamel, cementum and pulp, so it doesn’t look like a tooth.

Question 208

John a 9 year old attends with his mum who is concerned that one of John’s front teeth has not erupted yet and he is being teased at school because of this. The baby tooth fell out 1 year ago. * Explain your clinical examination. * How would you investigate this tooth? * What is a common reason for delayed eruption of incisors? * What are the treatment options?

Answer 208

Clinical examination 1. Crowding 2. Mobility of adjacent teeth 3. Trauma 4. Discolouring/chipping of adjacent teeth 5. Palpate lingually and labially 6. Palpate cyst Investigate tooth 1. Parallax radiographs – two periapical Common reason for delayed 1. Supernumerary teeth 2. Odontome 3. Trauma – tooth dilacerated Treatment options 1. Not conservative – child teased and bullied 2. Interceptive – no because deciduous tooth fell out year a ago 3. Surgical exposure – only if tooth is in a reasonable position and not badly dilacerated 4. Surgical removal if tooth badly dilacerated or patient doesn’t want orthodontic treatment 5. If surgical removal is chosen then long-term replacement is required (short term cantilever bridge, denture, after 18 implant).

Question 209

12 year old Amanda still has a retained tooth 53. Mum mentions that she had the same problem. You decide to investigate. * What films will you take? * What causes failure of canine eruption? * What are your treatment options if Amanda does not want orthodontic appliances? * What can happen if you decide on a conservative treatment? * How long will the deciduous tooth last? * What options do you have of the deciduous tooth is removed?

Answer 209

Films to take – parallax with two periapical views What causes failure of canine eruption – longest eruption path, trauma to deciduous tooth, abnormality of lateral incisor. What are the treatment options if Amanda does not want orthodontic appliance? Surgical exposure might not be favourable without orthodontic intervention What can happen if you decide on a conservative treatment – if tooth is high then you can leave the canine, assuming no pathology with teeth. How long will deciduous last – 2 decades lucky if in 3^rd decade What options if tooth is removed – adhesive bridge, fixed fixed bridge, implant when older.

Question 210

What does MOS stand for?

Answer 210

Minor oral surgery

Question 211

Scalpels are held in which type of grip?

Answer 211

Standard pen grip

Question 212

Which two scalpels are generally used for creating a surgical flap?

Answer 212

No 15 & No 11

Question 213

what type of incision is this?

Answer 213

Crevicular incisions

Question 214

What does the green part of the blade signify?

Answer 214

The cutting part of the blade.

Question 215

What part of the blade should you use when making a crevicular incision?

Answer 215

The tip outlined by red

Question 216

What does the blue line represent on the model?

Answer 216

Blue line represents where the crevicular incisions will be

Question 217

If we do nothing more and have no relieving incisions and just the crevicular incision, what type of flap would this represent?

Answer 217

Envelope flap

Question 218

with the addition of a relieving incision represented by the number 2 and a crevicular incision represented by 1, this gives rise to what type of flap?

Answer 218

two-sided flap

Question 219

With the addition of two relieving flaps and a crevicular incision. What type of flap is created with these incisions?

Answer 219

Three sided flap

Question 220

What is the basic principle of relieving incisions?

Answer 220

To get better access

Question 221

Which type of flap gives the best access?

Answer 221

Three sided flap.

Question 222

How many units should we extend the flap from the target tooth?

Answer 222

Extend one unit either side, a unit being a tooth.

Question 223

In reference to planning what does this green arrow represent?

Answer 223

Path of withdrawal

Question 224

What do the different colours represent?

Answer 224

Green = path of withdrawal Red = point of application Yellow = obstacle

Question 225

Tooth removal involves 7 stages what are they?

Answer 225

1. Path of withdrawal 2. Position of instruments to elevate 3. Identification of obstacles 4. Methods to overcome obstacles 5. Bone removal 6. Incision 7. Flap design

Question 226

What must the base of the flap be when cutting it?

Answer 226

Broad

Question 227

What must you ensure that the flap has so it doesn’t become necrotic?

Answer 227

Blood supply

Question 228

Do you want tension to be present on the flaps?

Answer 228

Without tension

Question 229

What must we include in the flap design, for the aid of suturing?

Answer 229

Papilla

Question 230

Eruption of third molars generally occurs between which age?

Answer 230

18-24 years

Question 231

What are the 5 common indications for the removal of impacted teeth?

Answer 231

1. Pericoronitis 2. Caries 3. Periodontal disease 4. The presence of a cyst 5. External root resorption

Question 232

What are the indications to retain impacted teeth?

Answer 232

1. The tooth will erupt and be functionally useful 2. If there is a high risk to the health of the patient 3. If the tooth is deeply impacted with no associated pathology 4. If the risk of surgical complications is judged to be too high e.g. if there is a high risk of fracture of an atrophic mandible 5. Where the surgical removal of a single third molar tooth is planned under local anaesthesia extraction of asymptomatic contralateral teeth should not normally be undertaken.

Question 233

What are the management of pericoronitis?

Answer 233

Irrigation underneath the operculum with chlorhexidine mouthwash or warmed saline Eliminate trauma for the opposing cusps by grinding the cusps of extracting the opposing upper third molar Advise on the use of analgesics and to keep hydrated If there is a fluctuant swelling then incision and drainage to release the pus is appropriate using an IDB to avoid infiltrating into an area of acute infection If the patient has systemic signs and symptoms then referral for admission for management with IV antibiotics Review the situation to ensure there has been resolution of the problem Assess the third molar radiographically by DPT if not already been taken Advise the patient on the need for surgical intervention dependent upon clinical and radiographic findings

Question 234

Assessment of the mandibular third molar from the DPT How would you classify the depth of impaction? Superficial, moderate, and deep.

Answer 234

Superficial – at the level of the crown of the second molar Moderate – at the level of the ACJ of the second molar Deep – at the level of the roots of the second molar

Question 235

What type of impaction is being refereed? aligned correctly but there is overlying bone (hard tissue impaction) or overlying soft tissue (soft tissue impaction) occurs in 30-38% of cases

Answer 235

– vertical

Question 236

What type of impaction is being refereed? the crown of the third molar is orientated towards the second molar 0ccurs in approximately 40% of cases

Answer 236

– mesioangular

Question 237

What type of impaction is being refereed? the crown of the third molar is orientated away from the second molar occurs in 6-15% or cases

Answer 237

– Distoangular

Question 238

What type of impaction is being refereed? the crown of the third molar is orientated at 90 degrees to the second molar occurs in 3-15% or cases

Answer 238

- Horizontal

Question 239

What type of impaction is being refereed? any other orientation that does not fit with the above

Answer 239

- Aberrant

Question 240

the flap should be broad to maximise the blood supply and the reliving incision angulated to avoid what?

Answer 240

Avoid cutting across parallel blood vessels.

Question 241

What are the most common post-operative complications (M3M removal)

Answer 241

1. Pain 2. Swelling 3. Possible bruising 4. Jaw stiffness/limitation of mouth opening (trismus) 5. Risk of post-operative bleeding 6. Infection 7. Dry socket as third molars are commonest socket affected by dry socket

Question 242

Compression injuries may occur during the elevation of a third molar with roots in close proximity to the mandibular canal. Minor compression of the nerve will give rise to a temporary conduction block known as?

Answer 242

neurapraxia which usually recovers spontaneously over weeks to months.

Question 243

Compression injuries may occur during the elevation of a third molar with roots in close proximity to the mandibular canal. More severe compression or crush injuries cause the axon distal to the site of the injury to degenerate (Wallerian degeneration) and recovery of sensation is dependent upon regeneration of the damaged axons. This is known as?

Answer 243

axonotmesis

Question 244

Complete section of the nerve trunk may occur if the inferior alveolar nerve penetrates the root of a third molar and is severed during tooth removal. This is known as?

Answer 244

neurotmesis.

Question 245

This is the definition of which type of pain? Absence of all sensory modalities.

Answer 245

Anaesthesia

Question 246

This is the definition of which type of pain? Diminished sensitivity to stimulation, excluding special senses.

Answer 246

**Hypoaesthesia**

Question 247

This is the definition of which type of pain? An abnormal sensation, whether spontaneous or evoked.

Answer 247

Paraesthesia

Question 248

This is the definition of which type of pain? Unpleasant abnormal sensation, whether spontaneous or evoked

Answer 248

Dysaesthesia

Question 249

This is the definition of which type of pain? An increased response to a stimulus that is normally painful.

Answer 249

Hyperalgesia

Question 250

This is the definition of which type of pain? Pain due to a stimulus that does not normally provoke pain.

Answer 250

Allodynia

Question 251

What is a Mitchell’s trimmer used for?

Answer 251

is an effective periosteal elevator and can also be used as a curette to clean out sockets. The sharp pointed end can be used to release bands of scar tissue from the bone.

Question 252

What is the purpose of a, A lac’s retractor?

Answer 252

Used to retract the tongue

Question 253

What would you use to stop arterial and venous by clipping the bleeding vessel and crushing it?

Answer 253

A Spence-wells artery forceps.

Question 254

This is a Rongeures, what is the purpose of this instrument?

Answer 254

**Rongeures** are also called bone nibblers, and these are used to remove small fragment or spicules of bone.

Question 255

What is the name and purpose of this instrument?

Answer 255

Bone file, used to smooth down bone margins.

Question 256

Vicrly rapide is a sterile surgical suture composed of a copolymer made from 90% glycolide and 10% L-lactide and is used as a general-purpose suture material for intra-oral surgery as it dissolves in 7-10 days. 4/0 material refers to the thickness of the thread – the higher the number the finer the thread. Prior to this material being used, black silk sutures were used which did not dissolve, why would we use this suture over the Vicryl rapide?

Answer 256

These are still used in situations when you want to avoid premature wound breakdown such as managing an OAC or to ensure that your patient returns for follow up.

Question 257

Failure of eruption associated with maxillary permanent incisors teeth usually presents in the mixed dentition stage and is often noticed between the ages of?

Answer 257

7-9

Question 258

Delayed eruption of the permanent maxillary incisor teeth can be considered in the following circumstances? (three)

Answer 258

1. Eruption of the contralateral incisor occurred more than 6 months earlier 2. The maxillary incisors remain unerupted more than one year after the eruption of the mandibular incisors 3. There is a significance deviation from the normal eruption sequence (for example, lateral incisors erupting prior to the central incisors)

Question 259

Several local factors have been associated with delayed eruption of the maxillary incisor dentition. These include?

Answer 259

1. Early extraction or loss of primary teeth (with or without space loss) 2. Prolonged retention of primary teeth 3. Crowding in the upper labial segment 4. Previous trauma 5. Localised pathology (supernumerary teeth, odontomes, and more rarely cystic formation)

Question 260

What are the two most common causes of delayed eruption of the maxillary incisors?

Answer 260

1. Physical obstruction due to presence of supernumerary teeth or odontomes 2. Trauma to the primary tooth, which may contribute to dilaceration of the permanent successor/s

Question 261

When undergoing a clinical examination for the management of unerupted maxillary incisors, what are you looking out for?

Answer 261

1. Identify any primary teeth retained significantly beyond their normal exfoliation dates. 2. Spacing 3. Rotations 4. Displacement of permanent teeth 5. Labial or palatal swellings (may indicate the site of unerupted incisor)

Question 262

The majority of canines undergoing normal eruption should be palpable in the buccal sulcus by what age?

Answer 262

By 10 to 11 years

Question 263

The main risk from ectopic canines appears to be root resorption of which tooth?

Answer 263

Usually the incisors.

Question 264

During history and examination practitioners should suspect that a canine is ectopic if it is not?

Answer 264

If it is not palpable in the buccal sulcus by the age of 10-11 years.

Question 265

Why is the minor oral surgery tray set up from left to right?

Answer 265

The set up is designed broadly from left to right based on how we are starting to where we are finishing.

Question 266

What is the name of this equipment?

Answer 266

Towel clips

Question 267

What is the name of this equipment and what is it used for?

Answer 267

Mckessons mouth prop, used to prop the mouth open.

Question 268

What is the name of this instrument and its function?

Answer 268

Molt no. 9 periosteal elevator, used to elevate the flap.

Question 269

What is the name of this instrument and its function?

Answer 269

Mitchell’s trimmer, just like the Molt no. 9 periosteal elevator, used to elevate the flap. The triangular end is used often for the stripping of attachments from bone.

Question 270

What is the name of this instrument and its function?

Answer 270

Howarth’s nasal rasp/periosteal elevator. Used to elevate the flap

Question 271

What is the name of this instrument and its function?

Answer 271

Minnesota retractor, used to retract soft tissues when operating

Question 272

What is the name of this instrument and its function?

Answer 272

Bowdler-Henry rake retractor, used for mucoperiosteal flap retractor

Question 273

What is the name of this instrument and its function?

Answer 273

Surgical suction

Question 274

What is the name of this instrument and its function? Ficklings forceps

Answer 274

Holding soft tissue and manipulating it.

Question 275

What is the name of this instrument and its function?

Answer 275

Rongeurs – bone nibbler, used to remove bone

Question 276

What is the name of this instrument and its function?

Answer 276

Bone file – files the bone

Question 277

What is the name of this instrument and its function?

Answer 277

Irrigating syringe/needle

Question 278

What is the name of this instrument and its function?

Answer 278

Lacks retractor – multiple uses, more commonly used to retract the tongue

Question 279

What is the name of this instrument and its function?

Answer 279

Kilners cheek retractor – cheek retractor

Question 280

What is the name of this instrument and its function?

Answer 280

Tooth tissue forceps

Question 281

Name the two scissors

Answer 281

Mcindoe – top Iris – bottom

Question 282

What is the name of this equipment?

Answer 282

Needle holder

Question 283

Applied anatomy: the middle third facial skeleton defined by which landmarks superiorly, inferiorly, and posteriorly.

Answer 283

Superiorly * Frontozygomatic * Frontonasal * Frontomaxillary Inferiorly * Occlusal plane upper teeth * Alveolar ridge (edentulous) Posteriorly * Pterygoid plates sphenoid

Question 284

The middle third facial skeleton consists which bones/structures

Answer 284

* Two zygomatic bones * Two maxillae bones * Two zygomatic process Temporal bones * Two palatine bones * Two nasal bones * Two lacrimal bones * Vomer * Ethmoid (and attached conchae) * Two inferior conchae * Pterygoid plates of sphenoid

Question 285

What are the horizontal buttresses of the face?

Answer 285

1. Superior orbital rim 2. Inferior orbital rim 3. Maxillary alveolus 4. Palate 5. Serrated edges greater wings of sphenoid 6. Zygomatic arches

Question 286

What are the vertical buttresses of the face?

Answer 286

1. Nasomaxillary 2. Zygomaticomaxillary 3. Pterygomaxillary

Question 287

What are the sagittal buttresses of the face?

Answer 287

1. Zygomatic arches 2. Palate 3. Floor of orbit

Question 288

what is meant by buttresses?

Answer 288

A structure placed against the base of another to support or stabilize it.

Question 289

Which mid face structures have a low tolerance to impact?

Answer 289

1. Nasal bones least resistant 2. Zygomatic arch directly 3. Maxillae – horizontal forces

Question 290

Where would a Le fort 1 fracture take place?

Answer 290

Le fort 1 - Mobility of the maxilla; maxilla is free from the rest of the facial bones (floating palate) Le fort 2 - Mobility of the maxilla and nose as a combined segment. Le fort 3 - Mobilized segment to include the maxilla, nose, and zygomas.

Question 291

this is a lateral aspect of which le Fort fracture line

Answer 291

Le Fort 1

Question 292

this is a lateral aspect of which le Fort fracture line

Answer 292

Le Fort 2

Question 293

this is a lateral aspect of which le Fort fracture line

Answer 293

Le Fort 3

Question 294

What would be the initial management steps taken for midface trauma?

Answer 294

1. Airway management 2. Controlling any haemorrhage 3. Head injury assessment 4. Secondary survey – facial fracture survey (which type)

Question 295

For the airway management, when assessing someone who has had a midface trauma, what will you be wanting to look out for?

Answer 295

1. Physical anatomy changes – displacement of the maxilla and the lower face height. 2. Swelling – local oedema 3. Bleeding 4. Foreign body 5. Loss of consciousness 6. Head injury and respiratory depression

Question 296

Where would you expect to see the haemorrhage coming from in a midface trauma?

Answer 296

1. Maxillary artery 2. Nasal walls 3. Retrobulbar haemorrhage 4. Septal haemorrhage

Question 297

How would a head injury be assessed when someone has had a midface trauma?

Answer 297

Glasgow coma scale

Question 298

What are the three parameters the Glasgow coma scale uses?

Answer 298

1. Eye opening (E) 2. Verbal response (V) 3. Motor response (M)

Question 299

What is the Glasgow coma scale range measured from?

Answer 299

3-15

Question 300

What would someone have to score to be brain dead/normal on the Glasgow coma scale?

Answer 300

3 = brain dead, 15 = normal.

Question 301

These presentation and clinical findings determine which type of fracture? 1. Mobility of tooth-bearing segment of the upper jaw 2. Crepitus in buccal sulcus 3. “Cracked-pot” percussion note from upper teeth 4. Intra-oral haematoma in buccal sulcus 5. Palatal haematoma? 6. Fractured teeth cusps 7. Bruising of upper lip and lower mid-face 8. Occlusal discrepancy 9. Anterior open bite tendency 10. Dentures nor fitting

Answer 301

Le Fort 1

Question 302

These presentation and clinical findings determine which type of fracture? 1. Bilateral peri-orbital bruising (“panda eyes”) 2. Subconjunctival haemorrhage 3. Lengthening of face 4. Malocclusion - AOB 5. Gross oedema of face 6. Nasal deformity 7. CSF rhinorrhoea 8. Diplopia and other visual problems 9. Mobility of the upper jaw 10. Palatal haematoma

Answer 302

Le Fort II/III

Question 303

This CT scan shows which Le Fort Fracture?

Answer 303

Le Fort 1

Question 304

This CT scan shows which Le Fort Fracture?

Answer 304

Le Fort 2

Question 305

This CT scan shows which Le Fort Fracture?

Answer 305

Le Fort 3

Question 306

This CT scan shows which Le Fort Fracture?

Answer 306

parasagittal view Le Fort 1 – anterior of maxilla, sectioning through margin of the maxillary sinus.

Question 307

This CT scan shows which Le Fort Fracture?

Answer 307

Axial view of a Le Fort 2 – disruptions around the orbital region

Question 308

This CT scan shows which Le Fort Fracture?

Answer 308

coronal view of a Le Fort 2 – disruption on the infraorbital region

Question 309

what is the management for a patient when they have become stable after a facial trauma?

Answer 309

Aim is to restore normal functions such as: 1. Ocular 2. Nasal 3. Oral 4. Dental 5. Aesthetics

Question 310

What is panfacial bone fracture?

Answer 310

Panfacial bone fractures are defined as facial fractures simultaneously involving the upper, middle, and lower thirds of the face. Fractures of the frontal bone, maxilla, zygomatic complex, nasoethmoid-orbital (NEO) region, and mandible are the most common

Question 311

How would you reduce a fracture?

Answer 311

Disimpaction, using allot of force on impacted bone to force them back to original place.

Question 312

which fracture is being fixed?

Answer 312

Le Fort 1

Question 313

which fracture is being fixed

Answer 313

Le Fort 2

Question 314

Which forceps would you use for disimpaction of the maxillary following facial trauma?

Answer 314

Rowes maxillary.

Question 315

which fracture is being fixed?

Answer 315

Le Fort 3

Question 316

What is ORIF?

Answer 316

Open reduction and internal fixation (ORIF) are a type of surgery used to stabilize and heal a broken bone

Question 317

How does open reduction differ from closed reduction?

Answer 317

During an open reduction, orthopaedic surgeons reposition your bone pieces during surgery, so they are back in their proper alignment. In a closed reduction, a healthcare provider physically moves the bones back into place without surgically exposing the bone.

Question 318

What is referred to internal fixation?

Answer 318

Internal fixation refers to the method of physically reconnecting the bones. This might involve special screws, plates, rods, wires, or nails that the surgeon places inside the bones to fix them in the correct place. This prevents the bones from healing abnormally.

Question 319

Which is the largest of the paranasal sinuses?

Answer 319

Maxillary sinuses

Question 320

Can sinus pathology present in the mouth?

Answer 320

Yes

Question 321

What is the most common peri-operative complications with the maxillary sins?

Answer 321

Development of an OAC.

Question 322

What can sinusitis present itself as orally?

Answer 322

Tooth ache.

Question 323

Why can sinusitis mimic as toothache?

Answer 323

The bacterial infection that has caused the sinusitis, results in the inflammation stimulating the trigeminal maxillary division nerve.

Question 324

How many paranasal sinuses are there?

Answer 324

Paranasal sinuses are a group of four paired air-filled spaces that surround the nasal cavity. The maxillary sinuses are located under the eyes; the frontal sinuses are above the eyes; the ethmoidal sinuses are between the eyes and the sphenoidal sinuses are behind the eyes

Question 325

What are paranasal sinuses lined by? .

Answer 325

Ciliated epithelium

Question 326

Why is the draining ostium significant in the spread of sinus infection?

Answer 326

The draining ostium are all in proximity of the paranasal sinuses, so if there was an infection in one sinus, it can easily spread to the other.

Question 327

What is the relevant importance of the maxillary sinus in dentistry?

Answer 327

1. Roots of the upper molars/premolars closely related to the antrum and share a common innervation 1. Dental procedures complicated by problems involving the antrum such as OA communication, roots in antrum, fracture tuberosity, extruded root canal materials

Question 328

Infective sinusitis is more commonly viral or bacterial?

Answer 328

Viral 60-70% of the time.

Question 329

How would manage a patient suffering from acute sinusitis who is normally fit and healthy?

Answer 329

Mucolytics, inhalations for 2 weeks.

Question 330

How much penicillin v would you prescribe to an immunocompromised patient suffering from acute sinusitis?

Answer 330

500 mg 4 x a day for 7 days

Question 331

How much Doxycycline would you prescribe to an immunocompromised patient suffering from acute sinusitis?

Answer 331

100mg 1 x a day for 1 week, 200mg for a loading dose on the first day.

Question 332

What causes mechanical obstruction of the ostium that causes sinusitis?

Answer 332

1. Oedema of nasal mucosa 2. Polyps 3. Septal deviation

Question 333

What is an antral lavage:

Answer 333

this is a procedure in which a cannula is inserted into the maxillary sinus via the inferior meatus allowing irrigation.

Question 334

What is an intranasal antrostomy?

Answer 334

A procedure in which the patency of the ostium is increased.

Question 335

If a communication is greater than 5mm, what would happen to it in terms of closing?

Answer 335

Most likely it won’t close, communications less than 5mm will close.

Question 336

Extraction of which tooths can result in an Oro-antral communication?

Answer 336

Primarily the molars, can also be the premolars too.

Question 337

If an Oro-antral communication is not recognised early on, what can get develop in to?

Answer 337

Oro-antral fistula

Question 338

When does an Oro-antral communication become an Oro-antral fistula?

Answer 338

This occurs when the communication becomes lined with epithelium, resulting in an epithelial tract that runs through two bodies of cavity.

Question 339

How common are Oro-antral communications?

Answer 339

Up to 10% of upper molar extractions the 1^st molar being the most common.

Question 340

What happens to the sinuses at advancing age?

Answer 340

The sinuses get bigger (ages over 40)

Question 341

What are the risk factors for the development of an Oro-antral communication?

Answer 341

1. Large sinus 2. Large and unfavourable shaped roots extending into the sinus 3. Dry socket or poor healing 4. Being older (over 40) 5. 1^st and 2^nd upper molar teeth extraction 6. A difficult extraction 7. Infection, abscess or cysts associated with the tooth being removed 8. Periodontal disease (significant bone loss) 9. Hypercementosis – an excessive build up of cementum, which gives the tooth a fat appearance

Question 342

If you have managed to discover that the patient has an Oro-antral communication, how would you go abouts managing the patient?

Answer 342

1. Notify the patient of the development of this (you should have made them aware before treatment) 2. Ideally close immediately – buccal advancement flap 3. Place a saline soap gauze before taking alginate impression to create a plate or modified denture. (Only possible if technician is onsite) 4. If in primary care and you cannot provide a buccal advancement flap or plate/modified denture, then it is important that sinusitis is prevented, patients can be prescribed antibiotics, ephedrine drops, mucolytic inhalations. 5. If communication of greater than 5mm spontaneous closure unlikely. 6. Review the patient at 1 week

Question 343

How does ephedrine drop work?

Answer 343

Nasal drops, which help to shrink the mucosa, which don’t become distended, this prevents the ostium from becoming blocked.

Question 344

What would blowing your nose do, if you have had surgical management to close an Oro-antral communication?

Answer 344

By blowing your nose you increase the pressure in the maxillary sinus, this pressure would come through orally, which can tear the sutures.

Question 345

What are the two likely alternatives to an advancement flap?

Answer 345

1. Palatal rotation flap 2. Buccal fat pad

Question 346

What are the negatives of the palatal rotation flap?

Answer 346

1. Requires 2 surgical procedures 2. Not well tolerated by patients

Question 347

If you have a large Oro-Antral Communication, which technique would you use BEST to close the communication?

Answer 347

Buccal fat pad

Question 348

Which technique is being used to cover the OAC?

Answer 348

Palatal rotation flip.

Question 349

With the buccal fat pad technique, can you only use the fat pad to close the OAC?

Answer 349

With the Buccal fat pad technique, if possible, you can close the OAC completely with fat pad alone, however this technique still allows you place an advancement flap over the buccal fat pad.

Question 350

What would be the technique used to manage this small OAF (fistula)

Answer 350

Managed by excising the fistula tract and a buccal advancement flap to close primarily as per OAC

Question 351

The Caldwell-luc operation requires you to gain access to the maxillary sinus, this technique does not allow you to gain access through the breached OAC. How do you get access to the maxillary sinus?

Answer 351

The Caldwell-luc technique gives you access by drilling through the canine fossa, this procedure requires GA.

Question 352

What is an antrostomy?

Answer 352

The surgical formation of an opening into an antrum.

Question 353

What would you feel with your supporting hand if you fractured the tuberosity when extracting a last standing molar?

Answer 353

Sudden loosening of the tooth and bone together.

Question 354

What may the patient complain of if you have fractured the tuberosity whilst extracting a molar?

Answer 354

Patient may complain of sharp pain at the time of fracture or may be completely asymptomatic. If sinus perforation has occurred and diagnosis is delayed, the patient may complain of reflux of fluids from mouth to nose, sinus stuffiness, or present with overt sinusitis.

Question 355

What are the management plans for a fractured tuberosity?

Answer 355

For a **small fracture without sinus perforation**: dissect the segment from gingiva and periosteum and suture. For a **small fracture with sinus perforation** (less than 3 to 4 mm): dissect the segment and close the socket primarily

Question 356

Practice exam questions A patient attends in pain from a carious lone standing tooth 18. Medically he has atrial fibrillation and takes rivaroxaban. He is also a heavy smoker. What are in the implications of the medical history? What are the implications of the smoking history? What pre-operative warnings would you give the patient? How would you achieve anaesthesia? What post-operative instructions would you give him? What forceps would you use and why?

Answer 356

What are in the implications of the medical history? – patient has AF and takes rivaroxaban, increased risk of bleeding. (if patient takes drugs in morning, then request not to take it in morning and 4 hours after procedure). Pack socket with haemostatic pack and suture with resorbable sutures. What are the implications of the smoking history? Increased risk of a dry socket (not smoke for 48 hours day of and day after) What pre-operative warnings would you give the patient? – post op pain, diet, modification of oral hygiene regime, OAC, Risk of bleeding, risk of dry socket (how is all this managed) How would you achieve anaesthesia? – buccal and palatal infiltration lidocaine What forceps would you use and why? – upper right molar forceps pointed beak on buccal surface which indicates two roots. What post-operative instructions would you give him? 1. No exercise 2. No alcohol 3. No smoking 4. No eating whilst numb 5. Risk of bleeding – cope with bite packs (20 mins try twice if not worked first time) 6. Help if there are problems 7. Simple analgesics 8. Hygiene measures

Question 357

One week after the extraction your patient returns complaining that they have a bad taste, pain over their right cheek and a horrible smell. When they drink fluid comes down their nose. You looked in his mouth and the socket is still open and there is no clot. * What is your diagnosis? * How should this be managed by you? * What will happen if it is not managed? * Who should you refer the patient to and what would they offer the patient? * The patient asks could this have been avoided and do they have a claim for negligence?

Answer 357

* What is your diagnosis? OAC (if patient had come 2 -3 weeks later it would have developed into a fistula) * How should this be managed by you? – explain what has happened, infection (acute maxillary sinusitis), prescribe antibiotics post covid penicillin v 500 mg 4x a day 5 days, epinephrine nasal drops to encourage drainage of the sinus and inhalations to help with drainage of the maxillary sinus by opening the ostium. * What will happen if it is not managed? Develop to chronic maxillary sinusitis, develop to fistula * Who should you refer the patient to and what would they offer the patient? - Dental hospital * The patient asks could this have been avoided and do they have a claim for negligence? No risk at OAC Communication occurred due to secondary loss of blood clot

Question 358

what is the name of the structure labelled A

Answer 358

A = condylar head, leading to the condylar neck

Question 359

what is the name of the structure labelled B

Answer 359

B = coronoid process (attached to the ascending ramus)

Question 360

what is the name of the structure labelled C

Answer 360

C = coronoid/mandibular notch (beneath this area is called the ramus of the mandible)

Question 361

what is the name of the structure labelled D

Answer 361

D = oblique ridge

Question 362

what is the name of the structure labelled E

Answer 362

E = angle of the mandible

Question 363

what is the name of the structure labelled F

Answer 363

F = mental foramen (mandibular division of the trigeminal exists to innervate the lip

Question 364

what is the name of the structure labelled G

Answer 364

G = symphysis of the mandible is at the midline, the yellow lines indicate the para symphysis, the orange lines indicate the body of the mandible.

Question 365

There are 4 muscles of mastication, what are they?

Answer 365

1. Temporalis 2. Lateral pterygoid 3. Medial pterygoid 4. Masseter

Question 366

how common are fractures of the mandible?

Answer 366

Second commonest after nasal fractures, 10th commonest of all bone in the body.

Question 367

There are 5 types of fractures what are they?

Answer 367

1. Simple 2. Compound 3. Comminuted 4. Greenstick 5. Pathological

Question 368

Describe a simple fracture:

Answer 368

A simple fracture is a result of excessive force or impact on the bone, resulting in a break, but has not been displaced.

Question 369

What is a compound fracture?

Answer 369

An open fracture, also called a compound fracture, is a fracture in which there is an open wound or break in the skin near the site of the broken bone. Most often, this wound is caused by a fragment of bone breaking through the skin at the moment of the injury.

Question 370

What is a comminuted fracture?

Answer 370

Comminuted fractures are a type of broken bone. The term comminuted fracture refers to a bone that is broken in at least two places

Question 371

What is a greenstick fracture?

Answer 371

A greenstick fracture occurs when a bone bends and cracks, instead of breaking completely into separate pieces. The fracture looks similar to what happens when you try to break a small, "green" branch on a tree.

Question 372

Mandibular fracture site description, name the location of the fracture. A

Answer 372

A = dento-alveolar

Question 373

Mandibular fracture site description, name the location of the fracture. B

Answer 373

B = condylar – neck and angle (point of weakness)

Question 374

Mandibular fracture site description, name the location of the fracture. C

Answer 374

C = coronoid

Question 375

Mandibular fracture site description, name the location of the fracture. D

Answer 375

D = ramus

Question 376

Mandibular fracture site description, name the location of the fracture. E

Answer 376

E = angle – 3^rd molar

Question 377

Mandibular fracture site description, name the location of the fracture. F

Answer 377

F = body – canine tooth

Question 378

Mandibular fracture site description, name the location of the fracture. G

Answer 378

G = parasymphysis

Question 379

Mandibular fracture site description, name the location of the fracture. H

Answer 379

H = symphasis

Question 380

Which sites would you expect to see fractured in a guardsmen fracture?

Answer 380

A guardsman fracture, also referred to as parade ground fracture, is one of the common forms of mandibular fracture which is caused by a fall on the midpoint of the chin resulting in fracture of the symphysis as well as both condyles

Question 381

Name this type of fracture and why its presentation is like this?

Answer 381

This fracture occurs when you have bilateral parasymphysis fracture, and the muscles of the mylohyoid, genioglossus, and digastric all pulling the anterior segment down backwards, producing this what looks like a bucket handle fracture

Question 382

What are the extra oral clinical features of mandibular fractures?

Answer 382

1. Pain 2. Swelling 3. Bruising 4. Trismus 5. Concurrent soft tissue injury – cut lip, tooth fragment 6. Otorrhoea external auditory meatus tear may accompany condylar fractures 7. Anaesthesia/paraesthesia of lip

Question 383

What are the intra oral clinical features of mandibular fractures?

Answer 383

1. Haematoma in the floor of the mouth (Coleman’s sign) & buccal mucosa 2. Malocclusion 3. Tongue – stable position, swelling 4. Step deformity – displacement of fracture 5. Gingival laceration 6. Mobility or loss of teeth – teeth inhaled, swallowed, in soft tissue

Question 384

What deformity is being shown here?

Answer 384

Step deformity by a Para symphyseal fracture

Question 385

Which would be the best Xray technique to use to screen if there is a mandibular fracture?

Answer 385

DPT, however there is not a DPT available then a Lateral oblique will do. It is also important to have 2 views at 90 degrees to each other.

Question 386

Which technique best allows immobilisation of the bone (fracture site) to allow a period of healing. The open or closed technique?

Answer 386

The open technique

Question 387

Which technique allows for the wiring of the jaws?

Answer 387

Closed technique (although the technique is becoming out of favour)

Question 388

If you are reducing a fracture, what are you doing?

Answer 388

Aligning the bones anatomically to recreate the normal anatomy.

Question 389

How long does it take for the bone to heal in an adult?

Answer 389

4-6 weeks

Question 390

Having a cast placed on your arm, when you break your long bone is an example of closed or open technique?

Answer 390

Closed technique

Question 391

When doing fixation with plates, would we want load bearing or load sharing and what is the difference?

Answer 391

We would want to prioritise load bearing, so that 100% of the functional load is supported by fixation (2 large plates), whereas load sharing is such that the load is distributed between the hardware and the bone margins.

Question 392

Why are the plates placed this low?

Answer 392

If the plates were placed slightly higher, you would run the risk causing iatrogenic damage to the roots.

Question 393

What are the indications for closed reduction?

Answer 393

1. Non-displaced favourable factures 2. Grossly comminuted fractures 3. Significant loss of overlying soft tissue 4. Edentulous mandibular fractures 5. Fractures in children 6. Coranoid process fractures 7. Undisplaced or minimally condylar fractures

Question 394

What are the advantages of closed reduction?

Answer 394

1. Inexpensive 2. Simple procedure 3. No foreign body so reduced of infection

Question 395

What are the disadvantages of closed reduction?

Answer 395

1. Not absolutely stable 2. Prolonged period of IMF up to 6 weeks 3. Possible TMJ sequelae 4. Decreased oral intake 5. Possible pulmonary considerations

Question 396

Open reduction techniques are usually done intraorally, under what circumstances would you do an extra-oral open reduction?

Answer 396

When you have a displaced fracture on the lower border of the mandible, that is when you would approach with a sub-mandibular approach.

Question 397

What is osteosynthesis?

Answer 397

Surgical fixation of bone using any internal mechanical means.

Question 398

what is champy’s line?

Answer 398

Forces of mastication produce tensional forces on the upper border and forces of compression on lower border. Champy put forward the lines where plates and screws must be placed. Maxime Champy popularized the treatment of mandible fractures with miniplate fixation along the ideal lines of osteosynthesis. This approach is a form of load-sharing osteosynthesis applied in simple fracture patterns with an acceptable amount of bone stock.

Question 399

Does champy’s principle rely on load bearing or load sharing principle?

Answer 399

Load sharing

Question 400

Inadequate fixation of the mandible can result to poor healing giving poor mobility and falls in to three categories, what are they?

Answer 400

1. Non-union: non-union describes the failure of a fractured bone to heal and mend after an extended period of time 2. Fibrous union - Fibrous union was defined as. any fracture site that exhibited mobility after 8 weeks. of surgical management or after 4 weeks without treatment. 3. Mal-union: malunion refers to a fracture that has healed in a deformed position, or with shortening or rotation of the limb.

Question 401

If a fracture involves the angle of the mandible through a third molar socket, what would be the outcome of the 3^rd molar?

Answer 401

It would be removed upon management of the fracture.

Question 402

The teeth in the fracture line are rendered what?

Answer 402

Non-vital. They will not be extracted unless there is a vertical fracture present.

Question 403

Why is important to take radiographs of planned extractions after someone has had fixation?

Answer 403

Presence of plates in areas of planned extractions.

Question 404

Why are condylar fractures common on facial trauma?

Answer 404

The condylar is part of the facial crumple zone.

Question 405

A direct knock to the chin can cause trauma within the joint capsule of the condyle, where it doesn’t cause any breakage, but causes a joint perfusion, causing inflammation. What would you see radiographically and how would you manage the patient?

Answer 405

You would see no evidence of fracture and prescribe a two-week course of NSAID.

Question 406

Which type of condylar fracture is difficult to treat, extra-capsular or intra-capsular?

Answer 406

Intra-capsular because you’re dealing with small fragments.

Question 407

With a condylar fracture which way does the patient deviate to?

Answer 407

Towards the side of the fracture as the length is shortened. This will result in an open bite on the contralateral side.

Question 408

If the fractured condyle is not significantly displaced then you can manage a fractured condyle conservatively, how would you manage this?

Answer 408

Soft diet and analgesics/anti-inflammatory

Question 409

A 27 year old man attends with pain. He was tackled at rugby 2 days ago receiving blows to the jaw and since then has pain on trying to bring his teeth together and his right lower lip is numb. On examination he has a left lateral open bite. 1. Give 2 reasons why he is numb. 2. Give 2 reasons why he has an open bite on the left side? 3. What 2 radiographic views would you request and why? 4. How would you manage this? 5. What is he at risk of if not managed? 6. What is the ideal treatment for this injury?

Answer 409

1. Give 2 reasons why he is numb. – 1. Direct trauma to nerve due to inflammation causing swelling. Fracture may be displaced and affecting the inferior alveolar nerve (indirect trauma to the nerve) 2. Give 2 reasons why he has an open bite on the left side? Fracture of the condylar head on the right side, which has displaced and causing the shortening of the condyle. Damage to either the angle of the mandible or the parasymphysis. 3. What 2 radiographic views would you request and why? – PA mandible and a DPT (or lateral oblique view) this helps get a 3^rd dimension of the fractures. 4. How would you manage this? – recognise fracture and respond within 48 hours (fracture is already 48 hours in, so this constitutes as an emergency, so contact nearest hospital) and prepare for surgery 5. What is he at risk of if not managed? – infection, non-union/fibrous union. 6. What is the ideal treatment for this injury? – ORIF of the fracture with GA within the first 48 hours.

Question 410

What are the complications of endodontically treated teeth when extracting?

Answer 410

Endodontically treated teeth are brittle and likely to fracture easily.

Question 411

What complication does the upper left 5 have?

Answer 411

Bulbous roots – this would require a surgical approach.

Question 412

Why can you not use a high-speed handpiece to section of a tooth?

Answer 412

It causes surgical emphysema and introduces air into the tissues and can lead to cellulitis. There are surgical handpieces that do not introduce air into the tissues.

Question 413

The zygomatic bone has 4 major parts, what are they?

Answer 413

1. Frontal 2. Medial 3. Maxillary 4. Temporal

Question 414

how many classifications are there for fractures of the zygoma?

Answer 414

8

Question 415

Which part of AB face structure would have to be hit to cause this depression?

Answer 415

depression of the malar prominence.

Question 416

What is periorbital ecchymosis?

Answer 416

Periorbital ecchymosis (PE) is caused by blood tracking along tissue plains into periorbital tissues, causing discoloration in the upper and lower eyelids. This clinical feature is most associated with basal skull fractures

Question 417

What can clinically be seen here?

Answer 417

Subconjunctival haemorrhage.

Question 418

Epistaxis is commonly known as?

Answer 418

Nosebleeds

Question 419

What is opthalmoplegia?

Answer 419

ophthalmoplegia, also called extraocular muscle palsy, paralysis of the extraocular muscles that control the movements of the eye

Question 420

What is orbital dystopia?

Answer 420

Orbital dystopia, a common feature found in patients with facial asymmetry, refers to a degree of unevenness of the orbit that causes malposition of the orbital cavity in at least one of the three-dimensional planes

Question 421

What is enophthalmos:

Answer 421

Enophthalmos is posterior displacement of the eye.

Question 422

What is exophthalmos?

Answer 422

Exophthalmos, also known as proptosis, is the medical term for bulging or protruding eyeballs

Question 423

A haemorrhage placed in this location is known as a what?

Answer 423

Retrobulbar haemorrhage is the presence of a post septal orbital haematoma and is usually due to craniofacial trauma causing an extraconal haematoma. It may cause orbital compartment syndrome which is an ophthalmologic emergency

Question 424

What is diplopia?

Answer 424

Double vision is when you look at 1 object but can see 2 images. It may affect 1 eye or both eyes. Signs that your child may have problems with their vision include narrowing or squinting their eyes to try to see better.

Question 425

Which x-ray would determine a non-displaced zygomatico-maxillary complex (ZMC)?

Answer 425

Confirmed by CT scan

Question 426

what type of fixation method is being used?

Answer 426

Kirschner wire

Question 427

what type of fixation method is being used

Answer 427

lag screw fixation

Question 428

what type of fixation method is being used?

Answer 428

wire osteosynthesis

Question 429

what is the name of the instrument that is being used for reduction of displaced zygomatic complex?

Answer 429

ZMC hook

Question 430

explain what is happening in this reduction method?

Answer 430

A screw is being drilled into the displaced zygomatic complex, with the head of the head of the screw visible to manipulate with some instruments for the purpose of reduction

Question 431

what is the name of the instrument that is being used for reduction of displaced zygomatic complex?

Answer 431

Carrol Girard T-Bar

Question 432

what is the name of this white/grey discolouration of the mucosa generally asymptomatic?

Answer 432

Leukoedema

Question 433

What is the name of this condition, where there are ectopic sebaceous glands, on the buccal mucosa?

Answer 433

Fordyce spots

Question 434

what is the name of this ulcer?

Answer 434

Apthous ulcers, also known as canker sores

Question 435

This ulcer is a result of mechanical trauma, the image indicates a central ulcer surrounded by keratotic margin. The keratosis is the body’s attempt to form a barrier and thicken up and this happens if the trauma is either chronic or acute?

Answer 435

Chronic

Question 436

if you develop a white patch through frictional keratosis but no ulcer what does that suggest?

Answer 436

The trauma is low grade and chronic.

Question 437

If you develop a white patch with an ulcer as a result of frictional keratosis, what does it suggest in reference to its development?

Answer 437

It would suggest an acute development

Question 438

this is an example of thermal trauma causing an ulcer. If you were to eradicate the source of the trauma, how long before the symptoms resolve?

Answer 438

Two weeks

Question 439

morsicatio buccarum is commonly known as?

Answer 439

Cheek biting

Question 440

what is the name of this condition?

Answer 440

Linea alba - White tissue line at the level of the occlusal plane asymptomatic. Associated with clenching, sucking habits. Biopsy for diagnosis

Question 441

this image shows remnants of amalgam in buccal tissue, giving the appearance of a tattoo. You can identify this clearly on a radiograph, why is it still important to do a biopsy on this?

Answer 441

There are other lesions that look the same as amalgam tattoo such mucosal melanoma

Question 442

patients wearing there dentures consistently over the day without removing them, over a long period of time, tend to develop a growth of tissue surrounding the denture, causing ill fitting over time. This condition is completely asymptomatic. What is the name of this condition?

Answer 442

Denture induced hyperplasia and would be treated through excision.

Question 443

Saliva escaping from a damaged duct and into the surrounding lip and causing it swell, forming a minor salivary gland cyst is known as a what?

Answer 443

Mucocoele

Question 444

what is the clinical presentation of pseudomembranous candidiasis (thrush)?

Answer 444

White plaques that wipe free leaving a red base.

Question 445

If you sent a microbiology swab of pseudomembranous candidiasis lesion and do culture and sensitivity, what would be the most likely causative agent?

Answer 445

*Candida albicans*

Question 446

What is treatment option for someone suffering from pseudomembranous candidiasis (thrush)?

Answer 446

Systemic antifungal. If this condition is recurring then there may be an underlying condition that needs to be addressed, such as diabetes.

Question 447

How does candida leucoplakia differ from pseudomembranous candidiasis (thrush)?

Answer 447

Does not wipe free

Question 448

With candida Leucoplakia you would prescribe a two-week course of systemic antifungal, and if after two weeks the condition has not resolved, what would be the next course of action?

Answer 448

If the condition has not resolved in two weeks, then a biopsy would be mandatory, because there are other conditions that look like this that are potentially malignant.

Question 449

what is the name of this viral lesion?

Answer 449

Papillomas

Question 450

when a papillomas are excised, what happens to them?

Answer 450

They are sent for histological examination.

Question 451

what is the name of this condition?

Answer 451

Geographic tongue, also known as benign migratory glossitis, often asymptomatic.

Question 452

Lichenoid lesions form due to reaction to what?

Answer 452

Reaction to metal (localised contact reaction) or medication (symmetrical pattern) Antihypertensives - Hypoglycaemics NSAID’s

Question 453

with lichenoid lesions, will a biopsy be necessary?

Answer 453

Yes to establish a definitive diagnosis and it has been stated that lichenoid lesions can go on to develop as malignant lesions

Question 454

What is epulis? .

Answer 454

Epulis is a term given for growth on the gum

Question 455

what is the name of this growth?

Answer 455

Fibrous epulis

Question 456

what is the name of this growth?

Answer 456

Pyogenic granuloma. Vascularised and associated with females during pregnancy so may have hormonal association.

Question 457

Someone suffering from Addison’s disease, Primary adrenal insufficiency, Deficiency of cortisol and aldosterone. In addition to pigmentation what will you see orally?

Answer 457

More than likely you will see oral pigmentation too.

Question 458

Round or oval brown or black pigmented area on the lip or any mucosal surface (benign) Develops in the 50+ age group The above describes this condition, what is the name of it?

Answer 458

Melanotic macule

Question 459

What is the name of this condition?

Answer 459

Lichen planus

Question 460

Benign mesenchymal neoplasms are commonly known as?

Answer 460

Lipomas, which are made up of fat cells surrounded by a thin fibrous capsule.