Oral Surgery, Bitches COPY Flashcards Preview

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Flashcards in Oral Surgery, Bitches COPY Deck (129):
1

SOAP - expand and define:

Subjective: med Hx, CC

Objective: vitals, radiographs, etc. (obtain/organize)

Assessment: analyze and diagnose

Plan: and/or procedure

2

Surgical Wound Classification, Class I

Class II

Class III

Class IV

Clean, uninfected

Clean-contaminated (resp, alimentary, genital, urinary entered)

Contaminated - open, fresh, accidental

Dirty-infected - old, traumatic, infected

3

When making incisions, the blade is _______ to the surface

Perpendicular

4

3 potential complications of a Flap:

Necrosis

Dehiscence (opens up)

Tearing

5

In a Flap, the _____ should be wider than the ______

Base wider than Tip

6

T/F
It is almost impossible to make an incision too long

True

*avoid tears and nerve damage/pain

7

Important: Incisions heal in what direction?

In width (across)

*independent of length, does NOT heal end to end

**longer incision better

8

Make releasing incisions how many teeth away from the extraction site?

1 - 1.5 teeth away

9

Irrigate tissue with _______ instead of _______

Saline solution

Distilled water

10

If an instrument is used to place tissue in _______ , don't use it again

Formalin

*denatures tissues

11

T/F
Don't crush, overheat, or dry out tissue

True

12

Poorly controlled _______ will lead to increase tension on the wound, decrease vascularity, and provide a culture/medium for infection

Hemostasis

13

Dead space (like a socket) will remain empty after closure and will fill up with blood, with leads to what?

High potential for infection

14

Eliminate dead spaces by suturing from the bottom or a ______ dressing

Pressure

15

4 methods to promote wound Hemostasis:

Assist natural (direct pressure)

Thermal coagulation (electrocautery)

Suture ligation

Vasoconstrictors

16

4 methods to eliminate Dead Space:

Suture

Pressure dressing

Packing

Drains (suction/nonsuction)

17

In the 1st couple days use _______ to decrease inflammation

After use ______

Ice

Heat

18

Decrease infection risk by _________ during surgery

Remove necrotic and foreign ischemic material - known as ________

Irrigation

Debridement

19

4 ways to Control Edema during surgery:

Careful

Elevation

Systemic steroids

Ice

20

Mucosal edges heal until they meet, known as...

Epithelialization

21

When will epithelial healing stop?

Once it touches other free edge of epithelium

22

3 stages of wound healing:

Inflammatory

Fibroplastic

Remodeling

23

Anything tending to hold wound edges apart:

Tension

24

Primary intention:

Secondary intention:

Tertiary intention:

Sutured lacerations/incisions

Gap (extraction sockets)

Grafts

25

Primary intention of bone has edges less than _____mm apart

Secondary intention of bone healing has edges more than _____ mm apart

1 mm

1 mm

26

Healing in extraction socket - Whitish yellowish stuff:

Greenish:

Socket looks empty:

Fibrin clot (or fluid if soft, bone/tooth/peanut if hard)

Food

If symptoms, dry - if no pain, not dry

27

Extraction sockets heal by _______ intention

Secondary

28

If the nerve is Contused, you normally get _______ recovery

Spontaneous

29

When there is opening into sinus lining, how to wounds heal?

Proliferate along wound into tract

*creates opening (epithelialized tract between oral cavity and sinus)

30

Inflammatory Stage Phase I:

Phase II:

Vascular (vasoconstriction)

Cellular (Complement cascade)

31

What holds wounds together during the inflammtory stage?

Fibrin

*not strong

32

4 signs of Inflammation:

Rubor (redness)

Calor (heat)

Dolor (pain)

Tumor (swelling)

33

In the Fibroplastic Stage, _______ strands form the latticework in which _______ lay down ground substance and ________

Fibrin

Fibroblasts

Tropocollagen

34

After Tropocollagen is layed down by the Fibroblasts, capillary ingrowth occurs and wounds rapidly gain strength - this phase lasts how long?

These wounds are ______ due to excess/haphazard collagen arrangement

These wounds are _______ b/c lots of vascularization

These wounds are ___% as strong as uninjured tissue

2-3 weeks

Stiff

Erythmatous

70-80%

35

T/F
You can't wear hand jewelry in surgery

True

36

What stage of wound healing is 70-80% as strong as uninjured tissue?

What stage is 80-85% as strong?

Fibroplastic

Remodeling

37

Wound Maturation, aka...

Remodeling Stage of wound healing

38

In the Remodeling Stage, _____ is removed and the wound softens

Collagen

39

T/F
Every incision results in a scar

True

40

4 factors that impair wound healing:

Foreign material

Necrotic tissue

Ischemia

Wound tension

41

Foreign material (impairing wound healing) can be bacteria, dirt, or _______

Suture material

42

Flushing a wound with a sterile solution, aka...

Debridement

43

What can prevent the growth of reparative cells?

Necrotic tissue

44

2 factors that impair Wound Healing

Ischemia (leads to further necrosis and decreased nutrients)

Tension (anything tending to hold wound edges apart)

45

What heals better b/c there is less re-epithelialization, collagen deposition, contraction, and remodeling?

Primary Intention Wounds

46

What type of wound contains a Gap between epithelial edges and takes longer to heal?

What is an example?

Secondary Intention

extraction sockets

47

Wound treated by coverage with tissue grafts:

Tertiary Intention

48

Bone Healing has the same 3 stages as Soft Tissue: Inflammation, fibroplasia, and remodeling

In addition, what 2 factors are involved?

Osteoclasts

Osteoblasts

49

Bone
Less than 1 mm apart:

More than 1 mm apart:

Primary Intention

Secondary Intention

50

In Bone healing of Secondary Intention, a ______ formation extends beyond the free edges of the bone and is followed by ossification

Callus

51

Extraction Socket Healing:
Bleeding, Clot, Platelets adhere to surrounding tissued , then _____ transformed into ______ (thin, whitish)

Fibrinogen

Fibrin

52

T/F
In wound healing, Fibrinogen turns into Fibrin which trap cellular components

True

53

Extraction Sockets heal by ______ intention

Secondary

54

Week One wound healing:

Week 2 wound healing:

Week 3-4:

Inflammatory Stage

Granulation tissue/osteoid deposition

complete epithelialization

55

4 requirements of Implant Healing (Osseointigration):

Tight Fit

Viable bone

Implant Immobility

Implant surface free of contamination

56

Implant placed, superficial layer on surface of implant dies, scaffold forms, new bone forms, osteocytes secrete _______ at implant surface and secrete osteoid (new bone)

proteoglycans

57

Membrane that allows O2, fluids, nutrients through but not Fibroblasts - can exclude soft tissue and guide bone into the right position

GTR - Guided Tissue Regeneration

58

What type of epithelial junction exists at an implant?

Hemidesmosomal

59

3 most injured nerves:

IAN-Mental Nerve - Mn fractures

Lingual Nerve - 3rd Molars (impacted)

IA Nerve (AMC or orbital blow-out fractures)

60

Neurapraxia (loss of nerve conduction) causes resorption of ______

Recovery usually _______

myelin sheath

spontaneous

61

Resorption of myelin sheath:

Axons/myelin sheath disrupted, recovery 2-6 months

Complete loss of nerve/transection

Neurapraxia

Axonotmesis

Neurotmesis

62

Nerve healing proceeds by _____ followed by _____

Degeneration

Regeneration

63

What instrument is used to reflect mucoperiosteum, loosen soft tissue, or to retract flap after reflection?

Periosteal Elevator

*has that beaver tail

64

T/F
Mennesota cheek and flap retractor, Weider tongue retractor, seldin flap retractor all retract soft tissues

True

65

Stillies, Adson, and Cotton?

Forceps

66

2 Instruments to remove Bone:

Chisel

Mallet

67

T/F
You can't use any handpieces that blow air b/c it can cause serious infection/swelling

True

68

What Instrument is Primarily used for cutting/removing bone?

Rongeurs

*spring loaded handle

69

What instrument looks like a spoon and is used to remove soft tissue from bone cavities?

Curette


*periapical or double-ended dental

70

What clamps a vessel?

What sutures?

Hemostats

Needle Holder

71

Bone wax ____ blocks small bone channels

mechanically

72

What's your "go to" hemostatic material?

made of?

Gelfoam

*gelatin sponge

73

Gelfoam, CollaPlug, CollaTapa, and CollaCote all control hemmorrhage

True

74

The better instrument for suturing:

The better needle design:

3/8 circle

reverse cutting

75

Plain gut suture lasts ____ days in oral cavity

Chromic gut lasts ____ days

5 days

10-12 days

*made from sheep intestines serosal lining

76

Suture scissor for removing sutures

What 2 are for dissection/cutting soft tissue?

Iris

Metzenbaum

77

2 Instruments for holding mouth open:

Bite block

Molt Mouth Prop (use w/ caution)

78

What luxates teeth, removes broken/surgically sectioned teeth from sockets?

Dental Elevators

79

3 types of Dental Elevators:

Straight

Triangular

Pick

80

2 Types of Extraction Forceps: (and shape)

Mx - S shaped

Mn - L shaped

81

What is used for All OS procedures?

Pharyngeal Partition

82

T/F
Making a Flap makes a procedure surgical

False

*must be tissue and bone

83

2 Extraction techniques:

Closed (forceps)

Open (surgical with flaps)

84

In a Closed Extraction, loosen soft tissue with what instrument?

Luxation with what?

Then forceps

periosteal elevator

luxator/elevator

85

T/F
Usual post-op care of socket involves curette, irrigation, and CHX

True

86

Envelope Flap has how many teeth Anterior and Posterior to tooth of interest?

Releasing Incision?

2 teeth Anterior, 1 tooth Posterior

1 tooth each

87

To close an Antral-Oral Fistula, use what kind of Flap?

Pedicle

88

T/F
Not seeing the PDL is an indication for extraction

True

89

Where should you never suture after extraction?

Over socket

90

How does suturing usually proceed?

Buccal to Lingual

*Soft to Hard tissue

91

T/F
There should be no knots placed over the incision line

true

92

3 Cases in which Root Fragments can be left:

If excessive Trauma

Smaller than 4-5mm

Next to vital structures (nerves, vessels, sinus)

93

If there is _____ or _____ at the Apex of a tooth it must come out

infection

radiolucency

94

If multiple extractions, which usually come out first?

Last?

Maxillary

1st Molars, Canines

95

The width of the cuff should be __% greater than the diameter of the extremity

20%

96

In what part of SOAP are diagnoses listed?

A - assessment

97

American Academy of Anesthesiologists I:

ASA II:

ASA III:

normal/healthy

mildly systemic

severe systemic disease

98

T/F
If Angina is stable, ambulatory OS procedures are usually safe with proper precautions

True

99

With Angina Pectoris, what is the dental management Strategy if Stable

Stress reduction/pain control

100

How much should epi be limited with Angina?

ABx when?

0.04 mg

6-8 weeks post stent placement

101

When should procedures be done if pt has Unstable Angina?

after med consultation to PCP

OMFS if emergency

102

Tx should be deferred how long after MI?

6 months

103

How is Warfarin/Coumadin effect measured?

INR

104

3 types of blood thinners:

Clotting cascade interference

Platelet aggregation inhibitors

Direct Thrombin inhibitors

105

INR (if pt taking Coumadin) must be taken ___ hrs prior to surgery.

If it is less than ____, most minor surgery can be done

24 hours

3

106

Platelet Aggregation Inhibitors: Pts may be on Aspirin, _____, or both

Can be on what for surgery?

Clopidogrel

one, not both

107

Pt taking Aspirin and Clopidogrel must discontinue one ____ days pre-op

5-7 days

108

A Direct Thrombin Inhibitor (Pradaxa) must be discontinued when?

evening before, morning of procedure

*2 doses

109

Defer elective Tx ___ months after CVA (stroke)

Limit epi to ___ mg

6 months

.04

*like MI

110

CV pts should be treated with anxiety reduction, _______ should be available, and minimize epi

Nitroglycerin

111

T/F
ABx prophylaxis is required for Dysrhythmias

False

112

T/F
ABx prophylaxis is required for Acquired Valve Disease

True

113

ABx prophylaxis is recommended for what 3 conditions?

Prosthetic cardiac valve

Previous BE (bacterial endocarditis)

Congenital heart disease - various categories

114

Standard AB used for BE pt:

if allergic:

non oral:

allergic/non oral

amoxicillin

clindamycin/arithromycin/clarithromycin

ampicillin

clindamycin/cefazolin

115

HTN emergency:

HTN urgency:

over 200 systolic

over 115 diastolic

116

Pts with HTN should take what prior to Dental surgery?

normal antihypertensives

(just sip of water)

117

For mild/moderate HTN, Tx is limited and BP is _____

Severe HTN BP is _____ and electives are deferred

140/90

200/100

118

Bronchial asthma - keep albuterol on hand and use what in case of emergency?

Avoid meds containing ____ and _____

*Demerol (histamine) should be avoided

1:1000 epi

NSAIDS, aspirin

119

No supplemental what if pt has COPD

Oxygen

120

Renal Transplant pts - can have Cyclosporin A induced _____

gingival hyperplasia

121

If Prostate cancer, think what?

bisphosphonates

122

The best metric for Diabetes monitoring (avg over 3 months):

HbA1c

123

HbA1c reflect avg glc levels over previous ___ months

3

124

When should Diabetes pts be scheduled?

Early AM

125

What to do w/ dose if pts taking steroids if Dental Surgery?

Double dose prior, day of, day after

*adrenal suppression pts

126

If Hyperthyroidism avoid _____

*limit epi

Atropine

127

Stop taking Aspirin how long prior to Dental Surgery?

5 days

*restart day after

128

If INR is less than 3, proceed with surgery. If not stop Coumadin __ days prior to surgery (w/ physician approval)

3 days

129

If pt on Heparin, defer surgery ____ hrs after stopped and reverse with Protamine

6 hrs

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