Outcome 2 - Oral & Maxillofacial Surgery

Question 1

What is Oral & Maxillofacial surgery?

Answer 1

A dental specialty involved in diagnosis, surgical treatment, injuries of the head and neck.

Question 2

Training for Oral & Maxillofacil surgery

Answer 2

An oral surgeon is a dentist with an additional 4-6 years of postgraduate training in a hospital setting. According to CADA, it is within the scope of practice for an RDA to assist with oral and maxillofacial surgery.

Question 3

Indications for Oral and Maxillofacial Surgery

Answer 3

Oral and maxillofacial surgery generally happen after all other treatment options have been considered. A simple extraction of decayed teeth that cannot be restored to biopsy or surgical removal of impacted teeth is an example of few indications for oral and maxillofacial surgery.

Question 4

What is Osteoctomy?

Answer 4

Osteoctomy or subtractive osseous surgery is the removal of bony projections such as exostosis (bony growths/tori). If there is concern with the benign overgrowths for esthetic or prosthetic reasons, they may be surgically removed.

Question 5

What is Osteoplasty?

Answer 5

Osteoplasty or additive osseous surgery is also known as bone grafting or bone augmentation. There have been many great innovations in grafting processes in recent years. Whenever possible, the patient’s own bone is used for grafting; however, synthetic bone substitutes are available.

Question 6

What is Pericoronitis?

Answer 6

Is the condition in which the tissue around an erupting tooth becomes infected by bacteria due to difficulties in removal of food debris and plaque. A flap of tissue remains distal to an erupting tooth. The tissue becomes swollen and painful. There is often exudate and odor involved with pericoronitis.

Question 7

What is a Simple Extraction?

Answer 7

A simple extraction may also be called routine or uncomplicated. This procedure refers to the removal of teeth that are fully erupted into the arch. This can include teeth that need to be extracted to create space for orthodontic realignment, teeth that have abscessed and are not candidates for endodontic treatment, and fully erupted third molars.

Question 8

Multiple Extraction and Alveoplasty

Answer 8

If several teeth in the same area are to be extracted, the extraction procedure is repeated. After all teeth are removed, the dentist may perform alveoplasty to smooth and contour the alveolar ridge.

Question 9

Impacted Teeth

Answer 9

When a non-erupted or impacted tooth requires extraction, the procedure becomes more complicated. The third molars and the maxillary cuspids are the most likely to remain unerupted in the arch.

Question 10

Difficulty of extracting an impacted teeth

Answer 10

The difficulty of the extraction procedure is determined by the angulation of the tooth in the alveolar bone, as well as by the amount of bone covering the tooth and the proximity of the main nerve, artery and vein. The procedure may vary significantly as the difficulty progresses.

Question 11

Orthognathic surgery

Answer 11

Orthognathic surgery is performed to correct malformations or functional deformities of the mandible and/or maxilla such as:

-Severe class II or III malocclusion that cannot be corrected by orthodontics alone
-Anterior open bite
-Severe bilateral crossbite due to an extremely narrowed arch

Question 12

What is a Biopsy?

Answer 12

A biopsy is a minor surgical procedure involving tissue removal for the purpose of pathological examination and testing. The results will distinguish malignant (cancerous) tissue from a benign (non-cancerous) lesion.

Question 13

The most common biopsy used in dentistry are:

Answer 13

-Exfoliative
-Incisional
-Excisional
-Fine needle aspiration

Question 14

Biopsy Results

Answer 14

Biopsy sample will be sent to the laboratory where results will be returned to the dentist as soon as testing is complete. It is standard practice to have the patient return to the office to discuss the results with the dentist, whether benign or malignant. Benign lesions require ongoing monitoring and testing, while malignancies require immediate treatment by a team of specialists.

Question 15

Surgical Complications

Answer 15

There is a possibility of complications arising from extractions or oral surgery procedures. The dental assistant must be prepared to discuss and advise patients about any possible complications as part of pre- or post op instructions.

Question 16

Sinus Penetration

Answer 16

When impacted maxillary molars are extracted, there is always a chance that the sinus may be penetrated during the luxation process. There is only a thin layer of ligament and bone separating the two. If the root or root fragment remains in the socket or sinus, all efforts should be made to remove it.

Question 17

If root cannot be removed from sinus during extraction

Answer 17

If the root cannot be removed, a surgical incision must be made into the sinus from the facial vestibular area. The root is generally removed with a surgical curette and the surgical site sutured, as with any flap.

Question 18

Cautions for Sinus Penetration

Answer 18

Patients must be cautioned not to blow their nose for several days as this will disturb the healing. Antibiotics and decongestants are generally prescribed to prevent infection and reduce the likelihood of complications. If there was surgery into the sinus itself, the healing period will be much longer

Question 20

What is Paresthesia?

Answer 20

Numbness of a nerve

Question 21

Alveolitis (Dry Socket)

Answer 21

After a tooth has been extracted, blood fills the socket and forms a clot. This is necessary to protect the bone from exposure to the oral environment and facilitate healing and regeneration. A Dry socket (Alveoltitis) is the condition in which this blood clot is not present.

Painful condition that is evident 2-4 days after surgery.

Question 22

Reasons for the clot to be missing (dry socket) include..

Answer 22

-Inadequate blood supply - clot never fully formed

-Trauma to the socket - the alveolar ridge collapses in

-Prescense of infection within the socket - usually from a large pre-existing abscess

-The clot becoming dislodged by the patient not following post op instructions

Question 23

The most common ways that a clot becomes disloged are:

Answer 23

-Vigorous rinsing within the first 24 hours
-Creating suction in the mouth through smoking or drinking through a stray
-Carbonated beverages
-Strenuous physical activity within first 24 hours
-Consumption of very hot beverages

Question 24

Post Op Instructions for Surgery

Answer 24

Post op written and verbal instructions must be provided. In addition, a pack of sterile gause and/or ice pack may be provided to the patient. Post op instructions targer control of bleeding, swelling, pain and diet.

Question 25

What are dental implants?

Answer 25

They are commonly used as attachments for fixed or removable prosthetic teeth. They are surgically embedded into the alveolar bone and may have individual crowns, bridges, or dentures fixed to them.

Question 26

How long to complete implant treatment

Answer 26

in order to follow with the treatment, several requirements should be met by the patient as implant procedure may take from 3-9 months to complete.

Question 27

Team involved in implant treatment

Answer 27

Team of maxillofacial surgeon, periodontist, prosthodontist and implantologist will be involved in the treatment

Question 28

Criteria assessed to determine success of the future treatment for implant

Answer 28

-psychologic evaluation -dental examination -medical history -radiographs (PA, Pan, Cephalometic, and tomographic) -Diagnostic Cast and surgical stents

Question 29

Implant Preparation / Consent

Answer 29

Prior surgical preparation, patient should have written information presented containing implant specific information, possible complications, prognosis, time commitment, home care and additional follow up appointments.

Question 30

Surgical Preparation Site - for implants

Answer 30

Strict infection control protocols must be followed. Patient’s head should be covered with surgical drape, leaving only the mouth exposed. Implants must remain sterile until the actual time of placement.

Question 31

Bone Density for Implants

Answer 31

Bone density plays an important role in the future success or failure for the implant. Where there is not enough bone present, it may be required to add additional bone.

Question 32

3 Compositions of Bone Graft

Answer 32

Synthetic biocompatible material known as Osteoconductive Cadaver bone known as Osteoinductive Bone graft taken directly from patient, known as Osteogenesis

Question 33

3 Types of Dental Implants

Answer 33

Endosteal Subperiosteal Transosteal

Question 34

Endosteal Implant

Answer 34

These are the most common type of implants, and are surgically placed into the alveolar ridge of bone. The usual reason for placement is to support a crown, bridge or a partial or full denture.

Question 35

Subperiosteal Implant

Answer 35

These implants are attached to a large metal framework that is placed over the alveolar ridge, under the periosteal tissue. The usual reason for placement is to support a mandibular denture when there is insufficient ridge remaining to place endosteal implants.

Question 36

Transosteal Implant

Answer 36

These are used when there is insufficient bony ridge, and no other options exist. A metal framework is surgically located at the inferior border of the mandible, with supports extending through the thin ridge of alveolar bone to the superior border. The supports are of sufficient strength to stabilize a lower denture.

Question 37

Implant Maintenance

Answer 37

Ongoing patient commitment is necessary to maintain healthy tissue surrounding the implant. Dental prophylaxis including plaque and calculus removal is necessary to maintain implant longevity. Home care should include daily removal all plaque and debris including single-tufted toothbrushes, dental implant floss or specialized brushes when dentures are involved.

Question 38

Percentage Rate of Implant Success

Answer 38

Success Rate is 90%

Question 39

There are several reasons that may contribute to failure of the implant. For example:

Answer 39

Changes to patient health Periodontal disease Failure of bone integration Bone fracture during surgery Graft rejection Prosthetic design Tissue defects Bone or tissue density Inadequate implant type chosen Poor drilling technique Mastication forces

Question 39

Indications for dental implants include the following:

Answer 39

To replace one or more teeth as single units without affecting adjoining teeth To replace a bridge and eliminate the need for removable partial denture To provide support for a denture, making it more secure and comfortable To prevent bone loss and gum recession that often accommodate bridgework and dentures To enhance the patient’s confidence in smiling and speaking To improve the patient’s overall psychological health To improve the esthetic appearance of the patient’s teeth and mouth

Question 40

The following contraindications should be considered when implant options discussed:

Answer 40

The financial investment is greater than that for a conventional bridge or denture. Treatment can take several months or longer to complete. As with any surgical procedure, implants convey a risk of infection and other complications. An implant may loosen, requiring replacement. Emotionally the implant procedure may be challenging for some patients. Bruxism is a significant component of failed implants

Question 41

Medical conditions that could contraindicate implants include:

Answer 41

-Diseases of the Cardiovascular system -Disease of the respiratory system -disease of the gastrointestinal system - smoking and escessive alcohol consumption can impede perio health and healing factors

Question 42

Surgical instruments are designed to..

Answer 42

to separate the tooth from the socket, retract surrounding tissue, loosen and elevate the tooth within the socket, or extract the tooth from the socket.

Question 43

Pre-Op, Post-Op instructions that should be provided to patient

Answer 43

what to expect prior, during or after minor extraction of a primary tooth vs complex extractions of multiple teeth should be provided to the patient. In addition, a pack of sterile gauze and or ice pack may be provided to the patient. Post-operative instructions target control of bleeding, swelling, pain and diet.