Patient notes

Question 1

4 steps of history taking

Answer 1

• General information about patient(age, sex, martial status, address, race and occupation)
• Chief complaints
• Past/present medical history
• Personal and family history

Question 2

Instruments used to remove pathologic tissue

Answer 2

• Currete (Lucas)=>
• Remove particles or debris from bony tissue or soft tissue tract

Question 3

Instruments used to cut or remove bone

Answer 3

• Roungeurs Forceps(work on bony margins)
• Bone files(smoothen sharp bony margins)
• Osteotome(splits rather than cuts bone)
• Chisel(cuts bone
• Mallet

Question 4

Instruments used to suture the tissue

Answer 4

• Needle holder
• Suture cutting scissors
• Tissue holding forceps(hold tissues during process of dissection or suturing)

Question 5

Instruments used for extraction of teeth and root remnants

Answer 5

• Elevator(Straight, triangular, pick types)
• Handle
• Shank
• Blade

Question 6

Indications for elevator use

Answer 6

• Luxate
• Multi-rooted teeth
• Teeth that cant be engaged by forceps
• Fractured debris

Question 7

Rules when using elevator

Answer 7

• Adjacent teeth not used as fulcrum unless its to be extracted
• Protect soft tissues w/ finger guards
• Elevator supported with index finger
• Work on medial side
• Concave/flat surface of elevator faces tooth

Question 8

Extraction forceps

Answer 8

• Remove teeth from sockets
• Maxillary
• Mandibular

Question 9

Maxillary extraction forceps

Answer 9

• Handles and beaks straight
• Anterior forceps and molar forceps

Question 10

Mandibular extraction forceps

Answer 10

-Handles and beaks at right angle (easy access to mandibular teeth)

Question 11

Instruments used for removal of bone

Answer 11

• Bone burs
• Round and fissure

Question 12

Instrument used to remove bone and sharp bone spicules

Answer 12

Rongeurs Forceps

Question 13

Instrument used to smooth bone

Answer 13

Bone file

Question 14

use of chisels(Bibeveled)

Answer 14

Sectioning roots of multirooted teeth

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Question 48

Lidocaine

Answer 48

- **Gold** standard - **Plain** solution of **2%**-\> short lasting -**Epinephrine** vasoconstrictor common 1:200 000 to 1:80 000(5μg/m to 12.5μg/m)

Question 49

Mepivicaine

Answer 49

-Concentration of **2%** 1:100 000 epinephrine→ similar to 2% epinephrine lidocaine **3% plain** (better anaesthesia than lidocaine when vasoconstrictor free solution required)

Question 50

Prilocaine

Answer 50

- **4% plain** solution - **3%** solution w/ vasocontrictor **felypressin**(if epinephrine free required)

Question 51

Technique for infiltration anaesthesia

Answer 51

- Mouth **partly** open - Needle to depth of **buccal** sulcus(if bone contacted-slight withdrawal) - Injection site **supraperiosteal** - **Aspiration** and injection of **1-2 ml**

Question 52

How long do infiltration injections last?

Answer 52

Pulps 45 mins and soft tissues 1.5-2 hours

Question 53

Articaine

Answer 53

* **4%** 1:100 000 or 1:200 000 epinephrine * **Better** **mandibular** infiltration anaesthesia than lidocaine

Question 54

Bupivacaine

Answer 54

- **long** lasting - 1:200 000 - **Supplementary** intraoral injection during general anaesthesia - **Reduces** number of post-op analgesics required

Question 55

Active ingredient of Ubistein

Answer 55

Articaine and epinephrine

Question 56

Active ingredient of Scandonest

Answer 56

Mepivicaine and epinephrine

Question 57

Active ingredient of xylodren

Answer 57

Lidocaine and epinephrine

Question 58

Active ingredient of dentocain

Answer 58

Articaine and adrenaline

Question 59

Active ingredient of septonest

Answer 59

Articaine and Adrenaline

Question 60

Inferior Alveolar nerve block -Halstead Technique

Answer 60

- Targets **Inferior alveolar nerve** - Anaesthetises * **Teeth** and **bone** on one side of mandible * **Soft** **tissues** on **buccal** aspect anterior to mental foramen * Soft tissues of **lower** **lip** * **Reflected and attached gingivae** from premolar teeth to midline * **Lingual** **nerve**-anterior two thirds of tongue - Injection at **pterygotemporal space** on medial aspect of ramus(region of mandibular foramen)

Question 61

Halstead Technique procedure

Answer 61

- **Long** **35mm** needle **no** **narrower** than 27 gauge used - Patient mouth open **wide** - **Thumb** on coronoid notch - **Index finger extraoral** at height of posterior border of ramus - Syringe passed across **lower premolars** - Penetration of syringe between **external oblique ridge and pterygomandibular raphae** - Height of penetration **halfway** between **thumbnail** - Advance needle **until** bone contacted(25mm of needle insertion) - **Withdraw, aspirate** and **inject** 1.5-2 ml of solution

Question 62

Mental and incisive nerve block

Answer 62

-Anaesthetises * teeth and jaws from **premolars** to **anteriors** * Soft tissues of **lower** **lip** and **chin** to **midline** on one side * **First** **molar** in some cases - Usually **intraoral** but **extraoral** approach can be used - Needle inserted at depth of **buccal** **sulcus** between **premolar teeth at apices**→ Targeting mental foramen - **1.5ml solution** injected and tissues **massaged** to encourage entry of solution into foramen

Question 63

Long buccal nerve block

Answer 63

- Anaesthetises the **buccal** **gingivae** and **mucosa** and part of the **cheek** in the mandibular molar region - **0.5ml solution** in region of **coronoid** **notch** of mandible

Question 64

Tuberosity approach

Answer 64

- Solution deposited **high in buccal sulcus** → **distal** **surface** of maxillary second molar - Angle of **45 degrees** to depth of **15–16 mm** (about ⅔ of a short needle) * No bone contact should occur * **0.9–1.8 mL** of local anesthetic over **30–60 seconds** ## Footnote Common Complication ⚠️ Hematoma -Caused by puncture of the pterygoid venous plexus -Management: immediate pressure, reassurance, cold compress

Question 65

Weisbrem technique

Answer 65

* Open mouth as **wide** as possible * Syringe on opposite **premolars** * Advanced to **lateral edge of plica pterygomandibularis**(pterygomandibular fold) * Needle **0.5 cm below chewing surface of maxilllary third or second molar**=> * In absence of teeth **1.5 cm from alveolar crest** * Needle advanced to contact **bone**, **withdrawn**, **aspiration** and **injection** of 1.5ml * On withdrawl, rest of solution deposited for lingual nerve * Anesthesia after **5-7 minutes**

Question 66

Stages of tooth extraction

Answer 66

Syndesmotomy → Elevation(luxation)→ Forceps delivery → Socket management