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Revision Questions Flashcards

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1
Q

What are the indication for XLA?

A 
Gross caries
Advacned perio disease
Tooth/root fracture
Servere tooth surface loss
Pulpal necrosis
Apical infection

Traumatic position
Ortho indication
Syptomatic PE teeth
Interfernce with construction of dentures

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2
Q

What forces are applied to a single rooted tooth?

A

Apical pressure
Rotational movement (unscrewing)
Buccal and lingual expansion

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3
Q

What forces are applied to a molar tooth?

A

Apical pressure
Figure of 8 rotation
Buccal expansion

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4
Q

What are upper instruments?

A 
Straight - anterior teeth
Univerisal - canines and premolars
Molars - left and right
Roots - broken down roots/retained roots
Bayonettes - wisdom teeth or 7's positioned distally 
Root Bayonettes - for roots
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5
Q

What are lower instruments?

A

Universal - lower 5-5
Molars - molar teeth
Roots - broken down roots/retained roots
Cowhorns - broken down molar teeth, apically gauages in furcation

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6
Q

What are the mechanical principles for tooth elevation?

A

Wheel and Axele
Lever
Wedge

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7
Q

What are the uses of elevators?

A 
Removal of retained roots
XLA without forceps
Removal of root apices
Removal of root stumps
Loosen tooth prior to forceps
Provide point of applicaiton for forceps
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8
Q

What are the types of elevators

A

Couplands chisel - elevates and loosens the tooth off, rotational movement
Cryers - Elevates and looses the tooth off, for molar roots
Warwick james - removes roots, placed perpendicular to long axis of tooth
Luxator - Seperates perio ligament and widening of tooth socket, parallel to long axis of tooth and pushes down to seperate perio ligament

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9
Q

What are the soft tissue retractors?

A

Howarth’s periosteal elevator

Bowdler Henry Retractor (rake)

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10
Q

What are some heamostatic agents?

A

Adrenaline containing LA
Oxidised regenerated cellulose - surgicel - framework for clot formation (careful in lower 8 region as acidic and can damage IDN)
Gelatin sponge - absorbable/meshwork for clot formation
Thrombin liquid and powder
Fibrin foam

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11
Q

What are some systemic haemostatic aids?

A

Vit K
Anti-fibrinolytics - tranexamic acid - prevents clot breakdown
Missing blood clotting factors
Plasma or whole blood

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12
Q

How is haemostasis achieved

A

Peri op - LA with vasoconstrictor, artery forceps, diathermy, bonee wax
Post op - pressure, LA, diathermy, WHVP, Surgicel, Sutures

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13
Q

What are post op instructions for an XLA

A

Tell them they will be sore over the next few days as LA wears off
Use analgesia when required
Do not exercise that day and avoid anything that increases blood pressure which may result in bleeding
Avoid hard/hot foods
Avoid alcohol for that day
Do not rinse for about 24hours then start warm salty rinses
If bleeding occurs bite on damp gauze for 20-30 mins
Avoid smoking due to delayed healing and dry socket
Any concerns contact the practice

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14
Q

What are peri op complications

A 
Difficult of access and vision
Abnnormal resistance
Fracture
Involvement of maxillary antrum 
Loss of tooth
damage to nerves
Damage to vessels
Haemorrhage
Dislocation of TMJ
Damage to adjacent teeth
Broken instruments
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15
Q

What is anaesthesia?

A

Numbness/total loss of sensation

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16
Q

Paraesthesia?

A

Tingling

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17
Q

Dysaesthesia

A

impleasant sensation/pain

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18
Q

Hypoaesthesia

A

reduced sensation

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19
Q

Hyperaesthesia

A

increased/heightend sensation

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20
Q

Neuropraxia

A

Contusion of nerve/ continuity of epineural sheath and axons maintained

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21
Q

Axonotmesis

A

Continuity of axons but not epineural sheath disrupted

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22
Q

Neurotmesis

A

Complete loss of nerve continuity/nerve transected

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23
Q

What is the management of a oro antral fistuala/communication

A

Inform patient
Small sinus intact - ecourage clot, suture margins, antibiotics, post op instructions
Large lining torn - close with buccal advacnement flap, antibiotics and nose blowing instructions

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24
Q

What are the causes of a fracture tuberosity?

A

Single standing molar
Unknown unerupted molar wisdom
XLA gone wrong
Not enough alveolar support

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25
What is the diagnosis of a fractured maxillary tuberosity?
Noise Tear on palate More than one tooth moving movement
26
How do you manage a fractured maxiallry tuberosity
Dissect out and close wound/ reduce and stabilise Fixation - remove/treat pulp, ensure occulsion free, antiobiotics and antiseptics, post op instructions, remove tooth 8 weeks later after splint by surgical removal
27
What are the post op complications?
``` Pain Swelling Ecchymosis (bruising) Trismus Haemorrhage Prolonged effects of nerve damage Dry socket Sequestrum Infected socket Chronic OAF Osteomyelitis Osteroradionecrosis MRONJ Actinmycosis ```
28
Immediate haemorrahge (reactionary/rebound)
Occurs within 48hrs of XLA Vessels open up/vasoconstrcition efftcs of LA wear off sutures loose or lost Patient traumatised area with tongue/finger/food
29
Secondary bleeding
Often due to infection Commonly 3-7days after XLA Uusually mild ooze but can be major bleedin
30
Symptoms of dry socket?
``` Dull aching pain bad taste Bad/characterstic smell Exposed bone sens and source of pain Throbs and can radiate to pts ear Keeps them awake at night ```
31
What are some predisposing factors for a dry socket?
``` Molars Mandible Smoking Females OCP LA - vasoconstrictor ```
32
Management of dry socket
Supportive - reassurance/systemic analgesia LA block Irrigate socket with saline Curettage/debridement - encourage bleeding, new clot formation Antiseptic pack (alvogyl) Advise pt analgesia and hot salty mw's Review pt and change pack and dressings
33
What is osteomyeltisi?
Inflammation of the bone marrow - usually mandible due to poor blood supply Infection of the bone Pt often systemically unwell/ raised temp Site of XLA tender
34
What are predisposing facotrs of osteomyelitits?
Odontogenic infections | Fractures of mandible
35
What is acute supparative osteomyelitis
Little or no radiograph change | At least 10-12 days required for lost bone to be detected radiographically
36
Chronic osteomyelitis
+/- pus - bony destruction in the area of infection
37
Treatment for osteomyeltis
Medical and surgical Antibiotics - clindymacin/pencillin (longer course than normal) Serve acute osteomyelitis may require hosiptal admission and IV antibiotics Surgical - drain pus, remove any non vital teeth in area of infection, remove any loose peices of bone, removal of bony cortex, perofration of bony cortex, exicsion of necrotic bone
38
How can you prevent osteoradionecrosis?
Scaling/CHX Mw up to XLA Careful XLA technique Antibiotics, CHX mw and review Hyperbaric oxygen - in increase local tissue oxyenation and vascualr in growth to hypoxic areas
39
What is treatment for osteoradionecorsis
Irrigation of necrotic debris Antibiotics not helpful unless secondary infection Loose Sequestra removed Small wounds, heal over course of weeks/months
40
Factors for MRONJ
Deugs Length of time patient is on drugs Diabetes/ steriods/anti cancer chemo/smoking
41
What is the management for MRONJ?
Remove sharp edges of bone CHX Mw Antibiotics if suppration
42
What is actinomycosis?
Rare bacterial infection It crodes through tissues rather than follow typical fascial planes and spaces Thick lumpy pus
43
What is the treament for Actinomycosis?
I&D of pus accumulation Excision of chronic sinus tracts Excision of necrotic bone and foreign bodies High dose antibiotics for intial control Long term antibiotics to prevent reccurrence
44
What is infective endocariditis?
Inflammation of endocardium affecting heart valves or CMP caused by bacteria
45
What are the stages of surgery
``` Consent Safety checklist LA Access Bone removal tooth removal Debridement/wound management Suture Achieve haemostasis Post op instructions Follow up ```
46
Points for surgical access
Wide based incison - circulation and perufsion Use scalpel in one form/firm stroke No sharp angles and good sized flap Minimise truama to dental papillae No crushing and keep tissues moist Make sure wounds are not closed under tension Aim for healing by primary intentions to minimise scarring
47
Types of debridement
Physical - bone file or handpiece to remove sharp bony edges/ mitchell's trimmer to remove soft tissue debirs Irrigation - sterile saline into socket Suction - Aspirate under flap, check oscket for reainted apices
48
What handpieces are used for surgery?
Straight handpiece with saline cooled bur | Round or fissue tungsten carbide bur
49
Why do you not use an air tubrine handpiece for surgery?
Can cause surgical emphysema
50
Aims of suturing
``` Achieve haemostasis Cover bone Healing by primary intention Reposition Tissues Prevent wound breakdown ```
51
What are the suture types
Resorable - mono - moncryl - Poly - vicrly rapide Non resorable - mono - proliene - Poly - mersilk (black silk)
52
Monofilament sutures?
Single stranded and resistant to bacterial colonisation | Less filaments reduces the number of sources of possible infection
53
Polyfilament sutures
Several filaments twisted together Easier to handle Prone to wicking - more filaments increases the number of sources of possible infection, fluid and bacteria may accumulate
54
Resorable Sutures
Suture material absorbed by the tissues and patient does not need to come back Used where suture removable is difficult
55
Non - resorable sutures
Tensile strength does not reduce and not absorbed by the tissues and patient must return for suture removable Used in areas where suture is required for longer duration
56
Aims of retracting flap
Better access and vision Retraction of soft tissues Closure of OAF
57
4 things that influence flap design
``` Personal perfernces Access needed Procedure Surrounding nerves Ability to suture it back Area in mouth ```
58
Causes of neuro-sensory deficity?
Damage due to LA Damage to nerve in surgery Crushing on removal of tooth Cutting/shredding due to LA or flap design
59
4 nerves damaged by XLA 3rd molar
Lingual nerve Inferior alveolar nerve Buccal nerve Mylohyoid nerve
60
2 nerves that are blocked when injected into the pterygomandibular space
Lingual nerve | Inferior alveolar nerve
61
History of sharp pain that is not relieved by analgesia
Trigeminal Neuralgia
62
Stenson's Duct opens opposite (parotid duct)
Upper 2nd molar
63
Incidience of sialolitheis (salivary gland stones)
Submandibular gland
64
Complication of PSANB
Heamatoma

Oral Surgery (6 decks)

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