#3 Clinical Skills B > Tooth extraction notes > Flashcards

Tooth extraction notes Flashcards

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1
Q

Why is a thorough history important in dental assessment?

A

To gain a diagnosis and formulate a treatment plan.

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2
Q

How should the initial complaint be recorded?
whose words should i be recorded in?

A

In the patient’s own words.

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3
Q

What should you consider early when assessing pain? - whether its of what origin?

A

Whether it is odontogenic (dental origin) or not.

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4
Q

Example of non-odontogenic pain that mimics dental pain?

A

Sinusitis.

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5
Q

What is mneumonic used to take a detailed pain history?

A

The mnemonic SOCRATES.

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6
Q

What else should be recorded besides pain history?

A

Previous dental attendance, social, and family history.

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7
Q

What social factors are important to ask about?

A

Occupation, smoking status, alcohol intake, family history.

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8
Q

What should a succinct medical history include?

A

Known allergies and a full systems review.

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9
Q

Why is medicine important in dental practice?

A

It integrates into clinical dental care and affects treatment.

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10
Q

What medication information should be collected? - which medication are we collecting info about?

A

Prescription (POM) and over-the-counter (OTC) meds.

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11
Q

What follows history taking?

A

Extra-oral and intra-oral examination.

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12
Q

What do you begin to formulate after clinical examination?

A

A differential diagnosis.

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13
Q

What investigations help confirm diagnosis?

A

Vitality testing, pressure testing, imaging.

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14
Q

What comes after confirming a diagnosis?

A

Formulating a treatment plan.

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15
Q

Common reasons for tooth extraction?

A

Unrestorable caries,
pulpal necrosis,
periodontal disease,
pathology,
ortho reasons,
pre-radiation therapy,
infection.

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16
Q

What is the SAC approach in extraction complexity?

A

S = Straightforward
A = Advanced
C = Complex

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17
Q

SAC Patient factors include:

A

Age, ethnicity, perio status, oral hygiene, mouth opening, consent capacity.

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18
Q

SAC Medical factors include:

A

ASA grade, medications, BMI.

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19
Q

SAC Surgical factors include:

A

Tooth anatomy, bone density, adjacent teeth, pathology, impaction, local anatomy.

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20
Q

Why preserve bone during extraction?

A

To reduce post-extraction bone loss, especially buccal/labial plate.

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21
Q

How much bone can be lost post-extraction in a year? - how much horizontal and vertical?

A

Up to 56% horizontal, 30% vertical (buccal plate).

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22
Q

What’s the aim of ‘atraumatic’ extraction?

A

Minimise trauma and preserve bone.

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23
Q

What tools help with atraumatic extraction?

A

Periotomes and luxators.

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24
Q

What is piezosurgery?

A

Ultrasonic surgical tool that selectively cuts mineralised tissues.

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25
Advantage of piezosurgery?
Preserves bone and protects soft tissues.
26
Key principle in extractions?
"The bone belongs to the patient, the tooth belongs to you."
27
What forms after a tooth is extracted?
A blood clot.
28
What replaces the clot by day 3?
Highly vascular granulation tissue.
29
What begins to form 5 days post-op?
Granulation tissue replaces clot; angiogenesis begins at 1 week.
30
Events at 1 week post-op:
Plasma leaks, fibroblasts aggregate, fibroplasia begins, WBCs clean area.
31
3–4 weeks post-op:
Granulation tissue becomes connective tissue; woven bone starts forming.
32
What happens to socket bone at 3–4 weeks?
Cortical crest and thin buccal/palatal plate begin resorbing.
33
4–6 weeks post-op:
Lamellar bone begins forming; trabeculae nearly fill socket.
34
16 weeks post-op:
Osteogenic activity mostly complete; periosteum re-established by 180 days.
35
What legal case changed consent standards?
Montgomery v Lanarkshire Health Board (2016).
36
What did Montgomery case rule?
Patients must be informed of any material risks and alternatives.
37
Old standard for risk disclosure?
The Bolam test – based on responsible medical opinion.
38
Routine risks to warn about in extractions:
Pain, swelling, bleeding, bruising, infection, dry socket, adjacent tooth damage.
39
What affects additional risk disclosure?
The specific procedure and patient factors.
40
What is PRF?
Platelet Rich Fibrin – made of platelets, leukocytes, and fibrin matrix.
41
Benefits of PRF in extraction sites?
Accelerates soft tissue and bone healing; reduces bone resorption and pain.
42
Examples of anatomy-related complications:
Inferior alveolar nerve, lingual nerve, maxillary sinus.
43
Q: What are the key aims when dealing with complications in oral surgery?
A: To develop a constructive, competent, and confident approach to complications in oral surgery.
44
Q: What are the objectives in managing complications in oral surgery?
Predict the possibility of a complication occurring Recognize an adverse outcome Manage complications appropriately Be aware of how to avoid complication
45
Q: What are the three general phases where complications may arise in oral surgery?
A: Pre-operative, peri-operative, and post-operative phases.
46
Q: List common complications in oral surgery.
Pain Bleeding Infection MRONJ (Medication-Related Osteonecrosis of the Jaw) Alveolar osteitis OAC/F (Oroantral communication/fistula) Nerve injury Fracture Iatrogenic issues Inhalation Swallowed objects Trismus
47
Q: What should be included in preparation to minimize complications in oral surgery?
1. Patient’s history 2. Medical history 3. Clinical assessment 4. Appropriate investigations 5. Diagnosis 6. Treatment plan
48
Q: What factors can increase the severity of pain in oral surgery?
Bone removal (associated with higher pain) Patient anxiety Procedure complexity (SAC classification)
49
Q: What are the types of pain in oral surgery?
A: Odontogenic or non-odontogenic, further classified into: Neuropathic pain Inflammatory pain
49
Q: What is the recommended analgesic for mild to moderate pain after tooth removal without bone removal?
A: 1 g paracetamol every 6 hours as necessary, up to a maximum of 4 g per 24 hours.
50
Q: What is the first-line analgesic for moderate to severe pain after tooth removal with bone removal?
A: 400 mg ibuprofen every 6 hours regularly.
51
Q: What is the next step if ibuprofen alone is inadequate for moderate to severe pain?
A: Add 1 g paracetamol with 60 mg codeine combination every 6 hours as necessary, up to a max of 4 g paracetamol in 24 hours.
52
Q: What should be given if NSAIDs are contraindicated?
A: 1 g paracetamol with 60 mg codeine combination every 6 hours regularly (max 4 g paracetamol/24 h).
53
Q: What is used for inpatient management of moderate to severe pain after complex surgeries?
A: Morphine by intravenous titration against verbal pain rating or intramuscular injection.
54
Q: What medication(s) are recommended for mild pain according to the WHO analgesic ladder?
A: Paracetamol OR ibuprofen.
55
Q: What medication combination is recommended for mild to moderate pain?
A: Paracetamol AND ibuprofen.
56
Q: How is moderate to severe pain managed?
A: Paracetamol AND ibuprofen AND opioid (e.g., codeine).
57
Q: What is the treatment for severe to very severe pain in the WHO ladder?
A: Interventional treatments ± non-opioid ± adjuvant therapy.
58
Q: What is the WHO’s guiding principle for analgesia delivery?
A: “By the clock, by the mouth, and by the ladder.”
59
Q: What causes swelling and inflammation in oral surgery?
A: The body’s response to injury, irritation, or harmful stimuli (e.g., trauma, allergens, or pathogens).
60
Q: Can swelling occur without infection?
A: Yes, inflammation can occur without infection.
61
Q: What mediates swelling/inflammation?
A: The immune system through cytokines, histamines, and prostaglandins.
62
Q: What causes infection in oral surgery?
A: Pathogenic microorganisms (bacteria, fungi, viruses) invading tissue and multiplying.
63
Q: What symptoms can infection present with?
A: Pus, fever, lymphadenopathy, and possibly systemic symptoms.
64
Q: Can inflammation occur without infection?
A: Yes, inflammation can exist without infection.
65
Q: Does infection always cause inflammation?
A: Yes, infection always leads to inflammation because it is caused by pathogenic organisms.
66
Q: When does swelling/inflammation typically occur post-op?
A: It usually begins 12–24 hours after surgery.
67
Q: How long can swelling/inflammation last post-op?
A: Up to 72 hours, but for mandibular third molars (MTMs), patients should be warned it can last up to 10 days.
68
Q: What factors influence swelling/inflammation post-surgery?
A: The extent of the procedure and patient-specific factors.
69
Q: What causes heat and redness in inflammation?
A: Increased blood flow to the site of inflammation.
70
Q: What causes swelling during inflammation?
A: Accumulation of fluid in the affected tissues.
71
Q: Why does inflammation cause pain?
A: Due to inflammatory mediators and stimulation of sensory neurons.
72
Q: What leads to loss of function in inflammation?
A: Tissue damage resulting from the inflammatory process.
73
Q: Name some patient-related risk factors for post-op infection.
A: Smoking, vaping, extremes of age, poor oral hygiene, and poor nutrition.
74
Q: How does operator experience influence infection risk?
A: Inexperienced operators increase the likelihood of post-op infection.
75
Q: What groups are considered immunocompromised or immunosuppressed?
A: Patients on immunosuppressive meds (e.g. steroids) and oncology patients undergoing chemo/radiotherapy.
76
Q: What is the average post-operative infection rate in oral surgery?
A: Less than 1%.
77
Q: What are the systemic signs of infection?
Pyrexia (fever) Tachycardia (elevated heart rate) Lymphadenopathy (swollen lymph nodes) Changes in blood picture (e.g. elevated white cell count
78
Q: What are the local signs of infection/inflammation?
Heat Redness Swelling Pain Loss of function
79
Q: What are the early signs of infection progression in oral surgery?
Pain Halitosis Swelling Erythema Bad taste
80
Q: What are the later signs of infection progression?
Trismus Pyrexia Lymphadenopathy Malaise Dysphagia
81
Q: What is trismus and what can cause it?
Restricted mouth opening due to: Inflammation Trauma Infection
82
Q: What type of infections are most dental infections microbiologically?
Mixed infections (polymicrobial) Contain Gram-positive and anaerobic bacteria
83
Q: What is the sensitivity rate of dental infections to amoxicillin and metronidazole?
Approximately 70% of dental infections are sensitive to amoxicillin + metronidazole.
84
Q: What is sepsis?
“Life-threatening organ dysfunction due to a dysregulated host response to infection.”
85
Q: Is sepsis common in dentistry?
No, it's not common but dental infections can potentially spread and lead to sepsis.
86
Q: What does the SEPSIS mnemonic stand for?
Slurred speech or confusion Extreme shivering or muscle pain Passing no urine in a day Severe breathlessness It feels like you're going to die Skin mottled or discoloured
87
Q: What is trismus?
A: Trismus is restricted mouth opening.
88
Q: What are the three main categories of causes for trismus?
Inflammation Trauma Infection
89
Q: How can inflammation cause trismus?
Trauma from surgery: Especially tissue manipulation during mandibular third molar (MTM) surgery affecting muscles like masseter, temporalis, and medial pterygoid. Oedema from surgery: Inflammation around the muscles and TMJ complex can restrict movement.
90
Q: What are muscular causes of trismus?
Myofascial pain/spasm: Often from prolonged mouth opening during surgery. Needle trauma from local anaesthetic: May irritate the medial pterygoid muscle.
91
Q: What infectious conditions can cause trismus?
Surgical Site Infection (SSI): Infection or cellulitis affecting surrounding muscles. Pericoronitis: Infection around a partially erupted third molar. Deep Space Infection: Such as a submasseteric abscess
92
Q: What are key history questions to assess bleeding risk?
OBGYN history History of tonsillectomy History of bleeding from shaving/cuts
93
Q: Why is shaving/cut history important in bleeding risk assessment?
A: It helps evaluate abnormal bleeding tendencies or clotting disorders.
94
Q: What are medical conditions that increase bleeding risk?
Liver disease Idiopathic thrombocytopenic purpura (ITP) Haematological malignancies Chronic renal failure Heart failure (→ liver failure) Inherited bleeding/coagulation disorders Chemotherapy (affecting platelets/coagulation
95
Q: How does liver disease increase bleeding risk?
A: The liver produces clotting factors; disease impairs this function.
96
Q: What is ITP and how does it relate to bleeding?
A: Idiopathic thrombocytopenic purpura is a condition with low platelet count, leading to increased bleeding.
97
Q: How does chronic renal failure affect bleeding?
A: It causes platelet dysfunction and impaired coagulation.
98
Q: What medications increase bleeding risk?
Antiplatelets: Aspirin, Clopidogrel Anticoagulants: Warfarin, Dabigatran, Apixaban (DOACs) Cytotoxic drugs NSAIDs
99
Q: How do NSAIDs increase bleeding risk?
A: By inhibiting platelet function and affecting mucosal integrity.
100
Q: What’s the difference between antiplatelets and anticoagulants?
Antiplatelets prevent platelet aggregation. Anticoagulants interfere with the coagulation cascade
101
Q: Why is chemotherapy a bleeding risk?
A: It can suppress bone marrow, reducing platelets and clotting components.
102
draw out the bleeding management flowchart
103
what is another name for dry socket?
alveolar osteitis
104
Q: What is alveolar osteitis?
A: Post-operative pain inside or around the extraction site, increasing in severity between the 1st and 3rd day after extraction, often with a disintegrated blood clot and possible halitosis.
105
Q: What causes alveolar osteitis?
A: Failure to form or premature disintegration of the blood clot within the socket.
106
Q: What is the prevalence of alveolar osteitis?
A: Occurs in approximately 0.5–5% of extractions.
107
Q: Name 7 risk factors for alveolar osteitis.
Surgical trauma / difficult extraction Smoking Oral contraceptive pill (OCP) use Inexperienced operators Previous history of alveolar osteitis Increased local fibrinolysis Nutrient deficiency
108
Q: How is alveolar osteitis diagnosed?
A: Confirm by clinical presentation after excluding other causes of post-op pain.
109
Q: What is the initial step in managing alveolar osteitis?
A: Irrigate the socket with saline.
110
Q: What analgesics are used in alveolar osteitis?
A: NSAIDs or Paracetamol.
111
Q: What is Alvogyl and what does it contain?
A: A dressing used for alveolar osteitis, soaked in a fern plant from Sumatra, containing: Butamben (anaesthetic) Eugenol (analgesic) Iodoform (antimicrobial)
112
Q: Can Alvogyl dressings be repeated?
A: Yes, re-dressing may be necessary.
113
Q: Is alveolar osteitis a long-term condition?
A: No, it is self-limiting.
114
Q: What are common iatrogenic injuries during dental procedures?
Lacerations (lip/cheek) Burns Nerve injuries Fractured teeth Loss of restorations Damage to adjacent teeth Alveolar bone fractures
115
Q: What types of fractures are considered iatrogenic complications?
Tuberosity fractures Mandibular fractures
116
Q: What is surgical emphysema in dentistry?
A: Air trapped in soft tissues during surgery, often due to air-driven handpieces or improper technique.
117
Q: What is an oro-antral communication (OAC)?
A: An abnormal opening between the oral cavity and the maxillary sinus.
118
Q: What is an oro-antral fistula (OAF)?
A: A persistent, epithelial-lined tract between the oral cavity and the maxillary sinus.
119
Q: What procedures can cause OAC or OAF?
Tooth/root displacement into the sinus Tuberosity fracture Procedures involving maxillary molars or surrounding structures
120
Q: What is a tuberosity fracture?
A: Fracture of the maxillary tuberosity, often occurring during maxillary molar extractions.
121
Q: What complications are associated with a maxillary tuberosity fracture?
Oro-antral fistula (OAF) Bleeding Sinus exposure Bone instability
122
Q: What percentage of nerve injuries cause pain?
A: 70%
123
Q: What percentage of chronic pain patients experience depression?
A: 50%
124
Q: How many patients are appropriately warned about nerve injury risks?
A: Only 30%
125
Q: What percentage of nerve injuries result in just numbness?
A: 30%
126
Q: Which cranial nerve is commonly affected in dental nerve injuries?
A: Trigeminal nerve (Cranial Nerve V)
127
Q: What dental procedures can injure the trigeminal nerve?
Inferior alveolar nerve block Root canal treatment Implant placement Periodontal surgery Dento-alveolar surgery
128
Q: Which cranial nerve can be affected during extra-oral/maxillofacial surgery?
A: Facial nerve (Cranial Nerve VII)
129
Q: Can the facial nerve also be affected by an inferior alveolar nerve block?
A: Yes, though less commonly.
130
Q: Name 6 key strategies to reduce the risk of nerve injury.
Good anatomical knowledge Risk-benefit discussions Careful local anaesthetic technique Advanced imaging for high-risk cases Informed consent Post-operative phone calls & appropriate referral
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