1. Health Status Eval/Physical Exam & Principles of Uncomplicated Exodontia

what is a one sentence summary written in the patient’s own words?

chief complaint

what information should be included in history of present illness (HPI)?

info gathered by your questioning of pt regarding their CC

OLD CARTS!! (onset, location, duration, character, aggravating factors, relieving factors, timing, severity)

what are metabolic equivalents?

energy cost of physical activity (gives a good idea of pt’s CV health)

how are metabolic equivalents (METS) defined?

ratio of metabolic rate during activity to reference metabolic rate

1 MET = 1 kcal / (kg x h)

what type of radiograph should be taken for a single tooth (not including 3rd molars)?

PA

what type of radiograph should be taken for an overview of the maxilla and mandible?

pano

what type of radiograph should be taken for boney pathologies, 3rd molars, dentoalveolar/trauma to manible and maxilla?

pano

what type of radiograph should be taken for a detailed 3D view of the facial skeleton and soft tissue?

CT

what type of radiograph should be taken for maxillofacial trauma, severe infection, maxillofacial pathology, implant planning, etc.?

CT

what should go under “assessment”?

a summary of your findings

eg. 30 yo male presents w pain associated with #3. The pt is being treated for asthma, but is controlled with albuterol

what should go under “plan”?

stepwise tx for the pt

• include type of anesthesia

• eg. the plan is to extract #3 under local anesthesia

what are 4 key reasons why clinical documentation is so important?

1. pts have access to medical records

2. legal and regulatory considerations

3. justifies billed services and supports claims approval by payers

4. clear trail of clinical decisions and action (safeguard against audits and legal scrutiny)

which note is to be completed at initial visit (150 exam completion in UG clinics) to TUSDM clinics including consultation visits to specialty departments?

New Patient History and Physical Note

which note is to be completed for patients who are new to TUSDM (do not have established providers) and are having a procedure performed?

Details of the procedure may be recorded under the section “Record of Procedure”. This template includes components of both the New Patient note and the Procedure Note.

Emergency Procedure Note

which note is to be completed when a procedure is performed on an established patient who has already had a New Patient note completed?

Details of the procedure may be recorded under the section “Record of Procedure”.

Procedure Note

which note is to be completed during follow up visits after a procedure or other situations outside of those outlined in the above templates?

This template is in the SOAP format.

Follow Up Note

where do you document what you did during a particular procedure?

“Record of Procedure”

what are the 5 elements of informed consent?

• Disclosure of information

• Patient competency

• Voluntary decision-making

• Reasonable alternatives with risks

• Assessment of understanding

t/f: Consent involves a discussion of the risks, benefits, and alternatives of a procedure

true

what must be completed before ALL irreversible procedures?

Time Out (The individual signing the time out must see you identify the tooth with an instrument and obtain the patients agreement)

what are these surgical instruments?

mirror

no. 9 molt periosteal elevator

periapical curette

what are these surgical instruments?

• Root Picks (TOP 2)

• Bone File

• Seldin Retractor

Minnesota retractor

• Syringe

• Scalpel Handle

what type of scalpel blade is most commonly used in OMFS?

no. 15

Cheek / Tongue Retractor

• “Sweetheart” tongue retractor

• Bishop retractor

Side Cutting Rongeur

End Cutting Rongeur (used for cutting proximal pieces of bone, granulation tissue, etc.)

• Needle Holder

• Suture Scissors

• small curved hemostat

• tissue forceps

• Small Straight Elevator

• Large Straight Elevator

what are the 3 parts of an elevator?

• blade

• shank

• handle

east/west elevators (for extracting root tips)

#151 Lower Universal Forceps

#150 Upper Universal Forceps

• Root Tip Forceps (286)

• Bayonet forceps

Maxillary Anterior Forceps (#1)

Cowhorn Forceps #23

Ash Forceps (English Style)

Proximators

fractured teeth where it’s hard to use elevators

hall drill (sectioning teeth)

Numbers denote the _______ of suturing material

thickness (higher # = thinner material)

what is an absorbable suture material derived from bovine intestine?

chromic gut

(bovine intestine + chromic salts → slow absorption compared to plain gut)

how many days of tensile strength does chromic gut suture offer?

6-10 days

what is the most commonly used intraoral suture?

chromic gut

what is an absorbable braided synthetic suture material?

vicryl

vicryl holds tensile strength for how long?

14-21 days

what is a common, traditional non-resorbable suture?

silk

how should your patient be positioned for maxillary extractions?

higher / more reclined chair position

how should your patient be positioned for mandibular extractions?

lower, more upright position

when are simple extractions indicated?

extraction, erupted tooth or exposed root (ele- vation, and/or forcep removal)…routine removal of tooth structure, minor smoothing of socket bone and closure as necessary.

when are surgical extractions indicated?

Requiring removal of bone and/or sectioning of tooth, and including elevation of mucoperiosteal flap if indicated

what’s the code for simple extraction?

D7140

what’s the code for surgical extraction?

D7210

what must be done to soft tissue surrounding the tooth in a simple extraction?

detach soft tissue off of the tooth circumferentially

in a simple extraction, luxate the tooth in what direction to create space with an elevator?

mesio-distal

in a simple extraction, luxate the tooth in what direction to create space / overcome the undercuts for the tooth to be removed with a forcep?

bucco-lingually (primarily buccal)

what are the basic steps of a simple extraction?

• After the patient is positioned properly, the patient is anesthetized with local anesthetic

• For mandibular teeth a bite block must be placed

• Gauze is placed to prevent aspiration or ingestion of tooth fragments

• Periosteal elevator used to lift the periosteum off of the tooth, mostly on the buccal of the tooth

• Straight elevator used to luxate the tooth

• Forceps used to deliver the tooth

the concave surface of a periosteal elevator always faces…?

TOWARD the tooth/bone

straight elevator is used as a type ___ level and a wedge

type 1

how should a straight elevator be placed?

in the PDL space, adjacent to interproximal alveolar bone with apical pressure

Once in the PDL space-interproximal bone, continuous ______ pressure is placed as well as ________ force to luxate the tooth

apical; rotational

what type of forcep is used for anterior teeth (canine to canine)?

Straight Maxillary Anterior Forceps (#1)

what types of force should be applied with Straight Maxillary Anterior Forceps (#1)?

• Apical Force placed to wedge the tooth into the socket

• Bucco-lingual forces (mostly buccal) placed to expand the socket

• Rotational forces can be applied to single rooted teeth

delivery of the tooth is mostly toward the ______

buccal (except when using Cowhorn forceps; this is delivered occlusally)

what types of force should be applied with Extraction Forceps (Ash)?

• Apical Force placed to wedge the tooth into the socket

• Bucco-lingual forces (mostly buccal) placed to expand the socket

• Rotational forces can be applied to single rooted teeth

what types of force should be applied with Extraction Forceps (#1 or150)?

• Apical pressure is used to expand the socket

• Bucco-lingual motion (mostly buccal) is used to expand the socket

• Figure 8 movement can be used to continue expanding the socket

what types of force should be applied with Mandibular Extraction Forceps (#151)?

• Apical pressure is used to expand the socket

• Bucco-lingual motion (mostly buccal) is used to expand the socket

• Figure 8 movement can be used to continue expanding the socket

what types of force should be applied with Cowhorn Forceps #23?

• Apical pressure is used to expand the socket and to sink the teeth into the furcation

• A pumping motion may be used to extrude the tooth

• Buccal-lingual movement may also be incorporated to remove the tooth towards the buccal

• Tooth is delivered occlusally

• Apical pressure is used to expand the socket

what are some post-extraction management techniques?

• debride (if necessary)

• finger pressure around socket to reduce expanded socket

• sharp boney protuberance should be filed/removed w bone file

• irrigate with saline

• gauze for pressure

what are some indications of leaving root tips?

• <4-5 mm (generally)

• deeply imbedded in bone

• not infected

what are risks of removing impacted root tips?

• Destruction of surrounding tissue

• Damage of vital structure

• Potential displacement of root into tissue or maxillary sinus