Oral Surgery Midterm

What type of stroke should be used with making incisions?

Firm, continuous

Where should the cutting instrument be located in relation to epithelial surfaces when making incisions?

Perpendicular

What should be cut when making incisions?

Healthy bone and attached gingiva

What should be avoided when making incisions?

Thin tissue, lesions, bone removal

Where is the widest part of a flap?

Apex of root

T/F: Open wounds should be kept dry.

False - should be kept moist

What is asepsis?

absence of pathogenic microorganisms or disease

What are aseptic principles?

principles applied through use of aseptic techniques to prevent pathologic microbial contamination of the environment?

What technique is used in an office-based setting?

clean technique

What is used for pre-op intraoral rinsing in the clean technique?

chlorhexidine

What is used for drills in clean technique?

sterile water

What is used for patients in clean technique?

normal saline

What technique is used for skin incisions, implant surgery, and bone brafts?

sterile technique

What is infection?

multiplication of organisms in tissues of host

What is a nosocomial infection?

infection develops in hospital setting

Why do surgical site infections (SSI) happen?

because of cross contamination

What do we need to have any time we extract teeth?

A restorative plan to replace them

When should extractions occur for patients receiving radiotherapy or taking bisphosphonates?

BEFORE therapy begins because socket will never heal and you can have MRONJ

What is a local contraindication for removal of teeth?

Coronectomy of third molars with high risk of IAN injury

What is a coronectomy?

surgical procedure that removes the crown of the tooth and leaves the rot and associated nerve complex

What are systemic contraindications for removal of teeth?

diseases where socket may never heal

What is the best type of imaging for extractions?

periapical

What is the next best type of imaging for extractions?

CBCT

What type of imaging is useless for extractions?

bitewings

What is the maximum age a radiograph can be to be used for extractions?

1 year

What is a possibility if you see no PDL in a radiograph?

Ankylosed = may need surgical extraction

How does liver function affect biotransformation of local anesthetics?

half-lives of amide local anesthetics increase with decreased liver function

What should be taken into consideration when administering 2 types of local anesthetics?

total dose of both should NOT exceed. the lower of the 2 max doses for the individual agents

How does inflammation/infection affect the duration of action of local anesthetics?

decreases

How does increased vascularity affect the duration of action of local anesthetics?

decreases

What group of anesthetics has the shortest duration of action?

Group 1

What group of anesthetics has the longest duration of action?

Group 3

What types of LA are in Group 1?

Mepivacaine 3%

Prilocaine 4%

What types of LA are in Group 2?

Lidocaine 2% 1:50,000/1:100,000 epi

Mepivacaine 2% 1:20,000 levonordefrin

Prilocaine 4% 1:400,000 epi

Articaine 4% 1:100,000 epi

What types of LA are in Group 3?

Bupivacaine 0.5% 1:200,000 epi

Etidocaine 1.5% 1:200,000 epi

What blade is most commonly used in extractions?

15(c)

C=smaller

What is a 12 blade?

slightly curved

What is an 11 or 10 blade used for?

operating rooms

How should you grab the blade when loading it to the scalpel?

with hemostats

What does tearing of flaps lead to on adjacent teeth?

dehiscence

What release is made first when making a flap?

Start with one vertical release then medial

What types of hemostasis are transient?

Pressure & vasoconstrictors

What types of homeostasis are NOT transient?

heat & suture

What type of handpiece should not be used with a flap?

Turbine because air driven

What type of bur can be used with a turbine handpiece to remove bone?

702-L fissured

What type of handpience can remove bone?

electric

Why do you use a bone rile?

bone always needs to be smooth

What is an alveolar curette used for?

once tooth or bone is out, used to take out any additional tissue or debris

How is a needle holder held?

thumb and ring finger in holes and index finger rests on shaft of instrument

What are scissors used for in suturing?

used to cut the suture or even some additional tissue

What is a peritome?

paddle-shaped instrument that cuts the PDL

What is a luxator?

wedge-shaped instrument used to widen the PDL to loosen the tooth from the socket

What size should you start with luxators?

small

How are luxators placed in the socket?

parallel to root

What force is applied by a luxator?

apical force expands the socket in 2 locations

What is an elevator?

paddle-tip instument that is placed in the socket and axial force is applied to elevate the tooth

What type of force is used with an elevator?

axial force

Where in the socket is an elevator placed?

90 degrees against the tooth

What are forceps used for?

used to grasp the tooth just below the CEJ

Where should the beak of forceps be placed?

parallel to root tips at CEJ

Should a surgeon deliver force with their arm and shoulder or their fingers and hand?

arm and shoulder

Where should the maxillary occlusal plane be for extractions?

60 degrees to the floor

Is the chair higher of lower for extractions of maxillary teeth?

lower

Where is the dentist positioned for maxillary extractions?

in front of patient

Is the chair tipped backward or more upright for maxillary extractions?

tipped backward

Is the chair tipped backward or more upright for mandibular extractions?

more upright

Where is the mandibular occlusal plane located for extractions?

parallel to floor

Should the chair be higher or lower for extractions of mandibular teeth?

higher

What should be used for mandibular extractions?

pediatric bite block

Where should the dentist be positioned for mandibular extractions?

behind the patient or to the side

How are wedges used in extraction mechanics?

used to expand, split, displace portions of the substance that receives it, used to drive APICALLY into PDL

How are levers used in extraction mechanics?

first-class lever transforms small force and large movement to small movement and large force, depressed APICALLY

What is used as the fulcrum in extraction mechanics?

bucco-alveolar bone

What serves as the axel in extraction mechanics?

handle

What serves as the wheel in extraction mechanics?

tip of triangular elevator

What happens when forceps are applied apical pressure?

tooth socket is expanded by insertion of beaks down into the periodontal ligament space; center of rotation of tooth is displaced apically

What happens when forceps are applied buccal displacement?

expansion of the buccal plate, particularly at the crest of the ridge; excessive force can fracture buccal bone or cause fracturing of the apical portion of the root

What happens when forceps are applied lingual/palatal displacement?

lingual pressure will expand the linguocortical plate

at the crestal area and slightly expand buccal bone at the apical area

What happens when forceps are applied rotational pressure?

internal expansion of the tooth socket and tearing of

periodontal ligaments; teeth that have other than conical roots or have multiple

roots are more likely to fracture under this type of pressure

What happens if forceps are applied tractional pressure?

useful for delivering the tooth from socket once adequate bony

expansion is achieved. Should be limited to the final portion of the extraction

process and should be gentle; if excessive force is needed, perform other

maneuvers first to improve root luxation

How must post-op instructions be provided to patients?

both verbally and in writing

How should patients brush their teeth post-op?

gently brush teeth away from surgical site as usual and avoid

brushing adjacent teeth adjacent to extraction site to prevent bleeding, suture

disruption, and pain

How should patients rinse post-op on the first and second day?

gentle rinses with prescribed oral mouthwash or dilute saltwater; use warm water to prevent tissue burns

When can most patients return to normal oral hygiene routine post-op?

3rd or 4th day after surgery

What should the post-op diet be the first 12-24 hrs?

high calorie, high volume liquid or soft diet

What are the 4 steps of healing post-extraction?

1. hemostasis

2. inflammatory stage

3. proliferative stage

4. remodeling stage

How should gauze be placed to control bleeding after extractions?

moistened, folded gauze directly over socket, firmly bite for at least 30 min, avoid covering adjacent teeth

How long should patients avoid spitting post-op?

first 12 hours

Are analgesic meds for pain management or elimination?

management

When is the peak pain experience?

12 hours post-op; diminishes rapidly after

How long does significant pain last post-op?

rarely longer than 2 days

What does timely medication mean?

take first dose of analgesics before the effects of LA wear off

Are lower or higher potency analgesics usually suffient?

lower

What meds are used for mild-moderate pain?

non-opioids: acetaminophen & NSAIDs

What meds are used for moderate-severe pain?

opioids, acetaminophen combos

What is the recommended dose for adults of acetaminophen?

650-1000 mg every 4-6 hrs

What is the recommended dose for adults of ibuprofen?

400-800 mg every 4 hours

What is the recommended dose for adults of naproxen?

440 mg bid

How are acetaminophen and ibuprofen taken together?

at same time - simpler and better potentiation

Why are acetaminophen and ibuprofen taken together?

APAP potentiates ibuprrofen