Past Paper Questions: OS and Radiology 1

What should be considered when a patient is pregnant?

Lie on side to avoid vena cava compression

Avoid Xrays in first trimester

No sedation: IV/NO/GA

Use articaine, avoid prilocaine

Avoid NSAIDs

What should be considered with poorly controlled diabetes?

Risk of hypoglycaemia and collapse

Can check blood glucose before XLA

What should be considered with Angina?

Risk of agina attack

Slow delivery of anaesthetic with epinephrine

What should be considered with a patient with alcohol related cirrhosis of the liver?

prolonged bleeding due to lack of Vitamin K depending Clotting factors

Reduced drug metabolism and longer half life of anaesthetics

What should be considered with patients with previous radiotherapy of jaws?

Risk of ORN of jaw

When they last had Tx? When is their next doseage

What are a list of inherited conditions that can lead to blood loss?

VW disease

Haemophillia A/B

Thrombocytopenia

Why do you refer a patient with severe Haemophillia A?

Increased risk of bleeding

Need to liase with haemotologist

Pt needs tranexamic acid

What tests should be carried out prior to XLA for bleeding disorders?

Clotting screen

FBC

LFT

What systemic measures can be taken before, during or after XLA to minimize post op bleeding?

Before: Tranexamic acid

During: Avoid regional blocks, infiltrations only as haematoma can obstruct airways

After: Pack with surgicel and suture to ensure haem, pressure with gauze and ABx to prevent secondary infections

What is a ghost shadow on an X-Ray?

normal anatomy

Created by movement and cast by structures on opposite side

How are ghost shadows different from real objects?

Blurred

Magnified

Higher

What hard tissues on a DPT show a shadow?

Zygomatic arches

Body, angle and ramus of mandible

Which soft tissues on DPT show a shadow?

Ear lobe

Nasal cartilages

Dorsum of tongue

What do you give bisphosphonates for?

osteopetrosis

Pagets disease

Fibrous dysplasia

What 3 factors define MRONJ?

Pt on anti-resorptive or anti-angiogenic medication

Exposed bone for >8 weeks

Can be probed through an IO/EO fistula

No history of radiation therapy or cancer to the jaw

What are the risk factors with bisphosphonates that increase the change of MRONJ?

Taking for cancer

For >5years with steroids

Previous MRONJ

Perio

Denosuman in the past 9 months

How long after an XLA would you refer for suspected MRONJ?

No healing >8weeks

Refer to OS

What 3 things must be checked before carrying out treatment on a HIV patient?

Medication the patient is on

FBC

Allergies

What cells does HIV effect?

CD4+

T helper cells

What are the IO features of HIV?

Candida

Kapsosis sarcoma

Ulceration

ANUG

What is dry socket?

Inflammation of the alveolar bone following the extraction of a tooth

Caused by the loss of blood clot from a socket

How do you treat a dry socket?

Irrigate with Saline

Aveogyl pack

Analgesia advice

When would you prescribe ABX after XLA for a post-op infection?

Signs of systemic infection

Pyrexia

Spreading

Trismus

Swelling

Which ABx is prescribed for Dry Socket?

metro first

Bactericidal and interferes with cell wall synthesis

What is Rivaroxaban prescribed for?

Atrial fibrilation

DVT

PE

Mechanical prosthetic heart valves

Stroke

What is INR?

international normalized ratio: Prothombin time

Only needed for Warfarin patients

How does Riveroxaban work?

Factor Xa inhibitor

Why is riveroxaban preferred to warfarin?

Does not need INR monitoring

Less drug interactions

No diet restrictions

What local measures can be taken to adopt a minimized post-op bleeding?

Pack with surgicell

Suture

Pressure with gauze

Omit or delay dose

LA with vasoconstrictor

What are the long term consequences of steroids?

Cushingold features

Hypertension

Diabetes

Osteopetrosis

What infections can steroids lead to?

Herpes

Candida

Aspergillosis

What precautions should be taken with patients on 20mg prednisolone daily?

More than 10mg so need to double dose on day of XLA

Give 100mg Hydrocortisone if emergency consult endocrinologist

Prep for asthma attack

How can you manage a crown fracture during an XLA?

Stop and determine if root is visible using light and suction. XRay if not visible

Tooth was vital, <5mm can be left. Inform patient and document

If infection, fracture should be removed

Can be removed via cryers or surgical

Place sedative into root and refer to OS if unable to remove

What are the principles of flap design?

Avoid vital structures: Damage to these structures can lead to complications like excessive bleeding, nerve injury, or loss of sensation.

Ensure sufficient access: Ensuring sufficient access reduces the risk of complications,

Full thickness include periosteum: Preserves the blood supply to the bone and surrounding tissues.

Reflect mucoperiosteal flap: This technique minimizes tissue trauma

Include interdental papillae: Prevents the creation of defects or gaps in the gingiva post-surgery.

Why do we use flaps?

Increase surgical access

Remove appropriate bone

Increased vision

What would indicate a surgical XLA after a crown fracture?

Infected tooth and root > 5mm

Fracture happening when tooth is loose

How does Warfarin work?

Inhibit Vit K depending on clotting factors in the liver

Which local measures can be taken during XLA?

INR in the past 36hours

INR <4 for OS XLA

Treat in morning

Infiltration with vasoconstrictor

Atraumatic as possible

Pack with surgicel and suture with Vicryl