What are the 3 basic principles for carrying out oral surgery?
- risk assessment
- aseptic technique
- minimal trauma to hard and soft tissues
In risk assessment for minor oral surgery, what should you consider?
- Need good planning
- Consider local anatomical structures (maxillary sinus, inferior alveolar canal etc.)
- Take a good medical history (looking for bleeding probs etc.)
- The benefits of the surgery must outweigh the risks
Can we have a completely aseptic technique in oral surgery?
No because the mouth contains so many micro-organisms but should do our best not to introduce any new organisms
Why do we want minimal trauma to hard and soft tissues?
leads to less post-operative pain, bruising, bleeding and complications
What kind of environment is desired for minor oral surgery?
A theatre environment is not required but there should be good cross-infection control (good PPE, surgical gowns and caps worn).
Why is radiological assessment so important in minor oral surgery?
- essential for safe surgery
- It helps you to assess the risk of a procedure e.g., seeing where the roots of wisdom teeth are in relation to the inferior alveolar nerve or assessing how close a root is to the maxillary antrum.
What are the stages fo surgery?
- -consent
- -surgical pause/safety checklist
- -anaesthesia
- -access
- Bone removal as necessary
- Tooth division as necessary
- Debridement/Wound Management
- Suture
- Achieve haemostasis
- Post-operative instructions
- Post-operative medication
- Follow-up
Explain the kind of consent needed for oral surgery?
- valid consent
- must have written consent where treatment involved consious sedation or GA (GDC standards)
-In GDH written consent for all oral surgery procedures
If getting written consent, what must you ensure?
That the written form is explained to the patient.
Otherwise, the signature means nothing
What is the surgical pause/safety checklist?
-a pause before anything happens to check the right patient is being treated, the procedure is considered and planned sufficiently
What is the most commonly used access flap?
A muco-periosteal flap
What is a muco-periostal flap?
- where you lift both the mucosa and vascular periosteum lying over the bone
- Dont want to leave the periosteum attached to the bone
You want to achieve maximum access with minimal trauma. How wide should you flap be? Why?
Opt for a wider flap to allow good access and visualisation
A wider flap headls just as quickly as a shoter one
If creating flaps in the anterior region, what do you want to consider?
- post op aesthetics
- scarring and recession
What are the 10 things you should consider when thinking about sirgical access?
- Wide-based incision
- Use scalpel in one firm continuous stroke
- No sharp angles
- Adequately sized flap
- Flap reflection should be down to bone and done cleanly
- Minimise trauma to dental papillae
- No crushing
- Keep tissues moist
- Ensure that flap margins and sutures will lie on sound bone
- Make sure wounds are not closed under tension
- Aim for healing by primary intention
Why is a wide-based incision desireable?
-ensures there is still good circulation/perfusion in the flap and prevents necrosis of tissues
Why do you want to use the scalpel in one firm continuous stroke?
To minimise damage to underlying soft tissues
Why do you not want to close wounds under tension?
- likely the wound will break down
- less perfusion
- possible necrosis
Why do you want to aim for healing by primary intention?
Less scarring
What is the difference between primary and secondary intention healing?
- Primary intention is when the edges of a surgical incision are closed together with sutures/staples etc.
- Secondary intention is when a wound is left open to heal by granulation (proliferation) and remodelling
What is the most common type of surgical flap used for a wisdom tooth extraction?
a 3-sided flap
Where do you want your dital relieving incision to be for in a wisdom tooth removal and why?
More buccally placed in order to avoid damaging the lingual nerve
What is the most common retractor used for soft tissue retraction?
Howarths rake retractors (reflect light in too)
Why do we retract soft tissue?
Allows access and vision to operative field
Protects the soft tissues (dont want it getting caught in stuff)
