OS Midterm Flashcards by A G

What 5 things are included in the pre-op evaluation?

Med hx/surgical hx/meds
Diagnosis
Evaluation of X-Ray
Evaluation of pt
Disucss risks/benefits and alternatives

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We do a pre-op evaluation to assess the ability of the pt to _________ withstand the surgical procedure; do no harm!

safely

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Red flag pts (8)

MI/CAD
Insulin dependent DM
X-ray therapy/chemotherapy
Transplants
Bloodthinners
Steroids
Drug abuse
Bisphosphonates

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What drug category?

Coumadin/warfarin
Pradaxa
Xarelto
Eliquis
Plavix
Aspirin

Bloodthinners

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What drug category?

Fosamax
Actonel
Boniva
Reclast

Bisphosphonates

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Prolia, XGEVA, and Rank Ligand inhibitors have the same complications as which drugs?

Bisphosphonates

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What drug category?

Aredia
Zometa
Xgeva

Anti-resorptive

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How long should you defer elective tx for MI pts?

6 months

(risk of death is high in the first 6 months)

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The following management is for pts with what condition?

Consult patient’s physician
Anxiety reduction protocol
Nitro tabs/spray
Supplemental oxygen
Limit epi used .04 mg (2 carps 2% xylo with
epi 1:100,000 )

Angina

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The following management is for pts with what condition?

Consult patient’s physician
Anxiety reduction protocol
Nitro tabs/spray
Supplemental oxygen
Limit epi used .04 mg (2 carps 2% xylo with
epi 1:100,000 )
Defer elective tx for 6 months

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The following management is for pts with what condition?

Insulin versus non insulin
Short am appointments best
Check glucose with patients glucometer
Defer surgery until well controlled
Patient more prone to infection
Monitor for hypoglycemia

Diabetes

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The following management is for pts with what condition?

Consult OB/GYN
Dental care best in 2nd trimester
Care with radiographs
Care with supine position
Medications can affect fetus

Pregnant

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T/F: It is better NOT to treat than get stuck in
the middle…halfway into a surgical
procedure and NOT be able to finish

True

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Roots (number, configuration, conical, fused, dilacerated)
Prior RCT
Bone support
Proximity to adjacent structures (IAN, sinus)
Restorations on adjacent teeth

Evaluation of X-Rays

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Allows you to inform pt of risk involved

Allows you to decide if you should perform the surgery or refer

Evaluation of X-Rays

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T/F: Beware of the third molars…they can be
very deceptive and difficult. I would prefer
that you extract 100 plus teeth before even
attempting your first wisdom tooth
removal

True

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Beware of _______ teeth because they tend to be brittle and come out in multiple pieces

RCT

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Dr. Kushner says this is a clinical pearl

Glucometer

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T/F: 2 vertical release flaps are rarely necessary to take a tooth out

True

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Which bur is used to cut and remove bone precisely without elimination of tooth structure?

Round bur

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Which bur is used to cut and section tooth structure?

Fissure bur

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Which bur is used for bone contouring?

Specialty bur

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Which handpiece do you use to cut bone/teeth?

Slow speed

(never with high speed air rotor, can lead to air emphysema)

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Use ___________ forceps to gently handle tissue and avoid crushing injury

toothed

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Irrigate with ___________ when cutting bone

saline

Area that remains devoid of tissue or functional clot after wound closure

Dead space

What can dead space result in?

Hematoma (can result in wound breakdown and infection)

Removal of necrotic or injured tissue, debris, foreign substances

Debridement

Irrigation is best done with what solution?

Saline

In infection cases, _________ is the solution

Dilution (irrigate!)

T/F: You should suture from free to attached tissue (buccal to lingual)

True

How long to ice face after extraction to minimize edema?

24-48 hours

What can we do during the procedure to minimize edema?

Gentle handling of tissue

What type of edema? Soft Normal temp Tx: Ice Pressure Steroids

Traumatic edema

What type of edema? Hard Hot Erythematous Tx: Antibiotics Monitor vital signs Labs

Infectious edema

T/F: Edema is physiologic, not pathologic

True

What should there NOT be on wound closure?

Tension

Which instrument is an oral surgeon's best friend?

9 molt periosteal

Which instrument loosens soft tissue attachments from teeth?

Woodsen elevator

Which instrument is used to elevation full thickness mucoperiosteal flaps?

9 molt periosteal

Which instrument is used to retract soft tissue flaps and protect?

Seldin elevator (larger than periosteal elevators)

Which instrument is used to retract the cheek and soft tissue flaps?

Minnesota retractor (used at ULSD) Lind retractor Austin retractor

Which instrument is used to retract the tongue?

Weider or "sweetheart"

Which instrument is actually used to clamp vessels?

Hemostat

What instrument is often used for removal of debris from oral cavity and grasping of soft tissue that is going to be excised?

Hemostat

Which instrument is useful for blunt dissection of soft tissues (like in I&D procedures)?

Hemostat

What instrument has long, delicate beaks that can be curved or straight?

Hemostat

T/F: Cotton pliers are used to handle soft tissue

FALSE They are only used to grab items from tray or prepare packing materials

Which instrument is used to hold soft tissue?

Adson forceps Geralds forceps (longer version) (can have teeth or not)

Which instrument is used to grasp teeth or fragments of teeth due to its large rounded ends?

Russian forceps (actually designed for soft tissue)

Which instrument is used to remove soft tissue like cysts or follicles from the bone?

Molt curettes

Name the 4 instruments used to remove bone

Rongeur Bone file Osteotomes Surgical handpiece

Which instrument is used to remove small amounts of bone with multiple bites?

Rongeur

Which instrument is used to smooth bone edges?

Bone file

Which instruments were used to be used to remove bone and section teeth before handpieces?

Monobevel Chisel (remove bone) Bibevel Osteotome (section)

What instrument is used to remove bone and section teeth today?

Surgical handpiece

Which suction devices are most commonly used in OMFS?

Fraser tips Yankauer tips

Which instrument has fine teeth, the needle holder or the hemostat?

Needle holder (hemostats are ridged, would not be good to hold the needle)

Which scissor is used for tissue and suturing?

Dean

Which instruments are used to hold open the pt's mouth to support mandible and TMJ?

Bite block Molt mouth prep

Which instrument is used to luxate teeth and disrupt PDL fibers?

Elevator (straight elevators we use are #301 and #34)

What are the 3 major components of elevators?

Handle Shank Blade

Name the 5 types of elevators

Straight Spade Pennant ("east/west") Spoon Pick

Which instrument is used to extract periodontally involved teeth?

Periotome

What are the 3 components of extraction forceps?

Handle Hinge Beak

The beaks of extraction forceps are designed to move ____________ along the long axis of roots

apically

Extraction forceps displace the center of rotation ____________

apically

Which instrument has universal, semi-anatomic, and anatomic varieties?

Extraction forceps

What is the maxillary extraction forceps?

150 Cryer Universal

What is the mandibular extraction forceps?

151 Cryer Universal

What extraction forceps do we use for mandibular molars?

#23 Cowhorn

T/F: Dentures function w/ 12-15% efficiency of natural dentition

True

The objectives of preprosthetic surgery are to create proper ____________ structures for subsequent placement of prosthetic appliances as well as preserving this _______, particularly in younger patients for a long life with dentures or placement of implants

supporting; bone

What are the 3 things to consider for full dentures?

Psychological Anatomical Physiological

What do the following characteristics refer to? Adequate bone support “Fixed tissue” under denture No opposing undercuts Adequate ridge relationships and inter-ridge distance Broad ridges (not sharp) Adequate buccal and lingual sulci No displacing muscle attachments Adequate saliva

Ideal edentulous mouth

What are 4 types of surgical preps for prostheses?

Alignment of jaws Removal of teeth/roots Osseous surgery Soft tissue surgery

Which surgical prep for prostheses includes the following? Minor alveoplasty (sharp areas) Adequate interarch distance Eliminate opposing undercuts (path of insertion) Eliminate tori and exostoses

Osseous surgery

Which surgical prep for prostheses includes the following? Release freni Thin/reduce fibrous tuberosities Thin/reduce palatal fibromatosis Trim tissue w/ closure Preserve attached gingiva

Soft tissue surgery

Which surgery has the following options? Simple (smooth sharp edges/corners) Interradicular (intraseptal) Radical (horizontal/vertical problems, pre-radiation tx) Preserve attached gingiva

Alveoplasty

Remember, the position of the ________ __________ "migrates" towards the crest of the ridge in edentulous patients

mental foramen

What surgery is indicated by the following? Chronic irritation Inability to construct prosthesis Opposing undercuts Horizontal/vertical problems

Tori/exostoses removal

Which surgery has the following problems? Pneumatization of palatal tori Thin mucosa on mandibular tori

Tori/exostoses removal

Which surgery should you use a pressure dressing or splint for the elimination of dead space after the procedure?

Palatal torus removal

Always design flaps to preserve __________ _________

attached gingiva

Which prosthesis has the following technique? Remove all maxillary and mandibular teeth except maxillary anteriors Perform necessary osseous and soft tissue surgery After adequate healing, take impressions, registrations and construct denture Remove remaining teeth and insert CD/CD Reline after major remodeling occurs (1 – 6 months)

Immediate/interim denture

Which prosthesis has the following potential problems? Bone trim difficult or impossible without clear template or trimmed model Fewer teeth extracted the better it works Think about tori, exostoses & freni Keep “stickum” handy

Immediate/interim denture

What are the 2 methods for improving the existing ridge?

Osseous Soft tissue

Which method for improving the existing ridge? Removal of knife edge or saw-tooth ridges Removal of lingual balconies Lowering of mental foramina Releasing IAN from canal Bone grafts and bone graft substitutes

Osseous

Which method for improving the existing ridge? Removal of hyperplastic tissue (epuli) Reposition of muscle attachments Provide more fixed

Soft tissue

Generalized hyperplastic enlargement of mucosa and fibrous tissue in the alveolar ridge and vestibular area

Inflammatory fibrous hyperplasia (Epulis fissuratum)

Typically results from denture irritation

Inflammatory fibrous hyperplasia

Hyperplastic tissue in the palate seen as the result of mechanical irritation in patients who wear prosthetic appliances, have poor OH, use tobacco, or have fungal infections

Papillary hyperplasia of the palate

Early lesion will respond to non-surgical tx in the form of tissue conditioning (soft liner), but once extensive fibrosis has occurred, must be excised

Inflammatory fibrous hyperplasia

When do you write for an antibiotic?

Visible swelling of face (intraorally or extraorally) Pus coming out of the socket Immunosuppressed pt with infection

What is the format for writing a prescription?

Medication Strength Quantity Instructions

Which technique? Minimizes wound contamination by pathogenic microbes Use sterile or clean technique Gown, cap, gloves, and mask are utilized Once you start, do not touch anything outside the sterile operative field

Aseptic technique

Which technique? Designed to protect the patient from “bugs” of others and yourself (and staff) from the patient’s

Aseptic technique

What are the 3 basic surgical necessities?

Access Light Visibility

Incisions heal ______ to ______, not end to end

side to side

When making an incision, use a sharp blade #_____

When making an incision, use a _____ grasp with firm continuous stroke. No hesitation cuts

pen

When making an incision, cut ____________ to mucosa

perpendicular

What are the 2 blood/vascular supply patterns?

Random Axial

Which blood/vascular supply pattern? Base must be wider than apex

Random

Which blood/vascular supply pattern? Depend on dermal (or submucosal) plexus since there is not a specific vascular supplying

Random

Which blood/vascular supply pattern? These are flaps with a specific blood supply

Axial

Which blood/vascular supply pattern? Apex may be wider because there is a specific blood supply

Axial

What are the flap designs?

Random pattern Envelope Envelope w/ vertical 2 verticals

The proper care of flaps includes: Proper design Careful retraction (_______ tissue handling) Debridement Hemostasis Elimination of dead space Close without __________ Suture line over sound _______

gentle; tension; bone

What handpiece do you use to cut bone/teeth?

Slow speed

Why do we NEVER cut bone/teeth with a high speed handpiece?

Air emphysema

What bur do we use to cut bone?

Round bur

What bur do we use to cut teeth?

Fissure bur

When cutting bone/teeth, use continuous ___________, we do not want to burn the bone

irrigation

What do the following help with? Local anesthesia infiltration Direct pressure Ligation of vessels Electrocautery Pressure dressing Hemostatic agents: collagen, cellulose, wax Pro-coagulants: thrombin, TXA, … etc

Hemostasis

What do the following help with? Suture similar tissue planes together (layered closure) Pressure dressing for 12-18 hours (fibrin formation) Open packing of cavity Filling dead space with PRP,PRF, antibiotic solution, bone substitutes Drains: suction and gravity

Eliminating dead space

T/F: Saline with antibiotic has NOT been proven to be more helpful

True

What type of needle do we use to suture?

3/8 circle reverse cutting

What are the 5 possible suture materials?

Silk Gut PGA Nylon Vicryl

What position the chair be in when preparing for ext?

"V" (prevents pt from sliding off)

Which medical emergency has the following symptoms? Slow, weak pulse Drop in BP and HR Decrease in or loss of consciousness

Syncope

Which medical emergency has the following tx? Place supine with head lower than heart Loosen tight clothing around the neck Cool towel on forehead Oxygen Ammonia inhalant

Syncope

Which medical emergency has the following symptoms? Anxiety induced rapid and deep breathing

Hyperventilation syndrome

Which medical emergency has the following tx? Position patient comfortably Attempt to “talk patient down” Elevate CO2 levels by rebreathing IV sedation Call EMS if carpopedal tetany, seizures or unconsciousness occurs

Hyperventilation syndrome

Which medical emergency has the following symptoms? Tightness of chest, sensation of constriction Sensation of “weight” on chest Dyspepsia / indigestion Pain radiating to neck / jaw / arms

Angina

Which medical emergency has the following tx? Position patient comfortably Oxygen Nitroglycerin (administer up to 3 doses at 2 – 5 minute intervals) Call EMS after third dose or sooner if clinical symptoms warrant

Angina

Which medical emergency has the following symptoms? Rapid pulse Normal or decreased BP Increased RR with shallow respirations Hunger Dizziness, weakness, mental confusion, irritability Nausea/vomiting LOC

Hypoglycemia

Which medical emergency has the following tx? Conscious patient: oral sugar Unconscious patient: 50% Dextrose IV – 20-30 cc for children – 50 cc for adults

Hypoglycemia

Which medical emergency has the following symptoms? Itching Swelling of face, hands, eyelids, etc. Rash or hives Nasal congestion, sneezing, respiratory difficulty

Allergic rxn

Which medical emergency has the following tx? Mild reaction = immediate physician referral Moderate reaction = oral Benadryl, immediate physician referral Severe reaction = IM Benadryl, consult w/ physician, prepare to tx anaphylaxis

Allergic rxn

Which medical emergency has the following symptoms? Urticaria and development of rash Anxiety and restlessness Respiratory difficulty / wheezing Cyanosis, rapid and weak pulse Severe drop in BP Cardiac arrythmia and arrest

Anaphylaxis

Which medical emergency has the following tx? Epinephrine Repeat after 5 minutes if ineffective Place patient supine Benadryl IM Oxygen Emergency airway

Anaphylaxis

Which medical emergency has the following symptoms? Tonic-Clonic convulsions LOC Oozing of saliva

Grand mal seizure

Which medical emergency has the following symptoms? Trance like state Flickering of eyelids Twitching of mouth

Petit mal seizure

Which medical emergency has the following tx? Keep patient away from equipment (may need to place on floor to prevent him from injuring himself) Observe patient until he returns to normal state Airway control

Seizure

Which medical emergency has the following symptoms? Excessive thirst Frequent urination Malaise Loss of apetite Fruity breath Nausea Vertigo Coma

Diabetic ketoacidosis

Which medical emergency has the following tx? Get emergency help Oxygen Keep patient warm Basic life support

Diabetic ketoacidosis

Which medical emergency has the following symptoms? Wheezing with prolonged expirations Normal or elevated BP Cyanosis

Asthma attack

Which medical emergency has the following tx? Patient’s own inhaler Oxygen If no inhaler or if ineffective, epinephine Keep patient semi-erect

Asthma attack

Which medical emergency has the following symptoms? Weakness Pallor Perspiration Weak and rapid pulse Hypotension

Addisonian crisis

Which medical emergency has the following tx? Oxygen CPR Get help IV solu-cortef

Addisonian crisis

Which medical emergency has the following tx? Initial excitement with apprehension, anxiety, tremors, rapid breathing Subsequent depression with stupor, LOC, weak and rapid pulse, weak and rapid respirations, cyanosis, drop in BP, shock

LA toxicity

Which medical emergency has the following tx? Place supine Oxygen Monitor vitals CPR Anticonvulsants

LA toxicity

Papillary hyperplasia of the palate is an ______________ ___________, it is NOT neoplastic

inflammatory process

Tx includes superficial removal if tissue conditioning is unsuccessful

Papillary hyperplasia of the palate

Creating more fixed tissue using skin, mucosa, or dermis as a graft

Vestibuloplasty

These techniques have a 50% relapse in the maxilla and a 90% relapse in the mandible

Vestibuloplasty

Can often be done in conjunction w/ removal of epuli

Vestibuloplasty

The need for post-op medication should be thought of ________ in the treatment plan…..not as an afterthought

early

T/F: The majority of mild and even some moderate dental pain can be managed with nonprescription or OTC medication

True

What type of analgesics? NSAIDs Acetaminophen Aspirin Tylenol w/ codeine

Mild

What type of analgesics? Hydrocodone Ultram/ultracet

Moderate

What type of analgesics? Oxycodone Morphine Demerol Oxycontin Fentanyl

Potent

What does KASPER stand for?

Kentucky All Scheduled Prescription Electronic Reporting

You must request Kasper for which drugs?

Class II drugs

T/F: You need Kasper for tylenol #3

FALSE (it is not a class II drug)

T/F: You need Kasper for hydrocodone

True!

T/F: You can call in class II drugs

FALSE (you must request Kasper)

How long is Kasper good for?

30 days

You can write a _____ day supply of narcotics after a surgical procedure

What type of infection is most common?

Mixed (anaerobic and aerobic organisms)

What are the 4 signs of infection?

Dolor (pain) Rubor (redness) Calor (heat) Tumor (swelling)

What are the following symptoms associated with? Dysphagia Odynophagia Stridor Dysphonia Dehydration Fever, fatigue, malaise Trismus Inability to handle secretions

Infection

What are the 3 things for a "recipe of infection"?

Portal of entry Virulence Host resistance

What are 3 portals of entry for bacteria to cause an infection?

Dental disease Trauma Iatrogenic

Which portal of entry? Perio Caries

Dental disease

Which portal of entry? Dentoalveolar Fracture Soft tissue damage

Trauma

Which portal of entry? Needle tract Endo files Burs

Iatrogenic

What are the common reasons for being immunocompromised?

HIV Diabetes Corticosteroids DMARDs Anti-rejection drugs

Potential spaces; act as barriers to limit spread of infection in soft tissues

Fascial spaces

Can communicate freely, allowing spread of infection from one to another

Fascial spaces

Lend themselves to prediction of routes of spread and drainage along strict anatomic lines

Fascial spaces

Which fascial space infection is associated with the following signs/symptoms? Pain Swelling Trismus Fluctuance Induration Drainage

Masticator space

What are the 5 principles of treating an infection?

1. Maintain airway 2. Remove etiology (involved tooth, etc) 3. Establish drainage through socket or I&D 4. Support systemically (antibiotics, fluids) 5. Post-op care (rinses, follow-ups)

What are 4 common difficulties of treating an infection?

LA doesn't work as well Less access (due to swelling, trismus, guarding) Concern for airway Pts in pain are hyperactive/hyperacute

Dosing schedule for Amoxicillin

Amoxicillin 500 TID

Dosing schedule for Pen VK

Pen VK 500 QID

Dosing schedule for Augmentin

Augmentin 875 BID

Dosing schedule for Clindamycin

Clindamycin 300 QID

What are the 5 things to remember when treating an infection?

Remove the source Drain the pus Change environment Consider antibiotics Refer early if outside comfort level for tx

OS Midterm Flashcards

(180 cards)