third molar notes flashcards

Question 1

Name some patient factors to consider before third molar remova

Answer 1

Age, social history, medical history, drug history, BMI, ethnicity, capacity, TMJ status, occlusal relationship.

Question 2

Name some surgical factors to consider.

Answer 2

The tooth itself, periodontal status, surgical anatomy, systemic factors, mouth opening, adjacent structures, associated pathology, surgeon factors.

Question 3

How does age affect third molar extraction?

Answer 3

Increased age is associated with higher complication rates.

Question 4

What medications may affect surgery?

Answer 4

Anti-platelets, anticoagulants, steroids, bisphosphonates, biologics.

Question 4

What medical history considerations are important?

Answer 4

Co-morbidities like ischemic heart disease, stroke, diabetes, mental health issues.

Question 4

Why consider BMI?

Answer 4

High BMI may cause access problems and is associated with comorbidities like diabetes and cardiovascular disease.

Question 5

What is essential in the clinical examination?

Answer 5

Complete extra-oral and intra-oral examination focusing on the third molar area.

Question 6

What imaging modalities are used for third molars?

Answer 6

Periapical radiographs, orthopantomogram (OPG/OPT), Cone Beam CT (CBCT)

Question 7

When is CBCT indicated?

Answer 7

When 3D anatomy or local pathology assessment is required; must justify benefits over risks.

Question 8

What should be included in consent for third molar surgery?

Answer 8

Pain, swelling, bleeding, bruising, infection, sutures, TMJ pain, alveolar osteitis, damage to adjacent teeth, oro-antral communication, nerve injuries (IAN, lingual, chorda tympani).

Question 9

What is the S.T.O.P. mnemonic for radiographic abnormalities?

Answer 9

: Site, Size, Shape; T: Translucency; O: Outline; P: Previous imaging.

Question 9

What are non-surgical options?

Answer 9

Conservative monitoring, patient review, written information/advice.

Question 9

Name some red flags on radiographs.

Answer 9

oss of symmetry, distorted anatomy, bony erosions, teeth appearing to float.

Question 10

Radiographic signs of close relation of mandibular canal to third molar?

Answer 10

Canal deviation, narrowing, periapical radiolucency, root darkening/curvature, loss of lamina dura.

Question 10

Key adjacent structures to be aware of in surgery?

Answer 10

Maxillary antrum/tuberosity, inferior alveolar nerve, lingual nerve, mylohyoid nerve, long buccal nerve.

Question 11

What is a coronectomy?

Answer 11

Intentional removal of the crown only to reduce risk of nerve injury; technique-sensitive; patient selection is key.

Question 11

Risk of permanent vs temporary nerve injury?

Answer 11

Permanent >2% (up to 10% if high risk), temporary >5%.

Question 12

When might extraction of the opposing maxillary third molar be indicated?

Answer 12

If non-functional and low risk of complications.

Question 12

What is an operculectomy?

Answer 12

Removal of operculum over partially erupted mandibular third molar to reduce food trapping.

Question 13

Risks of coronectomy?

Answer 13

Root mobility, post-op infection, alveolar osteitis, re-operation (0–2%), root migration (13–33%).

Question 14

: LA technique for maxillary third molars?

Answer 14

Buccal and palatal infiltrations (lidocaine or articaine).

Question 15

Other anaesthesia options?

Answer 15

LA + IV sedation (conscious sedation), LA + GA.

Question 15

LA technique for mandibular third molars?

Answer 15

Inferior alveolar, lingual, and long buccal nerve blocks (lidocaine) OR IAN, lingual, buccal infiltrations (articaine).

Question 16

Name different types of impaction

Answer 16

Question 17

What do we use In patient assessment

Answer 17

Question 17

Question 17

Question 18

tx for pericornitis

Answer 18

Initial management with no systemic features Irrigation with saline (patients to use a monoject™ syringe if possible) Regular analgesia – NSAID / Paracetamol (check contra-indications and interactions) Caution with chlorhexidine If the patient presents with features of infection, follow the algorithm for management of patients with dental infections:

Question 19

what is Montgomery consent s

Answer 19

Discuss with patient and formulate a treatment plan (discuss pros and cons of options) Must discuss warnings with the patient and risks (Montgomery Consent)

Question 20

Management for patients with features of active infection

Answer 20

Management for patients with features of active infection As above PLUS Antimicrobial Metronidazole 200mg TDS for 3/7 or Amoxicillin 500mg TDS for 3/7

Question 21

What do we include in consent and the risk

Answer 21

Question 22

Question 23

Technique for third molar removal

Answer 23

Local anaesthesia Maxillary third molars Buccal and palatal infiltrations (lidocaine or articaine) Mandibular third molars Inferior alveolar, lingual and long buccal nerve blocks (lidocaine) OR Inferior alveolar, lingual and buccal infiltrations (articaine) LA + Intra venous sedation (conscious sedation) Patient Procedure LA + GA Patient Procedure Risks

Question 24

what patient and surgical factors should you consider

Answer 24

Question 25

Specific warnings for mandibular third molar surgery

Answer 25

- Inferior alveolar nerve - Lingual Nerve - Chorda Tympani Loss or altered sensation (often a painful sensation) which can be temporary or permanent to the lower lip, skin of the chin, gums of the teeth, lower teeth and tongue and taste. >2% permanent but if high risk can be up to 10% - specific to individual >5% temporary