Oral Surgery Midterm Review Introduction to Exodontia Who is considered the Father of Oral Surgery?

What was the first specialty board in dentistry? List some reasons why you wouldnt pull a tooth that needed to be pulled?

Carl Bhend p1 13Jan05 Garretson American Board of Oral Surgery (1946) Systemic: overall health is poor, uncontrolled metabolic disease, leukemia, lymphoma, severe cardiac disease, uncontrolled hypertension, severe bleeding diathesis, patients on specific medications, debilitating diseases (AIDS) {basically severe illness}; Local: history of radiation for cancer, severe periocoronitis, teeth located w/n a malignant tumor, acute dentoalveolar abscess (on occlusion) 20Jan05 Review of systems Can occur at rest, can have increasing frequency, requires more nitroglycerin; dont treat, refer 0.04mg, which is 2 carpules having 1:100,000 epi; 1:100,000 solutions = 0.01mg/cc, and each carpule has 1.8cc 1.8cc X 0.01mg/cc 0.018mg, which doubled (0.036mg) is under the maximum dose T F; CHF kills women more than men Yes, if uncomplicated recovery and anxiety isnt a problem Not; elective procedures should be deferred for 6 months, so the chisel and mallet can wait for a couple months Pulmonary and peripheral edema (RHF), dyspnea (LHF), weakness, orthopnea, paroxysmal nocturnal dyspnea, pedal edema Supine No; defer Increased bleeding >200 systolic or 110 diastolic Polyphagia, polydypsia, polyuria How often are you hospitalized? (ER visits with epinephrine administration) Afternoon; upright <60

Health Status Evaluation What part of the medical history may uncover hidden disease? Describe unstable angina. What kind of treatment can be done? What is the maximum dose of epinephrine for a cardiac patient? Describe how this is derived. T/F: Myocardial infarctions kill men more than women. T/F: Congestive heart failure kills women less than men. A 62y/o female presents to your office with an acute tooth that requires extraction. In her medical history she reports a myocardial infarction 4 months ago. Should you extract the tooth? Near the tooth, she has a buccal exostosis she would like shaved down so that it looks better. Should you call for Bambi and Thumper or not? What 7 things can congestive heart failure lead to? What position should be avoided when treating a CHF patient? A CVA patient wants elective surgery 3 months after his the accident. Should you? What is the main concern with performing oral surgery on a hypertensive patient? What is the BP at which you defer elective surgery? Name 3 classic signs of diabetes mellitus. When taking a medical history on an asthmatic patient, what is the best way to determine severity? When should you appoint a COPD patient? Describe the chair position. At what blood glucose level would a diabetic become disoriented?

Oral Surgery Midterm Review At what blood glucose level would a diabetic need antibiotics? A Type 1 diabetic patient is needing an appointment, and he wont have to have IV sedation, what instructions should be given? What rule should be followed when determining if steroid supplementation is needed for an adrenally suppressed patient? An adrenally suppressed patient comes in for routine, basic surgery, and she is not anxious. She 5mg of prednisone for 2 weeks last October. Describe her supplementation. What two drugs should not be used with and untreated or incompletely treated hyperthyroidism? What two labs should be done on a patient with impaired liver function? Why should you avoid lidocaine in an alcoholic? Does hepatitis have an effect on the metabolism of epinephrine? List and describe 4 labs that are elevated in an anticoagulated patient. What is required when performing surgery on a hemophiliac? At what platelet level does bleeding become a problem? Decisions to control coumadin therapy are whose responsibility? At UMKC-SOD, what is the suitable INR level for basic tooth extractions? T/F: Reanal dialysis patients should be treated the day of dialysis. What drugs should be avoided when treating a dialysis patient? Why? List some drugs that should be avoided during pregnancy. Wound Repair What solution should be used for surgical irrigation? Describe an oral-antral fistula. How can one be prevented? T/F: During the inflammatory stage of wound healing, there is no collagen deposition. How long does the inflammatory/lag phase last?

Carl Bhend p2 >200 b/c thats when WBCs dont do what they are supposed to do (but not always the case) Schedule an AM appointment, eat a normal breakfast, take the normal dose of regular insulin; one-half the NPH (b/c pt wont eat dinner due to mouth pain) 5mg prednisone or 20mg cortisol for 2 weeks during past year. None; she is non-anxious

Epinephrine and atropine PT or PTT Lidocaine is metabolized by the liver, which may not function normally No; epinephrine is metabolized in the plasma not the liver, so there is no effect Prothrombin time: factors in the extrinsic pathway; Paratial thromboplastin time: factors in the intrinsic pathway; Platelet count: platelet quantity only; INR: derived from PT, but more accurate Surgery on a hemophiliac should be done only in conjunction with physician care <50,000 The physicians, not the dentist 2.5-3.0 F; treat them the day after (bleeding) NSAIDs; they are metabolized in the kidneys Aspirin, NSAIDs, steroids, Valium, tetracyclines 3Feb05 Sterile water Joining of the oral epithelium with the antral epithelium through an maxillary extraction site in which a perforation into the sinus occurred; a good blood clot is established in the socket T 3-5 days

Oral Surgery Midterm Review T/F: There is immediate vasoconstriction after creating a wound. What is the only element holding the wound together during the first 2-3 days of wound healing? When do fibroblasts start to play a role in wound healing? Describe that role. Three weeks after an injury, how much resistance to tension is present in wound healing? Wound strength is never stronger than Why does a wound have loss of tissue flexibility? Contrast a hematoma from a blood clot. Give 4 reasons for ischemia in oral surgery. Summarize what takes place in the various weeks (1st, 2nd, 3rd &4th) of healing of extraction sockets. What causes a dry socket? Describe secondary bone healing. What factor is most important to proper bone healing? If oxygenation is low in bone healing, what will result? Injuries to which of the following has a poorer prognosis: inferior alveolar nerve or lingual nerve? Wound Repair (continued) Describe Wallerian degeneration. Describe neuropraxia. Describe axonotmesis. Describe neurotmesis. Define osseointegration. Define osteoinduction. Define osteoconduction. To insure that there is no stress on or movement of the implant during the bone healing phase, do what Principles of Surgery What is the most common scalpel blade used?

Carl Bhend p3 T Fibrin 3-4 days after injury; they migrate into the clot and begin to lay down collagen 70-80% 80-85% of normal tissue Failure to replace elastin A blood clot is small and functional; a hematoma is large and of no functional use; a hematoma invariably becomes infected Poorly designed flaps, tight sutures, incorrectly placed sutures, internal pressure from edema or hematoma or injected fluids 1st: inflammation w/ WBCs, fibroplasia begins; 2nd: granulation tissue increases & matures, osteoclastic activity begins near crestal bone; 3rd&4th: epithelial closure by 21 days If neovascularization penetrating clot fails to occur during 1st week of healing when fibroblasts proliferate forming granulation tissue Bone fragment separation that requires replacement of initially deposited fibrous tissue with bone Vascularity Cartilage will form instead of bone; if severe, fibrous tissue may never calcify leaving a fibrous union Lingual b/c it doesnt have a tube to guide reconnection like IAN 10Feb05 Axon degenerats proximally and/or distally, but nerve sheath with epineurium remains intact Segmental demyelinization; chance for recovery is good Sheath is intact providing a guide for axon to repair Sheath is severed also and fibrous connective tissue will exist between the free ends Development of intimate contact between bone and a foreign material Cells or chemicals that stimulate other cells to produce new, viable bone Graft that provides a supporting scaffold for the process of creeping replacements to occur Bury the implant during healing 10Feb05 #15 (never knew my left maxillary 2nd molar was so

Oral Surgery Midterm Review What are the preferred areas to make incisions? Describe flap design regarding the base. Give 4 reasons for dehisence occurring. What is the most common error in flaps? What is the most important aspect of how well your patient will do in oral surgery? Give 3 adverse effects of hematomas. Give 2 means of promoting wound hemostasis. Define dead space. What usually happens to them? Define debridement. The solution to pollution is Name two types of sutures. How is gut eliminated? How is polyglycolic acid eliminated? How long? How is gut suture eliminated? How long? What is an advantage and a challenge of polyglycolic acid? What is the most commonly used form of suture used in oral surgery? What is a problem with the above answer? What is the least reactive of all monofilamentous sutures? What size suture is most common in oral surgery? Which suture material is the easiest to handle? How many throws for knots is required of silk, gut, polyglycolic, nylon, prolene? What is the most commonly used needle in o.s.? Describe the placement of sutures on skin. How long to you leave in nonresorbable sutures? What instructions should be given to a patient with nonresorbable sutures regarding cleansing? Name 3 diseases favoring tissue catabolism.

Carl Bhend p4 versatile) In attached gingiva (not free alveolar mucosa), and over good bone Twice width of the apex Incision not placed over bone, too much tension with closure, placing relaxing incisions in muscle or frenae, not handling the flap gently Tearing Tissue handling Decreased blood flow from pressure on tissues, increased wound tension, bacterial growth and infection Clean, atraumatic surgery, and direct pressure Void left from tissues that were removed; fills with a hematoma, becomes infected, breaks down Removal of nonviable, necrotic tissue and foreign debris Dilution Resorbable and nonresorbable Sit ups Slow hydrolysis; 4-6 weeks Proteolytic enzymes; 5-7 days Antibacterial; tough to slide knot, but once slid it stays Silk (especially if you are lactose intolerant) It tastes bad considerable inflammation due to wicking PROLENE (polypropylene) 3-0 or 4-0 Silk Silk (3), gut and polyglycolic (4), nylon and prolene (5) X-1, FS-2, P1,2,3 2mm apart and 2mm from wound edge 2-5 days generally Oral: rince with warm salt water; skin: bacitracin oinment TID for 2 days, then H2O2 and bacitracin TID for 5 days Poorly controlled IDDM, end stage renal or hepatic disease, malignant disease

Oral Surgery Midterm Review Principles of Asepsis OSHA is intended to protect T/F: Hepatitis immunization doesnt protect us from C nor delta viruses. What inactivates HbV and HcV? (3 things) What % of HcV pts are carriers? What is the chance of contracted HbV and HcV by needle stick? Contrast disinfectant and antiseptic. Study the table from the text, p 69 What is the diameter of a single soft bristle? Describe what is eliminated in the following levels of infection: high, intermediate, low. For each give an example agent that can achieve this. On your own The employee T

Carl Bhend p5

Iodophors, hypochlorite, and gluteraldehyde 80% 6-30% Disinfectant for inanimate surfaces, antiseptic for disinfecting living tissues cause you have nothing but time Sorry that just came to my mind High: spores, TB, viruses, vegatative bacteria (Gluteraldehyde); intermediate: same minus spores (iodophors, bleach 1:5, 70% alcohol {which hopefully wont be consumed in large amounts after this test}); low: vegatative bacteria (quaternary ammonium, phenols) F; but can kill TB, HbV, and HIV Light source 17Feb05 #3; #15 Molt #9, Woodson #1, Molt #4 Minnesota retractors Adson: w/^, gentle, used on skin, not very good for grasping the needle; Brown-Adson: www/mmm, not gentle, used on keratinized mucosal edges, good for grasping suture needle Allis clamp is used for grasping tissues that will be removed Remove bone 5S: side cutting only; 4A: side and end cutting more versatile Chisel and mallet Bi: sectioning teeth; mono: removing bone High speeds (>100,000rpm), high torque, fully autoclavable, rear air exhaust, leather seats, stick shift, accepts standard diameter burs, any water spray must be sterile T Needle holders have stronger, shorter, and more blunt beaks, and grasping surface is crosshatched (as opposed to parallel grooves on a hemostat) X-1 (1/2 circle, cutting) or FS-2 (3/8 circle, cutting)

T/F: 70-90% isopropyl alcohol can kill endospores. What is one of the most frequent fomites, for spread of organisms? Instrumentation, Part I What is the most common scalpel handle? Scalpel? Name 3 periosteal elevators. What instrument is particularly good for access to upper 2nd and 3rd molars areas? Compare and contrast Adson and Brown-Adson forceps. What clamp can you use on a flap that will be tossed? What is the use of Rongeur forceps? How does a 5S Rongeur forcep compare w/ a 4A? What is the cleanest way of removing bone? What is the function of the bibeveled and monobeveled chisels? What qualities should you look for in a handpiece?

T/F: Throw away carbide burs after 1 use. Give 3 differences between needle holders and hemostats. Describe the most common needle used in o.s.

Oral Surgery Midterm Review What is the most common specific suture material? You want to cut tissue. Use what scissors? You want to cut tissue and sutures. Use Instrumentation, Part II What is the basic function of dental elevators? T/F: Dental elevators are not intended to be the sole means of extracting teeth. What type of instrument is a Woodson #1? What straight dental elevators allow access to upper 3rd molar areas? What type of instruments are the only ones that can create all three mechanisms of action? What instrument is most useful when one broken root remains in the socket of a multirooted tooth? To what arch is it limited? Instrument w/ least damaging way to extract? Principles of Uncomplicated Exodontia Part I What type of anesthesia is required here? Give 3 general systemic contraindications of TE. Name 4 local contraindications of TE. Periodontally involved teeth make easy buckets, but what are 3 things to watch out for? Which is more relevant regarding bone density, age or radiograph? Describe the position for maxillary extractions. Describe the position for mandibular extractions. What instrument is the best example of a lever? What instrument is the best example of a wedge? What instrument is an example of a wheel & axle? DONT TAKE AN ELEVATOR FROM THE What is the primary instrument for removal of teeth Name 5 forces used with forceps. Which is the first and one force used for all teeth? Which is probably the most frequently used socket expansion force? Which force is the best application in teeth with single, conical roots? What is the verse after John 3:16? Read Matthew 26:42 Then think about how much Jesus loves you. -Carl

Carl Bhend p6 3-0 black silk Iris Dean angled scissors 24Feb05 To go up to oral surgery on the 3rd floor (luxation) T Straight dental elevator Millers and Potts Straight dental elevators (lever, wedge, wheel and axil) Triangular elevators; mandible Forceps 03Mar05 Profound Uncontrolled disease, coagulopathy, drug therapy Prior irradiation therapy, periocoronitis (ANUG), AAA, inability to open mouth Bleeding is greater, soft tissue management is more involved, root fractures Age Chair tipped back, mouth slightly below level of your elbow, turn patients head so you can see Pt more upright, mandibular occlusal plane is // to floor, chair is much lower and are is inclined at about 120 degrees at the elbow (use a protractor) Crane pick. Woodson #1 Triangular elevator LINGUAL ON THE MANDIBLE Forceps Apical, buccal, lingual, rotational, traction Apical Buccal Rotational John 3:17 For God did not send his Son into the world to condemn the world, but to save the world through him. My Father, if it is not possible for this cup to be taken away unless I drink it, may your will be done.