Oral Surgery Second Semester Midterm Flashcards

Codeine
Terms Definitions
When making an incision use __ grip and __ stroke
pen grip
Firm continuous stroke
#__ blade is curved and is the work horse of OS
#12
__ is the easiets and most commonly used flap
Envelope
FLAP DESIGN
1. Apex should __ than base
2. Lenght __ width
3. __ should be included in base
4. Base should/should not be __
1. Never be wider
2.L no more than 2x width
3. Axial blood supply
4. Should not kink, twist, strech base
__ is exposure of underlying bone-can be avoided by __ and ___
Dehiscence
Closing w/o tension and gently handeling flaps edges
Flap should be cut at __ angles
oblique
Inscision should be made w/ blade __ to tissue-why?
Perpendicular-easier to close, less risk or necrosis, better cosmetic scar
Incision should be placed over __ and in __ gingiva (usually around teeth) but sometimes in __ tissue when releasing
Healthy bone
Attached gingiva
Sometimes unattached
Flaps should be smaller or larger
larger
T/F Properly repaired long incisions heals slower than a short one
False-heal at same rate
Oblique releasing incision is placed where?
1 tooth anterior to area of bone removal
When handeling tissue: Avoid __ __ and __
Extremes of temp
Aggressive retraction
Inadvertent injury to lips
Only allow __ fluids to contact tissue
Physiologic
Advantages of proper hemostasis:
Preserve pt's O2 carrying capacity
Decreased operating time
Avoid hematoma
Steps in Pre-Operative Hemostasis
History
Lab investigation
Case sleection
Intra-operative hemostaisis:
Local infiltration at least __ min b4 surgery
__ wound if bleeding
Apply __ min of pressure for sm. vessle or __ min for lg
7 minutes
Dab
20-30 sec
5-10 min
Best way to control bleeding __
Pressure
__ may be soaked in trombin but __ cannot be but is bacteriocidal
Gelfoam
Surgicel
__=bovine collagen
__-mechancially stops bleeding by tamponade but can't be used where osseous integration is necessary
__-inactivates conversion of plaminogen to plasmin and is administered orally/IV
Avitene
Bone Wax
Tranexamic acid
Post-op hemostasis
Head of bed elevated >30, avoid exercise, no spitting, avoid alcohol, apply heat for 1st 24 hrs
Examples of URT flora
Ex. of Max/face flora
Nonmax/face flora
URT: G+ cocci, H. influenzae, Staph. aureus
Max/Face: Staph, corynebact
Nonmax/face: E.coli, Klebsiella, Proteus, B. frag
Heps:
__ spreads by fecal contamination
__ and __ by contact w/ any secretion __ by fecal contamination and blood routes
A
B and D
C
Hep B resists __
Phenols, alcochols, ammonium compounds
Don't treat pt's w/ HIV if CD4 is below
200
TB is resistant to __ and suceptable to __ sterilization
Chemical
Heat, ethylene oxide gas, irradiation
Autoclave is faster but may cause rust; __ is temp for __ minutes
24 min at 121 degree
__ are the spores tested for to monitor sterilization
Bacillus stearothermophilus
BLADES
#__ is strait and pointed
#__ is borad and curved
#__ is the workhorse and is curved and pointed
#11
#10
#12
#__ handel is the most commonly used
#3
Instruments used for elevating mucoperiosteum
#1 or 9 Woodsen
#2 or 4 Molt
Instruments for retracting Soft tissue
Weider (sweetheart) Seldin, Minn., Austin
Grasping soft tissue
Adson, Gerald pickup, College pleir (locking cotton plier), Russin tissue , forceps Allis clamp
Removing bone
__-combo of end and side cutting
__ and __ used for uni belvel ostetome
__-removes bone in pull stroke-not efficient for removing a lot of bone-irrigate afterwards
__-medium speed/high torque
Blumenthal rongeurs
Chisels and mallet
Bone file
Brassler
Sever PDL
__-small, easily broken/bent
Periotome
Removing soft tissue
__-removal of PA ST after extraction, systecomy
PA curette
2 types of suction
Frazer tip and yankauer
Describe the needle holder grasp for suturing
Thumb and ring finger engage handle-index finger stabilize shank
__ tyes of needes are used in OS for suturing
Reverse cutting needles
Cutting ST
Iris scissors
Metzenbaum scissors
Adding __ to the cryer potts or miller elevators will give you more force
"T" or crossbar handle
The __ side of the elevator is the working side and should be toward tooth
concave
The __ elevators are used to remove bone and roots, as are __ but after placemnt of purchase point using handpiece or bur
Cryer
Crane Pick
__ used to remove fracture root tips
Root tip pick
Forcep grasp for max teeth: __
Mand teeth=__
Max: palm under handle
Mand: thumb around and under handle for grtr force
__ grasp is in verticle direction, palm over top, thumb to side but can generate a lot of force so be careful
English Forcep grasp
__ is the maxillary "Universal" forceps, __ is where you should grasp
#150
Grasps below CEJ
__ forceps-beaks are more parallel, beaks don't tough w/ handles t/g unlide the regular verison; used for __ extractions
#150 A-Max PM's
#__ is used for max anterior teeth
#1
# __ has a paired left and righ for max molars and grasps at CEJ
#53 L/R
#__has paired left and right, beaks fid max molar roots
#88 L/R
#__ is the max 3rd molar forecps
#210 S
#__ is the bayonet-maxillary root forceps
#65
#__ and __ foreps are mandibular "Universial" with the A having more parallel beaks
#151 and #151A
In 150S and 151S-what does the S indicate?
It is for primary teeth
#__ is the mandibular molar forceps w/ beaks into furcs which is like the #__ aka cowhorn
#17
#23
#__ is for mand 3rds
#222
Indications for Special Technique include:
Infection, pathology, trismus, trauma
__ injection was develope to improve sucess rate and is a "true" nerve bock
Gow-Gates
Target area for gow gates=__
Name the 3 land marks:__
How long does mouth have to be open
Neck of condyle below insertion of pterygoid
ML cusp of Max 2nd molar, intertragic notch, corner of mouth
1-2 minues
Name 2 compliations of Gow-Gates
Hematoma, trismus
__ is the alternitive for mand block when opening is limited; T/F the sucess rate is high
Aknosi
True
T/F When doing and Akanosi you should hit a bony stop
False-if you do may cause trauma
Target area for akanosi=__
Landmarks=__
Soft tissue medial to ramus-above foramen, below condyle
LM= mucogingival junciton of max 2nd or 3rd molar, max tuberosity
Area of insertion for akinosi and technique
Soft tissue overlying medial ramus-adjacent to tuberosity
Penetrate 25 mm, parallel to max occlusal plane in a posteriolateral direction
Complications of Akinsoi
Hematoma-lgr risk then with GG
Facial nerve paralysis
Trismus (rare)
Name Category B anesthetics for pregnancy
Lido, prilo, etido (LEP)
Name Category C drugs for pregnancy (Better Avoid)
Articaine, Bupivicaine, Mepivicane (BAM)
__ works best for anesthetizing inflammed or abscessed tissue due to __
what is the max dose
2 car in juvenile
Max dose:
Epi in heathly
Epi in cardiac
Levonor in healthy
Levonor in cardiac
Epi-healthy 200 mcg
Epi cardiac 40 mcg
Lec-healthy 10000mcg
Lev-cardiac 200 mcg
Name some thing you should evaluate (regarding teeth) before you extract
TMJ dysfuntion, mobility of tooth, condiiton of crown, relationship of assoc. vital sutures, configuration of roots, surrounding bone
Extraction in max. left quadrant-turn pts head toward __
operator
Mand extractions: pt should be __ and occlusal plane should be __
More upright
Parallel to floor
Ant. mand teeth: pt should look __
straight ahead
Mand posterior teeth: pt head turned __, use __ grasp, for mand right post teeth stand __
toward operator, overhand grasp
Stand slighly behind pt
Purchase point is designed to pick tooth out but _ is a risk
excessive force=pressure necrosis
__-placed apically and expand bone and force tooth occlusally-do this by walking #__ all the way around to get good bone expansion
Wedge
#301
__ are example of wheel and axle machine-engage root and remove it
Cryer, potts, miller
3 ways to begin extraction
Elevaton, Wedge, wheel-and axle
When using bite block the small is usually fine but use large when?
Edentulous
Names some reasions you want to detach gingival attachments
Ensure anesthesia, allows more apical position of elevator, dec. tearing of tissue, dec. risk of trauma to papilla
Luxation accomplishes 2 things:
Bone expansion, Sever PDL
Where do you want to place forecps and why?
As far apical as posslbe, weges and causes bone expansion, decreases incidence of root fracture
__ bone is the thinnes and most likely to expand there for most of your movment should be in __ direction
Buccal bone
move more bucally
Which root is most likely to fracture and which root is the hardtest to remove
Root you are moving towards-so if you are moving buccal you will fracture the buccal
Paletal is most difficult
__ is the best forcep to use on max canine b/c has a broader beak and engages more root surface; if buccal plate fractures remove it with tooth or leave it attached to periosteum
#150
Common cause of post op bleeding=__
Granulation tissue-this is my you need to remove granulation tissue-longer bleeding time=prolonged healing
Name some systemic factors that may contribute to impacted teeth
Cleidocranial Dysplasia, endocrine deficiencies, Febrile Illness, Downs, radiotherapy
List the MC impated teeth in decending order
Man/Max 3rds, Max canine, Mand PM's, Man 2nd molar
Dev. of mand 3rd molars: tooth germ visible at __ yrs, mineralization complete by __, root half fomed by __ and completed by __
9 yrs
14 yrs
16 yrs
18 yrs
If 3rd are going to erutp 95% will have done it by age __
24
Name some causes of impaction of 3rds
Differential growth b/t M and D roots, not enough room in arch, lateral positioning of tooth buds, retarted maturation of 3rs
Teeth are considered impaced when...
Tooth has failed to erupt into mouth w/i its expected time and can no longer be expected to do so
When doing a flap: release incision on __ (reverse hockey stick incision); never extend incision beyond __;
Ext. oblique ridge
DL angle of the 2nd molar
__ incision is used for apical access in PA surgery-avoid crssing bony prominences
Semilunar incision
T/F when retrieving a broken root you can grasp buccal bone with forcepts to remove tooth or remove some buccal bone
True-but not a good idea in ortho cases-use periotome instead
When doing the open extraction technique list the finishing steps
Smooth bone, irrigate and suture w/ 3-0 gut suture
How would remove surgically a max molar
Flap, remove buccal bone, section buccal roots from crow, remove crown w/ paletal and remove other 2 roots
When removing bone-remove from __ __ and __if necessary
occlusal, buccal, careful from the distal
T/F you should be very conservative with removing bone
False-five yourself room to work
When exposing a tooth-bone should be removed to __
CEJ of crown
__ burs are good to remove bone; bone can be chipped away from buccal in max/mand
#702 or 703 fissure burn or #8 round bur

max w/ a #9 or straight elevator
T/F You should section all the way through the tooth to the lingual plate
False-leave a plate and break through it
Mesolingual impaction-what do you do? Parital impaction?
Section off distal half from buccal groove to CEJ and luxate rest w/ 301
Make a trough/ditch then proceed as above
Horizonal impactions-needs more/less bone reomved than mesioangular impactions,section crown and deliver w/ __ elevators; make purchase pt and luxate in __ direction
More
East-west elevators
anterior
Pain peaks __hrs post-op and only persistis __ days
6-12 hrs
2-3 days
When should first dose of analgesic be taken after surgery
B4 anesthetic wears off
List some centrally acting analgesics
Codeine, hydrocodone oxycodone
Tylenol #1 contains __ amt of tylenol and __ amt of codeine
300 mg tylenol
7.5 mg codeine
#4=60 mg codeine, just remember 7.5 is baseline and it is doubled for every step up
What is max dose in a day of:
Tylenol
Asprin
Ibuprofen
Naproxen
Tylenol 4 g
Aspirin 4g
Ibuprofen 3.2 g
Naproxen 15 g
List drugs used for mild pain
Tylenol, aspirin, ibuprofen
Lisdt drugs for moderate pain
Naproxen, Ibuprogen, Tylenol/Aspirin w/ codeine, Propooxyphene
List drugs for severe pain
Oxycodone, hydrocodone, combunox
Oxycodone, hydrocodone come in what mg dosages?
5, 7.5 or 10 and both can be combines w/ ASA or tylenol, Hyrocodone can aslo be combined w/ ibuprophen
T/F Pain killers given b/4 pain is felt is more effective than after feel pain
True-reduces "pain memory" in the nervous system
Name the long acting anesthetic that should be given pre-operatively and sometimes post-operatively
.5% Marcaine w/ Epi 1:200,000
Describe a post-op diet
High volume, high calorie liquid diet for 1st 24 hours, longer for multiple extractions
__ is the inflammation of masticatory muscles and happens as a result of injury usually from needles; what is the tmt of choice
Trismus-warm compress and analgesics
Brusing is more common in __; onset __ days, lasts __ days
Older ppl
2-4 days
7-10 days
What are the hygiene instruction after surgery (including rinsing)
Do not rinse for 1st day, brush/floss as usualy, careful near site, rinse with warm salt water beginning 2nd day the more the better
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