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 wouldn’t 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; don’t 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 isn’t 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?

Platelet count: platelet quantity only. 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. 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. Paratial thromboplastin time: factors in the intrinsic pathway. 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. steroids.0 F. take the normal dose of regular insulin. so there is no effect Prothrombin time: factors in the extrinsic pathway. what is the suitable INR level for basic tooth extractions? T/F: Reanal dialysis patients should be treated the day of dialysis. She 5mg of prednisone for 2 weeks last October. she is non-anxious Epinephrine and atropine PT or PTT Lidocaine is metabolized by the liver.5-3. 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. INR: derived from PT. which may not function normally No. not the dentist 2. Wound Repair What solution should be used for surgical irrigation? Describe an oral-antral fistula. epinephrine is metabolized in the plasma not the liver. Describe her supplementation. treat them the day after (bleeding) NSAIDs. 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.000 The physician’s.Oral Surgery Midterm Review At what blood glucose level would a diabetic need antibiotics? A Type 1 diabetic patient is needing an appointment. a good blood clot is established in the socket T 3-5 days . Valium. but more accurate Surgery on a hemophiliac should be done only in conjunction with physician care <50. What drugs should be avoided when treating a dialysis patient? Why? List some drugs that should be avoided during pregnancy. and he won’t have to have IV sedation. they are metabolized in the kidneys Aspirin. eat a normal breakfast. How long does the inflammatory/lag phase last? Carl Bhend p2 >200 b/c that’s when WBCs don’t do what they are supposed to do (but not always the case) Schedule an AM appointment. NSAIDs. and she is not anxious. basic surgery. None. there is no collagen deposition. How can one be prevented? T/F: During the inflammatory stage of wound healing.

Summarize what takes place in the various weeks (1st. 3rd &4th) of healing of extraction sockets. but nerve sheath with epineurium remains intact Segmental demyelinization. fibrous tissue may never calcify leaving a fibrous union Lingual b/c it doesn’t have a tube to guide reconnection like IAN 10Feb05 Axon degenerats proximally and/or distally. 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. Define osseointegration. Define osteoconduction. 2nd: granulation tissue increases & matures. What causes a dry socket? Describe secondary bone healing. To insure that there is no stress on or movement of the implant during the bone healing phase. 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.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. 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. do what Principles of Surgery What is the most common scalpel blade used? Carl Bhend p3 T Fibrin 3-4 days after injury. if severe. internal pressure from edema or hematoma or injected fluids 1st: inflammation w/ WBCs. tight sutures. 2nd. Give 4 reasons for ischemia in oral surgery. a hematoma invariably becomes infected Poorly designed flaps. fibroplasia begins. osteoclastic activity begins near crestal bone. What factor is most important to proper bone healing? If oxygenation is low in bone healing. Describe axonotmesis. Describe neurotmesis. Describe neuropraxia. a hematoma is large and of no functional use. Three weeks after an injury. 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. Define osteoinduction. 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 . 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. incorrectly placed sutures.

Give 4 reasons for dehisence occurring. 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). The solution to pollution is… Name two types of sutures. 5-7 days Antibacterial. polyglycolic. prolene? What is the most commonly used needle in o. Carl Bhend p4 versatile) In attached gingiva (not free alveolar mucosa).3 2mm apart and 2mm from wound edge 2-5 days generally Oral: rince with warm salt water. P1. 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. nylon. too much tension with closure. bacterial growth and infection Clean. then H2O2 and bacitracin TID for 5 days Poorly controlled IDDM. malignant disease . end stage renal or hepatic disease. fills with a hematoma. skin: bacitracin oinment TID for 2 days. 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. nylon and prolene (5) X-1. not handling the flap gently Tearing Tissue handling Decreased blood flow from pressure on tissues. placing relaxing incisions in muscle or frenae.Oral Surgery Midterm Review What are the preferred areas to make incisions? Describe flap design regarding the base.s. necrotic tissue and foreign debris Dilution Resorbable and nonresorbable Sit ups Slow hydrolysis. tough to slide knot. gut and polyglycolic (4). Give 2 means of promoting wound hemostasis. breaks down Removal of nonviable.? Describe the placement of sutures on skin. Define dead space. FS-2. gut.2. increased wound tension. 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. becomes infected. and over good bone Twice width of the apex Incision not placed over bone. atraumatic surgery. What usually happens to them? Define debridement. and direct pressure Void left from tissues that were removed. 4-6 weeks Proteolytic enzymes.

and more blunt beaks. but can kill TB. cutting) T/F: 70-90% isopropyl alcohol can kill endospores. used on skin. p 69 What is the diameter of a single soft bristle? Describe what is eliminated in the following levels of infection: high. 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.000rpm). Brown-Adson: www/mmm. and grasping surface is crosshatched (as opposed to parallel grooves on a hemostat) X-1 (1/2 circle. stick shift. 4A: side and end cutting  more versatile Chisel and mallet Bi: sectioning teeth. and HIV Light source 17Feb05 #3. and gluteraldehyde 80% 6-30% Disinfectant for inanimate surfaces. 70% alcohol {which hopefully won’t be consumed in large amounts after this test}). shorter. 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.Oral Surgery Midterm Review Principles of Asepsis OSHA is intended to protect… T/F: Hepatitis immunization doesn’t protect us from C nor delta viruses. Part I What is the most common scalpel handle? Scalpel? Name 3 periosteal elevators. not very good for grasping the needle. for spread of organisms? Instrumentation. antiseptic for disinfecting living tissues ‘cause you have nothing but time Sorry… that just came to my mind High: spores. intermediate: same minus spores (iodophors. Describe the most common needle used in o. Woodson #1. #15 Molt #9. rear air exhaust. HbV. On your own The employee T Carl Bhend p5 Iodophors. low. For each give an example agent that can achieve this. accepts standard diameter burs. hypochlorite. Molt #4 Minnesota retractors Adson: w/^. bleach 1:5.s. not gentle. What instrument is particularly good for access to upper 2nd and 3rd molars areas? Compare and contrast Adson and Brown-Adson forceps. leather seats. low: vegatative bacteria (quaternary ammonium. cutting) or FS-2 (3/8 circle. viruses. mono: removing bone High speeds (>100. phenols) F. used on keratinized mucosal edges. vegatative bacteria (Gluteraldehyde). . fully autoclavable. intermediate. What is one of the most frequent fomites. good for grasping suture needle Allis clamp is used for grasping tissues that will be removed Remove bone 5S: side cutting only. high torque. TB. gentle. any water spray must be sterile T Needle holders have stronger. Give 3 differences between needle holders and hemostats. Study the table from the text.

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. rotational. conical roots? What is the verse after John 3:16? Read Matthew 26:42 Then think about how much Jesus loves you. soft tissue management is more involved. traction Apical Buccal Rotational John 3:17 – For God did not send his Son into the world to condemn the world. -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. drug therapy Prior irradiation therapy. Use what scissors? You want to cut tissue and sutures. Periodontally involved teeth make easy buckets. turn patient’s head so you can see Pt more upright. “My Father. inability to open mouth Bleeding is greater. 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. mandible Forceps 03Mar05 Profound Uncontrolled disease.” . wedge. may your will be done. age or radiograph? Describe the position for maxillary extractions. Name 4 local contraindications of TE. mouth slightly below level of your elbow. buccal. Describe the position for mandibular extractions. Woodson #1 Triangular elevator LINGUAL ON THE MANDIBLE Forceps Apical. periocoronitis (ANUG). coagulopathy. 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? DON’T TAKE AN ELEVATOR FROM THE … What is the primary instrument for removal of teeth Name 5 forces used with forceps. but to save the world through him. AAA. mandibular occlusal plane is // to floor. 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. but what are 3 things to watch out for? Which is more relevant regarding bone density. if it is not possible for this cup to be taken away unless I drink it. wheel and axil) Triangular elevators. root fractures Age Chair tipped back. chair is much lower and are is inclined at about 120 degrees at the elbow (use a protractor) Crane pick.Oral Surgery Midterm Review What is the most common specific suture material? You want to cut tissue. lingual.

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