Download NBDE Dental Boards Oral Surgery-27 PDF

TitleNBDE Dental Boards Oral Surgery-27
File Size198.4 KB
Total Pages27
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Sequence of Extractions
1) Maxillary teeth before mandibular teeth
2) Posterior teeth before anterior teeth

Impacted Teeth
-impacted teeth are ones that don’t erupt into arch in expected time
-teeth become impacted b/c adjacent teeth, dense overlying bone, or excessive soft tissue prevents eruption

-inadequate arch length is most common reason teeth fail to erupt
-impacted teeth are retained for pt’s lifetime unless surgically removed

-most common impacted teeth are mand. 3rd molars, max. 3rd molars, and max. canines
-unerupted teeth include both impacted teeth and teeth in process of erupting

-embedded teeth is used interchangeably w/ impacted teeth (Embedded teeth = Impacted teeth)
-impacted max. 3rd molars can be displaced into:

1) infratemporal space
-removed via hemostat

2) maxillary sinus
-removed via Caldwell-Luc approach

-mand. 3rd molars can be displaced into:
1) submand. space (most likely)
2) IA canal
3) cancellous bone space

Caldwell-Luc Procedure
-opening made into max. sinus by incision into canine fossa above max. PM roots
-after tooth/root removal, figure-8 suture made, antibiotics, nasal spray, and decongestant given

-palatal root of max. 1st molar is most often dislodged into sinus

Reasons to Extract Impacted Teeth
1) Prevention of perio dx in adjacent teeth 5) Prevention of odontogenic cysts and tumors
2) Prevention of caries 6) Treatment of pain of unexplained origin
3) Prevention of pericoronitis 7) Prevention of jaw fractures
4) Prevention of root resorption of adjacent teeth 8) Facilitation of ortho txt

Contraindications to Extracting Impacted Teeth
1) Extremes of age (preteen or over 35 yrs old)
2) Compromised medical status
3) Likely damage to adjacent structures

Classifications of Impacted Teeth
1) Angulation

a) Mesioangular (least difficult for mand. and most difficult for max., most common)
b) Horizontal
c) Vertical
d) Distoangular (most difficult for mand. and least difficult for max.)
-most mand. 3rd molars angled to lingual

2) Pell and Gregory Classification
a) Relationship to anterior border of ramus

i) Class 1: normal position anterior to ramus
ii) Class 2: half of crown is within ramus
iii) Class 3: entire crown is within ramus

b) Relationship to occlusal plane
i) Class A: tooth at same plane as other molars
ii) Class B: occlusal plane of 3rd molar is btw occlusal plane and cervical line of 2nd molar
iii) Class C: 3rd molar is below cervical line of 2nd molar

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3) Tension
a) Onset: chronic
b) Location: global and unilateral
c) Symptoms: multisomatic complaints
d) Pain: aching
e) Duration: daily
f) Diagnostic test: none
g) Prior hx of headaches: yes

4) Temporal Arteritis
a) Onset: acute or chronic
b) Location: localized
c) Symptoms: weight loss, polymyalgia, fever, vision problems, jaw claudication
d) Pain: severe throbbing pain
e) Duration: prolonged
f) Diagnostic test: erythrocyte sedimentation rate test (ESR), tender temporal arteries
g) Prior hx of headaches: no
-can lead to blindness on affected side if not treated quickly

Nerve Injuries
1) Anesthesia: loss of sensation
2) Paresthesia: abnormal sensation (burning, tingling, etc.)
3) Hyperesthesia: increase in sensitivity
4) Dysesthesia: painful sensation to normal stimulus
5) Neurapraxia: mild injury w/ no axonal damage (spontaneous recovery within 4 weeks)
6) Axonotmesis: axonal damage but intact endoneural and perineural sheath

-Wallerian degeneration occurs distal to injury
-Potential for recovery in 1-3 months

7) Neurotmesis: complete severance of axon with a gap created
-no recovery expected w/o surgery

Part 5: Temporomandibular Disorders
TMJ
-classified as ginglymoarthrodial joint w/ both translational and rotational movement

-synovial joint
-anatomy:

1) TMJ: articulation btw condyle of mandible and squamous portion of temporal bone
2) Articular surface of temporal bone: fxnal aspect of TMJ made of dense fibrous CT

a) concave portion: articular fossa (glenoid/mandibular fossa)
b) convex portion: articular eminence (tubercle)

3) Articular disc: dense fibrocartilagenous CT (avascular and aneural)
-separates joint into inferior and superior joint spaces
-anterior/posterior bands: thick (post. band thicker and attached to retrodiscal tissues)
-intermediate zone: thin (center of disc)

4) Retrodiscal tissues: loose CT that is vascular and innervated

Myofascial Pain Disorder
-most common cause of masticatory pain/TMJ pain and compromised fxn
-diffuse, poorly localized pain in preauricular region, often involving muscles of mastication
-pain and tenderness result from abnormal muscle fxn and hyperactivity, as well as spasm and dysfxn

-parafunctional habit may be etiologically related (wear facets often seen)
-if pt has nocturnal parafunctional habit, symptoms are worse in morning
-can also be result of disc displacement disorders and degenerative arthritis

-is stress-related disorder (increased stress causes increased muscle tension/bruxism)

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1) Malignant hyperthermia: prevents release of calcium from sarcoplasmic reticulum of skeletal muscle,
leading to persistent contraction

-rigidity, fever, tachycardia, hypoxia
-triggered by succinylcholine and Halothane
-treated w/ Dantrolene

2) Phlebitis: inflammation of superficial veins that can occur after insertion of IV
- pain, tenderness, induration, erythema
-treated w/ elevating limb, moist heat, NSAIDs

3) Laryngospasm: forceful, involuntary spasm of laryngeal muscles caused by oral fluids triggering
laryngeal reflex during lighter stages of anesthesia

-prevented by using pharyngeal barrier and tonsil suction
-treated w/ positive pressure oxygen-supplemented ventilation w/ facemask

-if still persists, use succinylcholine or last resort cricothyrotomy
-most common complication of office-based anesthesia is loss of airway
-most common dental emergency is syncope

Syncope
-transient loss of consciousness caused by transient cerebral hypoxia
-txt: 1) place pt in supine position w/ feet slightly elevated (Tendelenburg position)
2) Establish airway by chin left and administer 100% oxygen
3) Monitor vital signs

Vital Signs
1) Temperature: normal oral temp is 98.6 F or 37 C
2) Heart rate: normal range is 60-80 bpm
3) Blood pressure: normal is 120/80
4) Respiratory rate: normal range is 12-18 breaths/min

Cardiopulmonary Resuscitation (CPR)
-ABCDs
1) Airway: head tilt or jaw thrust (if neck trauma suspected)
2) Breathing: is respiration absent/inadequate, must provide rescue breathing

-bag-valve mask
-ventilation rate: 1 breath every 5-6 seconds (10-12 breaths/min)
-child rate is one breath every 3 seconds (20 breaths/min)

3) Circulation: check pulse and if absent, initiate chest compressions
-compression to ventilation ratio is 30:2

4) Defibrillation
-time interval from first defribrillation is most impt factor in determining survival

-for every 1 min delay btw defrib. and collapse decreases survival by 10%

Shock
-syndrome in which there is inadequate cellular perfusion/oxygen for metabolic demands of tissues

-reduced cardiac output is main factor in all types of shock
-characterized by:

1) increased vascular resistance 4) myocardial ischemia
2) tachycardia (increased HR) 5) mental status change
3) adrenergic response (sweating)

Stages of Shock
1) Compensatory: compensatory mechanisms attempt to maintain perfusion to vital organs

-increased HR and peripheral resistance
2) Progressive: metabolic acidosis
3) Irreversible: organ damage occurs and survival not possible

Categories of Shock

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