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222 Cards in this Set
- Front
- Back
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When giving an injection Avoid verbiage like...
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4 letter words like shot, pain/hurt, pull
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Where are 6 year molars located?
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3, 14, not IN the sinus
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How to diagnose sinusitis pain?
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1. jump up and down - pain in tooth
2. hold toes: pain should move to inferior of orbit |
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Condyle is a --------- shaped joint
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football-shaped joint
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What is the alveolar process?
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-mandibular bone which surrounds teeth roots
-resorbs when teeth are absent |
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TMJ is a described as what type of joint
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complex.
More movement than simple ball and socket. |
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T/F. Bilateral condylar Fx is an airway emergency?
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True. Airway emergency (jaw will retract)
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TMJ clicking and popping is indicative of what?
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without associated pain, normal.
with pain, abnormal |
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4 muscles of mastication
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masseter, temporalis, medial pterygoid
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Function of lateral pterygoid besides lateral movement?
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open mandible
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3 components of cleft lip
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1. 6 weeks post-conception
2. failure of mersion of mesenchymal cell layer 3. philtrum is part of the nasal process |
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Vestibule is __-__ tissue
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non-keratinized soft tissue
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3 things to know about vestibule
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1. site to infiltrate anesthesia
2. bounded by lips, cheeks, and gingiva 3. nonkeratinized, highly mobile tissue (NOT SKIN) |
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What are the 3 major salivary glands?
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1. parotid
2. sublingual 3. submandibular |
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Describe the Stenson's Ducts
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found in cheek - deposits of calcular (tartar) can accumulate on lateral surface of maxillary first molar due to this duct
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What criteria is used to give tonsillectomy?
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5 tonsil infections in a year
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T/F Gingiva is unkeratinized?
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False. highly keratinized
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What is the function of the Periodontal probe?
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for assessing depth of papillar.
normal depth is 1-3mm |
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What are the main sensory nerves of dentisty?
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Trigeminal V - V1, V2, V3
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What nerves do we primarily anesthesize?
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V2-3. V1 is opthalmic
V2 - maxillary branch (superior alveolar and palatal branches, posterior superior alveolar nerve) V3 - mandibular branch (inferior alveolar, lingual, long buccal, auriculotemporal branch) |
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4 tissues of teeth
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1. enamel: hardest tissue in body, can't regrow
2. dentin: bulk of tooth, sensitive 3. pulp: connective tissue - nerves, blood vessels and lymphatics. this removed during endodontics (root canal) to save root 4. cementum: sensitive, outside of root adheres to bone |
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Tissues of the periodontium
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1. gingiva: firm, stippled, pink/pigmented
- connective tissue, covered by keratinized epitheium 2. periodontal ligament (PCL)- connective tissue fibers connecting cementum to bone 3. alveolar bone - surrounds and supports tooth. ALVEOLAR BONE RESORBS WHEN TEETH ARE REMOVED which can lead to dished-in appearance |
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If PDL is torn, tooth must be re-attached w/i __ to __ minutes
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30, 60
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anterior teeth
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social 6 - incisors and cuspids (single point teeth)
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How many posterior teeth in each quadrant?
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5 - includes two bicuspids (pre-molars), and 3 molars
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Crown to root ratio is?
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1:2
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Where is the entry and exit of innervation, blood vessels, and lymph vessels?
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apex of tooth/tip or end of root
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Universal numbering system, also used by military?
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numbered 1-32, top right to top left, lower left to lower right
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FDI Two Digit numbering system used by dentists?
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developed 1970
top right: anterior tooth is 11, 3rd molar is 18 top left: anterior tooth is 21, 3rd molar is 28 bottom left: anterior tooth is 31, 3rd molar is 38 bottom right: anterior tooth is 41, 3rd molar is 48 |
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What is the natural loss of baby teeth?
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exfoliation
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Naming deciduous teeth (first to erupt) - 20 in total
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Universal: add a D
FDI Two-Digit: use 5, 6, 7, 8 for corresponding regions |
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T/F. Position of teeth is straight up and down?
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False
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Bone between teeth?
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interradicular bone
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Where are the first upper premolars found?
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5 and 12
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What are the last teeth to erupt?
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wisdom teeth/18 year molars
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T/F. Third molars are routinely removed in sections
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True
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Describe Amalgam
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silver-mercury metal metal restoration for posterior teeth
10-30 year life |
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Describe Composite
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white plastic for anterior tooth, sometimes posteriors for vanity
5-10 year life prone to decay underneath |
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How do we protect a severely broken tooth?
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crown - porcelain for anterior, gold for posterior
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Bridge
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prosthetic replacement for missing tooth
teeth on either side of tooth are ground down 20-30 year life |
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Root canal known as?
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endodontics
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Reason for endodontics?
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bacterial infection of NERVE which causes discomfort
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Where does a denture ride?
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on the alveolar process
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Dentures retain __% of function?
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15
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Orthodontics deal with...
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braces. mind blown. can deploy with these
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Describe Normal variants
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torus: hard solid bone in palat
exostosis: buccal bone protuberance - often caused by clenching of teeth: more stress on teeth results in more bone development toothbrush abrasion: v shaped groove at gingiva. no decay but may be sensitive, use soft toothbrush Attrition: physiologic loss of occlusal or incisal tooth structure due to tooth-to-tooth contact Abrasion Acquired Defect: mechanical wear/sand. don't eat rocks |
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S/Sx of geographic tongue
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(normal variants)
diffuse multifocal red lesion asymptomatic dorsum and lateral surface affected with loss of filiform papilla - affects 2% of population |
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Normal variants cont:
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Varicosity: blue area in floor of mouth or ventral surface of tongue
-often asymptomatic -blanches upon pressure -caused by varicose veins -no Tx...do not incise for obvious reasons |
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Describe Ankyloglossia
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- "tongue-tied"
-can't just clip attachment...have to suture at floor of mouth or the ventral of the tongue, or use a "laser" |
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Describe Fissured Tongue
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ballsack tongue, only seen in 1% of pop
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Steps to examinig a patient's oral cavity
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1. symmetry
2. swelling/tumor 3. rubor - redness 4. calor - heat 5. dolor - pain |
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Instruments used for exam?
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No. 4 periodontal probe
No. 23 Explorer |
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For examining intraoral, what order do we follow?
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Out -> in, follow universal numbering
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Classifications for intraoral probing?
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3mm or less = normal
6mm or more = severe |
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How to probe the gingival sulcus
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attachment of soft tissue?
alveolar bone loss? probe 3 sites buccal, 3 sites lingual |
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What are some high risk sites of decay?
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-occlusal surfaces
-margins of existing fillings |
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Do we use explorer on restorations?
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Nope
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High risk sites for decay on lower molars?
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occlusal and buccal pit
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Why would we suspect a nonvital (devitalized) tooth?
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one lone grey tooth
may asymptomatic. Dx/test Tx: endodontics or extraction |
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How to assess for asymptomatic nonvital tooth?
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1. percussion test - assess for pain. tap "normal" 1st
2. ice or cold test - test contralateral tooth 1st. Pain lasting longer than 10 seconds suggests hyperemic pulp |
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Dental Caries
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decay/disease. cavity is formed after caries are removed
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Dental plaque takes __ hours to form?
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24; cannot be rinsed off with water, consists of colonies of bacteria, new species constantly supercede
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Requirements for dental decay
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1. tooth surface
2. plaque bacteria 3. dietary sugar or sucrose 4. time |
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What is the caries process
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Process to infiltrate dentin takes a long time...once dentin is reached, can advance quickly
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Will a periapical absess be painful?
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maybe...maybe not
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Major contributors to caries
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1. lack of saliva (buffers acid)
2. decreased rate of secretion due to some treatments and medications 3. ETOH and smoking don't help |
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Areas with high risk of carries
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1. pits and fissures/occlusals
2. crowding 3. interproximal areas 4. improperly contoured restorations 5. margin of a restoration 6. root |
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Physical appearance of caries
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enamel is usually transluscent, then white, yellow, or brown due to exposure to colored dentin
- early appearance of caries is chalky white - still reversible - carious area will also be "sticky" when probed with a dental explorer |
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Fluoride protects smooth surfaces of teeth and provides up to __% decrease in dental caries
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60; greatest public health measure after polio
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Medical intervention to preventing caries?
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sealants
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__% of US flosses
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20
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Disadvantage of mouthwash?
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cetyl alcohol can dehydrate
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What is Peridex?
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Rx mouthwash; aid to plaque control, but not substitute for toothbrush
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Periodontal disease
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a variety of inflammatory and degenerative diseases causing loss of bone and connective tissue - wears away teeth
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Presentation of gingivits
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most common sign: GINGIVA READILY BLEEDS
color -- red/purple with rounded papilla Tx: improve dental hygiene |
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ANUG (acute necrotizing ulcerative gingivitis)
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Vincent's Disease/Trench Mouth/almost like gangrene of the mouth
- requires compromised immune sytem PAINFUL - clean teeth under anesthetic |
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Tx for ANUG?
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Flagyl 250mg tid 4-5 days
hygiene rest once healed...tissue is gone forever |
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Calculus
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hard - can not be removed by toothbrush
- plaque is precursor - painless - bone loss - porous like coral/bacterial growth |
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How to remove calculus?
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curette McCall 13S/14S
- sharpen with diamond CC |
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Stages of Periodontitis in relation to probing depths (bone loss)
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normal: < 3mm
early: < 3-4mm -- daily plaque removal moderate: 4-5.99--possible tooth mobility; may not not appear inflamed severe: 6 or more-- major bone loss, teeth are loss and abscesses are common; may or may not have inflamed gingiva |
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Periodontitis refers to __; carriers/tartar leads to __
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gums; bone/tooth loss
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What is Pericoronitis and how to manage?
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most common dental casualty - lower third molar
Tx: curette, abx, extraction |
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Subacute Bacterial Endocarditis
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streptococcus viridans colonizes scar tissue of previously damaged mitral valve
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SBE orphylaxis?
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Amoxicillin 500mg x 4 (2 g), p.o. one hour prior to treatment
Penicillin allergy? Clindamycin 600mg p.o. one hour prior to treatment |
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SBE prophylaxis for children?
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Amoxicillin 50mg/kg
Clindamycin 20mg/kg |
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Inflammatory versus Neoplastic
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Inflammatory:
rapid growth fluctuant tender/soft lymph nodes local Neoplastic: asymptomatic (painless) slow growth persistent, progressive non-tender/firm lymph nodes systemic |
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ANUG
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"Trench Mouth," fever, malaise, fiery red gingiva, pain, metallic fetid oris, "punched out" interdental papilla
Tx: anesthetize, debridement of membrane, Flagly 250mg tid for 4-5 days |
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Pyogenic Granuloma
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benign neoplasm
Tx: scale under tissue, do not remove; excise by trained provider when edema is resolved more common in women |
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Disorder commonly seen with dentures?
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Epulis. Irritant causes exuberant response, looks worse than it is. No emergency, refer for Tx
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Intraoral surface lesions classified by?
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color - normal, red, white, blue
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White Surface Lesions
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Leukoplakia: white area can not be rubbed off. 5% are cancerous or cancer-in-situ (not past basement membrane)
Hyperkeratosis: MOST COMMON WHITE LESION OF ORAL CAVITY. Benign Snuff Keratosis: white, wrinkled, corrugated appearance of mucosa Trauma: rough surface, diffuse outline, likely from biting numbed lip or cheek Candidiasis (thrush): white curd-like lesions that CAN be wiped off, leaving red bleeding Tx: antifungals or nystatin |
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Red Lesions
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Erythroplakia: red patches on oral mucosa (description not diagnosis), ALWAYS BAD, 95% CANCEROUS - commonly squamous cell carcinoma
Palatal Petechia: pin-point red spots - can be caused by mono, platelet disorder, etc. prodromal for sore throat; orogenital sexual activity - treat based on etiology |
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Red and White Lesions
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Erythroplakia - variant appearance? BAD, requires biopsy
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Erosion versus Ulcer?
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erosion - basement membrane intact
ulcer - through basement membrane (location of nerves/painful) |
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Vesicular/Ulcerative Lesion
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Aphthous Ulcer: common from stress or trauma, very painful for 10-14 days
- shallow ulcer with red halo |
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Vesicular/Ulcerative Lesion
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Angular Cheilitis (Perleche)
- mild erythematous ulcerations at commissures of the mouth |
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Tuberculosis
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-scarring from draining
-lymph nodes -isoniazid resistance |
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Actinic Cheliosis
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clinical lesion of lower lip caused by excessive sun exposure (precancerous)
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Syphilis
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not painful -- primary chancre, 2-6 weeks post infection; raised, hard, then ulcerates followed by cervical lymph node swelling
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Primary Herpetic Stomatitis
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cervical lymphadenopathy in young children 6 mo to 9 years; ulcers with halos, fever and malaise (throughout oral cavity and perioral regions)
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PHS cause and Tx
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initial episode of Herpes simplex virus exposure in YOUNG CHILDREN
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PHS Tx:
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-supportive care: soft diet, liquids
-acetaminophen, 1% viscous lidocaine -zovirax, valtrex, abreva for subsequent episodes |
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Recurrent or Secondary Herpes
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Reactivation of virus due to stress, trauma, sickness, sunlight
--more than 80% of US exposed, of which 20-45% have lifelong recurrences 2-3x/yr |
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Reactivation of dormant chickenpox?
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herpes zoster: shingles
-pain may persist for 6-12 mos |
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What demands immediate referral?
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basal cell carcinoma
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1 SPF = 10 minutes protection
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Once SPF wears off, applying more won't help
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What type of sunscreen protects against both UVA and UVB?
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broad spectrum
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sunscreen chemical blocks __?
octocylene, benzophenones sunscreen physical blocks__? zinc oxide, titanium dioxide |
absorb rays, deflect rays
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Blue amalgam tattoo? (blue pigmented lesions)
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could be blood...squeeze, if there is blanching, do NOT incise. if there is present amalgam, and a lesion, could be considered amalgam tatoo
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Most common type of malignant neoplasm in mouth?
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squamous cell carcinoma
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All 4?
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1. squamous cell carcinoma
2. adenoid cystic carcinoma 3. mucoepidermoid carcinoma 4. primary lymphomas |
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Which is most commonly found on tongue?
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squamous cell carcinoma
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S/Sx of squamous cell carcinoma
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-white patch/ulcerative
-non-painful -lateral border of tongue -potentiated by ETOH/tobacco use -readily metastasizes TX: excise/resect |
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Malignant Melanoma
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typically starts as mole and then becomes irregular.
-non-movable dark lesion -twice as common in males than females -found in maxillary ridge, palatal tissue -POOR prognosis |
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Hematoma is also known as?
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Purpura, Ecchymoses -- pooling of extravascular blood
-does NOT blanch under pressure |
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Common benign tumors
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Papilloma
-pink-white cauliflower-like Caused by: human papilloma virus Tx: excision |
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Condyloma Acuminatum
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veneral wart - pink to gray, surface similar to papilloma, from sexual transfer
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Causes of smooth bald tongue
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Deficiency Anemia: Iron, Vitamin B12, folic acid
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Atrophic tongue?
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xerostomia-induced - dry, fissured
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Hairy tongue
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coated tongue with diffuse white, yellow, brown, or black on dorsum.
Elevated filiform papillae. Tx: cleanse tongue (antifungal as needed) |
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__% of all Asian cancer is oral cancer due to __ __?
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50, betel nut
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Betel Nut Abrasion
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females > males
- seen as red stains to oral cavity |
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Oral manifestations of HIV/AIDS?
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hairy leukoplakia, epstein-barr virus, DX by biopsy
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Oral manifestations of AIDS/HIV Periodontitis
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- rapid loss of support tissues
- soft tissue - ulcerations - blunted papilla - deep jaw pain |
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Local anesthesia
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temporary loss of sensation due to chemical inhibition of nerve conduction - induces transient/reversible inhibition of nerve conduction
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Functions?
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blocks electrical nerve conduction
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1st anesthetic used?
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cocaine - awesome
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When and why was epi added?
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1901, to potentiate numbing agent - slows uptake into bloodstream
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Procaine?
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1905, known as novocaine, now rarely used due to allergic reactions
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What is the most commonly used local anesthetic since 1955?
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Lidocaine 2%
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0.5% bupivacaine with 1:200K epinephrine (aka marcaine - in SF tacset)`
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- duration: 6-8 hours
- blue label - max dose is 1.3mg/kg, up to 90mg -- total of 10 carpules for a 70kg (150lb) person |
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2% Lidocaine with 1:100K Epinephrine
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- duration: 2-4 hours
- max dose w/ epi = 7mg/kg, up to 500mg (total of 13 carpules) - max dose w/o epi = 4.5mg/kg, up to 300mg (total of 8 carpules) |
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Complications of Local Anesthesia
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toxicity
true allergy (very rare) syncope - MOST COMMON tremors hematoma tachycardia seizure trauma |
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Tx for local anesthetic toxicity?
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airway, 02, vitals, IV, diazepam
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Adverse effects of vasoconstrictors
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1. local ischemia
2. vasovagal response (fight or flight) 3. early contractions in pregnancy |
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Ester, only one "i"
Amide, 2 "i's" |
...
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Standard needle size for local anesthetic?
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long needle: 1 3/8", 27 gauage (YELLOW) - universal
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Steps for preparing syringe
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1. attach needle
2. place anesthetic in barrel with rubber stopper towards handle 3. seat harpoon with one hard hit on thumb ring - CAN NOT ASPIRATE WITHOUT A HARPOONED STOPPER |
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Do we stand in between Pt legs?
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no. 7 o'clock or 5 o'clock 11 o'clock, or 1 o'clock
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Anesthetic Infiltration for maxillary teeth
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aspirate and inject near the root apex (1-2 injections)
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...
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Infraorbital nerve (V2)
- align with canine, and insert toward pupil until contacting bone with finger on foramen as a guide (3-4 injections) |
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...
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Posterior Superior Alevolar (PSA)
- for posterior molars to bypass tooth's apex Inject 45 degrees superior/medial. Numbs molar teeth and buccal tissue, but not palatal tissue (5-6 injections) |
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What teeth are most commonly extracted?
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3, 14 (6 year molars) - they've been around the longest
Inervated by MSA AND PSA - have to anesthetize both |
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How do we anesthetize palatal tissue?
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inject at foramen between upper second molar and the midline
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Greater Palatine
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locate point halfway between midline of palate and second molar, insert needle to bone
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anterior palate?
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incisal nerve
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Anesthetic Injections for MANDIBULAR TEETH
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mandibular branch, V3 of trigeminal has four branches:
1. auriculotemporal 2. inferior alveolar 3. long buccal 4. lingual |
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mandibular block
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insert from contralateral bicuspids until hitting bone with thumb on anterior border of ramus as a guide
(6-8 injections) |
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successful mandibular block
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1. lingual block
2. "lip and tongue signs" 3. no pain during procedure |
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Complications of block?
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-trauma to nerve sheath (electric shock)
-intravascular injection: apprehension, shaking, tachy -pain: cold anesthetic, rapid injection, dull or barbed needle |
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Long Buccal Nerve
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branches off ganglion early and requires separate injection. (8-10 injections)
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Gibraltar
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critical to allied victory in WWII
only 2.5 square miles belongs to British since 1713 |
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Indications for tooth extraction?
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1. painful conditions - swelling/infection, bone loss, dental caries/cavities (non-restorable caries)
2. nonpainful conditions - nonrestorable caries, periodontal involvement, nonfunctional tooth For the field...if it doesn't hurt, and no infection, LEAVE IT ALONE |
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Extractions that require soft tissue removal?
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Dental Officer referral
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Extractions to avoid?
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1. Lower Third Molars (wisdom teeth)
2. lone-standing maxillary molar (can fracture tuberosity) |
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Tuberosity?
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bulge of bone distal to upper third or second molar -- 1/2 and 5/16
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Avoid in field?
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badly broken or decayed
endodontically treated teeth (root canals) |
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In the presence of active infection?
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DO NOT REMOVE
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More extractions to avoid?
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- severe pericoronitis - swollen and infected tissue around third molar (usually tooth is impacted and bone removal is necessary)
- teeth that don't move or "budge" upon elevation |
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Proper extraction technique?
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- ensure proper diagnosis
- adequate access and visualization - unimpeded pathway for removal - use controlled force to luxate and remove tooth |
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What tool is used to sever soft tissue connection?
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Molt #9
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What is used to elevate the tooth?
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Straight Elevator #301
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What tool to use for fractured roots?
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Seldin 1R and 1L elevators
aka Cryers, Flags, East/West |
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Universal maxillary forceps?
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No. 150AS - although it can be used for any tooth
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What forceps to use for LOWER molars?
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No. 23 cowhorn forceps
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Extraction Steps
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1. Molt #9 - test for anesthesia - releases fibers between root and bone and allows placement of root elevator and forceps without crushing gingiva
2. Root elevator 301 - place between the root and alveolar bone - insert perpendicular to bone and tooth - cup shape toward tooth (note: adjacent tooth should NOT move) 3. Root Retrieval - elevator forceps (301 elevator) or Seldin 1R/1L elevator for remaining root (do not fulcrum on adjacent tooth) |
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For a single rooted tooth?
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(all anterior teeth except 5 and 12 are single-rooted)
place beaks of forceps on tooth at the bone and root junction, beaks are along the long axis of the tooth Step 4: luxate tooth with forceps - use slow deliberate controlled pressure to tear and crush PDL |
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...
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Step 5: teeth are not pulled, rather gently removed from the socket once the alveolar process has been sufficiently expanded
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Post Extraction
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place gauze, and have patient CLOSE OVER GAUZE, this will encourage clotting
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Multi-rooted teeth?
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molars and maxillary first bicuspids
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Tool for mandibular molars?
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no. 23 cownhorn forceps
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After multiple extractions?
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1. squeeze together the alveolus
2. suture the papilla together (triangle of gums between teeth) Ensure not to suture across the pocket, will leave blood clot 3. use absorable 3-o gut |
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Post-Op Care
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1. inspect the root to ensure it is intact and complete
2. irrigate with saline 3. compress bone w/ fingers 4. suture as needed 5. place 2x2" gauze over site 6. patient bites down to provide hemostasis 7. over next 24 hours, make sure patient avoids spitting, rinsing, smoking, chewing on side of extraction so that clot is not disrupted |
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Complications of dental extraction
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1. hemorrhage
2. alveolar osteitis (dry socket) - painful, but WILL heal w/o treatment (not infection), pack as needed 3. fractured root 4. post extraction infections 5. swallow or aspirate tooth 6. oroantral communication |
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Dry socket complications
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1. dull throbbing pain through mandible
2. fetid odor 3. may or may not see exposed bone 4. will heal w/o treatment Notes (want to have clot, and not an infection) |
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cont.
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Tx: palliative
Can use NuGauze/Eugenol/gel foam, or dressing -- place dressing in less than a minute - must be retrieved in 1-2 days; dressing must be changed evey 1-2 days |
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cont.
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Fractured root: do not attempt to retrieve if near sinus
If accessible: use a 301 elevator or 1R/1L Seldon or 9L-9R if root tips are short |
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cont.
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Bone removal may be necessary to access root tip - remove bone on buccal plate to increase visualization and access.
If flap is necessary, incise using no. 15 blade |
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Which teeth commonly have problematic fractured roots?
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5/12 (1st premolars) - have two spindly roots, use 9R/9L root tip picks to luxate
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Fractured root will do one of 5 things?
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1. remain in place
2. migrate in socket for easier access 3. migrate to surface for removal (like splinter) 4. became a nidus of inection 5. resorb in place Note: if root is left in place, be sure to document this |
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Last course of action for complicated root fracture?
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use mallet and osteome to separate roots and then remove
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Tooth removal complications?
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1. hemorrhage
2. osteitis (dry socket) 3. fractured root 4. infection 5. aspiration - use gauze as throat screen. if aspirated, do CXR and referral 6. orantral communication - floor of sinus is fractured - large opening will not heal without surgical intervention |
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Oroantral communication
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remove buccal bone as needed (hatched area)
incise buccal tissue with #15 and reflect buccal and lingual flap with a Molt No. 9 advance buccal tissue and suture with 3-0 gut, to lingual and then suture all edges to flap Do not put fillers in socket as this may cause a nidus of infection and cause closure to fail (create flap-suture via primary closure and do not pack) Instruct Pt not to blow nose, smoke, use a straw, sneeze or cough. AUGMENTIN: 875 BID X 10 DAYS, decongestants PRN |
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Sterillization of tools
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cold sterilization jar with strainer - heat is superior, but not always available
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Full immersion sterilization?
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allows full immersion with ability to retrieve instruments without dunking hands, as well as a screw-top to store sterilization fluid
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How many WW II war crimes trials were prosecuted?
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25 Japanese
24 Germans |
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How to clinically examine soft tissue
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1. ABC/c-spine
2. clear face 3. examine soft tissue for bleeding, laceration, deformity 4. palpate bone and wiggle teeth |
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Medications for Dental Emergencies
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DOC - ibuprofen (800mg: 1mg tab TiD w/ food); must be taken for 2-3 days
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Rx w/ absence of head injury?
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Tylenol #2 - 1 tab q 4-6 hrs
Percocet 5: 1-2 tabs q 4-6 Local injection of Marcaine or Lido - lido first (fast-acting); marcaine for 6-8 hrs |
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Abx therapy?
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Penicillin VK
500mg QID x 10-14 days if allergic? Clindamycin 300mg TID x 10 days or Azithromycin 500mg first day, then 250mg each day for 4 days Flagyl |
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Common dental injury?
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fractured cusps - common in large posterior restorations; use "crowns" for large restorations - can use Transbond or 1RM for field treatment
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Avulsion?
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-tooth completely out of socket - must re-insert within 30-60 mins
- rinse toogh, flush socket, place tooth socket back in same height as contralateral tooth |
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How to splint avulsion?
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splint 5 total teeth using L-Pop preparation with Transbond. Wire should extend to cover two unaffected teeth on either side
L-Pop, Transbond XT composite, light cured with minimag for 60 seconds, using 24 or 25 gauge wire. Keep in place for 7-10 days for teeth and 3-4 weeks for teeth and bone |
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Where to store avulsed tooth?
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under tongue is best in adults with adequate LOC
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Resoption Sequelum Tx?
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prosthetic tooth
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MOI and dangers of root fracture?
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horizontal blow; difficult to diagnose; internal hemorrhage
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MOI and dangers of extrusion or fractured alveolus?
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extrusion due to oblique force -- tooth extruded (forced sideways in pocket)
- bone is fractured on one side due to horizontal force, APEX MAY BE LOCKED OUT |
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The sooner the tooth is repositioned, the __ the hematoma, and the __ prognosis is for maintaining the tooth
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smaller, poorer
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How to Tx fracture of alveolar process?
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fractures bone on all sides of tooth, can see two or more teth move together when checking mobility -- move fragments to correct position and splint in place
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Odontogenic infection?
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odont = tooth
genic = to start Periodontal - infection starts in the tissue surrounding the tooth Periapical - infection starts inside the pulp and expresses out the apex |
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Periodontal Emergency?
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ANUG (acute necrotizing ulcerative gingivitis)
Tx: anesthesia, scale, Peridex, pain meds Abx: Flagyl 250mg tid x 4-5 days |
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Periapical absess?
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Appears similar to periodontal absess, localized purulence - pulpal death by caries or trauma. throbbing pain sensitive to percussion.
Can take blow to tooth - tissue can be sterile but necrotic for years and remain until immune system is compromised...then proliferate |
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Tx for periapical absess?
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-anesthesia
-I&D w/ Penrose drain -Abx -endodontics and restoration or extraction I&D only when abscess "points" and do not anesthetize into or near an infection |
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Pulpitis
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pain of short duration <30 seconds, due to thermal stimulus or sweets
Tx: place 1RM then Adper Prompt L-Pop and Transbond XT or 1RM |
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Pericoronitis
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P-Cor - inflamed operculum over lower 3rd molar - painful swelling, trismus (infection spreads), dysphagia, lymphadenopathy, fever, malaise
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Life Threatening Infections
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1. cavernous sinus thrombosis
upper tooth infection involving the infraorbital area could progress intracranial; IV Abx 2. pharyngeal abscess Molar infection can progress to close airway - IV Abx, evac 3. Ludwig's Angina airway obstruction - urgent, IV Abx, relieve pressure extraorally 4. Mediastinal Abscess extension of odontogenic infection - urgent evac |
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Floor of the mouth?
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mylohyoid line attaches to mandible and allows infections under the floor of the mouth and down potential spaces of the neck - threat to airway (Note: where third molars would drain)
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Tx of oral infections
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- I&D if pointed infection
- intraoral incision preferred - bunt dissection - Penrose Drain - remove when non-productive (drain keeps area open for drainage) |
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Most important indicator of possible closed-head injury?
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LOC; repeatedly review airway
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Tx of facial injuries
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1. airway
2. LOC 3. evaluation and cleansing of the wound 4. debridement of the wound 5. hemostasis of the wound 6. closure of the wound: inside to outside |
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How to suture vermillion border?
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after muscle/deep closure with absorbable 3-0 suture, use 6-0 or 5-0 size non-absorbable for vermillion re-approximation then complete remaining outside closure
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How to reduce a mandibular "open lock"
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maniupate mandible down and forward to clear eminence
then gently allow mandible to return to its normal posterior position. now have patient maintain closure to prevent re-open lock NSAIDS, warm compress |
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Evaluation of mandibular fracture?
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do teeth come together as they did before the incident?
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Favorable mandibular fracture?
Unfavorable mandibular Fx? |
greenstick, simple; reduced with muscle pull
comminuted, compound displaced with muscle pull |
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Bilateral mandibular fracture?
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MANAGE AIRWAY, ivy loops and MMF, intubate, evac
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Evaluating midface fractures
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1. assess maxillary mobility alone or with zygoma or nasal bones
2. palpate for step deformities in the forehead, orbital rim, or nasal or zygoma areas 3. LeFort I, II, III 4. Dentoalveolar Fx: one tooth or several 5. Do you teeth come together naturally? |
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Le Fort Fractures
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Le Fort type 1
horizontal maxillary fracture, separating the teeth from the upper face fracture line passes through the alveolar ridge, lateral nose and inferior wall of maxillary sinus Le Fort type 2 pyramidal fracture, with the teeth at the pyramid base, and nasofrontal suture at its apex fracture arch passes through posterior alveolar ridge, lateral walls of maxillary sinuses, inferior orbital rim and nasal bones Le Fort type 3 craniofacial disjunction fracture line passes through nasofrontal suture, maxillo-frontal suture, orbital wall and zygomatic arch History and etymology |
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Zygoma Fx
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orbit fractured, eye droops; blunt trauma from baseball bat, hammer, etc.
Not emergent - no compromised airway |
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Zygomatic complex fracture
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periorbital ecchymosis and subconjuctival hemorrhage
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Traumatic Telecanthas
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nasal orbital ethmomid injury: nasal bone fracture and/or medial canthal ligaments detached causing wide nasal bridge
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Tx of facial fractures (hard tissue injuries)
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1. ABCD's
2. physical eval of facial structures after the initial airway assessment a) perioorbital ecchymosis: subconjunctival hemorrhage, orbital rim, zygomatic complex fx b) bruises behind ears (Battle's sign) skull fx c) ecchymosis in floor of mouth: anterior mandibular fracture |
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Treatment of maxillofacial Fx?
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Barton bandage (cravat) - only temporary - for stability and support, does not protect airway
arch bars - maintain until healed, time consuming and tough on soft tissue (surgical pt's) ivy loops - arch bars are in the general dentistry field kit of all divisions - wire ties connect upper and lower loops (best for 18D) inter-maxillar fixation (IMF) or Maxillomandibular fixation (MMF) 6 weeks to heal |
