Oral Surgery Exam 1

Front 1

normal flora of the oral cavity

Back 1

aerobic gram + (strep)
actinomyces
anaerobes (prevotella melaninogenicus)
candida

Front 2

normal flora of nasal cavity

Back 2

aerobic gram + (strep)
haemophilus (children)
staph aureus

Front 3

normal flora below clavicles that you know shouldn't be in mouth

Back 3

gram - aerobes (E. coli, klebsiella, proteus)
enteric gram - anaerobes (bacteroides fragilis), also staph epidermidus & corynebacterium diptheriae

Front 4

pathogen that is most serious risk of transmission for dentist/staff/pts

Back 4

hep B. virus excreted in blood and saliva. may enter thru any moist mucosal surface or epithelial skin wound. good news- there's a vaccine for hep B (no vaccine for C)

Front 5

universal precautions ***

Back 5

tx all pts as if they had a communicable disease since you are unable to identify all pts who may be infective. treat all surfaces exposed to blood or secretions as potentially infectious. wear barriers for all pt contacts. avoid touching and contamination of surfaces w/ contaminated gloves or instruments

Front 6

what is sepsis?

Back 6

breakdown of living tissue by action of microorganisms. (not just the presence of microorg)

Front 7

what is sterility? ***

Back 7

freedom from viable organisms. absolute state. no degrees of sterility.

Front 8

what is sanitization

Back 8

reduction in # of viable organisms to levels judged safe by public health standards

Front 9

how do you monitor sterility? ***

Back 9

bacterial endospores eg Bacillus stearothermophilus is extremely resistant to heat and is used in sterilization monitoring services. required monthly test

Front 10

necessary sterility in the dental environment**

Back 10

most materials & drugs sterilized by manufacturer with double wrapping. absolute sterility in oral procedures is impossible. goal is to eliminate cross contamination from surgeons or other pts to surgical wound. **any surface patient contacts is potential carrier of infectious organisms and must be wrapped or disinfected btwn pts. contaminated supplies must be discarded in labeled bags by waste company.

Front 11

"clean" technique ***

Back 11

office based that doesn't require sterile tech. gown or long sleeved coat over street clothes. gloves over washed & dried hands. eye protection. mask. may prep mouth w/ CHx or EtOH mouthwash. drape patient w/ optional eye protection for pt. irrigate only w/ sterile water or saline in open wounds

Front 12

"sterile" technique

Back 12

skin treated w/ antiseptic. implant placement, office or hospital. goal to minimize # of organisms that enter wounds created by surgeon. surgical hand scrub. sterile gloves placed in sterile fashion. sterile gown. meticulous attn to detail & cooperation among staff

Front 13

how do you elevate mucoperiosteum?

Back 13

after incision elevate mucosa & periosteum in one layer. students have problem getting cleanly subperiosteal. should see bone. #9 Molt periosteal elevator: use sharp end to get started at papilla. use broad end to slide under flap separating periosteum from bone. can also be used as a retractor

Front 14

are needle holders & hemostats the same?

Back 14

NO! hemostats control hemorrhage by clamping vessels, pick up root tips/toothfrag/granulation tissue. needle holder has a locking handle, flat surface to stabilize triangular needle.

Front 15

characteristics of suture needles

Back 15

curved 1/2 or 2/8 circle, triangular tip is "cutting", tapered tip is "noncutting". swaged on tip or load your own. hold 2/3 from tip

Front 16

suture sizes**

Back 16

size designated by # of zeros. the more zeros, the smaller the suture. 3.0 most commonly used.

Front 17

extraction forceps & their shapes

Back 17

remove teeth from alveolar bone. beaks adapt to root structure of tooth and NOT crown. should parallel long axis of tooth w/ handle in a comfortable position. 2 basic shapes of maxillary forceps: 1) #150 universal forceps 2) #150A parallel beaks. #23 cowhorns for mandibular teeth only- pointed heavy beaks to enter furcation of lower molar. MD-3 (Ashe) forceps are for anterior teeth (bird beak).

Front 18

characteristics of proper incisions

Back 18

sharp blade, firm continuous stroke, avoid vital structures, blade perpendicular to epith surfaces, make incisions over intact healthy bone in attached gingiva when possible

Front 19

characteristic of proper flaps

Back 19

apex never wider than base. keep blood supply in base of flap- dont cut off blood source. don't twist or stretch falp. tearing sign of insufficient access. use vertical release to avoid tearing

Front 20

3 things required to make blood clot

Back 20

1) clotting factors made in liver that make fibrin 2) platelet adhesion 3) vessels constrict locally

Front 21

5 methods of obtaining hemostasis

Back 21

pressure, heat (electrocautery), ligation w/ hemostat, vasconstriction (epi), procoagulation (gelatin sponge, thrombin topical, collagen, cellulose)

Front 22

purpose of irrigation

Back 22

removes necrotic, foreign or ischemic material w/ sterile saline

Front 23

monofilament vs multifilament sutures

Back 23

monofilament is weaker, no wicking, looser knot, less inflam
multifiliment is stronger, wicks, holds knot better, more inflam

Front 24

basic suturing technique

Back 24

suture loose tissue first to tight tissue. gently approx edges (excessive tightness compromises vascularity). excessive # of sutures traps foreign material and incr tissue injury. no need to suture average extraction socket (only if loose tissue & exposed bone)

Front 25

what is epithelialization & how is it important for dentistry?

Back 25

free edge of epith migrates across injured (but vascularized) wound tissue bed. contact inhibition = stops when reaches another epith margin. contact inhibition may be detrimental if sinus epith heals to oral epith leaving a fistula in a sinus perf. 2e epithelialization is useful for vestibuloplasites

Front 26

3 stages of wound healing

Back 26

1) inflammatory
2) fibroplastic
3) remodeling

Front 27

importance of inflammatory stage of wound healing

Back 27

3-5 days. get edema to dilute contaminants. lag phase (no incr in wound strength occuring). but get PMNs, macrophages, B and T lymphocytes in to clear body of foreign substances

Front 28

importance of fibroplastic phase of wound healing

Back 28

2-3 weeks. get fibrin lattice and fibroblasts come in and lay down ground substance and tropocollagen (crosslinks to form collagen). new capillaries follow fibrin network. 70% strength. wound stiff and erythematous.

Front 29

importance of remodeling phase of wound healing

Back 29

strength never greater than 85%. collagen fibers realign to resist tensile forces. scar softens, vascularity decr, erythema decr. flexibility less due to lack of elastin. contraction slowly diminishes size of wound. remodeling continues indefinitely

Front 30

what type of wound healing do extraction sockets undergo?

Back 30

healing by secondary intention (gap in wound requires epithelial migration, collagen deposition and remodeling, slower healing, more scarring compared to primary intention).

Front 31

types of healing in bone

Back 31

primary and secondary intention apply to bone healing as well. gap btwn free ends of bone results in fibroblast/osteoblast matrix (callus) which ossifies more slowly & must be extensively remodeled.. vascularity & immobility are required

Front 32

purpose of doing a medical history

Back 32

to perform a medical risk assessment. (allows you to predict how well a pt will tolerate a proposed tx, predict & prepare for medical emergencies, prepare & modify planned tx based on medical status, predict complications and prepare strategies to avoid them)

Front 33

stress reaction

Back 33

complex state of physiologic rsns. reflex withdrawal. central stimulation (amygdala, hypothalamus, pituitary), ACTH, thyroid stimulating hormones, cortisol release, autonomic NS activation. **catecholamine production w/ alpha and beta effects, incr BP and cardiac work, blood flow shunting to facilitate fight or flight, form of exercise that may be a challenge to some pts. cortisol generates fight or flight by having adrenal medulla produce epi & norepi.

Front 34

when is tx a pt considered "unsafe" & must be medically worked up and cleared before tx

Back 34

"heart disease" checked on med history. hx of unstable angina, no current medical monitering, poorly compliant w/ medications, dental plan is for multiple extractions

Front 35

definition of angina

Back 35

chest pain caused by cardiac ischemia

Front 36

definition of fibrillation

Back 36

chaotic electrical activity w/ no effective pumping action

Front 37

definition of defibrillation

Back 37

depolarizes all cells at once so dominant pacemaker takes over