Oral Surgery Final Exam

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apicoectomy: removal of apical 2-4mm of root

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apical curretage: removal by scraping of pathology from above

a root
retrograde restoration: filling apical aspect of root canal to
obtain sealage

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what is the first step to take in all emergencies?: stop the

procedure and monitor vital signs
hyperventilation: increase in rate and depth of breathing,
triggered by change in oxygen/CO2 balance, exhaling too much
CO2 causes anxiety which causes them to breathe even deeper
(its a cycle)
at what level of blood glucose can hypoglycemia be defined
as?: less than or equal to 60mg/dL
syncope: sudden and brief loss of consciousness due to
decreased oxygenation or glucose to the brain
how does BTA work?: being a dichain molecule, the heavy
chain binds selectively to the neurotoxin to the cholinergic
nerve terminals, the light chain prevents acetylcholine release,
inhibition of acetylcholine activity yield muscular paralysis
dynamic rhytides: occur in areas of dynamic motion, this is
where botulinum can improve wrinkling (glabellar, lateral
canthal, upper nasal, horizontal forehead, for example), can
also use for assymetric eyebrows

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contraindications to botox: pregnancy/lactation,

neuromuscular disorders, those taking amino glycosides should
lower botox dosage
alternative uses for botox therapy: migraines,
hypersialorrhea, hyperhidrosis
hyaluronic acid: main component of fillers, HA serves as
ground substance of dermis/fascia, usually broken down in two
days but cross linking them makes them stronger and harder to
breakdown (6-8months)

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trigeminal neuralgia: sever, unilateral, more frequently

mandibular or maxillary branch (instead of ophthalmic), usually
>50yo, can be blocked by LA, more likely in multiple sclerosis pts
drug treatments for Trigem neuralgia: dilantin, tegretol,
baclofen, conazepam, neurontin
procedures for trigem neuralgia: peripheral neurectomy,
alcohol block/glycerol injection, janetta procedure, gamma knife
radiation
janetta procedure: only procedure that grants complete pain
relief without sensory loss, microvascular decompression
gamma knife radiation: ablation of benign or vascular lesion
that is etiologic towards the neuralgia
etiology of trigem neuralgia: most commonly a benign
neoplasm pushing on the nerve, aberrant artery pushing on
the nerve
glossopharyngeal neuralgia: very similar to trigem neuralgia,
pain occurs on posterior third of tongue and pharynx, may
avoid pain by not swallowing (drooling)

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sphenopalatine neuralgia: aka pterygopalatine neuralgia,

unilateral pain in area of sphenopalatine ganglion, this is a
longer lasting neuralgia (avg 20 minutes) unlike other
neuralgias, not confined to older aged patients
cluster headaches: unilateral headaches with orbital or
intraoral pain, occur periodically, with active period interrupted
by spontaneous remissions, affects men more frequently, s/s
include red conjunctiva, lacrimation, nasal congestion,
rinorrhea, and ptosis (all ipsilateral to the pain)
postherpetic neuralgia: occurs following herpes zoster
infection in older patients, pain occurs for more than a month
after onset of zoster eruption, usually involves CNV3, unilateral
neuritis: inflammation of a nerve, most dental pain can be
defined this way, pulpal or PDL pain
hypesthesia: decreased sensation, could be malignancy or
osteomyelitis
paresthesia: dysfunction/perversion of sensation (pins and
needles), could be malignancy or osteomyelitis
referred pain: pain originates in one area and is felt by a
patient in a nearby area, never crosses midline (usually
vertical), as sensory nerves progress centrally there is "crosstalk" when they meet
bells palsy: unilateral, idiopathic, ipsilateral facial paralysis, CNV
travels the longest distance and it is through a bony canal
making any inflammation prone to disruption, corneal abrasion,
ulceration, and blindness can occur due to inability to close eye
supratentorial mass: a mass located above the tentorium
cerebelli, increased intracranial pressure, cerebral edema,
destruction of surrounding tissue, personality and cognitive
changes, headaches (most common), seizures, papilledema
characteristics of radiation and neoplastic cells: the faster
the cellular turnover the more susceptible that tissue is to
radiation damage, therefore neoplastic cells are (relatively)
selectively destroyed, while normal tissues with rapid turnover
are also affected (heme, epithelial, endothelial cells)
initial effects of radiation on oral mucosa: erythema->mucositis w/o ulceration-->pain/dysphagia and loss of taste,
nutrition intake is difficult
evaluation of dentition before radiotherapy: extract all
questionable/poor prognosis teeth, increase patient's dental
awareness and enforce oral hygiene, weekly recall, antifungals
if candida occurs
how to extract before radiotherapy: atraumatic exodontia,
primary closure, usually surgical (flap), prophylactic antibiotics,
need to extract 3wks prior min 2 wks
impacted third molar removal prior to radiation: partially
erupted third molars need to be removed

hyperbaric oxygen for extractions, before and after

radiation: improves angiogenesis, bone metabolism, and bone
turnover, 20 "dives" of HBO (5days/week), 10 dives
postoperatively

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implants in irradiated patients: radiation associated with less implant survival in mandibular bone; prolonged time for
osseointegration, HBO can help, even though survival is lower the implants are still a good option
stage I of ORN treatment: 30 sessions of HBO
necrotic bone removal
10 more sessions of HBO
stage II of ORN treatment: patients didn't respond to stage I, large resection of bone and ten more sessions of HBO
stage III of ORN treatment: patients didn't respond to stage II/pathologic fracture, more resection of bone and large reconstruction
surgeries
what is the limit of WBC and platelet count in regards to dental procedures?: the patient must have a WBC count of at least
2,000mm3 and a platelet count of at least 50,000mm3
three characteristics present in order to diagnose MRONJ: current/previous tx with antiresorption or antiangiogenic agents, exposed
bone or probable bone (through fistula) that lasts for eight weeks, and no history of radiation to head and neck (or no obvious
metastasis)
why are the jaw bones so susceptible to MRONJ (mandible more)?: it is under constant remodeling, is a non-sterile environment, and
is more likely to be traumatized

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in Wilke's classification, where do most patients with TMD fall under?: usually class III or IV

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of the systemic arthritic conditions, which is the most common to cause TMD?: rheumatoid arthritis

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intracapsular ankylosis: infratemporal fossa is fused to condyle

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extracapsular akylosis: coronoid process interferes with interior of zygomatic process

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which seizures do you not see loss of consciousness?: simple (has aura) and absence

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whats the dose of benadryl for a mild hypersensitivity?: 50mg

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whats the dose for aspirin for an acute MI?: 325mg, non-enteric coated, tell patient to chew and swallow

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what are the steps for a patient having an MI?: stop procedure, give oxygen, pulse oximetry, nitroglycerin sublingual (0.4mg), monitor
vitals
which areas hs botox been FDA approved for?: glabellar rhytides and crows feet (in the middle and on the outside of the eyes)