Clinical classifications of impacted teeth: ___ of the __ axis of the impacted third molar in relation to the __ __
Angulation, vertical, 2nd molar
Procedural classifications of impacted teeth: relationship of the impacted molar to the __ __ (__ of the impacted third molar)
occlusal plane (depth)
Good time to remove wisdom teeth is when ___ __ developed
roots 1/3
Post operative patient management requires what?
Follow up visit
Principles of Fracture Management? (4)
1. Reduction (open or closed) --> realigning bones2. Fixation (external or internal) --> cast, plate, screw3. Immobilization (weeks/months) --> cast, wire jaw4. Prevention of infection
Crown Fracture:- if confined to enamel is Ellis class ___- enamel and dentin involved Ellis class __- Enamel, dentin and exposed pulp involved Ellis class ___
IIIIII
Root Fractures:- __ __ = best prognosis - Treatment = ?
- apical 1/3- reduce and rigidly splint for 3 months
Pulp survival after replantation in permanent dentition:__ apex teeth have higher chance of survival compared to __ apex
open, closed
Alveolar Fracture:- alveolar, PDL and pulpal tissues are injured- these injuries often involve multiple teeth in segment - Treatment = ?
reduce and rigidly splint for 4-6 weeks
3 types of soft tissue injuries?
A - abrasion B - contusion C - laceration
Allograft bone:- from ___ ___- osteoconductive- osteoinductive- increased ___
same speciesexpense
Autograft bone:- bone from __ __- osteoconductive- osteoinductive- osteogenic- requires __ __
- same individual- donor site
Bone graft placement: rigid __ __ placed for __
fixation screws, stability(at least 2 points of fixation)
How long should you wait before placing the implant following bone graft?
4 to 6 months
Cardinal signs of acute inflammation? (5)
RednessSwellingHeatPainLoss of Function
__ = invasions and multiplication of microorganism in the living tissues of the host
Infection
__ = collections of fluid material called pus contained within a cavity lined by a wall
Abscess
___ = spreading infection with poor localizing tendency
Cellulitis
Microbiology:- Aerobic = ___- Anaerobic = ___
- cellulitis- abscess
What antibiotic? - No allergy to penicillin?- Patient reports allergy to penicillin?
- 2 g amoxicillin 1 hour prior to surgery- 600 mg Clindamycin 1 hour prior to surgery
Rx line should include?
- name of medication- Dose or strength in mg- dosage form (tablet, liquids, etc)Ex: Acetaminophen 650 mg tablet
Sig = instruction how often to take the medication and the ___
ROUTE
Opioid crisis: How did we get there?- Giving 30-60 tablets of Percocet- Adding benzodiazepine- Alcohol- Street drugs, ___ __ (phencyclidine), __ (cocaine), ___ (barbiturates), __ (marijuana), __ (concentrated tetrahydrocannibinol), magic mushrooms (psilocybin) and ___ (amphetamines)
- angel dust, coke, downers, grass, hash, speed
Opioid Crisis: Who is to blame? - physicians and dentists- pain patient advocate groups- insurance companies, - professional societies- JCAH- lawyers- federation of State Medical Board- __ __**
Crooked media
Article from 1980 by Porter J, Jick H titled: Addiction rare in patients treated with narcotics stated "risk of addiction is much less than __%"--> cited __ times via Google Scholar
1%824
June 16, 2016 --> AMA drops __ as a vital sign
PAIN
The deadly D triangle = ?
DentistsDrugsDependence (ad claiming drug dependency begins at the dentist)
Rx misuse and abuse in AZ:- __ deaths per __ is due to prescription opioid overdoses in AZ
1 death per day
Controlling the epidemic, a 3-pronged approach --> involved what?
1. PREVENT new cases of opioid addiction 2. TREAT people who are already addicted3. REDUCE SUPPLY from pill mills and the black-market
The Strategies:1. __ Illicit acquisition and __ of Rx drugs2. Promote ______ and ____ policies and practices3. Enhance Rx drug __ and ___ in law enforcement4. Increase __ __ and __ __ about Rx drug misuse5. Enhance __ and __ to treatment
1. Reduce, diversion 2. responsible prescribing and dispensing3. practice and policies4. public awareness and patient education 5. assessment and referral
Time line:- enhanced surveillance advisory went into effect ____- Opioid overdose epidemic response report due ___
June 15, 2017September 5, 2017
Schedule II drugs, substances or chemicals are defined as drugs with _____, use potentially leading to severe __ or __ __. Also considered ___.
high potential for abusepsychological or physical dependence dangerous
New law for AZ providers to....
Review controlled substance dispensing info
What to do? - __ for the AZ PMP program before the deadline of ___- Check the __ before prescribing an opioid or benzo (class II, III, IV)
- register, october 16, 2017- PMP
Prescribor NOT required to check PMP:If the practitioner is prescribing controlled substance for no more than __ __ period for an acute injury or a medical or dental disease process diagnosed in an emergency department that results in acute pain
10 days
Alternative Medications: Max dose/day?- Ibuprofen: ___- Acetaminophen: ___- Naproxen: ___
- 3200 mg- 3000 mg- 1000 mg
Postoperative Care:- most should be explained at the consultation visit to __ ___ patient concerns- Attention to postoperative ___ will minimize the patients concerns in the postoperative period- it ______ that instructions were given
- pre-empt- expectations- must be documented in chart
Prevention and control of bleeding: beware of what kind of patient?
Redheaded patient
Successful pain control depends on what?
Attitude of mind of both clinician and patient
Postoperative analgesia:- prescribe an __ and ___ analgesic- do not say ___
appropriate and adequate"use your usual painkillers
If pain decreases at first but on the 3rd or 4th day begins to increase and is not accompanied by swelling or other signs of infection and pain does NOT respond to analgesics?
Consider dry socket
Prevention of complication should be _________.If complications do occur the operating surgeon should always have the skills, knowledge and experience to manage it
major goal of the surgeon
Management of Displaced Teeth and Tooth fragments: Maxillary sinus? Root tips should ___
- obtain a periapical or panorex radiograph to determine position - should be removed
Management of Displaced Teeth and Tooth fragments: - attempts can be made to retrieve smaller root tips by placing patient ___, ___ the sinus and ___ with a __ __ catheter- a regimen of ___, __ and __ __ should be given - for removal of roots with __ or __ __, the ___-__ approach should be used
- supine, irrigating, suctioning, flexible suction - antibiotics, antihistamine, nasal spray- pathology, larger roots, Caldwell-Luc
Management of Displaced Teeth and Tooth fragments: - if a root tip is left....?- __ should be taken and document in patients chart- follow ups should be taken at __ and __ __
- patient should be informed - radiographs- 6 and 12 months
Root tips in ___ NEED to be removed
sinus
Criteria for root tips that need removal include what?
roots with apical lesions on radiographs or those with visible pathology or infection
Oral Antral Communications:- small apex (__-__) at the apex of the socket will usually heal- __ precautions should be reviewed with patient- __ affects the healing process and increases the likelihood of an oral antral fistula forming
- 2-4 mm- nasal- smoking