Oral Surgery 1 Past Paper PDF - 4th Year - 2024-2025

ORAL SURGERY 1 DR. CHRISTIAN BELTRAN Ç DMD 4-Y2-1 4TH YEAR A.Y. 2024-2025 MODULE 1 History Taking an...

ORAL SURGERY 1 DR. CHRISTIAN BELTRAN Ç DMD 4-Y2-1 4TH YEAR A.Y. 2024-2025 MODULE 1 History Taking and Clinical Examination Objectives: Define Oral Surgery Enumerate and Explain the 5 pillars of patient management Know the different parts of the GPA Enumerate and define SOAP Define Chief complaint, HPI, Medial and Dental History, etc. Identify and discuss the different types of radiographs used in dentistry Enumerate the different types of diagnosis Define treatment plan and prognosis Oral Surgery Branch of dentistry that deals with diagnosis, surgical (invasive), and adjunctive (medications) treatment of disorders, disease or injuries and defects in the human oral cavity, jaw and associated perioral structures. May be corrective and not pathologic (eg. Orthognathic surgery) 5 Pillars of Patient Management 1. Case Discussion and Treatment Planning 2. Pre-Operative Procedures 3. Operative Procedures 4. Post Operative Procedures 5. Recall Things that you check after tooth extraction (RECALL): Check sutures if it is still intact Count the no. of sutures Check for inflammation of the extracted site Check for presence of bleeding Check for sharp bony spicules and extreme undercut Check the adjacent tooth (mobility, proximal caries) What is SOAP Subjective. Objective. Assessment. Plan Subjective Observations that are VERBALLY expressed by the patient. Ex. Chief Complaint, History of Present Illness, Family History, Social History, Dental History, Medical History Objective Includes information that the dentist or healthcare provider measures from the current presentation of the patient. Findings from physical examination Ex. Vital Sign (BP, Temp, Pulse Rate, Respiratory Rate), Weight, Height, Lab tests (CBC), Physical examination (Intraoral examination, Extraoral examination), Radiographic examination Assessment Diagnosis of the condition that the patient has Plan Treatment plan based on the diagnosis 1 PRELIMS  ORAL SURGERY 1 DR. CHRISTIAN BELTRAN Ç DMD 4-Y2-1 4TH YEAR A.Y. 2024-2025 MODULE 1 Case History – Patient Work-up Upon consult, patient claims that the tooth is asymptomatic. Chief Complaint Patient still takes Mefenamic acid 500mg caps PRN, Amoxicilling 500mg caps OD. ® Dx: Chronic Apical Periodontitis Basic reason why the patient is seeking treatment (patient’s problem) Medical History / Background Should be written in patient’s own words Can greatly affect the treatment plan in surgery. Should denote a pathology or a disorder (pain, swelling, Important because most patients are ignorant of their bleeding, unesthetic appearance, defects in the condition. masticatory function) Look out for systemic diseases such as heart disease, Helps the clinician establish priorities in history taking hypertension, angina, myocardial infarct. and treatment planning. Also includes past illnesses – BOTH serious and minor illnesses and traumatic injuries. Allergies (penicillin, latex, NSAIDs) ® ask for the specific drug History of hospitalization or surgery Attending physician Precaution for: o Pregnant woman – especially those on their 1st trimester o Nursing mother (breastfeeding) – any drug that is prescribed can be passed on to the infant through breastfeeding “Sira na yung ngipin ko.” (Patient referring to tooth number 11) Dental History Always write what the Gives the clinician an idea on how meticulous or patient is referring to concerned the patient is about his or her oral health and how the patient sees the dentist. Information you can get: History of Present Illness (HPI) o Oral hygiene of the patient Chronological history of the patient’s chief complaint o Last dental visit (past and present symptoms), starting from the time the o Dental procedure / treatment done patient felt the present condition to the patient’s visit o Iatrogenic causes of pathology (prior to consultation) o Exposure to LA o When did the chief complaint started? (ex. 6 months o Frequency of dental visit PTC) o Type of pain? (throbbing, sharp, dull, etc.) Social History o Duration of pain? (seconds, minutes, hours) Addresses the recreational aspects of the patient’s o Location? (localized, generalized, etc.) personal life that have the potential to be clinically o What initiates/triggers the pain? What stimulus significant. causes the pain? (hot, cold, biting, sleeping, etc.) What we ask for Social History: o What relieves the pain? (cold or hot compress, o Smoking – which delays the healing, can cause dry analgesics, etc.) socket “Upon consultation” o Intake of alcoholic beverages – bleeding Example of HPI (hemorrhage), liver problems 2 years PTC (prior to consultation), patient noticed caries lesion on o Illicit drug use – illicit drug can interact with the her 11. No consult was done since the tooth is asymptomatic. 1 year PTC, patient felt sharp shooting pain on tooth no. 11. Pain is other drugs you will prescribe provoked whenever she drinks cold beverages. Patient claims that o Lifestyle (sexual activity, promiscuous / many pain would eventually subside upon removal of stimulus. Still, no partner ® HIV (AIDS) consult was done due to financial constraints. ® Dx: Reversible Pulpitis 6 months PTC, patient felt sharp shooting pain on tooth no. 11. Family History Pain is provoked by sweet foods and would linger for around 30 Record of health information about a person and his or minutes. She took Mefenamic Acid 500mg caps OD and pain her close relatives. subsided. Still, no consult was done. ® Dx: Irreversible Pulpitis 1 week PTC, patient felt dull throbbing pain on tooth no. 11 lasting Occupation / Job for about an hour. Patient claims that pain is provoked by cold weather and food impaction. She took Mefenamic Acid 500mg Occupational Hazards – pollutants, exposure to caps PRN and Amoxicillin 500mg caps OD and pain subsided. No radiation and harmful chemicals swelling was observed. Consult was done to a local health center Predisposition to carcinoma, asbestos, aerosols and was advised to have the tooth extracted. ® Dx: Acute Apical Periodontitis 2 PRELIMS  ORAL SURGERY 1 DR. CHRISTIAN BELTRAN Ç DMD 4-Y2-1 4TH YEAR A.Y. 2024-2025 MODULE 1 Habits Extraoral Examination Night grinding, bruxism, mouth breathing, cheek biting, Nourishment thumb sucking. Physical Development Ex. If the patient has attrition can be seen intraorally Facial Deformity Perioral Lesions Vital Signs Lymphadenitis V/S Lymphadenopathy Clinical measurements that indicate the state of a patient’s essential body functions. Vital Signs Normal Range Blood Pressure (BP) < 120/80 mmHg Pulse Rate (PP) 60-100 bpm Brady ® low Tachy ® high Respiratory Rate (RP) 12-20 cpm Blood Pressure Systolic Contraction of ventricles Diastolic Relaxation of ventricles Bell’s Palsy Systolic Diastolic Two Types of Palpation Normal 90 – 119 and 60 – 79 Elevated 120 – 129 and 60 – 79 Bimanual Tactile method of oral examination in which High Blood Pressure 130 – 139 or 80 – 89 Palpation the examiner uses both hands to examine (Stage 1) the patient’s mouth from both the inside and High Blood Pressure 140 or higher or 90 or higher outside at the same time. (Stage 2) High Blood Pressure Higher than 180 and/or Higher than 120 (Stage 3) Consult your doctor immediately Temperature Measuring Method Normal Temperature Axillary Temperature 34.7 oC – 37.3 oC Tympanic Temperature 35.8 oC – 38 oC Forehead Temperature 35.8 oC -37.8 oC Bidigital A tactile method of oral examination in Rectal Temperature 36.6 oC – 38 oC Palpation which the examiner uses the thumb and Oral Temperature 35.5 oC – 37.5 oC forefinger of one hand to rule out abnormalities. Clinical Exmaination Clinical Examination consist of: o Inspection o Palpation o Percussion o Auscultation Examination maybe classified broadly into: o Routine o Specific complaint o Emergency (depending on the case of the patient) Lymphadenopathy vs. Lymphadenitis Two Types of Clinical Examination: Lymphadenopathy Lymphadenitis o Extraoral Palpable Palpable o Intraoral Non-tender Painful upon palpation Two Types of Palpation: Movable / Fixed Movable o Bimanual Palpation – extraoral o Bidigital Palpation – intraoral 3 PRELIMS  ORAL SURGERY 1 DR. CHRISTIAN BELTRAN Ç DMD 4-Y2-1 4TH YEAR A.Y. 2024-2025 MODULE 1 Intraoral and Extraoral Manifestations Associated with Communicable Thermal Test Heat and Cold Test Diseases o Heat – constrict Chickenpox Rash on the trunk o Cold - dilate Pulp sensibility test Application of agents to the teeth to increase or decrease temperature and to stimulate pulp sensory responses through thermal conduction. We do it at the cervical 3rd of the tooth since the enamel is thinner on that area. Adjacent and contralateral tooth. Oral lesion Herpes Labialis An infection of the lip by Herpes Simplex Virus (HSV-1). An outbreak typically causes small blisters or sores on or around the mouth commonly known as cold sores or fever blisters. Mobility Test PDL measures at 0.25mm Physiologic Mobility 0.25 mm Herpetic Whitlow A lesion on a finger or thumb caused by the Grade 1 / Class I 0.5 – 1.0 mm FL (Index finger) Herpes Simplex Virus. It is a painful infection that Grade 2 / Class II 1.0 – 2 mm FL typically affects the fingers or thumbs. Gade e / Class III >2 mm FL with vertical displacement Ankylosed 0.0 mm FL - faciolingual Diagnostic Aids in Tooth Examination Percussion Not a vitality test! Would test the integrity of the PDL Gutta Percha Use to determine which one is the offending Tapping of the tooth (blunt end of the mouth Tracing tooth. mirror) Inserting a gutta-percha into the sinus tract. No need for anesthesia. Then take a radiograph and the gutta-percha will point to the offending tooth. Use a thinner / smaller diameter of gutta-percha. 4 PRELIMS  ORAL SURGERY 1 DR. CHRISTIAN BELTRAN Ç DMD 4-Y2-1 4TH YEAR A.Y. 2024-2025 MODULE 1 Transillumination Use of light in order to detect tooth fracture. Electric Pulp Test Ascertains the vitality of the tooth. (EPT) To use it you need to put toothpaste at the tip to lubricate it. Other PULP VITALITY TEST: o Laser doppler flowmetry o Pulse oximetry Radiograph o Electric Pulp Test (EPT) An integral part of the majority of dental and oral surgery patient evaluations. It is only an adjunctive tool (helps in diagnosis), supplement. Types of Radiograph Periapical Structures around the apex can be seen, but the Radiograph view or structures seen is limited. Provide detailed information about the bone structure. Must include 2mm beyond the apex of the tooth. Test Preparation Also known as Cavity Test Involves drilling of tooth structure until the patient feels sensitivity. This method should be used only when ALL other test methods provide inconclusive results. DO NOT expose the pulp! NO anesthesia needed Bitewing Also called interproximal radiograph. Radiograph Includes the crowns of the maxillary and mandibular teeth and the alveolar crest on the same receptor. Can be used to detect: Proximal caries, overhanging dental restoration, height of alveolar bone, recurrent caries, pulp size and pulp change, presence of calcular deposit 5 PRELIMS  ORAL SURGERY 1 DR. CHRISTIAN BELTRAN Ç DMD 4-Y2-1 4TH YEAR A.Y. 2024-2025 MODULE 1 Occlusal An intraoral radiograph made with the film placed Waters View “Jug-handle view” Radiograph on the occlusal surfaces of one of the arches. Good for viewing the maxillary sinuses. Shows the relationship of teeth of underlying Pneumonic: MEF structures in the alveolar process, such as cysts and o Maxillary sinus abscesses. o Ethmoid sinus Can be used to detect: Bone expansion o Frontal sinus Can used to detect: Zygomatic fracture Postero- Examines skull of disease, trauma, developmental Diagnosis Anterior and abnormalities or provides a good record to detect Art and science of determining the disease process by: Anteroposterior progressive changes in mediolateral dimensions of o Systematic collection and recording of facts View skull. Can be used to evaluate orbital rim, frontal and o Careful analysis and integration these facts ethmoid sinuses, nasal septum, nasal fossa and Three Different Phases of Diagnosis orbits; invaluable in detecting a fracture-dislocation. Working Diagnosis Differential Diagnosis Written as DDX Definitive Diagnosis Need to perform biopsy in order for your to arrive with a definitive diagnosis. Diagnosis – Importance Correct diagnosis Proper treatment Panoramic Also known as Orthopantomograph (OPG) Radiograph Gives an overall assessment of the dento alveolar system. Can be used to detect: Better prognosis o Supernumerary o Impacted tooth o Presence of jaw fracture o Amount of bone loss Treatment Planning o Presence of pathology Objectives: Reduction or removal of ALL etiologic o Level of maxillary sinus factors. o Level of IAN Address the patient’s complain Overall Prognosis Consider the following: o Attitude of the patient o Age of the patient o Number of remaining teeth o Systemic background o Malocclusion o Tooth morphology Cephalometric Used to survey the skull and facial bones for Radiograph evidence of disease, trauma, developmental o Maintenance availability abnormalities. o Mobility – caused by: Used for orthodontics § Gingival and periodontal inflammation Assessing head growth § Parafunctional habits Poor Man’s Cephalometry – facial profile § Occlusal prematurities § Torque forces § Loss of supporting bone o Teeth adjacent to edentulous areas o Location of remaining bone in relation to individual root surfaces 6 PRELIMS