1. What is smoker melanosis mechanism?
    • melanocytes stimulated by polycyclic amines (nicotine, benzpyrine) for protection
    • reverse smokers where melanocytes lost have depigmented red mucosa
  2. What is the clinical/histo feature of smoker melanosis?
    • pigmentation in anterior facial gingiva
    • histo: increased melanin in basal layer sim to melanotic macule
  3. When should smoker's melanosis be biopsied?
    unexpected pigmentation location: hard palate or increased density (surface elevation)
  4. How do drugs discolor oral cavity?
    • stimulate melanocytes
    • deposition of metabolites
  5. What does mincocycline do to oral cavity?
    • discolor bone/teeth
    • dark green bone through oral mucosa -> linear band above the facial attached gingiva near mucogingival juntion and broad zone discoloration of hard palate.
    • http://mydental.uw.edu/oralpath/caseofthemonth/april-05/images/Fig_1.jpg
  6. How long do records have to be kept?
    • 7-10 years (vary states)
    • pediatric: until majority
  7. What is least reliable ID method?
    personal recognition
  8. NASH?
    natural, accidental, suicide, homicide
  9. What are some dental ID marks?
    • anatomic, restorative, pathological components.
    • patern of palatal ridge, ridges on lip surface and radiographic outline of max & frontal sinuses.
    • ID markings on removable prosthesies
  10. What are the steps of the postmortem exam?
    • tools: long-handled pruners, 8-10" knife
    • Photos: head/face, occlusal planes, unusual pathology, restorative
    • impressions & resection: not necessarily required, use 10% formalin
  11. How do you examine oral cavity in rigor mortis body?
    • use reciprocating (stryker) saw or osteotome and mallet to create LeFort I maxilla fracture
    • place above inferior nasal spine and malar process to enure apices aren't transected.
    • cut high on rami to avoid damage to impacted thirds
  12. What is the national organization for disaster management?
    • NDMS: national disaster medical system: establish morgue, ID and dispose remains to funeral via 10 regional DMORTs (disaster morturary operational response team)
    • dental team: assemble antemortem, interpret, postmort
  13. What are the ellis classifications?
    • I: enamel
    • II: dentin
    • III: pulp
    • IV: root
  14. What are modified WHO trauma classes?
    • Luxation: perio
    • Hard dental: enamel, crown, root (complicated implies endo)
    • Supporting bone:intrusion, socket, jaw fractures, alveolar (DA)
    • gingiva & oral mucosa: contusion(no epithelial break), abrasion, laceration
  15. What is a contusion?
    no epithelial break
  16. What are luxation injuries?
    • concussion
    • subluxation
    • extrusive/lateral/intrusive luxation
    • avulsion
  17. What malocclusion are most at risk for trauma?
    Angle Class II, Div 1 are 3x more prone
  18. What is the Ellis III fracture in WHO?
    Complicated Crown Fracture (hard tissue)
  19. What are the risk factors for trauma?
    • 25-30% prevalence
    • <20 yrs (8-12 especially MIXED dentition)
  20. Where are open apices typically found?
    • normal (w/o pulp & periradicular disease) developing roots of immature teeth
    • necrotic pulp: before root growth is complete, dentin stops and growth arrested
    • dev anomalies: dens in dente
  21. What is apexogenesis?
    vital pulp therapy: promoting root groth to lenth and maturation of apex
  22. What is the sequlae of trauma?
    • Pulp necrosis: uninfected via coagulation/ischemia or liquefaction (infection)
    • Pulp canal obliteration: accelerated deposition of hard tissue along the pulp canal walls
    • external inflammatory root resporption
  23. What is external inflammatory root resorption?
    • result of removal of injured periodontal ligament tissue next to the root surface by macrophages and osteoclasts
    • results in a saucer-shaped cavity on the root surface mostly involving cementum.
    • resorption cavity will subsequently be fully or partially repaired by new cementum with insertion of new Sharpey’s fibers.
  24. What are the steps of examination?
    • hx:
    • clinical:
    • radio: esp resorptive and calcific changes
    • photographs: esp for abuse & litigation
    • follow up: varied recall 1 week, 2 week, 6 weeks, 3, 6 12 months, then yearly, pulp vitality
    • ENDO:
    • subjective: chief complaint, med/dent hx
    • objective: pulp tests, radio, bite test, cracked tooth, refrerred pain
  25. What are presentations of vertical root fractures?
    • perio pockets
    • uniformly widened lamina dura
  26. What are the diagnostic tests for teeth?
    • pulpal: CO2, Ice, EPT
    • color: gray v yellow
    • mobility
    • percussion
    • palpation
    • perio
    • transillumination: fractures
    • radiographic
  27. What is concussion?
    • supporting structures w/o loosening
    • marked reaction to percussion
    • good prognosis: 100% open, 95% closed
  28. What is subluxation?
    • LOOSE not displaced
    • good prognosis: 100% open, 90% closed(>1yr)
  29. What is extrusive luxation?
    • partial OUTWARD displacement
    • ok prognosis: 90% open, 50-40% closed
  30. What is lateral luxation?
    • displacement other than axial w/ communication or fracture of alveolar socket
    • ok pulp prognosis (worse than extrusive): 90% open, 25% closed
    • pulp survival higher though than extrusive for open apices
  31. What is intrusive luxation?
    • displacement into alveolar bone w/ communication or fracture of alveolar socket
    • poor prognosis: 40% open, 0% closed
  32. What is avulsion?
    • complete displacement out of socket (Exarticulation)
    • worst pulp prognosis 30 % open, 0% closed
    • PDL healing: 40% open, 20% closed
    • Must be reinserted quickly (<30 mins) and wet stored (socket, saline, saliva, milk)
  33. what are the most common oral injuries?
    • 1. dental
    • 2. soft tissue
    • 3. bone fractures
  34. How long does it take mature teeth to regain vitality after injury?
    3 months
  35. What is the treatment for reversible pulpitis?
    apexgenisis: vital pulp therapy
  36. What is the treatment for irreversible pulpitis (necrotic pulp)?
    • Closed apex: RCT
    • Open: apexification: Root end closure & obturation or Regenerative endo
  37. What is apexification?
    root end closure to induce root end formation (apical calcific barrier) when pulp is necrotic
  38. What is the order of occurrence for facial bone fractures in children?
    Alveolar, nasal, mandible, zygomatic & orbit, maxillary
  39. What are the common locations of mandibular fractures in children?
    condyle, symphisis (& contralateral condyle)
  40. What are clinical features of mandibular fractures?
    submandibular swelling, ecchymoses, lacerations, anterior open bite
  41. What are tx for mandibular fractures?
    • closed reduction: wiriing jaw (MMF), splint
    • open reduction: direct surgical reaaprox (ORIF), wire or rigid fixation
    • fixate much shorter time for children
  42. What are the complications of pediatric facial bone fractures?
    • mal-union
    • non-union rare
    • infection: raare
    • TMJ ankylosis
    • growth arrest (asymmetry)
  43. Who is the OMFS godfather?
    Kazanjian (WWI)
  44. What are MCC of OMF injury?
    • violence>MVA>accidents
    • men>women
  45. What are the various severities of mandibular fractures?
    • greenstick: young bend, not break
    • simple: not displaced
    • compound: displaced
    • communited: multiple fracture lines & fragments
  46. What are the most common areas of mandibular fractures?
    • body (41%), angle (23%), condyle (18%), parasympheseal (9%), alveolar process (3%), coronid (0.4%)
    • parasympheseal/ sympheseal- in the region btw the canines
    • sympheseal = midline
    • weak points: condyl, ramus, mental foramen
  47. What is a favorable vs. unfavorable displacement of fracture?
    • favorable: muscles tend to draw bony fragments together
    • unfavorable: displaced by muscle forces
  48. Explain the midfacial fractures:
    • dentoalveolar fracture: only involving bone investing roots of teeth
    • Le Fort 1: horizontal maxillary fracture, running through entire maxilla above apices of teeth; posteriorly, it crosses the pterygoid plate
    • Le Fort 2: pyramidal fracture, crossing inferior orbital nerve & nasal & lacrimal bones, medial wall of the orbit
    • Le Fort 3: the most serious, where entire midface has separated from base of the skull
    • zygomatic complex- zygomatic bone articulates w maxillary & temporal bone
    • orbital- fracture of thin orbital floor
    • nasoethmoidal- anything affecting the nasal zone & ethmoidal region
  49. What are the perhospital care steps?
    • secure airway
    • hemostasis: direct pressure, swab
    • stabilization: barton bandage, bridle wire
  50. What is the normal nasal bridge width?
    half of interpupillary
  51. What is racoons' eyes indiciative of?
    • basilar skull fracture
    • may present later
  52. What is battles sign?
    mastoid bruising (posterior basilar skull base injury)
  53. How is CSF tested?
    • filter paper: separates from blood -> ring, double ring or halo
    • test for glucose or beta-2 transferrin
  54. What is the preffered high PPV test for CSF?
    beta-2 transferrin
  55. What does anterior open bite suggest in trauma?
    • bilateral condylar or angle fractures
    • posterior and inferior displacemnt of facial bones (lefort III)
  56. What is the key nerves for midface trauma?
    IAN and Infraorbital
  57. what is telecanthus?
    increased distance between medial anthi(corners of eye)
  58. What are presentations of nasoehtmoidal fractures?
    • widened nasal bridge
    • epistaxis
    • telecanthus
    • periorbital edema
    • subconjunctival hemmorhage
  59. What are presentations of orbital fractures?
    • diplopia: double vision
    • enopthalmus: posterior displacement of eyeball
  60. What is the best way to palpate the zygoma?
    intraoral: buccal uper molars to ID displacement or collapse of arch
  61. What are the best imaging techniques for the face?
    • upper: axial/coronal CT, skull, waters
    • midface: axial/coronal CT, waters,, bumental, posteroanterios occlusal
    • mandible: pano mandible series, elongated towne.
    • use lateral oblique if pano isn't available
  62. What view should be used if panoramic is not available for lower facial trauma?
    lateral oblique
  63. What is the ring bone rule?
    one fracture or dislocation implies another
  64. What is a imaging sign of a midfacial fracture?
    • opacification or increased fluid levels in maxillary sinus
    • tear drop: orbital floor fracture
Card Set
Opath1 block 3