Gold Coins in the Form of Key Pointschapter 1

The LOGIC in reference of radiograph:

Luxation is the best policy for extraction of tooth “to avoid fracture of tooth and to have atraumatic extraction”.

Patient position for mandibular teeth—occlusal plane should be parallel to the floor and for maxillary teeth, occlusal plane should be 45° to the floor.

In case of routine extraction; if there is no pathology-related and oral hygiene is moderate to fair or periodontium is healthy, then no antibiotic therapy is required postoperatively.

After any tooth extraction, socket should be compressed with finger pressure “to recontour the expanded socket and to control bleeding”.

Three basic principles of elevator and three basic steps in tooth extraction can be correlated in the following way:

Elevator should be applied on cemento-enamel junction (CEJ) in predetermined direction with finger guard. Never use the adjacent tooth as fulcrum.

Perfect suturing can increase 40% success rate and surgeon skill. In 99% cases, interrupted suturing is indicated or advised and is advantageous. Suturing avoids food lodgment, delay healing and infection.

Collection of anything, e.g. pus, blood, saliva may cause infection; therefore, dependent drainage should always be provided.

There is no hard and fast rule that the impacted tooth should be removed with dental elevator; sometimes tooth extraction can be done with the help of extraction forceps also.

Irrigation of any wound or cavity as local care—Last irrigation with H₂O₂ should be avoided, otherwise it may cause periapical emphysema due to release of nascent O₂ which results of increase in pressure in cavity and the patient may complain of severe pain. Thus, last irrigation should be either with normal saline or betadine.

In suppurative conditions, whenever possible, avoid suturing.

If the patient is diabetic and, in emergency, if fluid replacement is required in case of hypoglycemic shock, then IV DNS is advisable. Best treatment for hypoglycemic unconscious patient is IV 50% Dextrose in water.

Radiation therapy should start after 2-3 weeks of tooth extraction. And if the patient is on radiation therapy, extraction should be avoided for at least 3 months.

In the management of dry socket, avoid unduly curettage or antibiotic therapy.

If an abscess is present and is treated with antibiotic alone and without I and D (where required), it may cause “formation of antibioma”.

Basic principle: Before closure of any surgical wound, hemostasis should be achieved.

Any intraoral dressing should be changed maximum within 72 hours, otherwise it may act as a source of infection, delayed healing or may act as foreign body.

Initially, antibiotic therapy should be prescribed for minimum three days (unless the patient is allergic); frequent changes may 3cause “Antibioma”. The strength of antibiotic therapy depends upon severity and age of the patient. The dose should be repeated after definite intervals.

The golden hour of the trauma refers to “the period of time which is exactly one hour after the trauma is sustained”.

The most frequent cause of airway obstruction in an unconscious patient is the “Tongue”.

The ABCD of basic life support (BLS) is:

A victim, whose heart and breathing have stopped, has the best chance for survival if the emergency medical services (EMS) are activated and CPR is given within 4 minutes.

The three major signs of cardiac arrest are:

In case of neck injury, airway can be established by three basic maneuvers are:

No surgical intervention should be done in acute conditions; otherwise infection may spread to deep fascial spaces resulting in life-threatening conditions, e.g. Ludwig's angina, cavernous sinus thrombosis.

The cause of uncontrolled bleeding at the scalp region is because of its rich blood supply and also the vessels are bound firmly in the dense connective tissue, making it difficult to control the vessel.

Avoid hot fomentation in acute conditions or infection; otherwise it may cause spread of infection due to vasodilatation.

Hot and cold fomentation should be as follows:

Symphysis fracture is best diagnosed in occlusal view; sometimes unable to be diagnosed in OPG.

If a patient has a head injury, the most important thing to note is “patient's ability to open his/her eyes”.

More than 50% of mandible fractures are multiple. Associated injuries are present in 43% of the patients. 11% of these patients suffer from cervical spine injuries.

In case of maxillofacial injury, if the patient is unable to voluntarily control the tongue, then at the emergency sight, Towel Clipping of tongue avoids the tongue fall.

In gross comminuted fracture, if the patient is in shock, then immediately start with Ringer's Lactate as its high osmotic value maintains the fluid in vascular compartment.

The safest initial approach to maintain patent airway in emergency maxillofacial trauma is “Head Tilt, Chin Lift” position.

Middle third fracture generally does not undergo any displacement.

Root Canal Treatment is contraindicated in fascial space infection (acute or odontogenic condition).

Injection Voveran should always be given IM (never IV).

In case of Maxillofacial trauma or jaw fracture, during primary care, the goal should be to save the patient's life instead of achieving normal occlusion.

Temporary immobilization can be done:

90% cases of condylar or subcondylar fracture can be treated by closed method (use of surgical elastic or ligature wiring).

In pregnant women, 2nd trimester is the safest for extraction; reason being it can lead to abortion in 1st trimester and premature delivery in 3rd trimester.

In hypertension, if the patient had taken antihypertensive and BP is recorded normal, even then, during surgical procedure the patient's BP can shoot up high.

Dexamethasone (Dexona) is the safest life-saving drug; only contraindication being severe hypertension (>200/120 mm Hg).

Ibuprofen is absolutely contraindicated in asthmatic patients as it causes bronchospasm.

Adrenaline (epinephrine) acts as vasoconstrictor when used locally but, when given systemically, causes bronchodilation, i.e. used for asthmatics.

In case of a patient allergic to penicillin, erythromycin is the safest alternative antibiotic.

The most important step in the control of bleeding (during or postoperative) is “application of local pressure” to the site.

In a cardiac patient, aspirin should be stopped minimum 3 days before any surgical intervention.

In a hemophilic patient, aspirin is contraindicated.

Atropine is contraindicated in glaucoma.

In LA, the loss of function will be in the following sequence—pain, temperature, touch, proprioception and skeletal muscle tone. The return of sensation will be reverse.

All local anesthetics readily cross the BBB (blood-brain barrier). They also readily cross the placenta and enter the circulatory system of the developing fetus.

In syncope, pupils get “dilated”.

Bilateral mandibular nerve block is not contraindicated.

The adult on an average should take “1800 mL” of fluid daily.

One unit of fresh blood raises the Hb concentration by 1 gm%.

30-60% amount of bone should be destroyed to manifest itself on radiographs.

If both the parents have cleft lip and cleft palate, the probability of first child suffering from the same will be 60%.

The four clotting factors synthesize in the liver are factors II, VII, IX and X.

The level of reduced hemoglobin at which a patient becomes cyanotic is 05 gm/dl.

Tramadol is a unique analgesic with opioid-like activity for both acute and chronic pain management; side-effects include sedation and dizziness; seizure is rare. It is used with caution in a patient with history of seizure.

Heparin increases the normal clotting time (4-6 minutes) to 6-30 mins. The duration of action is 3-4 hours.

For every one degree centigrade rise in body temperature, there is corresponding 9-10 beats/minute increase in patient's heartbeat.

Some common cause of postoperative nausea and vomiting are hypoxia, hypertension and narcotics. It is more common in children than in adults and more in women than in men.

The average rate of an injured axon's forward growth is approximately 1-2 mm/day.

What are anesthetics artery and why

The calvaria or brain case is composed of 8 bones and facial skeleton is composed of 14 bones.

What are triple antibiotics and doses—A shotgun approach to potential life-threatening infection when the patient is seriously ill (the therapy is):

An inhaled foreign body most probably enters into right bronchus.

Hyoid bone present in the neck is the only jointless bone in the human body.

Nails and cornea are the only tissues in the human body which do not take oxygen from the blood.

Autogenous cancellous bone graft has greater osteogenic potential than other grafts.

Advantages of sharp dissection over blunt dissection are:

The patient with maxillofacial injuries should be carried in lateral position but in case of spinal and cervical injury, the patient should be carried in “supine position”.

Eyebrows should not be shaved when facial lacerations are repaired because these do not always grow back.

In general, for IV fluid, common site is “dorsal vein at the back of the hand”.

In case of uncontrolled bleeding after tooth extraction (for example, in case of hemangioma) replacing the tooth in the socket should be the first step to control bleeding.

In the case of an unconscious patient with no pulse and dilated pupils, the correct procedure is “to start artificial ventilation at once”.

Universal distress signal characterizing the obstructed airway in a conscious adult is “victim's hand at his throat”.

Postoperative edema can be minimized by:

In case of cardiopulmonary resuscitation (CPR), if efforts are effective, there will be “constriction of pupils”—one of positive sign.

The complete physical examination of a patient includes:

If a normal patient loses 1000 cc of blood due to surgery, it should be replaced by 3000 cc of colloidal fluid.

Few drugs that may cause syncope are:

‘5-As’ that may cause postextraction bleeding are:

If a patient gives history of allergy to Sulfa drugs, the same patient may be allergic to xylocaine (Lignocaine) because both are having same benzene ring.

Adrenal crisis is characterized by “Hypotension, Hypoglycemia and Shock”.

‘4-As’ that are important in management of allergic reaction are:

In case of trigeminal neuralgic attack, pain never crosses the midline of the face (either left or right) and never occurs during sleep.

Digastric muscle having dual nerve supply, one from mandibular nerve (motor branch from trigeminal nerve) and another from facial nerve (motor branch).

The patient with tongue-tie or ankyloglossia cannot pronounce the words like “P, Q, R, S and T”.

The central nervous system does not have any lymphatic drainage system.

Lateral pterygoid muscle is only one of the principal muscles of mastication which are attached to the condyle and responsible for depression of the lower jaw (to open the mouth).

Thickness of skin is 0.5-3 mm.

Each cardiac cycle takes 0.8 seconds and denotes series of changes which the heart undergoes during each beat.

The pain is defined as “an ill-defined, unpleasant sensation, usually evoked by an external or internal stimulus”.

Sleep is periodic resting stage for the body, especially the cerebral cortex.

Syncope is one of the common complications in dental clinic. It requires immediate attention, otherwise untreatable syncope may turn into shock and may be fatal.

The brain works for three minutes after cardiac arrest till the oxygenated blood circulates to the brain. Each cycle takes three minutes.

In general, the following drugs should be avoided during pregnancy:

The tip of the tongue is responsible for sweet taste and the lateral wall of the tongue is responsible for other tastes, like bitter, salty, sour.

In temporomandibular joint, the articular cartilage and central portion of the disc do not have any nerve supply and blood supply.

Aneurysmal bone cyst (ABC) is considered as a giant cell lesion because histopathological examination shows the presence of giant cells.

In case of suspected head injury the patient is never given morphine (as sedative and to reduce pain) because morphine 10mask the head injury symptom and arrests the respiratory center.

About 44.6 kg/m to 74.4 kg/m energy is required to fracture the mandible, zygoma and frontal bone.

Above 40 years of age, 60-75% patients of facial space infection suffer from diabetes and/or hypertension. Medical history should be evaluated and treatment should be done accordingly.

Mild to moderate oral submucous fibrosis is treated conservatively with antioxidant therapy. It is one of the key treatment modalities.

Apart from other local hemostatics, hydrogen peroxide also plays an important role in arresting the intraoral bleeding.

Crocodile tears (False tears) is a condition that results after the injury to fibers of facial nerves, leading to crying when the patient eats.

All the facial muscles receive their innervations along their deep surface except Mentalis muscle, Levator angularis superioris and Buccinator muscle. They receive their innervations along their superficial surface.

Three actions must occur at the time of cardiac arrest: