2018 Flashcards
What are the aims for raising a flap?
- better access to the tooth
- ## for protection of soft tissue
What are the aims for retracting a flap?
- protection of soft tissues
- better access
- better vision
What is dry socket?
- localised alveolar osteitis - inflammation of the lamina dura
What are predisposing factors of dry socket?
- excessive trauma during extraction
- Excessive mouth rinsing which removes the clotting
- smoking
- previous experience of dry socket
- oral contraceptive pills
Most common in mandibular molars
What are symptoms of dry socket?
- Dull aching pain
- Sharp pain that radiates to the ear
- Pain disturbing sleep
- bad breath
- Bad taste in the mouth
What are treatment options for dry socket?
- support and reassure the patient
- irrigate the socket with warm saline
- debridement to remove the old clot and allow new clotting
- systemic analgesia
- Antiseptic pack or Alvogyl
could give LA block for pain
What drug family is apixaban from?
DOAC (direct otal anticoagulant)
What does apixaban inhibit?
- Factor 10A, it inhibits conversion of prothrombin to thrombin stopping the producing of the fibrin clot
What is apixiban used for?
- treatment or prevention of DVT
- treatment or prevention of pulmonary embolism
- prevention of stroke
- reduce risks if patients have AF
What is the SDCEP guidance for treating patients on DOACs?
- for low bleeding risk procedures - treat without interruption of medication
- for high bleeding risk procedures - discuss with cardiologist- may advice patient to miss or delay morning dose before treatment
REMEMBER to advice them when to restart medication
Always treat early in the day and limit initial treatment area
Consider suturing and packing
Give examples of procedures unlikely/low to cause bleeding?
- local anaesthesia by infiltration or block
- BPE
- PMPR - supra gingival
- restorations with supra gingival margins
- simple extractions
- detailed 6 point pocket charts
Give examples of procedures with high risk of bleeding?
- Complex extractions (adjacent extractions causing large wounds)
- Flap raising procedures
- Periodontal surgery
- Crown lengthening
- Dental implant surgery
- Biopsies
What are the methods of haemostat control?
- Apply pressure by biting on damp gauze
- Use LA with vasoconstrictor
- Pack with oxidised regenerated cellulose (surgicel)
- Suture
- Diathermy
What is a contraindication of surgicel?
Avoid use on lower 8 regions as it is acidic and may damage the Inferior Alveolar Nerve
What are physical features of downs syndrome?
- Broad flat face, especially flat nasal bridge
- Short neck
- Small arched palate
- Short nose
- Small head and abnormal ears
- Slanting eyes
- Class III malocclusion
- Hypodontia
What genetic difference causes Down’s syndrome?
- an additional copy of chromosome 21
extra chromosome may be full or partial
What are factors of Down’s syndrome that increase risk of periodontal disease?
- Patients are immunocompromised (impaired neutrophils)
- Poorer oral hygiene
- saliva - quality is altered
What are reasons for patients with Down’s syndrome lacking capacity?
May have:
- Learning difficulty
- Alzheimer’s
- Intellectual impairment
What is the difference between welfare guardian and welfare power of attorney?
Power of Attorney is granted by the adult while they still have capacity
It is certified by a lawyer
It is only in effect once the person loses capacity
Welfare guardians are appointed by the courts and require 2 medical reports
They can make financial and welfare decisions
They are usually appointed for 3 years
