7 - Post-op compilations 3

Question 1

What are the common post-operative complications?

Answer 1

• pain/swelling/bruising
• trismus
• haemorrhage
• nerve damage
• dry socket
• sequestrum
• infected socket
• chronic OAF

Question 2

What are the more uncommon post-operative complications?

Answer 2

• osteomyelitis
• osteoradionecrosis (ORN)
• medication related osteonecrosis (MRONJ)
• actinomycosis
• bacteraemia/infective endocarditis

Question 3

What can increase the pain experience post-op?

Answer 3

• poor technique
• rough handling of instruments
• laceration of tissues
• leaving bone exposed
• incomplete extraction

Question 4

What should post-op swelling feel like?

Answer 4

Soft not hard

Question 5

What can increase swelling post-op?

Answer 5

• very individual response
• poor technique
• rough handling of instruments
• pulling at flaps or crushing tissues
• tearing periosteum

Question 6

What can increase bruising post-op?

Answer 6

• very individual response
• poor technique
• rough handling of instruments
• pulling at flaps or crushing tissues
• tearing periosteum

Question 7

Describe the appearance of bruising post-op.

Answer 7

• gravity pulls blood down so bruise can appear down neck
• if severe check for underlying medical issues
• very individual response

Question 8

What causes trismus post-op?

Answer 8

• LA deposited in meidal pterygoid
• oedema
• muscle spasm from having mouth open for extended period
• haematoma in medial pterygoid or masseter
• damage to TMJ (oedema or effusion)

Question 9

How do you manage trismus?

Answer 9

• reassurance and analgesia
• monitor as may take weeks to resolve
• mouth opening exercises include trismus screw and using wooden spatulas

Question 10

What is considered low risk for bleeding?

Answer 10

• simple extractions (1-3 teeth)
• incision/drainage of intra-oral swellings

Question 11

What is considered high risk for bleeding?

Answer 11

• complex extractions
• adjacent extraction with larger wound
• more than 3 extractions at once
• flap raising procedures
• biopsy

Question 12

How do you manage a patient taking an antiplatelet drug?

Answer 12

• treat without interrupting medication
• expect prolonged bleeding with clopidogrel, dipyridamole etc and consider suturing and packing wound

Question 13

How do you manage a patient taking a DOAC?

Answer 13

• low risk procedure, treat without interrupting medication BUT limit initial treatment to assess bleeding
• high risk procedure, advise patient to delay or miss AM dose and advise when to restart (usually PM)

Question 14

What causes immediate post-op bleeding?

Answer 14

• reactionary or rebound bleeding
• within 48 hours
• vessels open as vasoconstriction wears off, patient traumatises area with tongue or finger, suture is lost

Question 15

What causes secondary bleeding?

Answer 15

• infection
• 3-7 days post-op
• can be medication related

Question 16

What are examples systemic haemostatic aids?

Answer 16

• vitamin K
• anti-fibrinolytics (eg tranexamic acid)
• missing blood clotting factors
• plasma or whole blood
• desmopressin

Question 17

How do you manage post-operative bleeding?

Answer 17

• remove clot
• identify where bleed is coming from
• pressure
• LA with vasoconstrictor
• suture socket with packing agent

Question 18

What is the procedure if you cannot arrest bleeding?

Answer 18

• urgent hospital referral
• weekdays - dental hospital or maxillofacial outpatient
• weekends - A&E

Question 19

How do you prevent haemorrhage post-op?

Answer 19

• thorough medical history
• atraumatic technique
• obtain and check good haemostasis
• POI

Question 20

What are the POI you should tell your patient after the procedure?

Answer 20

• do not rinse for several hours (next day best)
• avoid touching socket as may traumatise
• avoid hot food
• avoid alcohol
• avoid excessive physical exercise

Question 21

What is dry socket?

Answer 21

• alveolar osteitis
• common in 2-3% of extractions
• the normal clot disappears so that you can see bone
• causes intense pain

Question 22

When does dry socket happen?

Answer 22

• 3-4 days post op
• takes 1-2 weeks to resolve

Question 23

What are the symptoms of dry socket?

Answer 23

• dull aching pain (moderate to severe)
• throbbing pain which radiates to ear
• keeps patient awake at night
• exposed bone is source of pain
• bad smell or taste from area

Question 24

What are the risk factors for developing a dry socket?

Answer 24

• molars are more common
• mandible is more common
• smoking
• female
• oral contraceptive pill
• LA with vasoconstrictor (BUT always necessary)
• excessive trauma
• mouth rinsing post op

Question 25

What is the management of a dry socket?

Answer 25

• reassurance and systemic analgesia
• LA
• irrigate socket with warm saline
• curettage and debridement encourages new clot to form
• alvogyl antiseptic pack

Question 26

What is a sequestrum?

Answer 26

• small pieces of dead bone that appear through gingiva
• sometimes small pieces of tooth or amalgam
• delay healing and require removal

Question 27

Describe an infected socket.

Answer 27

• very rare complication (dry socket more common)
• pus discharges from socket

Question 28

How do you manage an infected socket?

Answer 28

• check for remaining tooth or root fragments
• radiograph and explore socket
• irrigate
• remove any debris
• consider antibiotics