Common complications in OS

Question 1

What are the EO signs to check for?

Answer 1

Temp/vital signs
Swelling, look/feel
Lymphadenopathy
Trismus

Question 2

What are the IO signs to check for?

Answer 2

Site of surgery
Swelling
Bleeding
Suppuration/halitosis/food packing

Question 3

What is another name of dry socket?

Answer 3

Acute alveolar osteitis

Question 4

What are the signs and symptoms of dry socket?

Answer 4

Inflammation of alveolar bone
Unpleasant taste/smell
Pain from socket site

Question 5

What is thought to be the cause of dry socket?

Answer 5

Loss of blood clot leaving the alveolar bone exposed to bacteria

Question 6

What is the incidence of dry socket?

Answer 6

1-20% of routine XLA
30% for surgical 3rd molars

Question 7

What is the time frame of dry socket?

Answer 7

24-48hrs post XLA

Question 8

What are the risk factors of dry socket?

Answer 8

smoking
OCP
ANUG/pericoronitis
Immune suppression - diabetes
Previous radiotherapy
Vasoconstrictors - LA decreases blood supply to area
Altered bone metabolism - Pagets
XS trauma at time of XLA - blood supply damage

Question 9

What mouth rinse could be used to decrease dry socket?

Answer 9

CHX gluconate (0.12% and 0.2%)
Be aware of CHX allergies and deaths

Question 10

What is the management of dry socket?

Answer 10

1. Irrigation of socket with 0.9% saline
2. Obtundent pack, e.g. alveogel (resorbable) or BIPP - bismuth subnitrate and iodoform paste + ribbon gauze (non-resorbable)
3. Smoking cessation - OHI
4. Prescribing appropriate analgesia - e.g. paracetamol, 500mg QDS and Ibuprofen TDS +/- codeine 30mg QDS for 5 days

Question 11

What is the active ingredient in alveogel?

Answer 11

eugenol

Question 12

What to check for in socket management?

Answer 12

Determine is airway is compromised
Significant swelling
Patient unable to swallow their own saliva
Unable to push tongue forwards
Hot potato voice - airway compromised

Question 13

How to manage if airway is not compromised

Answer 13

Optimal analgesia
Local measures - incise and drain abscess
Do not prescribe ABs unless there are signs of spreading infections (facial/neck) systemic infection or for an immunocompromised pt)

Question 14

Which ABs are prescribed in spreading infection?

Answer 14

Amoxicillin 500mg TDS
Phenoxymethylpenicillin 500-1000mg QDS
Consider metro 400mg TDS
Clindamycin if allergic to amoxicillin 250mg QDS