Common Post-Op Complications of Exodontia Flashcards
What happens in the 5 phases of wound healing
Phase 1: Haematoma and clot formation
Phase 2: Granulation tissue formation
Phase 3: Replacement of granulation tissue with CT
Phase 4: Replacement/maturation of CT into woven bone
Phase 5: Mature bone
What 2 things might cause severe pain after an extraction indicate
- Dry socket
- Infection
What is the recommended pain killer course to be taken after an extraction
- 400mg of ibuprofen shortly after the extraction
- Then 500/1000mg of paracetamol in 3 hours
- Then 200/400mg of ibuprofen after 4 hours and so on
What is the max dose for paracetamol in a 24 hour period
4 grams
What is the max dose for ibuprofen in a 24 hour period
2400mg
When should paracetamol be avoided
In patients with severe liver disease
When should ibuprofen (and other NSAIDs) be avoided
In patients with:
- Renal failure
- Congenital or acquired bleeding disorders
- Antiplatelet medications
- Anticoagulant medications
- Some asthmatics
- GI disorders
When can primary haemorrhage occur
During the operation
What are some of the causes of primary haemorrhage
- Soft tissue bleeding
- Inflammation
- Damage to blood vessels
- Bony bleed
- Granulomas
When does reactionary haemorrhage occur
A few hours after an operation
What can cause reactionary haemorrhage
- Loss of the blood clot
- Bleeding disorders
- Antiplatelet/anticoagulant medications
- Adrenaline wearing off, resulting in vasodilation
When does secondary haemorrhage occur
A few days after the extraction
What can cause secondary haemorrhage
- Infection
- Bleeding disorder/anticoagulant treatment
What are the management methods for primary haemorrhage for patients without bleeding disorders
- Identify source and apply pressure, can use gauze soaked in LA with adrenaline
- Use haemostatic agents like oxidised cellulose or use diathermy if you can see the vessel
What are the management methods for primary haemorrhage for patients with a bleeding disorder
- May need to use Tranexamic acid mouthwash and suturing
- If the bleed is from the bone then identify the vessel and crush it with a blunt instrusment or apply bone wax (which is NON-resorbable)
What should be done if the haemorrhage is from the bone
- Identify the vessel and crush it with a blunt instrument or apply bone wax (which is NON-resorbable)
What are the management options for Reactionary haemorrhage
- Advise patient to wet gauze and bite on it for 15mins, if it doesnt resolve after a few repetitions and there is continuous ooze/stream of blood, they should attend the practice
- Repeat primary haemorrhage steps in practice after applying LA, removal of clots and cleaning of socket/wound
What are the management steps for secondary haemorrhage
- Identify cause
- May need to repeat primary haemorrhage steps plus antibiotics if infection is evident
What should be mentioned to the patient about the bruising and swelling risk after an extraction
- May take a few weeks to disappear and could change colours alot
- Application of ice pack can help to reduce swelling but must be applied quick af after surgery or it’ll have no effect once swelling is established
What is dry socket also known as
Alveolar Osteitis
What is dry socket
- Localised inflammation and infection of socket following extraction
What are some of the factors that are associated with dry socket
- Age of patient
- Surgical trauma
- History of smoking
- Poor oral hygiene
- Gender
- Use of contraceptive pill
- Concomitant periodontal disease
What should be doe if the patient inhales the tooth/fragment
- If ingested this is a less severe issue
- Must ascertain if inhaled as it can cause significant morbidity
- Send patient to A&E for an X-ray
