Complication Flashcards
Postoperative swelling and it’s management
- postoperative infection or presence of a haematoma
- Surgical trauma
- Surgical trauma
Management
1.Management of infection may require systemic antibiotics or drainage.
2. A large haematoma may need to be drained. Less likely is surgical emphysema
Trismus
limited mouth opening after a dental extraction is unusual and is likely to be infective in origin.
Why does crown fracture accur and is it interfer with extraction procedure progress ?
crown may fracture because of the presence of a large restoration, this may not prevent the extraction from continuing as the forceps are applied to the root.
What we should do if if the fracture occurs subgingivally ?
a transalveolar approach will be necessary to visualise the root.
How should we deal of 3mm of apical tooth splitter ?
may be left in situ, providing it is not associated with apical infection.
1. The patient must be informed of the decision to leave the apex
to avoid the morbidity associated with its surgical retrieval and the decision recorded.
2. Antibiotics should be prescribed.
How do we know if the patient is shocked or not in excessive bleeding ?
blood pressure and pulse measurement while bitting of gauze
systolic pressure is below 100 mgHg
heart rate in excess of 100 beats/min
there is an urgent need to replace lost volume.
Hospitalization
Why we transfer shocked patient to the hospital ?
infusion of a plasma expander such as
Gelofusine
Haemaccel
crystalloid such as sodium chloride via a large peripheral vein.
To replace lost volume
Plasma volume expanders increase the oncotic pressure in the intravascular space. Water moves from the interstitial spaces into the intravascular space, increasing the circulating blood volume
What’s the local and general causes of excessive bleeding ?
• Local causes
— mouthrinsing
— exercise
• General causes
— previous postextraction or surgical haemorrhage
— medications
— liver disease
— family history of disorders of haemostasis.
How do we exam in excessive bleeding ?
Determine the source of the haemorrhage by sitting the patient upright (unless
feeling faint) and using suction and a good light
* commonly from capillaries of the bony socket or the gingival margin of the socket, or more unusually from a large blood vessel or soft tissue tear.
Achieve haemostasis If the history has suggested a general cause,
then local methods will not adequately result in haemostasis and the patient should be transferred to hospital where specialist haematological management is available.
What’s most techniques used in hemostasis ?
• socket capillaries: pack the socket with resorbable cellulose, such as Surgicell
*gingival capillaries: suture the socket with a material that will permit adequate tension, such as vicryl or black silk
• large blood vessel: ligate vessel, usually by passing a suture about the vessel
and soft tissues.
What’s is dry socket ( alveolar osetitis )? And it’s symptom
blood clot may inadequately form or be broken down
The exposed bone is extremely painful and sensitive to touch.
What’s Predisposing factors of alveolititis ?
*smoking, surgical trauma,
*the vasoconstrictor,
*oral contraceptives ( estrogen interfere with normal healing process and prevent blood clot )
*history of radiotherapy.
How to manage dry socket ?
*reassuring the patient that the correct tooth has been extracted
*irrigation of socket with warm saline or chlorhexidine mouthrinse to remove
any debris
*dressing the socket to protect it from painful stimuli: bismuth-iodoform-
paraffin paste (BIPP) and lidocaine (lignocaine) gel on ribbon gauze are useful.
Give axample of soft tissue damage .
patient does not respond to the stimulus and
. This may happen to a lower anaesthetised lip when extracting an upper tooth; the
(lip crushed between forceps and teeth if it is not rotated out of the way.)
Nerve damage common site and symptoms ?
Paraesthesia or anaesthesia can result from damage to the
nerves in the intradermal canal during extraction of ( lower third molars ) .
What’s other name of open sinus and common site ?
oroantral fistula (OAF)
during extraction of upper molar teeth.
Where is the sites of teeth loss and in which procedure it’s common ?
whole tooth may occasionally be displaced into the maxillary sinus, when it is managed as for displacement of a root fragment.
infratemporal fossa
tissue spaces about the jaws,
usually only occurs when mucoperiosteal flaps are raised
Loss of tooth fragment.. Rarely, a
fractured palatal root of an upper molar tooth is inadvertently pushed into the maxillary sinus by the misuse of elevators
fragment may be lost elsewhere,
such as into the inferior alveolar canal.
Which teeth cause Fracture of the maxillary tuberosity ?
Posterior upper molars
How mandible fracture occur ?
excessive force in an uncontrolled way.
More commonly, small fragments of alveolar bone are fractured
, which may be attached to the tooth root.
Any loose fragments should also be removed.
Dislocation of the mandible.
may occur when extracting lower teeth if the mandible is not adequately supported.
It is more likely to occur under general anaesthesia
should be reduced immediately.
Displacement of tooth into the airway.
In which cases it’s protected ?
The airway is at risk when extracting teeth on a patient in the supine position.
It can be protected when the patient is being treated under general anaesthesia
not when the patient is conscious or being treated under conscious sedation.
How to avoid and manage displacement to airways ?
assistant is present and high velocity suction
an appropriate instrument for retrieval of any foreign body are immediately available.
A chest radiograph is essential if a lost tooth cannot be found, to exclude inhalation.
Emphysema
Reassure patient & antibiotics
