complication of tooth extraction

Question 1

What is a complication

Answer 1

Any event that would not normally occur or an unanticipated problem that carries following and is a result of procedure, treatment or illness

Question 2

What are the implications of complications

Answer 2

1. Was the reason for the surgery valid
2. Patients expectations of the surgery
3. Legal issues could the patient sue
4. Management of the event is key

Question 3

How can we prevent, limit and prepare for complication

Answer 3

1. TAKE a Thorough history & exam
2. Know the pt. and their problem
3. Know your abilities & facilities
4. Use appropriate investigation
5. Have a diagnosis that fits the facts
6. Agree a treatment plan with the patient
7. Warn the patients of any complications that may arise
8. Follow accepted practice & use the correct instruments for practice

Question 4

What complications can occur during tooth extraction

Answer 4

1. Fracture of tooth or incomplete extraction
2. Fractures tuberosity
3. Pushing roots into the antrum leading to OAC
4. Iatrogenic complications
5. Paraesthesia/ Anaesthesia/ Nerve damage
6. Fractured mandible
7. Loss of tooth or fragments into deep structures
8. Inhalation of tooth fragments

Question 5

What should we check for following extractions

Answer 5

Check apices of extracted teeth are intact

Question 6

When can we leave an apices in situ

Answer 6

1. As long as there is no infection
2. Fragments should no exceed 1/3 of the root
3. Should not have been displaced from socket
4. No risk of distant infection such as endocarditis

Question 7

Why might you not be able to retrieve apices

Answer 7

1. There is a considerable risk to adjacent structures such as nerves or antrum
2. The patient declines further surgery

Question 8

Why might fractured tuberosity occur

Answer 8

1. Lone standing molars
2. Increased bone density
3. Incorrect use of instruments

Question 9

How do we recognise fractured tuberosity

Answer 9

1. Audible crack of bone fracturing on attempted extraction
2. Movement of the tuberosity
3. Palatal tear
4. Difficult extraction

Question 10

How do we manage tooth fracture

Answer 10

1. STOP
2. Explain to the patient what has happened
3. Dont remove the mobile segments
4. Refer or seek advice ASAP

Question 11

what is oroantral communication

Answer 11

A non epithelialised passage between the oral cavity and the maxillary antrum

Question 12

What is oroantral fistula

Answer 12

A pathology epithelial lined tract between the oral cavity and the maxillary sinus

Question 13

What is oroantral communication due to

Answer 13

Root fracture

Question 14

What is an oroantral fistula caused by

Answer 14

Usually as a result of an unresolved oroantral communication

Question 15

What do we do if the roots are lost in the antrum

Answer 15

Estimate the amount of roots that are unaccounted for
take radiographs and inform the patient

Question 16

List some predisposing factors to oroantral communication

Answer 16

1. Teeth close to sinus
2. Thin alveolar bone
   3, Periapical infection
3. Root morphology

Question 17

List some Iatrogenic factors that may increase likelihood of oroantral communication

Answer 17

1. Traumatic extractions
2. Use of elevators

Question 18

List some signs and symptoms of oroantral communication (OAC)

Answer 18

1. Radiographic findings
2. A visible defect between the mouth and antrum when looking with a mirror
3. Bone fragments with a smooth concave upper surface adhering to the root of extracted tooth

Question 19

How do we investigate a suspected oroantral communication

Answer 19

1. DO NOT probe for an OAC
2. Test for suspected OAC by instructing the patient to gently blow the nose whilst pinching their nostrils
3. if bubbles of blood and saliva found in the socket then OAC

Question 20

List some signs and symptoms of an oroantral fistula (OAF)

Answer 20

1 Soft tissue proliferation around socket
2. Prolapse of sinus lining
3, Discharge of infected material
4. Reflux of fluid into nose
5. Air escapes into mouth on nose blowing

Question 21

How do we treat an oroantral fistula

Answer 21

Refer for specialist treatment as minor oral surgery may be required

Question 22

Where do inhaled teeth usually end up lodging

Answer 22

In the right bronchus due to anatomy

Question 23

What should you do if you think the paint has inhaled their tooth

Answer 23

Get them to cough vigorously
if it doesn’t dislodge then refer to the hospital

Question 24

List some completion that can occur after procedure

Answer 24

1. Abnormal bleeding
2. Dry socket
3. Infection
4. Osteonecrosis
5. Anaesthesia/ paraesthesia

Question 25

How can we reduce the chances of abnormal bleeding after a procedure

Answer 25

Take a thorough history and make sure you have a valid INR number from patients on anticoagulants

Question 26

What is classified as abnormal bleeding

Answer 26

Patient who bleeds beyond normal limits as a result of treatment

Question 27

What should the iNR be before we continue with extraction

Answer 27

Less than or equal to 4.0

Question 28

If a patient is bleeding abnormally after extraction and they don't have anything in their medical history what should you look for

Answer 28

Tears in the mucosa

Question 29

How can we control bleeding

Answer 29

1. Place direct pressure on socket 2. Place pressure on the artery leading to the socket 3. Suture/ligate 4. Use local heamostatic agents 5. Use systemic agents like vitamin k

Question 30

Give examples of some local haemostatic agents

Answer 30

Surgicel, Kaltostat, collagen granules, fibrin foam

Question 31

What is another term for dry socket

Answer 31

Alveolar osteosis

Question 32

What is alveolar osteosis

Answer 32

Inflammation of bone

Question 33

How common is dry socket

Answer 33

Occurs In 3% of XLA

Question 34

When does dry socket usually occur

Answer 34

2-3 days post op

Question 35

Give some signs and symptoms of dry socket

Answer 35

1. Halitosis 2. Foul taste 3. Severe pain not eased by analgesia 4. Socket is partly of completely devoid of a blood clot

Question 36

What can increase your chance of developing dry socket

Answer 36

1. Smoking 2. Mandibular teeth extraction 3. Excessive mouth rinsing in the first 24 hrs 4. Single extraction 5. Traumatic/difficult extraction 6. Increased bone density 7. Females taking oral contraceptives 8. Poor OH

Question 37

How can we treat dry socket

Answer 37

1. Explain to the patient they have dry socket 2. Irrigate with warmed saline 3. Place a small amount of Alveogyl obtundent dressing in the socket 4. Will heal eventually

Question 38

If post op a patient develops a systemic infection what can we prescribe

Answer 38

1. Amoxicillin 500mg TDS PO (double if severe) 2. Metronidazole 200 mg TDS PO (double if severe)

Question 39

What is osteonecrosis caused by

Answer 39

antirespoptive medications including bisphosphonates

Question 40

How can bisphosphonates lead to osteonecrosis

Answer 40

Bisphosphonates inhibit osteoclasts resorption thus decreasing the rate of turn over

Question 41

Name soem commonly prescribed bisphosphonates

Answer 41

Alendronic acid & Risedronate sodium

Question 42

Whom might be prescribed bisphosphonates

Answer 42

Patients with cancer, osteoporosis or pagets disease

Question 43

What can increase your risk of developing osteonecrosis

Answer 43

1. Age 2. Surgical procedures 3. Medication

Question 44

What is the treatment for osteonecrosis

Answer 44

Nothing just good oral hygiene, prevention and abiding surgery