Complications Flashcards
Immediate complications?
- FailureofLA
- Failuretomovethetooth
- Fractureofthetoothorrootbeingremoved * Fractureofalveolus
- OroAntralCommunication(OAC)
- Displacementofatoothorrootintotissues * Lossoftoothorroot
- Damagetosurroundingtissues&teeth
- Thermalinjury/chemicalinjury
- Haemorrhage
- TMJinjury
- Fractureofthemandible
- DamagetotheTrigeminalnerve
What do you call communications with the maxillary sinus?
oro antral communication
Artery in the lip?
Superior labial artery
Delayed complications?
- Excessive pain, swelling, trismus * Haemorrhage
- Dry socket
- Oro Antral Fistula (OAF)
- Osteomyelitis / osteonecrosis * Failure of the socket to heal * Nerve damage
Oro antral fistula?
Why can’t we extract the 8?
partially erupted, impacted on distal of the 7, chunky root
Surgical procedure
Management depends on what?
- Amount fractured: apex or whole root
– Medical history of patient
– Presence of infection
Can you remove the crown and leave the root?
no, blood clot cannot form on top of it
Can leave small apical area of root
Can only leave a small root - 4mm can be left
If there is a periapical area, what can happen to the root?
alveolar bone has resorbed - can flick the apical root out
Problem with tuberosity?
attached to molar
Can break
If you fracture the tuberosty, what can occur?
oro antral fistula
Into middle meatus - difficult to clean antrum if blood gets there
When can the tuberosity fracture?
Usually Lone standing upper molar
- bone becomes denser due to increased function
Hypercementosis
Bulbous roots
Splayed roots
What to do if lone standing ,auxiliary molar needs extracted - dense bone indicated on X-ray?
elective surgical procedure
Fractured bone?
fractured tuberosity
Fractured alveolus
Fractures mandible
TMJ injuries presents how?
dislocation presents as a malocclusion/trismus
TMJ painful?
no
What happens in TMJ dislocation?
Condylar head slides forward on to the articular emminence and beyond
Gel lid fossa to in front of the articular eminence
Do you check TMJ after extraction?
yes
How to put put TMJ back?
Pt keep calm
Wrap gauze around things
Push down on mandibular molars
Wrap bandage around head
Sedatives?
benzodiazalines
= diazepam
= midazolam
OAC?
oro-antral communication
What is an oro-antral communication?
pathological communication between the maxillary antrum and the oral cavity
What happens if OACs don’t heal?
they become an oro-antral fistula
Other causes of OAC?
osteomyelitis/osteonecrosis, maxillary fracture, sinus tumour, osteoradionecrosis, endodontics, dental implant placement
A vs B
A = oro-antral communication
B = epithelialised and now a oro-antral fistula
Type of X-ray?
Occipito- mental X-ray
Taken to look at mid-face
Arrow pointing to what?
fluid - pus / blood
Fluid in right antrum
Oro-antral fistula
Called what?
buccal advancement flap
Used for oro-antral communication
Ring up oral surgery department
Regent sinusitis
Where can displaced roots be?
– Inhaled
– Swallowed
– Antrum
– Buccal/Palatal mucosa
– Floor of nose
– Infratemporal fossa
– Lingual pouch
Who would you give antibiotics?
swelling
Lymphopayhy
Systemic signs - fever
Main oro-facial infection?
pericoronistis
Periapical abscess
Periodontal abscess
Less common oro-facial infections?
- Infected cysts
- Acute ulcerative gingivitis
- Cancrum oris
- Necrotising fasciitis
- Osteomyelitis
- Non-specific lymphadenitis
- Fungal infections (immunocompromised patients)
Lidwigs angina?
- Bilateral sublingual, submandibular and submental space infections
- Raised swollen tongue
= Pyrexia, dysphagia, dysarthria, dyspnoea
* Potentially life threatening
* Treatbydrainage,I.Vantibiotics
* Mayneedtracheostomyforairway
management
What to do if pt shows signs of Ludwig’s angina?
sent to hospital
Symptoms of Ludwig’s angina?
Bilateral sublingual, submandibular and submental, space infections
Raised swollen tongue
Prexia, dysphagia, dysarthria, dyspnoea
Signs that a lt can’t swallow?
Drooling
Treatment for Ludwig’s angina?
Treatbydrainage,I.Vantibiotics
* May need tracheostomy for airway management
- Drain pus & remove source
- Extraction or pulpectomy
- Antibiotics empirically then MC&S
- Pen V & Metronidazole
- Analgesia
- In severe cases:
- Hospital admission, IV antibiotics, GA drainage, blood tests
Pus aspiration, what to watch out for?
facial nerve
Marginal mandibular shown here - drooping of corner of mouth
Cause of Ludwig’s angina?
oral infection
Poor oh
What is occuring here?
Cavernous sinus infection
Can travel to brain
Increased pressure in brain
Meningitis
Cerebral abscesses
How to know if a swelling is more serious?
hard - pus
Severely immune-compromised pts?
transplant pts
Cancer pts - chemo/radiotherapy
HIV
Where to make impression to remove submandibular infection?
w finer space under jaw
Raise complications of infection?
- Airway obstruction
- Pus aspiration into lungs
- Spread;
– septicaemia
– orbital cellulitis
– Septic cavernous sinus thrombosis
– encephalitis, meningitis - Acute necrotising fasciitis
- Mediastinal spread
- Death
