complications Flashcards
mx of displaced root in antrum
first confirm with radiographic imaging
either
- 2 xrays perpendicular to each other
- ct scan
then identify size of root lost in sinus, whether its root tip or entire root
establish if there was any infection of the tooth or sinus bc it determines mx protocol
If root is small (2-3mm) and sinus not infected, attempt retrival via forceps or suction or flush root out with saline irrgating and suctioning from the socket
confirm radiographically
if small, can leave alone no need surgery but inform patient to monitor
if root is large or infected or got sinusitis liao then need to remove via caldwell luc
2 theories for pathology of dry socket
1) fibrinolytic theory
- excessive local fibrinolytic activity so got lysis of blood clot and exposure of bone
2) bacterial theory
- proteolytic enzymes produced by bacteria (likely anaerobes)
when the blood clot is dislodged, socket is empty and the necrotic bone will lodge bacteria which proliferate freely, leucocytes wont be able to reach the bone through avascular material and the dead bone is gradually separated by osteoclasts.
risk factors for dry socket
1) site of exo
- more common in mandible due to relatively poor blood supply
- posterior more than anterior bc defect is bigger in size
2) infection
- because some microbiota has fibrinolytic activity eg trep denticola
3) smoking
- vasoconstrictive action of nicotine
4) difficult exo
- because excessive force or movement of tooth burnishes the bony walls of the socket and crushes blood vessels
5) OCP
- estrogen activates fibrinolytic system, contribute to premature destruction of clot
6) radiotherapy
- cause several changes to tissue, resulting in decreased blood supply
7) inadequate operative lavage - overheat and hence trauma
8) increased age
- comes with decreased healing ability
9) females more prone
- hormone induced fibrinolysis because of estrogen during menstrual cycle
10) alcohol
how to prevent dry socket
1) minimise trauma during surgery
2) minimise bacteria contamination
- copious irrigation of socket with saline under pressure
- can place small amounts of antibiotics in socket
- pre and post op antimicrobial rinses eg CHX
3) squeeze sockt edge firmly after exo
4) dont smoke for 2 days after exo
what does alveogyl comprise of
- butamben - moderate anesthetic action
- iodoform - effective antimicrobial action
- eugenol - effective analgesic action
differentiate between primary, reactionary and secondary bleeding
primary happens immediately, reactionary within 48h and secondary about 7 days after op.
primary and reactionary may have heavy bleeds whereas secondary is usually mild ooze which is the capillary form, unless major vessel is involved
causes
- primary usually due to local factors like preop infection, trauma
- reactionary may be a coagulation disorder but more commonly due to disturbance of clot eg because of a rise in local BP when vasoconstrictive LA wears off
- secondary usually due to infection, which destroys the blood clot or ulcerates vessel wall
mx:
- local measures usually sufficient for primary bleed
- for reactionary and secondary bleeds, determine source of bleeding first.
- if its soft tissue bleed, compress socket, suture, hemostatic agent
- if its bony socket, compression wont be able to stop the bleeding then we suspect bony socket. need to pack surgicel or bone wax
- if its a vessel bleed, ligate or cauterize
risk of MRONJ in patients receiving anti resopritves for cancer and osteoporosis
- cancerpatient exposed to Zolendronate
- cancer patient exposed to DMB
- osteoporsis patient exposed to BPs
- osteoporosis patient exposed to DMB
cancerpatient exposed to Zolendronate: 0-18% (<5%)
but still higher than cancer patient exposed to DMB: 0-6.9% (<5%)
osteoporsis patient exposed to BPs: 0.02-0.05%
osteoporosis patient exposed to DMB: 0.3%
list the causes of post op bleeding following a minor oral surgical procedure
split into local and systemic causes
LOCAL
- excessive trauma
- inflamed mucosa at the site of exo
- poor compliance with postop intructions
- reactive hyperemia (is just a transient increase in blood flow to the organ following a period of temporary blood flow obstruction)
SYSTEMIC
- bleeding disorders
- platelet disorders
either decreased production eg anemia, leukemia or increased destruction bc of drugs like NSAIDs OR platelet dysfunction in the case of liver disease, renal failure
- coagulation disorders
hemophilia A, B, vWD, vit k deficiency
what are the 2 methods to identify how severe an IDN injury is
MECHANORECEPTIVE METHOD
- use brush stroke or static light touch with von frey monofilaments and this evaluates A beta and pressure perception
- can do 2 point discrimination so touch at 2 points and see if the patient can identify that it is at 2 points, then repeat in 2mm increments until patint no longer perceives 2 points (normal values for IDN is 4mm, normal for LN is 3mm)
NOCICEPTIVE METHOD
- use a pain stimuli to assess free nerve endings innervated by A delta and C fibers. can use a sterile dental needle to prick and see if pain sia
- thermal discrimination
using ethyl chloride or heated GP
what is the presentation of lingual nerve injury
- drooling
- tongue biting
- swallowing and taste perception alterations (bc lingual nerve provides sensation to anterior 2/3 of tongue)
- atrophy of lingual papillae
how to reduce the risk of alveolar osteitis
- studies have shown that AB do NOT prevent AO
- existing pericoronitis should be treated adequately before operations and OH to be satisfactory
- give 0.12% mouthwash CHX 1 week pre op, on the day of surgery and several days after
- op should be done as atraumatically as possible with copious irrigation
- intra alveolar meds like tetracycline might be beneficial
