complications

Question 1

mx of displaced root in antrum

Answer 1

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

Question 2

2 theories for pathology of dry socket

Answer 2

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.

Question 3

risk factors for dry socket

Answer 3

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

Question 4

how to prevent dry socket

Answer 4

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

Question 5

what does alveogyl comprise of

Answer 5

• butamben - moderate anesthetic action
• iodoform - effective antimicrobial action
• eugenol - effective analgesic action

Question 6

differentiate between primary, reactionary and secondary bleeding

Answer 6

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