Complications Of Exodontia Flashcards
What are the risks of exodontia?
What are the 3 categories for surgical complications?
Surgical complications can be :
Immediate intraoperative complications include?
(7)
Haemorrhage- coagulation process
Primary haemostasis
Secondary haemostasis
Haemorrhage- coagulation process
Primary haemostasis - what happens in primary haemostasis?
Haemorrhage- coagulation process
Secondary haemostasis - what does it involve?
•Formation of fibrin through the coagulation cascade
•Defects in the coagulation cascade manifest as more serious bleeding than primary haemostasis defects.
Secondary haemostasis pathways?
Extrinsic pathway
Intrinsic pathway
Common pathway
Secondary haemostasis
What does extrinsic pathway involve?
Secondary haemostasis
What does intrinsic pathway involve?
Secondary haemostasis
What does common pathway involve?
Bleeding
When should haemostasis usually occur
If prolonged bleeding occurs in normal patient what can be done
What is haemostasis
Stopping of blood
What is a haemostatic measure
Way to stop bleeding
Haemorrhage - local heamostatic measures
What are local heamostatic measures?
What is a coagulopathy?
A condition that affects how your blood clots
Haemorrhage
Examples of different coagulopathies?
(6)
Soft tissue bleed (vessel/ Inflamed tissue/ periodontal disease)
Bone bleed
Anti-platelet medication (aspirin, clopidogrel)
Warfarin
Bleeding disorders (haemophilia, Von Willebrand disease, thrombocytopenia), liver or kidney disease
Combination warfarin AND bleeding disorder, liver/kidney disease
Haemorrhage
How would you manage a patient with Soft tissue bleed (vessel/ Inflamed tissue/ periodontal disease)
Ligate, suture or bipolar in pic
Haemorrhage
How would you manage a patient with bone bleed?
Haemorrhage
How would you manage a patient with Anti-platelet medication (aspirin, clopidogrel) ?
Local haemostatic measures
Haemorrhage
How would you manage a patient with warfarin ?
(For tooth extractions/ exodontia )
Haemorrhage
How would you manage a patient with Bleeding disorders (haemophilia, Von Willebrand disease, thrombocytopenia), liver or kidney disease
Haemorrhage
How would you manage a patient with Combination warfarin AND bleeding disorder, liver/kidney disease?
Soft tissue injury
How can it be caused? (2)
How can it be prevented? (2)
Fracture of tooth/ root
Why might a tooth or root fracture occur? (4)
How to manage?
•Normal part of process of tooth extraction
•Brittle teeth (previous RCT)
•Grossly carious/ heavily restored
•Curved apex
•Inappropriate use of elevators/forceps
Displacement of root in antrum
How do we retrieve it?
For understanding - antrum is another way of saying maxillary sinus aka root could go to maxillary sinus
Understanding - Oroantral communication - unnatural space that forms between maxillary sinus and oral cavity following extraction of antral teeth
Caldwell Luc Procedure
Fracture of bone
May be caused by? (5)
Management?
Fracture of Buccal / lingual cortical plate + alveolus is what is being referred to by fracture of bone
Replacing - as in puttting it back
Fracture of maxillary tuberosity
Causes?
Management - when small fragment attached to tooth ?
- when large fragment of bone?
Oro-antral communication
Incidence ?
Risk factors?
What can develop?
Oroantral fistula for understanding is an epithelialised pathological unnatural communication between oral cavity and maxillary sinus. - develops when Oroantral communication fails to close spontaneously
Treatment of oroantral communication
What is antral regime
Treatment of oroantralcommunication pt 2
How do we treat OAFs?
OAF - essentially when OAC doesn’t close + epithelised now
Concurrently = at the same time
Line 3 means refer to ENT if sinusitis persists where they can do FESS
Surgical closure of Oroantral fistula
Look at answers for more diagrams
Dislocation of TMJ
How can this be avoided?
What happens to the patient?
Management?
Prevention?
Avoid by always supporting the mandible
Patient will not be able to close mouth and occlusal derangement.
Manipulate mandible manually downwards and backwards to correct +/- IV sedation or GA.
Prevention with use of mouth props
(Pt may have flat articular eminence)
Dislocated jaw/tmj
Everything up to now has been Immediate Intraoperative complications
Early post-operative
What are Early post-operative complications that can occur? (10)
Pain and swelling
What is most post op pain?
What causes swelling?
What is given for the pain and what are contraindications for that?
Contraindications for NSAIDS: asthmatics, kidney disease
Trismus
Occurs when?
Causes?
Management if it doesn’t resolve?
Dry socket
Common in?
Occurs when?
Causes?
Management
Dry socket risk factors
(6)
Delayed haemorrhage
Reactionary haemorrhage Occurs when?
What is reactionary haemorrhage in response to?
Delayed haemorrhage occurs when?
What is delayed haemorrhage in response to?
Management?
Prolonged anaesthesia
Follows what?
Risk increases with?
Is it permanent?
Late lost operative
Late post operative complications include?
Bisphosphonates
What are Bisphosphonates ?
What conditions are Bisphosphonates used for? (3)
What can they do in regards to extraction?
BISPHOSPHONATES - extra from oral surgery consultant clinic year 4
What is a major risk factor for patients who take Bisphosphonates ?
MRONJ - medically related osteonecrosis of the jaw
Clinical sign of MRONJ - exposed bone and delayed healing
Bisphosponates
What are the 2 risk categories for bisphosphonates and developing MRONJ?
Explain what makes a patient high risk? (3)
1- High and low risk
2-
HIGH RISK:
1. IV bisphosponates as opposed to oral
2. Taking bisphosphonates more than 5 years
3. bisphosphonates taken for cancer
bisphosphonates stay in system for every so MRONJ risk is present even if patient no longer on bisphosphonates
Bisphosphonates
Low risk management
Bisphosphonates
High risk management
Examples of Bisphosphonates
Alendronic acid
