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LA > Complications of Exodontia Lecture 12 > Flashcards

Complications of Exodontia Lecture 12 Flashcards

1
Q

Normal post-op of dentoalveolar surgery?

A

Swelling, pain, infection, bruising, bleeding, trismus and sutures

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2
Q

Pre-operative complications?

A
  • Wrong patient
  • Wrong treatment plan
  • Wrong x-ray
  • Medical emergency- e.g. collapse
  • Spread of infection- pain, swelling, airway compromise or systemic symptoms
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3
Q

Peri-operative complications?

A
  • Failed LA
  • Complications of LA, vasovagal syncope/facial palsy
  • Fracture to tooth to be extracted
  • Retained fragments
  • Oro-antral communication
  • Bone fracture
  • Displaced fragments
  • Damage to adjacent teeth/restorations or soft tissue
  • Haemorrhage
  • Inhaled tooth/debris
  • Ingested tooth
  • Wrong tooth (LA or exo)
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4
Q

Post-operative complications?

A
  • Infection
  • TMJ complications: trismus, subluxation or dislocation
  • Pain
  • Infection
  • Haemorrhage
  • Dry socket
  • Osteonecrosis
  • Osteoradionecrosis
  • Swelling/bruising
  • Anesthesia/paraesthesia
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5
Q

Fracture of tooth to be extracted, management?

A
  • Stop
  • Access
  • Suction
  • Danger to other structures
  • Mobility
  • Remove fractures portion with forceps/elevators or picks if possible
  • May require surgical procedure- lift mucoperiosteal flap and bone removal
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6
Q

When do you leave a fragment?

A

In almost every case if tooth requires extraction then not safe to leave fragment behind, but if requires significant surgery with risks then small fragment may be left.
Can leave if:
- No evidence of apical infection/pathology
- root tip is less than 3mm and not associated with periapical infection
- Risk of damage high e.g. IAN, close to sinus
- No risk of distant infection
- Patient declines further surgery, you must inform them of the risks
- Antibiotics should be given

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7
Q

When there is a tooth fragment you must?

A
  • Inform the patient
  • Record in your notes
  • Take x-ray if suspicious root has been displaced
  • Deal with problems if they occur- REVIEW
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8
Q

Trauma to adjacent teeth management?

A
  • Inform the patient
  • Record in notes
  • Place temporary restoration
  • Book for permanent restorationz
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9
Q

Oro-antral communication, upper 5,6,7 and 8 more likely to have close association with maxillary sinus because?

A
  • Upper 5,6,7 and 8 have close association with the maxillary sinus
  • More likely to occur in the elderly, lone standing tooth or pneumotised sinus
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10
Q

Risk assessment for oro-antral communiction?

A
  • Pneumatisation of sinus
  • Periapical pathology
  • Lone standing molar
  • Bone atrophy
  • Difficult exo
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11
Q

Root in antrum?

A
  • Caused by uncontrolled upward pressure
  • Refer for retrieval
  • Antibiotics and analgesics
  • Nasal decongestant, 0.5mg/mL oxymethazoline nasal spray
  • Minimise risk of infection and subsequent breakdown of mucosal repair
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12
Q

Oro-antral communication?

A
  • Infection in the maxillary sinus
  • Fluid comes out of nose when drinking, due to communication of maxillary sinus and nasal cavity through hiatus semilunaris
  • Difficulty smoking
  • See bubbles of blood or hear passage of air on examination
  • If small, 5mm will need repair by local flap- buccal advancement flap.
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13
Q

Mandibular fracture, management?

A
  • STOP
  • Explain situation to the patient
  • Urgent referral to OMF unit for advice and treatment- telephone
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14
Q

Maxillary tuberosity fracture treatment?

A
  • If bone still attached to periosteum then it is vital
  • Option 1: Splint tooth and bone in place and allow to heal and deal with symptoms, leave for 6-8 weeks and then remove tooth surgically
  • Option 2: remove tooth and attached bone and close surgically to repair OAC, best to consult OMF unit/refer
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15
Q

Extracting the wrong tooth, causes?

A
  • Operator error
  • Poor notes
  • Poor communication
  • Wrong x-ray
  • Mixed dentition, especially when teeth have exfoliated between treatment planning and extractions
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16
Q

Extraction of wrong tooth prevention?

A
  • Always check the treatment plan
  • Use clinical judgement, does this tooth need to be removed?
  • Each time place forceps or elevator on tooth, be sure it is the correct one
  • When administering LA again check it is the right tooth. and then re-check once done that
  • Use tie-out to help prevent this avoidable error
17
Q

Extracting wrong tooth management?

A
  • Re-implant tooth if possible
  • Always inform the patient
  • Medicolegally indefensible
18
Q

Post op advice?

A

If bleeding occurs roll up damp gauze and place over the socket and bit for 20-30 minutes

  • Avoid excessive exercise
  • Do not smoke for up to 1 week (one cigarette causes 6 hours of vasoconstriction)
  • Avoid excessive exercise today
  • Avoid alcohol
  • Avoid hot food or drinks for today
  • Tomorrow start rinsing 3-4 times a day for next 3-4 days (with saline- 2 teaspoons of salt in warm glass of water)
  • Brush teeth normally, but avoid agitating blood clot
  • Contact surgery on-call dentist if urgent help needed.
  • Remember to give instructions regarding LA
19
Q

Dry socket, facts

A
  • aka alveolar osteitis
  • Dicruption of the healing process in an extraction site after clot formation but before wound organisation
  • Occurs in 3% of routine extractions
  • Usually starts 1-3 days after extraction; pain usually worse than original pain; throbbing, constant pain at extraction site and often resistant to analgesics
  • Result of host mediated or microbiologically mediated fibrinolysis or break down of the blood clot
  • Exposure of bony walls of socket to bacteria in saliva with resultant severe radiating pain completely out of proportion to clinical signs and symptoms
  • Usually minimal swelling and inflammation
  • Characteristic foul odour combined with socket full of food debris
20
Q

Dry Socket epidemiology?

A
  • Female > Male
  • Oral contraceptive pill
  • Mandible
  • Traumatic extraction
  • Smoker
  • Diabetic
  • Peak age 20-40 years
  • Inexperienced operator
21
Q

Dry socket on examination?

A
  • Socket devoid of blood clot with exposed tender bone
  • Greyish remnants of clot remain
  • Surrounding mucosa red and tender
  • Bad smell and taste
  • Severe pain
  • Can be local lymphadenopathy but systemic upset is rare
22
Q

Dry socket treatment?

A

Usually self limiting (1-2 weeks, can take up to 4 weeks)- treatment therefore symptomatic

  • LA for immediate pain relief and comfort during procedure
  • Wash with warm saline irrigation to remove wound debris
  • Antiseptic dressing e.g. alvogyl (contains iodine antiseptic, eugenol and local anaesthetic); left in situ and should be removed after a few days
  • Mouth rinses and analgesia
  • review
23
Q

Alvogyl prescribing information?

A
  • Not resorbable, so never stitch up after setting the alvogyl in place unless the stitch is there to hold it in place and you plan to leave it there for a few days and remove it yourself
24
Q

Causes of haemorrhage?

A

Local

  • Excessive rinsing; failure to adhere to post op instruction
  • Periodontal disease
  • Mucosal tear
  • Alveolar bone fracture
  • Jaw fracture
  • OAC

Systemic

  • Platelet disorder
  • Coagulation disorder
  • Acquired/congenital
    e. g. haemophilia, von Willebrand’s disease, coumarin treatment, liver disease
25
Q

Heamorrhage treatment?

A
  • Apply pressure on wound for up to 30 minutes
  • Check medical history/medication
  • Remove blood stained items and re-assure patient (anxiety increases blood pressure which increases bleeding)
  • Also good idea to apply pressure to sides of socket prior to placing gauze as downward pressure can displace the mucoperiosteum away from the socket

If continuous bleeding:

  • Suction to remove clot
  • Confirm bleed from socket
  • LA with adrenaline
  • Suture
  • Spongostan/gelfoam- gelatine material- acts as a framework to encourage clot formation
  • Further gauze compression- confirm haemostasis
  • If ok discharge with instructions including emergency contact number
  • Diathermy useful if bleeding point
  • Bone wax should not be used in extraction sockets as it is not resorbable
  • Tranexamic acid- antifibrinolytic agent
    - Inhibits activation of plasminogen to plasmin
    - Plasmin causes degradation of fibrin
  • Hospital admission? telephone referal to OMF unit
26
Q

Swelling likely occurrence?

A
  • Rare after simple extraction, more common after surgical extraction of lower 8’s
27
Q

What is absolute trismus (patient cannot open their mouth) indicative of

A

Submasseteric abcess

28
Q

What to do when something goes wrong?

A
  • Recognise it- Diagnosis
  • Investigate as necessary
  • Be honest and open
  • Be factually accurate and objective with patients and maintain good records
  • Make the earliest reasonable efforts at correction
  • Involve specialists if necessary
  • Contact defence organisation as it may become a legal matter

LA (4 decks)

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