Complications Of Extractions Flashcards
Name the complications
1) Uncontrollable pain
2) Uncontrollable bleeding
3) Swelling -> simple extraction should not get swelling (only tearing PDL)
* tearing of periosteum causes swelling
4) Infection from swelling
5) Nerve damage (IAN, lingual)
- usually irreversible
6) Alveolar Osteitis
- most common complication
- most often misdiagnosed as dry socket
7) Soft tissue injury
- tongue, lip
- forcep brushes upper lip (LA patient cannot feel)
8) Damage to adjacent teeth
- DO NOT touch nearby crowns
9) Displacement into lingual pouch, maxillary sinus, infra temporal fossa
- take xray
- scope and take out if lodged somewhere
10) Mandibular fracture
11) Trismus
- injection into raphe
- injection into medial pterygoid
- injection into masseter
12) TMJ dislocation
- give LA blocks bilaterally
- stand behind patient and press on the molars
- rotate the mandible upwards while pulling down then push backwards
13) Post- LA
- Reactivation of herpes simplex
- Disease was dormant in the nerve but activated
What is alveolar osteitis? List the cause, symptoms and high risk groups
- loss, lysis or breakdown of a fully formed blood clot prior to its maturation into graduation tissue in an extraction socket
- due to compressive forces causing fibrinolysis
- pain occurs 3-5 days post extraction
- symptoms: dull, throbbing pain, foul taste, malodour
- socket grey, brown clot, exposed bone
- more common in smokers, women taking oral contraceptives, traumatic procedures
How to treat alveolar osteitis?
1) irrigation, gentle debridement, medicated dressing
2) if pain continues
- irrigate and repack until resolution
3) if pain continues
- could be another cause and not just inflammation
- treat accordingly
What is alveogyl? When do u use antibiotics? Osteomyelitis? Tranexamic acid, surgicel, spongioston?
Alveogyl: antiseptic, analgesic cream for treatment of dry socket
Osteomyelitis: inflammation of bone due to infection
Tranexamic acid:
Treat heavy menstrual bleeding/ stop bleeding
Surgicel:
Topical hemostatic agent
How to tackle post-op bleeding?
- clinical examination
- lack of compliance -> most common cause of bleeding
- identify source of bleeding
- check MH again
What are the types of bleeding?
Immediate:
- vessel injury
- soft tissue injury
- undiagnosed malformations
Delayed:
- infection
- patient risk factors
-> congenital hemophilia
-> drug induced antiplatelets/coagulants
Management:
-identity source
- local measures: irrigate, pressure pack, hemostats, suture, tranexamic acid
- chronic pain
- Necrosis
Explain the reasons for perforation of maxillary sinus
- posterior teeth
- thin sinus floor/pnematisation (max 2nd premolar most common)
- bulbous roots
- pathologies (periapical, cyst tumour)
How to detect perforation of maxillary sinus?
Inspection:
- mirror mists out
- bubbles forming
- palpation (probe) -> feel the hole
- irrigate/rinse
How to treat perforation of maxillary sinus?
1) size <2mm closes spontaneously
2) surgical intervention
- xenografts
- buccal advancement flap
- palatal rotation flap
- autogenous grafts
- buccal fat
- tongue flap
3) close within 24 hours
Risk factors (anatomical/patient), recognise, management
Learning issues
Where’s the buccal fat pad?
Between buccinator and masseter
Has 4 extensions (buccal, pterygoid, pterygomandibular, temporal)
What is Caldwell Luc?
- removal of tooth roots from within maxillary sinus
- removal of dental cysts
- treatment of sinusitis
- removal of anthral mucoceles
- closure of communications
List immediate vs delayed complications
Immediate:
- LA failure
- failure to move tooth
- fracture of tooth, alveolus, mandible
- Displacement in soft tissues
- haemorrhage
- tmj dislocation
- nerve damage
- bleeding
Delayed:
- pain, swelling
- bleeding
- dry socket
- osteomyelitis
- infection
- oro-antral fistula (communication between oral cavity and maxillary sinus)
- delayed healing
- paraesthesia
- chronic pain
- necrosis
