complications of extractions & delayed healing Flashcards
What are the 3 main complications following a paediatric extraction?
- pain
- bleeding
- local anaesthetic trauma
What are the 3 main complications following an adult extraction?
- dry socket
- post operative bleeding
- post operative infection
Why do younger children have less significant post-operative complications in terms of infection or inflammation?
Because their maxilla and mandible are well vascularised due to normal growth processes.
What is alveolar osteitis?
dry socket
What are the 4 basic stages of healing?
- coagulation
- formation of granulation tissue
- granulation tissue transferred into soft or hard tissue
- bony healing
How does alcohol impact clotting?
- reduced platelets and adhesion.
- impacts clotting factors
- inhibits inflammation
- reduces white blood cell activity increasing the risk of infection.
What are 3 types of medications that affect clotting?
(think warning cards)
- Antiplatlets
- Vitamin K antagonists
- Direct anticoagulants
Haemostatic agents are usually made from what?
Oxidised Cellulose
An INR blood test result is needed within how many hours of the extraction date?
72 hours
Which method of local anaesthetic administration should be avoided in patient’s with coagulation factor abnormalities and why?
IDBs - risk of vessel damage and haematoma development.
(this could result in obstruction to airway because of the position)
Where is a dry socket most likely to occur in the mouth?
In the mandible due to blood flow.
In what gender is dry socket more likely to occur and why?
Females due to them having different fibrolytic (clotting) system due to female hormones.
Why do smokers have an increased incidence for dry socket?
Decreased blood flow due to nicotine.
What are the typical symptoms of a dry socket?
- pain starts of day 3 and gets worse (localised to XLA site)
- deep, bony pain with poor response to analgesics
- bad taste / smell
- minimal swelling
How does dry socket appear on a radiograph?
nothing abnormal
What is the cause of a dry socket?
- Loss of clot due to excessive rinsing, abnormal fibrinolytic process and pre-existing inflammation resulting in a breakdown of clot.
- Bony socket wall is exposed which leads to inflammation which causes the pain.
- Can get secondary infection with bacteria.
Treatment for Dry Socket?
- Remove debris from socket using saline / chlorhexidine.
- Dress socket with alveogyl.
(can also prescribe metronidazole 400mg)
What kind of dressing is Alveogyl?
Eugenol-based dressing so causes pain relief.
Which type of autoimmune condition impacts the granulation tissue formation stage of healing?
Diabetes
Which type of medication can impact the formation of granulation tissue?
Steroids as it impacts bone metabolism and formation.
How does chemotherapy reduce healing?
inhibits cell activity / replication / angiogenesis
How would you manage a patient undergoing chemotherapy either regards to an extraction?
- Refer to a specialist.
- Consider liaising with their oncologist.
- Review
- Consider post-op antibiotics.
What is osteomyelitis?
infection of the bone
What kind of patient is osteomyelitis more likely to be seen in?
Immunosuppressed Patients
- bisphosphinates (osteoporosis, cancer)
- steroids
- chemotherapy / radiotherapy
- conditions affecting bone density
How would you diagnose osteomyelitis?
The presence of a non-healing socket weeks/months after XLA and pain/swelling/numbness.
May have radiographic changes.
How would you manage osteomyelitis?
- refer to specialist
- debridement of dead bone
- XLA of non-vital teeth in the area that may be contributing to the inflammatory response.
- antibiotics
Why does radiotherapy cause delayed healing?
Impacts blood supply - obliterates blood vessels, reducing blood flow to normal bone around growth resulting in delayed healing.
What are the symptoms of osteoradionecrosis?
- Pain
- Trismus
- Bad taste / smell.
- Exposed bone.
- Fistulae (a hole).
- similar to osteomyelitis *
How would you prevent osteoradionecrosis?
- smoking and alcohol cessation
- medications such as vitamin E to reduce oxidative stress, pentoxifylline, post op antibiotics.
How to bisphosphinates cause delayed bony healing?
Bind to the bone and stop the osteoclasts from working properly so reduces angiogenesis.
Reduces the production of new bone.
How would you manage a patient on bisphosphinates prior to XLA.
AVOID IF POSSIBLE
- consider referral to specialist.
- XLA with minimal trauma
- potential antibiotic prophylaxis in high risk pts.
- review in 6-8 weeks
How long would you expect post-op pain to last following an extraction?
3-5 days
How long would you expect swelling to last following XLA?
2-3 days
