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1. SBA > complications of extractions & delayed healing > Flashcards

complications of extractions & delayed healing Flashcards

1
Q

What are the 3 main complications following a paediatric extraction?

A
  1. pain
  2. bleeding
  3. local anaesthetic trauma
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2
Q

What are the 3 main complications following an adult extraction?

A
  1. dry socket
  2. post operative bleeding
  3. post operative infection
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3
Q

Why do younger children have less significant post-operative complications in terms of infection or inflammation?

A

Because their maxilla and mandible are well vascularised due to normal growth processes.

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4
Q

What is alveolar osteitis?

A

dry socket

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5
Q

What are the 4 basic stages of healing?

A
  1. coagulation
  2. formation of granulation tissue
  3. granulation tissue transferred into soft or hard tissue
  4. bony healing
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6
Q

How does alcohol impact clotting?

A
  • reduced platelets and adhesion.
  • impacts clotting factors
  • inhibits inflammation
  • reduces white blood cell activity increasing the risk of infection.
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7
Q

What are 3 types of medications that affect clotting?

(think warning cards)

A
  1. Antiplatlets
  2. Vitamin K antagonists
  3. Direct anticoagulants
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8
Q

Haemostatic agents are usually made from what?

A

Oxidised Cellulose

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9
Q

An INR blood test result is needed within how many hours of the extraction date?

A

72 hours

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10
Q

Which method of local anaesthetic administration should be avoided in patient’s with coagulation factor abnormalities and why?

A

IDBs - risk of vessel damage and haematoma development.

(this could result in obstruction to airway because of the position)

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11
Q

Where is a dry socket most likely to occur in the mouth?

A

In the mandible due to blood flow.

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12
Q

In what gender is dry socket more likely to occur and why?

A

Females due to them having different fibrolytic (clotting) system due to female hormones.

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13
Q

Why do smokers have an increased incidence for dry socket?

A

Decreased blood flow due to nicotine.

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14
Q

What are the typical symptoms of a dry socket?

A
  1. pain starts of day 3 and gets worse (localised to XLA site)
  2. deep, bony pain with poor response to analgesics
  3. bad taste / smell
  4. minimal swelling
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15
Q

How does dry socket appear on a radiograph?

A

nothing abnormal

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16
Q

What is the cause of a dry socket?

A
  1. Loss of clot due to excessive rinsing, abnormal fibrinolytic process and pre-existing inflammation resulting in a breakdown of clot.
  2. Bony socket wall is exposed which leads to inflammation which causes the pain.
  3. Can get secondary infection with bacteria.
17
Q

Treatment for Dry Socket?

A
  1. Remove debris from socket using saline / chlorhexidine.
  2. Dress socket with alveogyl.

(can also prescribe metronidazole 400mg)

18
Q

What kind of dressing is Alveogyl?

A

Eugenol-based dressing so causes pain relief.

19
Q

Which type of autoimmune condition impacts the granulation tissue formation stage of healing?

A

Diabetes

20
Q

Which type of medication can impact the formation of granulation tissue?

A

Steroids as it impacts bone metabolism and formation.

21
Q

How does chemotherapy reduce healing?

A

inhibits cell activity / replication / angiogenesis

22
Q

How would you manage a patient undergoing chemotherapy either regards to an extraction?

A
  1. Refer to a specialist.
  2. Consider liaising with their oncologist.
  3. Review
  4. Consider post-op antibiotics.
23
Q

What is osteomyelitis?

A

infection of the bone

24
Q

What kind of patient is osteomyelitis more likely to be seen in?

A

Immunosuppressed Patients

  • bisphosphinates (osteoporosis, cancer)
  • steroids
  • chemotherapy / radiotherapy
  • conditions affecting bone density
25
Q

How would you diagnose osteomyelitis?

A

The presence of a non-healing socket weeks/months after XLA and pain/swelling/numbness.

May have radiographic changes.

26
Q

How would you manage osteomyelitis?

A
  1. refer to specialist
  2. debridement of dead bone
  3. XLA of non-vital teeth in the area that may be contributing to the inflammatory response.
  4. antibiotics
27
Q

Why does radiotherapy cause delayed healing?

A

Impacts blood supply - obliterates blood vessels, reducing blood flow to normal bone around growth resulting in delayed healing.

28
Q

What are the symptoms of osteoradionecrosis?

A
  1. Pain
  2. Trismus
  3. Bad taste / smell.
  4. Exposed bone.
  5. Fistulae (a hole).
  • similar to osteomyelitis *
29
Q

How would you prevent osteoradionecrosis?

A
  1. smoking and alcohol cessation
  2. medications such as vitamin E to reduce oxidative stress, pentoxifylline, post op antibiotics.
30
Q

How to bisphosphinates cause delayed bony healing?

A

Bind to the bone and stop the osteoclasts from working properly so reduces angiogenesis.

Reduces the production of new bone.

31
Q

How would you manage a patient on bisphosphinates prior to XLA.

A

AVOID IF POSSIBLE

  • consider referral to specialist.
  • XLA with minimal trauma
  • potential antibiotic prophylaxis in high risk pts.
  • review in 6-8 weeks
32
Q

How long would you expect post-op pain to last following an extraction?

A

3-5 days

33
Q

How long would you expect swelling to last following XLA?

A

2-3 days

1. SBA (28 decks)

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