complications of oral surgery Flashcards
What key aspects should you assess in a patient’s medical history before oral surgery? 🤒
Bleeding disorders (e.g., haemophilia, ITP) 🩸
Cardiovascular disease, diabetes, immunosuppression 🫀💉
Medications: anticoagulants, steroids, bisphosphonates 💊
Pregnancy status 🤰
What investigations might be needed before surgical extraction of a lower molar near the ID canal? 🦷📸
Radiograph (OPG/CBCT) for root and canal proximity 🖼️
Blood tests if bleeding disorder suspected 🧪
Possibly microbiological culture if persistent infection present 🦠
What factors increase pain after oral surgery? ⚡
Bone removal or surgical trauma 🪓
Anxiety or fear 😰
Infection/inflammation at site 🔥
Poor pain control pre-op 🧊
Which pain medications are best for moderate-severe pain after bone removal? 💊🦷
Ibuprofen 400mg + Paracetamol 1g (every 6h)
If more severe, add Codeine 60mg
If NSAIDs contraindicated, use Paracetamol + Codeine
IV Morphine for multiple teeth/excessive pain (hospital setting) 💉
What’s the key difference between inflammation and infection? 🤔
Inflammation = body’s response to injury 🧠
Infection = presence of pathogens 🦠
Infection always causes inflammation, but inflammation can happen without infection.
When does post-op swelling peak and resolve? ⏳
Peaks: 12–24 hours
Can last up to 72 hours
May persist for up to 10 days in MTM extraction
Patient an procedure dependent
Name 4 risk factors that increase the likelihood of infection post-op. 🧪
Smoking 🚬
Poor oral hygiene 🪥
Immunocompromised state 🛡️
Difficult surgery (e.g. MTM) 🦷
inexperienced operators
oncology patients
What are systemic signs of infection? 🌡️
Fever 🤒
Tachycardia ❤️🔥
Lymphadenopathy 🦠
Pyrexia
blood picture
What does the SEPSIS mnemonic stand for? 🚨
Slurred speech
Extreme shivering
Passing no urine
Severe breathlessness
It feels like you’re going to die
Skin mottled/discoloured 🧊🩶
What are causes of trismus post-extraction? 😬
Restricted mouth opening
Trauma or inflammation of muscles- tissue manipulation
Odeama form surgery - inflammation around the muscles and TMJ complex
MUSCULAR CAUSES
- myofascial pain/spasm
Prolonged mouth opening 😮
Infection (cellulitis, deep space)
Needle trauma during IAN block 💉
TMJ disorders or haemarthrosis
INFECTIOUS CAUSES
- surgical site infection
pericoronitis - infection around partially erupted 3rd molar
Deep space infection - submasseteric abscess
TMJ INVOLVEMENT
- pre existing TMJ disfunction
Heamarthrosis - bleeding within the TMJ following trauma
What post-op bleeding is considered abnormal? 🩸
Bleeding after 12 hours post-op
Active, bright red or pulsatile bleeding
Blood mixed with saliva continuously
How do you manage persistent post-extraction bleeding? 🧻
Remove clot, suction area
Capillary = pressure + haemostat
Arterial = pressure/cautery
Bone = bone wax
Refer if uncontrolled 🚑
What are the signs of dry socket? 🦷🔥 alveolar osteoitis
Pain 1–3 days post-op, worsens with time
Empty socket with no clot
Bad taste/smell 😷
Visible bone
How is dry socket managed? 💊
Irrigation with saline
Place dressing (e.g., Alvogyl)
Provide analgesia
Usually self-limiting but may need redressing
Name 3 common iatrogenic complications during extraction. 🚫
Lip/cheek lacerations 💋
Nerve injury (IAN, Lingual) ⚡
Displaced root into sinus 🌬️
Fractured tooth/restoration 💥
Alveolar fracture 🦴
How do you manage a suspected oroantral communication? 👂👃
Small (≤2mm): may heal spontaneously 🤞
Large: surgical closure required (buccal advancement flap or buccal fat pad graft) ✂️🧵
What are the most commonly affected nerves in oral surgery? 🧠
Inferior Alveolar Nerve (IAN)
Lingual Nerve
Mental Nerve
Also facial nerve (during extraoral or parotid surgery)
What percentage of patients are warned about nerve damage risk? ⚠️
Only 30% are appropriately warned, despite 70% experiencing pain after nerve injury 😢
How do you reduce surgical risk in high-anxiety patients? 😰
Pre-op reassurance
Sedation if needed 🧘
Clear consent process
Offer post-op contact info ☎️
What does good consent in oral surgery include? 📝
Discuss risks, benefits, alternatives
Warn about pain, infection, bleeding, dry socket, nerve damage
Document the discussion clearly 🖊️📄
What is the maxillary tuberosity and why is it at risk during extractions? 🦷📍
The maxillary tuberosity is the rounded bony prominence behind the last upper molar (especially the 3rd molar). It’s thin and fragile, particularly in elderly or edentulous patients.
➡️ It’s at risk during upper molar extractions, especially if there’s ankylosis, large sinus pneumatization, or poor extraction technique.
What are the signs of a maxillary tuberosity fracture during an extraction? 🚨🔍
Sudden crack or loss of resistance
Tooth and a segment of bone move together
Tearing of mucosa
Excessive bleeding
Potential oroantral communication
Patient may feel or hear a “pop” 🎧
How do you manage a maxillary tuberosity fracture? 🩹
Stop the procedure immediately ⛔
Stabilize the mobile bone with sutures 🧵
Prescribe antibiotics & chlorhexidine rinse 💊🦠
Allow 4–6 weeks of healing 🗓️
Re-assess – plan surgical removal after healing if needed
⚠️ If the tooth is infected or mobile, remove tooth AND bone fragment (refer to OS/OMFS)
How can maxillary tuberosity fractures be prevented? ✅🔒
Use sectioning technique for upper molars 🪓
Avoid excessive force! 🙅♀️
Pre-op radiograph to assess sinus proximity 🖼️
Warn patients during consent about risks 🗣️📝
