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ORAL SURGERY > Complications of Oral Surgery > Flashcards

Complications of Oral Surgery Flashcards

1
Q

examples of pre-operative complications?

A
  1. submerging teeth
  2. note proximity of antrum, curved roots
  3. abscesses (sinusitis)
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2
Q

intra-operative complications?

A
  1. loose adjacent tooth
  2. failure to obtain LA
  3. wrong tooth
  4. tooth inhaled/swallowed
  5. fractured bur
  6. failure to move the tooth
  7. fractured alveolar plate
  8. difficult extraction i.e. curved root
  9. root/crown fracture
  10. damage soft tissues/adjacent tooth/restoration
  11. fractured tuberosity/mandible
  12. displaced tooth
  13. dislocated TMJ
  14. bleeding
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3
Q

bleeding: why? where from? management?

A
  • reactionary bleeding: occurs when LA wears off
  • primary bleeding: from soft/hard tissues
  • secondary: due to infection
  • deficiency: coagulation factor, platelets, vascular or drug therapy
  • bite on gauze for 10mins and check, if bleeding still continues then use surgicel and suture
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4
Q

bleeding: when to refer?

A

if BP below 100/60, and heart rate >100bpm

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5
Q

post op advice in 1st 24 hours?

A
  • dont rinse (to achieve clot stabilisation, fibrin crosslinkage)
  • start hot salt mouth washes
  • if bleed, put pressure with clean cloth
  • avoid alcohol, strenuous exercise and smoking etc
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6
Q

why should we be careful with elevators?

A

potential of disturbing the adjacent tooth e.g. restorations on the area immediately next to the tooth

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7
Q

departmental protocol to prevent WSS?

A
  • check notes
  • ask pt which tooth
  • get pt to point
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8
Q

steps to prevent dislocation of jaw?

A
  • support jaw properly
  • do not use excessive force
  • do not over-open the mouth
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9
Q

tuberosity fracture: what to do if:

  • fragment is small?
  • if there is pulpal infection?
  • if the tooth is not carious?
A
  • remove it
  • remove tooth and check for OAC
  • if tooth not carious, splint and surgically remove 1/12
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10
Q

post op complications?

A
  • bleeding
  • infection
  • OAF
  • trismus
  • haematoma
  • swelling
  • dry socket
  • osteomyelitis
  • needle track infection
  • nerve damage
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11
Q

dry socket - risk factors?

A
  • the pill
  • radiotherapy
  • previous dry socket
  • mandibular extractions
  • smokers
  • females
  • drugs e.g. BRONJ
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12
Q

dry socket - occurs due to?

A
  • loss of blood clot that occurs due to underactive clotting, or overactive fibrinolysis
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13
Q

dry socket - why irrigate with saline and not chx?

A

possibility of allergy to Chx, resulting in fatalities

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14
Q

failure to heal >2 weeks - possible reasons?

A
  • infection (prescribe antibiotics)
  • systemic condition (paget’s, cancer)
  • drug therapy that pt did not disclose (e.g. bisphosphonates)
  • oedema
  • osteonecrosis? BRONJ
  • adverse perio health
  • lingual/alveolar nerve damage
  • retained root
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15
Q

retained root - can be left if?

A

if small and if not abscessed

- otherwise remove

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16
Q

displaced root/tooth: where could it be?

A
  • may be under buccal or palatal mucosa
  • may be in mouth or up the suction tube
  • may be in the antrum
17
Q

retained root pushed into maxillary antrum - what could happen?

A
  • may resorb
  • may fibrose (easier to remove)
  • may cause infection (sinusitis)
  • may become an antrolith (remove if causes infection)
18
Q

large root in antrum: refer for what procedure?

A
  • caldwell-luc operation or endoscopy (functional endoscopic sinus surgery)
  • may also require repair of OAC/OAF
19
Q

dental management of patients taking bisphosphonates?

A
  • discuss risks and benefits of treatment
  • receive routine dental care esp prior to bisphosphonates
  • drug holiday? but will increase risk of diseases such as osteoporosis
20
Q

management of those on bisphosphonates?

consider CTX value

A
  • pre operative chx(?)/ drug holiday?
  • value of serum CTX (c terminal telopeptide)
  • bone resorption increases the CTX value (from collagen type I degradation)
  • bisphosphonates stop bone resorption, therefore decreasing CTX value
  • high risk if CTX value below 100pg/ml
21
Q

what to do when things go wrong?

A
  • recognize, tell patient
  • be honest
  • be objective, factually accurate, sensitive (but aplogize)
  • record events in notes, including explanation and mitigating factors
22
Q

options for patients to lodge a complaint? (private & NHS)

A
  • private: dental complaints service (GDC)
  • NHS:
    scotland - NHS national services scotland
    england: NHS choices
    N.I - NI direct
    wales: NHS direct

ORAL SURGERY (1 decks)

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