Complications of Oral Surgery Flashcards
examples of pre-operative complications?
- submerging teeth
- note proximity of antrum, curved roots
- abscesses (sinusitis)
intra-operative complications?
- loose adjacent tooth
- failure to obtain LA
- wrong tooth
- tooth inhaled/swallowed
- fractured bur
- failure to move the tooth
- fractured alveolar plate
- difficult extraction i.e. curved root
- root/crown fracture
- damage soft tissues/adjacent tooth/restoration
- fractured tuberosity/mandible
- displaced tooth
- dislocated TMJ
- bleeding
bleeding: why? where from? management?
- 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
bleeding: when to refer?
if BP below 100/60, and heart rate >100bpm
post op advice in 1st 24 hours?
- 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
why should we be careful with elevators?
potential of disturbing the adjacent tooth e.g. restorations on the area immediately next to the tooth
departmental protocol to prevent WSS?
- check notes
- ask pt which tooth
- get pt to point
steps to prevent dislocation of jaw?
- support jaw properly
- do not use excessive force
- do not over-open the mouth
tuberosity fracture: what to do if:
- fragment is small?
- if there is pulpal infection?
- if the tooth is not carious?
- remove it
- remove tooth and check for OAC
- if tooth not carious, splint and surgically remove 1/12
post op complications?
- bleeding
- infection
- OAF
- trismus
- haematoma
- swelling
- dry socket
- osteomyelitis
- needle track infection
- nerve damage
dry socket - risk factors?
- the pill
- radiotherapy
- previous dry socket
- mandibular extractions
- smokers
- females
- drugs e.g. BRONJ
dry socket - occurs due to?
- loss of blood clot that occurs due to underactive clotting, or overactive fibrinolysis
dry socket - why irrigate with saline and not chx?
possibility of allergy to Chx, resulting in fatalities
failure to heal >2 weeks - possible reasons?
- 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
retained root - can be left if?
if small and if not abscessed
- otherwise remove
displaced root/tooth: where could it be?
- may be under buccal or palatal mucosa
- may be in mouth or up the suction tube
- may be in the antrum
retained root pushed into maxillary antrum - what could happen?
- may resorb
- may fibrose (easier to remove)
- may cause infection (sinusitis)
- may become an antrolith (remove if causes infection)
large root in antrum: refer for what procedure?
- caldwell-luc operation or endoscopy (functional endoscopic sinus surgery)
- may also require repair of OAC/OAF
dental management of patients taking bisphosphonates?
- 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
management of those on bisphosphonates?
consider CTX value
- 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
what to do when things go wrong?
- recognize, tell patient
- be honest
- be objective, factually accurate, sensitive (but aplogize)
- record events in notes, including explanation and mitigating factors
options for patients to lodge a complaint? (private & NHS)
- private: dental complaints service (GDC)
- NHS:
scotland - NHS national services scotland
england: NHS choices
N.I - NI direct
wales: NHS direct
