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3rd yr- CSB- Oral surgery > Complications of tooth extraction > Flashcards

Complications of tooth extraction Flashcards

1
Q

What is a complication

A

Any event that would not normally occur or an unanticipated problem that carries following and is a result of a procedure, treatment or illness

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2
Q

What are the implications of complications

A
  1. Was the reason for the surgery valid
  2. Patients expectations of the surgery
  3. Legal issues could the patient sue
  4. Management of the event is key
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3
Q

How can we prevent, limit and prepare for compilations

A
  1. TAKE a Thorough history & exam
  2. Know the pt. and their problem
  3. Know your abilities & facilities
  4. Use appropriate investigation
  5. Have a diagnosis that fits the facts
  6. Agree a treatment plan with the patient
  7. Warn the patients of any complications that may arise
  8. Follow accepted practice & use the correct instruments for practice
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4
Q

What complications can occur during tooth extraction

A
  1. Fracture of tooth or incomplete extraction
  2. Fractures tuberosity
  3. Pushing roots into the antrum leading to OAC
  4. Iatrogenic complications
  5. Paraesthesia/ Anaesthesia/ Nerve damage
  6. Fractured mandible
  7. Loss of tooth or fragments into deep structures
  8. Inhalation of tooth fragments
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5
Q

What should we check for following extractions

A

Check apices of extracted teeth are intact

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6
Q

When can we leave an apices in situ

A
  1. As long as there is no infection
  2. Fragments should no exceed 1/3 of the root
  3. Should not have been displaced from socket
  4. No risk of distant infection such as endocarditis
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7
Q

Why might you not be able o retrieve apices

A
  1. There is a considerable risk to adjacent structures such as nerves or antrum
  2. The patient declines further surgery
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8
Q

Why might fractured tuberosity occur

A
  1. Lone standing molars
  2. Increased bone density
  3. Incorrect use of instruments
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9
Q

How do we recognise fractured tuberosity

A
  1. Audible crack of bone fracturing on attempted extraction
  2. Movement of the tuberosity
  3. Palatal tear
  4. Difficult extraction
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10
Q

How do we manage tooth fracture

A
  1. STOP
  2. Explain to the patient what has happened
  3. Dont remove the mobile segments
  4. Refer or seek advice ASAP
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11
Q

what is oroantral communication

A

A non epithelialised passage between the oral cavity and the maxillary antrum

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12
Q

What is oroantral fistula

A

A pathology epithelial lined tract between the oral cavity and the maxillary sinus

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13
Q

What is oroantral communication due to

A

Root fracture

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14
Q

What is an oroantral fistula caused by

A

Usually as a result of an unresolved oroantral communication

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15
Q

What do we do if the roots are lost in the antrum

A

Estimate the amount of roots that are unaccounted for

Take radiographs and inform the patient.

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16
Q

List some predisposing factors to oroantral communication

A
  1. Teeth close to sinus
  2. Thin alveolar bone
    3, Periapical infection
  3. Root morphology
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17
Q

List some Iatrogenic factors that may increase likelihood of oroantral communication

A
  1. Traumatic extractions

2. Use of elevators

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18
Q

List soem signs and symptoms of oroantral communication (OAC)

A
  1. Radiographic findings
  2. A visible defect between the mouth and antrum when looking with a mirror
  3. Bone fragments with a smooth concave upper surface adhering to the root of extracted tooth
19
Q

How do we investigate a suspected oroantral communication

A
  1. DO NOT probe for an OAC
  2. Test for suspected OAC by instructing the patient to gently blow the nose whilst pinching their nostrils
  3. if bubbles of blood and saliva found in the socket then OAC
20
Q

List some signs and symptoms of an oroantral fistula (OAF)

A

1 Soft tissue proliferation around socket
2. Prolapse of sinus lining
3, Discharge of infected material
4. Reflux of fluid into nose
5. Air escapes into mouth on nose blowing

21
Q

How do we treat an oroantral fistula

A

Refer for specialist treatment as minor oral surgery may be required

22
Q

Where do inhaled teeth usually end up lodging

A

In the right bronchus due to anatomy

23
Q

What should you do if you thin k the paint has inhaled their tooth

A

Get them to cough vigorously

If it doesn’t dislodge then refer to the hospital

24
Q

List some completion that can occur after procedure

A
  1. Abnormal bleeding
  2. Dry socket
  3. Infection
  4. Osteonecrosis
  5. Anaesthesia/ paraesthesia
25
Q

How can we reduce the chances of abnormal bleeding after a procedure

A

Take a thorough history and make sure you have a valid INR number from patients on anticoagulants

26
Q

What is classified as abnormal bleeding

A

Patient who bleeds beyond normal limits as a result of treatment

27
Q

What should the iNR be before we continue with extraction

A

Less than or equal to 4.0

28
Q

If a patient is bleeding abnormally after extraction and they don’t have anything in their medical history what should you look for

A

Tears in the mucosa

29
Q

How can we control bleeding

A
  1. Place direct pressure on socket
  2. Place pressure on the artery leading to the socket
  3. Suture/ligate
  4. Use local heamostatic agents
  5. Use systemic agents like vitamin k
30
Q

Give examples of some local haemostatic agents

A

Surgicel,
Kaltostat,
collagen granules,
fibrin foam

31
Q

What is another term for dry socket

A

alveolar osteosis

32
Q

What is alveolar osteosis

A

Inflammation of bone

33
Q

How common is dry socket

A

Occurs in 3% of extractions

34
Q

When does dry socket usually occur

A

2-3 days post op

35
Q

Give some signs and symptoms of dry socket

A
  1. Halitosis
  2. Foul taste
  3. Severe pain not eased by analgesia
  4. Socket is partly of completely devoid of a blood clot
36
Q

What can increase your chance of developing dry socket

A
  1. Smoking
  2. Mandibular teeth extraction
  3. Excessive mouth rinsing in the first 24 hrs
  4. Single extraction
  5. Traumatic/difficult extraction
  6. Increased bone density
  7. Females taking oral contraceptives
  8. Poor OH
37
Q

How can we treat dry socket

A
  1. Explain to the patient they have dry socket
  2. Irrigate with warmed saline
  3. Place a small amount of Alveogyl obtundent dressing in the socket
  4. Will heal eventually
38
Q

If post op a patient develops a systemic infection what can we prescribe

A
  1. Amoxicillin 500mg TDS PO (double if severe)

2. Metronidazole 200 mg TDS PO (double if severe)

39
Q

What is osteonecrosis caused by

A

antirespoptive medications including bisphosphonates

40
Q

How can bisphosphonates lead to osteonecrosis

A

Bisphosphonates inhibit osteoclasts resorption thus decreasing the rate of turn over

41
Q

Name soem commonly prescribed bisphosphonates

A

Alendronic acid & Risedronate sodium

42
Q

Whom might be prescribed bisphosphonates

A

Patients with cancer, osteoporosis or pagets disease

43
Q

What can increase your risk of developing osteonecrosis

A
  1. Age
  2. Surgical procedures
  3. Medication
44
Q

What is the treatment for osteonecrosis

A

Nothing just good oral hygiene, prevention and abiding surgery

3rd yr- CSB- Oral surgery (4 decks)

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