Consent for Extractions Flashcards
Triangulation for history for exodontia?
(Clerking)
Your history/exam findings
Referral letters details
Pts understanding of why they attended
= if everything matches up, can take tooth
Do you check who referred the pt?
Yes, when we are finished you need to refer back
Dentist
Orthodontist
A and e
Doctor
Student resto clinic
Review of systems?
Heart, lung, kidney
Excessive bleeding
Delayed/non healing
Collapse
Haemophelia types? - extensive bleeding
A and B
Haemophelia A?
Factor 8 in clotting cascade
Haemophelia B?
Factor 9 in clotting cascade
What to give pt with Haemophelia A?
Factor 8 precipitate
or plasma
What is Von Willebrand factor?
stabilises factor 8
Missing factor 8, doesn’t last as long so less of it
Can’t make fibrin mesh, wont stop bleeding
cant produce clots quickly
What to give pt with Von Willebrands factor?
desmopressin
Role of desmopressin?
which increases levels of Von Willebrand Factor and Factor VIII in the blood by releasing them from storage (endothelial cells).
This is given as an injection under the skin or into a vein or as a ‘sniff’ up the nose.
acquired blood disorders? - anticoagulants
Warfarin
DOACs:
rivaroxaban (brand names include Xarelto)
dabigatran (brand names include Pradaxa)
apixaban (brand names include Eliquis)
edoxaban (brand names include Lixiana).
Blood thinners - antiplatelets?
Aspirin
clopidogrel = newer
DH?
Regular/ irregular attender
Previous LA
Last visit and on going treatment e.g. denture/bridge/implant to replace extracted tooth
For EO exam, at would you play partiular attention to?
TMJ - will be putting a lot of pressure on this
Lymph nodes
Do you need to pay attention to teeth either side of the tooth you want to extract?
Yes, is it heavily restored, crown etc
apply a lot of pressure during extraction - if they are heavily restored they may not be able to cope
Diff dx?
List all the different possible diagnoses for the pt main compliant and secondary issues
Sieve approach
List in order starting with the most likely diagnosis
Special investigations?
Radiographs
Pulp sensibility testing
Transillumination
Diagnostic LA
Common determinants for extraction?
when tooth deemed unrestorable
Irreversible pulpits
periapical periodontitis
Dental abscess
subgingival caries
vertical fracture
advanced periodontitis
pt can refuse RCT - tooth can be extracted
Why sign a consent form?
It’s a record
It shows you have discussed:
Discussed the risks and benefits
Explained procedure
Post op:
Swelling
Bruising
Limited mouth opening
Pain
Complications may occur (e.g. excessive pain)
Congenital disease causing excessive bleeding?
haemophilia
Von Willebrand factor
DOACs?
direct oral anticoagulats
Anticoagulants vs antiplatelets?
anticoagulants - stop fibrin mesh
antiplatelets - inhibit platelet aggregation and inhibit thrombus
What could cause a pt to be delayed or non healing?
smokers
osteoporosis - bisphosphonates
monoclonal antibodies - work on osteoclasts for bone healing
steroids
diabetic pts
older pts
Names of bisphosphonates
pamidronate
alendronate
risedronate
zoledronic acid
What meds would a nervous pt take?
diazepam
beta blockers
Example of beta blocker for anxiety?
Propranolol
What antibiotic should you not mix with alcohol?
metronidazole
Example of DOACs?
rivaroxaban (brand names include Xarelto)
dabigatran (brand names include Pradaxa)
apixaban (brand names include Eliquis)
edoxaban (brand names include Lixiana).
