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BODC exodontia yr 2 > dry sockets and bisphosphonates > Flashcards

dry sockets and bisphosphonates Flashcards

1
Q

stages of socket healing normally (immediate to 12 months)

A

Immediate reaction
- blood clot forms
- white cells
- vasodilation
1st week
- fibroblasts, capillaries – granulation tissue
- early bone resorption in the borders of socket
- epithelial proliferation over top of socket
2nd week
- significant epithelisation – epithelial continuity achieved
- bone resorption, osteoid formation, maturing granulation tissue
4th week/6th week
- new bone formation
12months
- fully healed

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2
Q

dry socket, and effect and what it is also known as

A

early disruption of the healing
Alveolar osteitis/fibrinolytic alveolitis

Local inflammation of the bone, limited to socket wall
- due to loss of blood clot from socket

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3
Q

symptoms of dry socket

A
  • severe pain
  • resistant to simple analgesics
  • bad taste/smell
  • localised inflammation and tenderness
  • partial or total loss of blood clot
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4
Q

other things similar to dry socket but not dry socket

A

septic socket
osteomyelitis
osteonecrososs

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5
Q

ostenecrosis

A

death of portion of the Jae bone

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6
Q

septic socket

A

infection of the socket

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7
Q

osteomyeleitis

A

infection involving cancellous bone

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8
Q

aetiology of dry socket

A

1- failure of clot to form

2) clot degredation
3) clot loss
4) bacterial colonisation

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9
Q

what can cause failure of the clot to form

A

poor blood supply
smoking
sclerotic bone

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10
Q

clot degredation cause

A

firbinolysis as a result of oestrogen, trump, bacterial pyrogens

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11
Q

clot loss can be duet to

A

excessive mouth washing

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12
Q

why is dry mouth more likely for wisdom

A

lower jaw denser

more likely to have a traumatic removal than other teeth

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13
Q

risk factors for dry socket (patient and technical factorS)

A

patient factors

  • female
  • OCP and menstruation
  • smoker
  • age
  • failure to comply with POI (post operative instructions)
  • poor healing
  • sterioids

technical factors

  • posterior
  • mandible
  • pre existing infection/pericoronitis
  • traumatic extraction
  • experience of surgery
  • inappropriate irrigation
  • LA load (vasoconstrictor)
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14
Q

medications that may dispose to dry socket

A

steroids
cyclosporins
methotrexate
OCP

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15
Q

poor healing of socket risk factors

A
  • smoking
  • steroid therapy
  • immunosuppression/therapy
  • poor controlled diabetes
  • bone pathology
  • poor hygiene
  • previous radiotherapy
  • site of tooth extraction (mandible over maxilla)
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16
Q

how to prevent dry socket

A
  • post op mouthwash
  • avoid smoking
  • BIPP (historical)
  • pre emptive alvogyl (placed into the socket)
  • PRF(no evidence
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17
Q

therapeutic measures to prevent dry socket

A
  • irrigate
  • dress (alvogyl)
  • Analgesia
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18
Q

what does alvogyl contain

A

butamben
iodoform
eugenol

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19
Q

butamben

A

LA

removes pain

20
Q

iodoform

A

antiseptic

remove bactera

21
Q

eugenol

22
Q

septic socket symptoms

A

Symptoms for dry socket (and evidence of infection)

  • extra oral swelling
  • lymphadenopathy
  • formation of pus
23
Q

management of septic socket

A
  • same as dry socket

- antibiotics can be used, metronidazole (helps deal with infective part, not useful in dry socket)

24
Q

prevention of septic socket

A
  • careful POI
  • antibiotics to compromised patients/history of septic socket
  • consider antibiotics if surgical site is infected at the time of surgery (esp with wisdom)
25
delayed healing
Socket almost healed over, but not quite right
26
what can cause delayed healing
``` Consider other diagnosis - eg retained root - SCC(squamous cell carcinoma) Delayed healing treatment - curettage (with dressing) ```
27
osteomylitis and symptoms
``` infection into cancels part of bone - pain - altered sensation - pus, sinus infection ```
28
acute vs chronic
chronic beyond 4 weeks
29
histology and microbiology of osteomyelitis
Looks like dead bone - loss of osteocytes from lacunae (necrotic bone) - leukocytic infiltration Histology - scalloping of bone - leukocytic infiltrate in marrow spaces - necrotic bone (lacunae devoid of osteocytes)
30
polymicrobial infection of osteomyelitis
- bacteriodes - porphyromonas - prevotella - staphylococcci
31
osteoradionecrosis and what it leads to
exposed to radiograpy | - causes endarteritis obliterans and damage to bone cells (arteries furinng up in bone, worse blood supply)
32
threshold between high and low risk for osteoradionecrosis
65 grays
33
management of osteonecrosis
- prevention better than cure - remove teeth of doubtful prognosis prior to radiotherapy - good oral health and prevention with F- - need antibiotics and careful surgery - hyperbaric oxygen, antibiotics if infected, debridement
34
MRONJ
Medication related necrosis of jaws | Previously known as BRONJ, bisphosphonates cause this
35
bisphosphonates
- Risedronate - Alendronate - Etidronate - Pamidronate *** - Zoledronate *** * **intravenous, therefore given for more severe illnesses
36
what do bisphosphonates do
reduce bone turnover through effects on oestoclasts
37
benefits of bisphosphonates in different diseases
1) osteoporosis - deposition less than resorption 2) pagets - excessive resorption +- deposition 3) metastasis - invasion involves bone resorption - therefore stop the cancer
38
structure of bisphosphonates
- 2 phosphonate groups (PO3) groups - linked by central carbon - 2x side chains (R groups) Phosphonate groups bind to calcium on bone - R group then exposed
39
nitrogenous vs non nitrogenous R group
Nitrogenous - prevent formation of proteins needed to maintain osteoclast cytoskeleton (loss of ruffle border) - disruption rather than killing Non nitrogenous - compete with ATP leading to osteoclast apoptosis - usually too toxic, kill of osteoclasts
40
criteria for MRONJ
exposed bone for more than 8 weeks no history of RT patient is linked drugs wise to it
41
stages of MRONJ
``` 0 - non specific, pain radiograph changes no exposed bone 1 exposed/necortic bone.no symptoms or infectin 2 exposed necrotic bone infection+- pus 3 as above extends beyond alveous etraorla features fracture ```
42
why does MRONJ occur
1) anti angiogenesis - compromised blood supply 2) direct toxicity to cells within bone - bone necrotic 3) toxicity to overlying soft tissues - inability to heal over exposed bone
43
prevention for MRONG
1) stop bisphosphonate? - risk of BRONJ persists for 12m - no merit for oral patients - some merit in a 3m drug holiday for IV - coming off medication may be outweighed 2) piecemeal extractions - reduce mucoperiosteal stripping 3) CTX (C terminal cross linking telopeptide) - marker of burn turnover? Classifies BRONJ risk - not predictive of BRONJ
44
patients with high IV dose of bisphosphonates
High risk of MRONJ - use antibiotic prophylaxis - may not prevent but lower the staging of MRONJ recommending - antibiotics 2 day before, 14 days after
45
management of MRONJ
``` Management is supportive - analgesia - chlorhex M/W - antibiotics if frank pus/pain - limited debridement Close review - consider withdrawal of bisphosphonate ```
46
different diagnosis of dry socket and how to rule out
septic socket - full exam, presence of pus, systemic signs of infection, lymphadenopathy retained root - radiograph MROJ- associated medications, review healing untill 8 weeks

BODC exodontia yr 2 (25 decks)

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