Exodontia (1) Flashcards
Name 5 indications for extraction
- Severe caries
- Pulpal necrosis
- Severe periodontal disease
- Impacted teeth
- Orthodontic requirement
Describe the contraindications to exodontia
- Contraindications are relative and tend not to be absolute
- It is more about minimising risk
- Systemic contraindications usually relate to medical history
- Local contraindications tend to be radiotherapy, bisphosphonate use or relation to tumours
What is the function of a preoperative assessment?
Assess how difficult the extraction is going to be
Describe 5 components of a general preoperative assessment
- Age
- HPC
- PMH
- PDH
- Examination
Describe how age can affect the difficulty of an extraction
- Children may be unable to co-operate
- Elderly patients have less elastic bone and co-morbidities
Name 3 complicating factors for an extraction with regards to HPC
- Pain
- Swelling
- Limited opening
Name 5 ways PMH can affect exodontia
- Access
- Cooperation
- Procedure
- Post operative complication
- Risk of systemic complications
Name 4 ways access may be affected by PMH
- Limited mouth opening due to radiotherapy
- Neck or back problems making positioning difficult
- Syndromes
- Obesity
Name 4 ways cooperation may be affected by PMH
- Movement disorders
- Behavioural problems
- Learning difficulty
- Dementia
Name 2 ways the procedure may be affected by PMH
- Osteogenesis imperfecta
2. McCabes disease
Why does McCabes disease affect exodontia?
In McCabes disease means teeth are more prone to fracture and turn into surgical extractions
Name 3 ways PMH may affect post operative complications
- Liver problems
- Diabetes
- Previous radiotherapy
Name 5 patient groups at risk of systemic complications following exodontia
- Cardiovascular disease
- Asthma
- Epilepsy
- Addisons disease
- Diabetes
Name 5 types of medications which can have an effect on exodontia
- Warfarin / NOACs (bleeding risk)
- Aspirin / Antiplatelet drugs (bleeding risk)
- Steroids (post op infection)
- Chemotherapy drugs (post op infection)
- Bisphosphonates (ONJ)
Describe 4 general components during an examination for exodontia
- Demeanour
- Swelling
- Problems with access
- Problems with position
Name 3 main aspects of the assessment of the tooth
- Crown integrity
- Root size and morphology
- Condition of surrounding bone
Why is crown integrity important during an assessment of a tooth for exodontia?
- Important as this is where the forceps are applied
- Difficult to position forceps correctly if tooth carious or broken down
Why is root size and morphology important during an assessment of a tooth for exodontia?
- Large root surface means more difficult extraction
- Roots which diverge tend to be more difficult
Why is the condition of the surrounding bone important during an assessment of a tooth for exodontia?
- Teeth affected by periodontal disease will be easier to remove
- Palpate for thickness
- Bone density and elasticity will play a role but difficult to assess
What must always be done before exodontia?
A radiograph (usually IOPA or OPT) must be taken
Name 3 things a pre operative radiograph must show
- Root numbers, shape and orientation
- Associated local structures (sinus / IDN)
- Condition of surrounding bone
Name 6 intra operative complications of exodontia
- Root fracture
- Fracture of alveolar bone
- Fractured tuberosity
- OAC
- Root displaced into antrum
- Damage to mental or ID nerve
Describe the complications with a root fracture during exodontia
- Decision to leave or remove (can leave smaller usually)
- Any infection risk
- Reason for initial exodontia will matter e.g pre radiotherapy
- Proximity to important anatomical landmarks
Describe the complications with a fracture of the alveolar plate during exodontia
- Leave or remove depending on size and blood supply
- Usually seen as a tear in mucosa and bone moving with the tooth
- Large bodies can be left unless there is poor blood supply
Name 5 common risk factors for a fractures tuberosity
- Long or bulbous roots
- Hypercementosis
- Multi rooted teeth
- Lone standing upper molars
- Pneumatized sinus / sinus pathology
Name 4 signs a fractured tuberosity has occured
- Crunch or loud crack of bone breaking
- Sudden loosening of tooth and bone together
- Bone comes away with tooth during extraction
- Tear in mucosa
Describe 3 ways to diagnose a fractured tuberosity
- Confirmed mobility of fracture fragments
- Radiographic evidence of fracture
- Determine size and if sinus involvement
Describe how to manage a fractured tuberoisty
- Small fragments without sinus involvement can be dissected out
- Large fragments, sinus involvement or multiple tooth involvement will need to be left in situ, 1st stage endo and onward referral for surgical removal
What is an oro-antral communication?
Communication between maxillary sinus and oral cavity
What is an oro-antral fistula?
If an OAC is not treated it can become lined with epithelium and is termed a fistula
What is the major issue with an OAC?
Allows the flow of food, fluid, bacteria etc from the mouth the maxillary sinus and the nose
Name 4 predisposing factors of OAC
- Lone standing molars
- Pneumatisation of the sinus
- Proximity of molar roots to maxillary antrum
- Difficult extractions
Name 4 ways to diagnose an OAC
- Sinus lining visible
- Air bubbles in socket
- Change of tone in the suction
- Very gentle probing with blunt instrument
Name 5 ways to manage a patient with an OAC
- Small fistulae may close spontaneously but will need follow up
- Large fistulae require buccal advancement flap ASAP
- Sinus regimen
- No nose blowing
- If unable to advance flap, pack and refer ASAP
What is the most common cause of root displacement into the antrum?
Usually due to injudicious use of elevators (operator error)
Describe the management of a root being displaced into the antrum
- Needs removed and resultant OAC closed
- Specialist referral
- Better to be done ASAP before cilia in sinus brush root towards top
When is damage to ID or mental nerve most likely to occur?
Extractions of lower 8s
Name 3 post operative complications
- Bleeding
- Infection
- Dry socket
Name 3 types of haemorrhage following extractions
- Primary (during surgery)
- Reactionary (within 24 hours due to failure to follow post op instructions)
- Secondary (days later due to infection)
Describe how to manage a haemorrhage during exodontia
- Reassure patient and make them comfortable
- Check medical history
- Identify the cause of bleeding
- Damp gauze and biting will usually stop bleeding
- Surgicel and sututre (possible antibiotics)
Describe dry socket as a post operative complication of exodontia
- Blood clot fails to form or breaks down
- Extremely painful
- Debris found in the socket with no clot
- Reassure, irrigate and sedative dressing eg alvogel
