Extraction Complications Flashcards
What are some reasons for difficult access during extractions?
Trismus
Reduced aperture of mouth - congenital syndromes
Crowded teeth
Poor gag reflex
Why might there be abnormal resistance during extraction?
Thick cortical bone
Shape/ form roots - hooked
Number of roots
Ankylosis
Hypercementosis
What are the 3 anatomical structures that can fracture during extraction?
Tooth fracture
Alveolar bone fracture
Jaw fracture
What should you do if jaw fracture occurs during extraction?
Inform patient
Post-op radiograph
Refer (phone call)
Ensure analgesia
Stabilise
If there is delay, prescribe antibiotic
How should a large OAC be managed? (and/ or if lining is torn)
Close with a buccal advancement flap
Antibiotics and nose-blowing instructions
How should a small OAC (and/ or sinus intact) be managed?
Encourage clot
Suture margins
Antibiotic
Post-op instructions
What may happen if you do not expand the socket appropriately when extracting?
Fracture of the crown or alveolar bone - taking the tooth out too quickly
Where is the most common region for the buccal, alveolar plate to fracture?
The canine region
What should you do if there is an alveolar bone fracture but it is STILL ATTACHED to the periosteum?
Put the bone back in place, and suture the soft tissue back together
What are some indicators that tuberosity fracture has occurred?
Noise
Movement noted visually and/ or with supporting fingers
More than one tooth movement
Tear on the palate
What is the definition of neurapraxia?
Epineural sheath and axons are maintained.
Neurapraxia is the mildest form of peripheral nerve injury commonly induced by focal demyelination or ischemia.
In neurapraxia, the conduction of nerve impulses is blocked in the injured area. Motor and sensory conduction are partially or entirely lost.
What is axonotmesis?
2nd most severe type of nerve damage.
Nerves stretch and become damaged.
Epineural sheath is not damaged.
What is neurotmesis?
Complete loss of nerve continuity - nerve is severed.
What are the 5 types of nerve sensation?
Anaesthesia (numbness)
Paraesthesia (tingling)
Dysesthesia (unpleasant sensation)
Hypoaesthesia (reduced sensation)
Hyperaesthesia (increased/ heightened sensation)
What should you do if you think a patient has inhaled their tooth?
Refer to A&E for chest and abdominal imaging.
How to minimise likelihood of soft tissue damage?
- Correct placement of forceps - close the beaks around crown of tooth and work beaks down root of tooth while beaks are STILL CLOSED.
- Correct application point - for luxator and elevator
- Good retraction
What blood vessel is most likely to have been damaged if blood is spurting?
Artery or arteriole
What local factors cause most bleeds?
Mucoperiosteal tears or fractures of alveolar plate/ socket wall
Damage to soft tissues
What medical conditions are likely to cause increased bleeding following extraction?
Haemophilia
Von Willebrand’s
Liver disease
Why is there increased bleeding following extraction with liver disease?
Clotting factors are made in the liver