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BDS4 > Perio-operative Extraction complications > Flashcards

Perio-operative Extraction complications Flashcards

1
Q

Why would there be difficult access to the tooth when XLA? (3)

A
  • Trismus
  • Reduced mouth opening due microstomia
  • Crowded or malpositioned teeth
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2
Q

You have a patient for extraction, during the procedure you notice abnormal resistance , what might this be due to? (4)

A
  • Thick cortical bone
  • Hypercementosis
  • Ankylosis
  • Number of roots and shape of roots
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3
Q

Why might a tooth or root fracture during XLA?

A
  • Caries
  • Poor alignment of tooth
  • Small size tooth
  • Root morphology - fused or convegent/divergent
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4
Q

How would you prevent a jaw fracture?

A
  • do not put too much pressure
  • take pre-op radiographs
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4
Q

Why might a jaw fracture occur during an extraction?

A
  • Impacted tooth
  • Large cyst
  • Atrophic mandible
  • Too much force application
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5
Q

A jaw fracture occur while you are extracting a tooth , what would be your management?

A
  • Inform patient
  • Post op radiograph
  • Refer by phone call
  • Ensure analgesia and stabilise
  • If there is a delay in management consider ABs
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6
Q

What 3 ways can the maxillary antrum be involved during an extraction?

A
  • Oroantral communication
  • Loss of root in antrum
  • Fractured tuberosity
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7
Q

2 ways to assess the risk of involvement in maxillary antrum?

A
  • Size of tooth
  • Radiographic position of roots in relation to antrum
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8
Q

5 ways to diagnose involvement of maxillary antrum?

A
  • Bone at trifurcation of roots
  • Bubbling of blood in the socket
  • Nose holding test
  • Direct vision with good light
  • Echo sound of suction
  • Using a blunt probe
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9
Q

What is the difference between OAC and OAF?

A
  • OAC is an acute communication with the maxillary antrum whereas OAF is a chronic communication involving the formation of an epithelium
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10
Q

How to manage small maxillary involvement ?

A
  • Inform patient
  • Encourage clot formation and suture margins
  • Prescribe antibiotic and give post-op instructions
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11
Q

How to manage large communication with maxillary antrum or torn lining between ?

A
  • Close with buccal advancement flap
  • ABs and nose blowing instructions
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12
Q

How would you manage lost root in antrum?

A
  • Confirm radiographically by OPT , occlusal or PA
  • Retrieve using ribbon gauze if possible
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13
Q

5 factors that may increase the liklihood of tuberosity fracture?

A
  • Single standing molar
  • Extracting in the wrong order
  • Pathological gemination
  • Inadequate alveolar support
  • Unknown unerupted wisdom tooth
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14
Q

How would you clinically diagnose tuberosity fracture in 4 ways?

A
  • Noise
  • Movement noted both visually of with supporting fingers
  • Tear on palate
  • More than one tooth movement
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15
Q

7 management options for tuberosity fracture?

A
  • Dissect out and suture
  • Reduce and stabilise using fixation
  • Remove or treat pulp
  • Ensure occlusion is free
  • ABS and antiseptics
  • Post op instructions
  • Remove tooth 8 weeks later
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16
Q

How would you reduce maxillary tuberosity fracture?

A
  • Using fingers or forceps
17
Q

What would you use for fixation of maxillary tuberosity fracture?

A
  • Splints
  • Orthodontic buccal arch wire
  • Arch bar
18
Q

You were extracting a tooth and suddenly it was lost , what would be your immediate management?

A
  • Stop and inform patient
  • Search for tooth
  • Suction
  • Take radiograph
19
Q

How would you prevent soft tissue damage during an extraction?

A
  • Correct placement using correct instrument
  • Take time positioning instrument
  • Good application point
  • Controlled pressure
  • avoid excessive force
20
Q

2 ways you can cause damage to nerve?

A

La and surgery

21
Q

What are the 3 types of nerve injuries?

A
  • Crush injuries
  • Cutting injuries
  • Transection of nerve
22
Q

What is neuropraxia?

A

Contusion of nerve with continuity of epieneural sheath and axons maintained

23
Q

What is axonotmesis?

A

Continuity of axons disrupted but not epineural sheath

24
Q

What is neurotmesis ?

A

Complete loss of nerve continuity

25
Q

5 types of nerve feelings?

A
  • Anaesthesia - numbness
  • Paraesthesia - tingling
  • Dysaesthesia - pain
  • Hypoaesthesia - reduced sensation
  • Hyperaesthesia - heightened sensation
26
Q

What 5 types of vessels that can be damaged during extraction?

A
  • Veins - bleeding
  • Arteriies - spurting and haemorrhage
  • Arterioles - spurting and pulsating bleed
  • Vessels in muscles
  • Vessels in bone
27
Q

4 causes of peri-operative haemorrhage?

A
  • Local factors such as mucoperiosteal tears or alveolar plate fracture (most cases)
  • Undiagnosed clotting abnormalities (haemophilia and von Willebrands)
  • Liver disease (alcoholism)
  • Medications such as antiplatelets and anticoagulants
28
Q

2 examples of antiplatelet medication?

A
  • Aspirin
  • Clopidogrel
29
Q

2 examples of anticoagulants other than Warfarin?

A
  • Rivaroxaban
  • Dabigatran
30
Q

4 ways you can stop a haemorrhage during extraction in soft tissues?

A
  • Pressure with damp gauze
  • Sutures
  • LA with VC
  • Diathermy - burn vessels to form protein plug in vessels
  • Ligatures and artery clips for larger vessels
31
Q

6 ways to stop haemorrhages from bone?

A
  • Pressure with swab
  • La injected into socket or via swab
  • Blunt instrument
  • Bone wax
  • Haemostatic agents
  • Pack
32
Q

During an extraction , the TMJ dislocated ,immediate management option?

A
  • Relocate immediately
33
Q

TMJ dislocated , you tried relocating it and was unable to , what would be your next step?

A

Try relocating with anaesthetic into the masseter intra-orally

34
Q

You tried to relocate TMJ using anaesthetic into masseter and you could not , what would be your management?

A

Immediate referral

35
Q

2 advice you would give a patient after relocating TMJ?

A
  • Analgesia
  • Supported yawning
36
Q

3 ways you can damage adjacent teeth or restorations during an extraction?

A
  • Hit opposing teeth with forceps
  • Crack or move adjacent teeth with elevators
  • crack or remove adjacent restorations
37
Q

3 management options for damage to adjacent teeth/restorations?

A
  • temporary dressing or restoration
  • arrange appt for definitive restoration
  • Warn patient about the risk before procedure
38
Q

How would you manage if an instrument was broken during exrtraction and you could not locate it ? for example tips of elevators/luxators/burs ?

A
  • Radiograph and retrieve
  • If unable to retrieve -refer
39
Q

5 ways you can determine that you are treating the correct tooth?

A
  • Concentrate
  • Check clinical situation against notes and radiographs
  • Safety checks
  • Count teeth
  • Verify with someone else
  • Contact defence unioin
40
Q

List 10 peri-operative extraction complications?

A
  • Damage to adjacent teeth and restoration
  • Maxillary tuberosity fracture
  • OAC
  • treating the wrong tooth
  • haemorrhage
  • damage to soft tissue and bone
  • TMJ dislocation
  • Broken instruments
  • Nerve damage
  • Lost root in antrum

BDS4 (68 decks)

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