extraction complications 2 Flashcards
what should be done if tooth is lost during an extraction
stop and attempt to locate tooth
inform pt
radiograph may be required
if cant locate presume inhaled and send pt to A and E
Discuss appearance / cause and treatment if vessels are damaged during an extraction
veins will show a continuous bleed
arteries will pulse/ spurt
most bleeds are due to local factors e.g tears and fractures but may be due to patient factors e.g medications, liver disease
Tx - pressure with damp gauze, sutures, diathermy , pack with surgicel , more LA with vasoconstrictor , bone wax
What should be done if an instrument is broken during an extraction
most commonly occurs when instruments used incorrectly
take radiograph and retrieve or refer
if lost bur cant be located presume inhaled and refer to a and e
how long should swelling post extraction take to go down
around 48 hours but wide individual variation
medical term for bruising
ecchymosis
discuss bruising post extraction
individual variation and may be caused by medications or medical conditions
increased risk if poor technique
gravity may pull bruising down towards clavicle about a week post extraction
Causes of trismus from extraction
muscle spasm/ oedema - relating to long time with mouth open
LA - IDB into medial pterygoid
hematoma in medial pterygoid
damage to tmj
may take several weeks to resolve
tx for trismus post extraction
monitor
mouth opening exercises e.g stacked wooden spatulas
what should INR of warfarin patients be and when should it be checked prior to extraction
INR should be less than 4 and should be checked 24 hours prior to surgery
can be up to 72 hours if patient stably anticoagulated but 24 hours is ideal
medication should not be interupted
how should pts taking anti platelets be treated for an extraction
antiplatelets - aspirin , clopidogrel, prasugrel
taking aspirin alone - advise no interruption to meds and treat as normal
taking 2 antiplatelets - no medication interruption but expect prolonged bleeding and utilise suturing and packing
how should pts taking DOACS be treated for an extraction
(direct oral anticoagulants)
DOACs - apixiban , rivaroxaban
low bleeding risk procedures - treatment with no medication interruptions
high bleeding risk procedures - miss or delay morning dose (delay at least 4 hours post haemostasis)
reactionary bleeding
term used to describe bleeding that occurs within 48 hours of an extraction
causes: LA with vasoconstrictor wears off , sutures lost , pt traumatises area with tongue , fingers or food
secondary bleeding
term used to describe bleeding that occurs 3-7 days post op
often due to infection
usually mild ooze
Pt is bleeding lots post op , pressure on plain damp gauze isnt working , what to do ?
- swap to gauze soaked in LA with vasoconstrictor
- pack socket with surgicel and suture closed
haemacollagen framework - can be cut to size and inserted into socket to act as framework
thrombin liquid + powder injection - only for pts of known bleeding risk
oxidised regenerated cellulose
e.g surgicel
provides framework for clots to form
absorbed by the body
caution in lower 8 region as these are acidic and could damage IAN
what systemic treatments are there for prolonged bleeding for patients on medications increasing their bleeding risk
vitamin K
tranexamic acid - antifibrinolytic which prevents clot breakdown
what should be done if the patient develops a large jelly like clot after extraction
this clot may ooze over occlusal surfaces of adjacent teeth making it prone to bleeding due to constant trauma
use LA and remove clot, use local haemostatic measures to promote new clot formation
after how many months is nerve damage post op likely to be permanent/ experience no improvement
18 months
anaesthesia
numbness
paraesthesia
tingling
dysaesthesia
unpleasant sensation/pain
neuropraxia
‘bruising’ of a nerve
continuity of axons and sheath are maintained
axonotmesis
nerve damage
myelin sheath is disrupted but axon continuity is maintained
neurotmesis
severe nerve damage
nerve transected , complete loss of continuity
medical term for dry socket
alveolar osteitis
where is the most common place to get a dry socket
mandible , further back in mouth = more likely so most likely place is lower 8s
what does a dry socket look like
an empty socket with no clot, exposed bone
causes intense pain
lamina dura has become inflamed, clot was either never formed or lost early
when would a dry socket appear post extraction and how long would it take to resolve
appear 3-4 days post extraction and takes around 7-10 days to heal even with intervention
symptoms of a dry socket
- dull, throbbing, aching pain that may radiate to ear and keep pt up at night
- characteristic smell/bad odour , pt may complain of bad taste
- exposed bone is sensitive and is the source of pain
predisposing factors for a dry socket
mandible
molars
female
smoker (reduced blood supply)
oral contraceptive pill
excessive trauma during extraction
post op mouth rinsing
family history/ previous dry socket
LA with vasoconstrictor (still always use)
treatment for a dry socket
re assure pt
recommend analgesia
put LA in area
irrigate with warm saline
antiseptic pack e.g alvogyl - soothing and resorbable , may want to suture to keep in place
No antibiotics should be prescribed as it is not an infection
