Extraction Complications 3

Question 1

what are the common POST EXTRACTION COMPLICATIONS?

Answer 1

• pain/swelling/ecchymosis (small bruise by leaking blood vessel)
• trismus/limited mouth opening
• haemorrhage/post-op bleeding
• prolonged effects of nerve damage
• dry socket (alveolar bone exposed, very sore)
• Bone sequestrum (necrotic bone that has separated from healthy bone)
• infected socket
• Oroantral fistula

Question 2

what are the LESS COMMON POST-OP COMPLICATIONS?

Answer 2

• osteomyelitis (infection of bone & bone marrow)
• medication related osteonecrosis (MRONJ)
• bacteraemia/infective endocarditis (patients with valve replacement prone)

Question 3

what is oedema?

Answer 3

swelling

• part of inflammatory reaction to surgical interference
• increased by poor surgical technique
• wide individual variation

Question 4

what is ecchymosis?

Answer 4

Bruising

• increased by poor surgical technique
• variation between individuals
• rough handling of tissues etc

Question 5

what is trismus?

Answer 5

muscle spasms in your TMJ / jaw stiffness / inability to open mouth fully

Muscles include:
- lateral & medial pterygoid
- temporalis
- masseter

Question 6

A patient on anticoagulants (like warfarin), what is the INR needed to be able to carry out invasive treatment?

Answer 6

3.9 or lower

IF 4, CANNOT PROCEED!

Question 7

what should you do for a patient on antiplatelet drugs if you’re going invasive treatment?

Answer 7

aspirin alone:
continue treating without interrupting meds - consider limiting initial treatment area and see how patient is. Then proceed.

Clopidogrel + aspirin:
EXPECT PROLONGED BLEEDING, start small initial bleeding. Make sure to suture and pack area for good haemostatic control.

SDCEP guidelines

Question 8

what are some haemostatic agents (things that help stop bleeds)?

Answer 8

• LA with adrenaline (vasoconstrictor)
• Surgicel (helps produce clot)
• hemocollagene sponge - meshwork allows for clot formation. Similar to kitchen sponge
• floseal

Question 9

what are systemic haemostatic aids (things within the body) that help with clotting?

Answer 9

• Vitamin K (necessary for formation of clotting factors in liver)
• antifibrinolytics (prevents clot breakdown/stabilises clot) [PREVENTS BREAKDOWN OF FIBRIN]

Question 10

whats the difference between neurapraxia, axonotmesis, neurotmesis?

Answer 10

neurapraxia - most mild nerve damage, bruising of nerve (contusion)

axonotmesis - axons ok, epineural sheath disrupted

Neurotmesis - nerve transected, no longer works (worst damage)

Question 11

what is dry socket and whats its actual medical term?

Answer 11

alveolar osteitis

when the clot of a socket breaks down or does not form exposing alveolar bone which gets irritated and inflamed

Question 12

what are predisposing factors for dry socket?

Answer 12

• most common in molars.
• mandible most common
• female
• smoking (reduced blood supply)
• LA - vasoconstrictor

Question 13

how can you manage a pt with dry socket?

Answer 13

• supportive, say that its normal and doesn’t mean the treatment went badly
• irrigate with warm saline (wash out debris)
• antiseptic pack (alvogyl)
• warm salty mouthwash

Question 14

what is a bone sequestrum?

Answer 14

a piece of devascularised bone

• delays healing/requires removal
• quite common