Extraction Complications 3

Question 1

what are the post extraction complications

Answer 1

pain/swelling
trismus
haemorrhage
prolonged effects of nerve damage
dry socket
sequestrum
infected socket
chronic OAF

Question 2

what are the less common post op complications

Answer 2

osteomyelitis
osteoradionecrosis
medication induced osteonecrosis
actinomycosis
bacteraemia/infective endocarditis

Question 3

what can cause more pain to the patient

Answer 3

rough handling of tissues
laceration/tearing of soft tissues
leaving bone exposed
incomplete extraction of tooth

Question 4

how is swelling increased

Answer 4

poor surgical technique

Question 5

how is bruising increased

Answer 5

poor surgical technique
maybe underlying medical issues

Question 6

what are the causes of trismus

Answer 6

related to surgery
related to giving LA IDB
haematoma medial pterygoid
damage to TMJ

Question 7

how do you help manage trismus

Answer 7

monitor
gentle mouth opening exercise

Question 8

when do you want an INR check

Answer 8

within 24hrs prior to surgery

Question 9

do you need to stop antiplatelets for surgery

Answer 9

no but expect prolonged bleeding time

Question 10

what do you advise for apixaban or dabigatran

Answer 10

miss morning dose and take at usual evening time

Question 11

what do you advise for rivaroxaban

Answer 11

delay morning dose and take 4 hours after haemostasis has been achieved

Question 12

what do you advise for edoxaban

Answer 12

take at usual time in evening

Question 13

why would immediate post op bleeding occur

Answer 13

reactionary/rebound
vessels open up/vasoconstricting LA wears off, sutures loose or lost, patient traumatises socket

Question 14

why would secondary bleeding occur

Answer 14

infection or medication related

Question 15

what do you do if bleeding is coming from soft tissue

Answer 15

pressure with damp gauze
sutures
LA with adrenaline
diathermy

Question 16

what do you do if bleeding is coming from bone

Answer 16

pressure
LA on swab
haemostatic agents
blunt instrument
bone wax
pack and suture

Question 17

what are the topical haemostatic agents

Answer 17

adrenaline containing LA
cellulose - surgicel
haemocollagen sponge
thrombin liquid and powder

Question 18

what are the systemic haemostatic aids

Answer 18

vitamin K
anti fibrinolysis - tranexamic acid
missing blood clotting factors
plasma or whole blood
desmopressin

Question 19

how do we manage post op bleeding in the surgery

Answer 19

put pressure
calm patient
clean patient
take history
suction
remove clot
identify where bleeding from

Question 20

what happens if you cannot arrest haemorrhage

Answer 20

urgent hospital referral

Question 21

where do you refer patients during the week

Answer 21

dental hospital/maxfax

Question 22

where do you refer patients at evenings/weekends

Answer 22

maxfax on call or local hospital A&E

Question 23

how do we prevent intraoperative and post operative extraction haemorrhage

Answer 23

thorough medical history
atraumatic extraction
obtain good haemostasis
provide good instructions to patient

Question 24

what are the post extraction instructions

Answer 24

do not rinse till next day
avoid trauma - no tongue exploring
avoid hot food that day
avoid excessive physical exercise and alcohol
advise on control of bleeding

Question 25

what advice do you give on bleeding

Answer 25

biting on damp gauze/tissue pressure for at least 30min points of contact if bleeding continues

Question 26

what are the 3 types of sensory change with nerve damage

Answer 26

anaesthesia paraesthesia dysaesthesia

Question 27

what could the sensation change of nerve damage be

Answer 27

hypoaesthesia (reduced sensation) hyperaesthesia (increased/heightened sensation)

Question 28

what is neuropraxia

Answer 28

contusion of nerve/continuity of epineural sheath and axons maintained

Question 29

what is axonotmesis

Answer 29

continuity of axons but not epineural sheath disrupted

Question 30

what is neurotmesis

Answer 30

complete loss of nerve continuity/nerve transected

Question 31

what happens with a dry socket

Answer 31

normal clot disappears causing intense pain

Question 32

when does a dry socket tend to start

Answer 32

3-4 days after extraction

Question 33

how long does a dry socket take to resolve

Answer 33

7-14 days

Question 34

what is localised osteitis

Answer 34

inflammation affecting lamina dura

Question 35

what are the symptoms of a dry socket

Answer 35

dull aching pain usually throb/can radiate to ear continuous and keep patient awake at night exposed bone is sensitive bad small and bad taste

Question 36

what are the predisposing factors of a dry socket

Answer 36

molars mandible smoking female oral contraceptive pill LA with vasoconstrictor infection from tooth haematogenous bacteria in socket excessive trauma during extraction excessive mouth rinsing post extraction family history/previous dry socket

Question 37

how do you manage a dry socket

Answer 37

reassurance/systemic analgesia LA irrigate with warm saline curettage/debridement antiseptic pack - alvogyl advise on analgesia review patient

Question 38

what does alvogyl contain

Answer 38

butamben iodoform eugenol

Question 39

what is sequestrum

Answer 39

usually bits of dead bone pieces of amalgam/tooth

Question 40

what does sequestrum do

Answer 40

delay healing

Question 41

what do you do if you see an infected socket with pus discharge

Answer 41

check for remaining tooth/root fragments/bony sequestra/foreign bodies radiograph/explore/irrigate/remove any of above/consider antibiotics

Question 42

when is infection more commonly seen

Answer 42

after minor surgical procedures involving soft tissue flaps and bone removal