Extraction Complications 4

Question 1

what is the main long term post extraction complications?

Answer 1

Chronic oroantral fistula/root in antrum

Question 2

What are less common post-op complications?

Answer 2

• osteomyelitis
• osteoradionecrosis (ORN)
• medication induced osteonecrosis (MRONJ)
• actinomycosis
• bacteraemia/infective endocarditis - note current guidance

Question 3

Which of the following are acute or chronic?

Oral antral communication
Oral antral fistula

Whats the difference between the two?

Answer 3

OAC - acute
OAF - chronic

OAF has epithelial lining that covers the inside of the fistula

Question 4

how do you diagnose an OAC?

Answer 4

• size of tooth
• radiographic position of root in relation to antrum
• bubbling of blood
• nose holding test
• direct vision
• blunt prove

Question 5

how do you manage acute OAC?

Answer 5

• inform pt
• if small/sinus intact;
  -> encourage clot, suture margins,

Question 6

what do you do if an acute OAC is large?

Answer 6

• close with buccal advancement flap
• antibiotics, decongestants, and tell them not to blow their nose

Question 7

how do you manage a pt with chronic OAF?

Answer 7

• remove the sinus tract
• buccal advancement flap
• buccal fat pad with buccal advancement flap
• palatal flap
• bone graft

Question 8

what is osteomyelitis?

Answer 8

inflammation of the bone marrow, its rare and usually the MANDIBLE

site of extraction - VERY TENDER

starts central to the bone and extends outwards eventually to the periosteum & overlying mucosa red/tender

Question 9

why is osteomyelitis more likely to occur in mandible vs the maxilla?

Answer 9

maxilla has rich blood supply compared to the mandible.

therefore mandible more likely to become ischaemic & infected

Question 10

what are the major predisposing factors for getting osteomyelitis?

Answer 10

trauma/injury/fractures of mandible

odontogenic (around teeth/jaw) infection

compromised host defence (diabetes, alcoholism, drug use, leukaemia, chemo etc)

Question 11

how do you treat osteomyelitis using antibiotics?

Answer 11

penicillin (antibiotics)
- longer course than usual and keep taking after resolution of symptoms to make sure it fully clears

• if severe acute osteomyelitis, may require hospital admission

Question 12

what is the surgical treatment for osteomyelitis?

Answer 12

• drain pus if possible
• remove any non-vital teeth in area of infection
• remove any necrotic bone
• clean out anything necrotic

Question 13

what is osteoradionecrosis (ORN)?

Answer 13

affects bones of jaw, complication of radition therapy for head & neck cancers. Radiation damages blood vessels leading to bone death/necrosis

Question 14

What are the symptoms of osteoradionecrosis?

Answer 14

• pain discofort,
• redness, exposed bone
• drainage or pus from site

Question 15

how can you prevent osteoradionecrosis?

Answer 15

• scaling/Chlorhexidine mw leading up to XLA
• careful xla technique
• antibiotics & review

Question 16

what is treatment for osteoradionecrosis?

Answer 16

• irrigation of necrotic tissue
• antibiotics
• hyperbaric oxygen therapy (improves blood flow & promotes healing)

Question 17

What does MRONJ stand for?

Answer 17

medication related osteonecrosis jaw

Question 18

what actually is MRONJ?

Answer 18

a condition which jaw bone is exposed & becomes to become necrotic due to certain medications.

Such as BISPHOSPHONATES

Question 19

what are symptoms of MRONJ

Answer 19

• Pain, swelling, numbness, exposed bone

Question 20

what are bisphosphonates and how do they work?

Answer 20

class of drugs used to treat OSTEOPOROSIS, Paget’s disease & malignant bone metastases

inhibit osteoclast activity and so inhibit bone resorption and new bone formation

bisphosphonates may remain in the body for years

Question 21

what are names of some bisphosphonates? are they IV, oral?

Answer 21

alendronate (alendronic acid) [oral]
Etidronate [oral]
Zoledronate [IV]

Question 22

what other concurrent medication increases the risk of MRONJ?

Answer 22

Use of steroids + antiresorptive drugs (bisphosphonates)

antiresorptive (bisphosphonates) + angiogenic drugs (formation of new blood vessels)

Question 23

what makes a patient low risk for MRONJ?

Answer 23

patients taking bisphosphonates for less than 5 years and NOT taking steroids or angiogenic drugs concurrently

Question 24

What makes a patient high risk for MRONJ?

Answer 24

if they have been taking bisphosphonates for more than 5 years.

Any patient taking bisphosphonates with steroids or angiogenic drugs

Question 25

how do you treat MRONJ?

Answer 25

treatment of MRONJ isnt that successful

• manage symptoms/remove sharp edges of bone, use antibiotics if suppuration (pus)
• debridement/major surgical removal of bone

Question 26

what is actinomycosis, symptoms and hows it treated?

Answer 26

rare bacterial infection caused by actinomyces bacteria and can affect various parts of the body.

symptoms: swelling, abscesses, draining sinuses and fever

Treatment: prolonged course of antibiotics

Question 27

what is the name of the bacteria that causes actinomycosis?

Answer 27

actinomyces israelii

Question 28

how do you treat actinomycosis?

Answer 28

• excision of the necrotic bone & foreign bodies
• high dose antibiotics (IV)
• long term oral antibiotics to prevent recurrence
• drainage of pus

Question 29

what is infective endocarditis?

Answer 29

IE is serious infection of lining of heart or valves (bacteria, fungi or other microorganisms)

Can cause serious complications such as HF, stroke, sepsis

Question 30

what are symptoms of infective encarditis?

Answer 30

fever, chills, fatigue, weakness, joint pain, night sweats, shortness breath

Question 31

what is treatment for infective endocarditis?

Answer 31

prolonged course of IV antibiotics and possible surgery to repair/replace damaged heart valves