Extraction Complications 4 Flashcards
what is the difference between OAC and OAF
OAC is acute - happens straight away
OAF is chronic - sinus tract forms if left untreated
what might be an indication of an OAC
bone at trifurcation of roots
bubbling at socket
what is the treatment for OAC
encourage clot
suture margins
encourage haemostasis
post op instructions
maybe antibiotics
how do you treat OAF
excise the sinus tract
buccal/ palatal flap depending where it is
collagen membrane
what decreases tension when closing a flap
scoring the periosteum
what is a palatal rotation flap
keep base attached to posterior palate and take it round and connect to the buccal aspect
what is a root in antrum
root is pushed up into the antrum
how can root in antrums be retrieved
via the socket
via the lateral antrum
how do you access the maxillary sinus through the nose
up the nose and past the middle meatus
what is osteomyelitis
inflammation of the bone marrow - patient usually systemically unwell
usually because of underlying problem with host defences
what occurs microbiologically in osteomyelitis
ingress of bacteria into cancellous bone and oedema in the bone marrow spaces
what is the treatment for osteomyelitis
take a swab - see whats there and prescribe antibiotics
drain pus
remove non-vital teeth
debride necrotic pieces of bone - remove down to bleeding bone
what is the first line drug for infection in dentistry
penecillin
what is ORN
osteoradionecrosis
what is osteoradionecrosis
seen in patients who have received radiotherapy of the head and neck
bone within radiation beam becomes non-vital
turnover of any remaining viable bone is slow
self repair ineffective
why is the mandible more susceptible to these post of infections
poorer blood supply
what is treatment of osteoradionecrosis
irrigation of necrotic debris
loose sequestra removed
what is MRONJ
bisphosphonates and other drugs inhibit osteoclast activity and inhibit bone resorption and renewal
what are some examples of bisphosphonates
alendronate
pamindronate
what other drugs to look out for in MRONJ
bisphosphonates
RANKL
antiangiogenic drugs
who are at higher risk of MRONJ
patients taking anti-angiogenic and anti-resorptive drugs
what are the classifications for patient risks of MRONJ
dental treatment
duration of bisphosphate drug therapy
dental implants
other concurrent medication
previous drug history
drug holidays (5 year half life)
what is an example of a RANKL inhibitor
denosumab
what are examples of anti-angiogenics
sunitinib
aflibercept
how is MRONJ managed
remove sharp edges of bone
chlorhexidine mouthwash
antibiotics is suppuration
what is actinomycosis
rare bacterial infection
actinomyces israelii
thick lumpy pus
what is treatment of actinomycosis
irrigation and debridement of pus accumulation
excision of chronic sinus tracts
high dose antibiotics
what is infective endocarditis
bacteria in the bloodstream following extraction would circulate to the heart and colonise on vegetations/ scarring/ artificaial valves
who are at risk of IE
adults and children with problems affecting structure of heart
previous IE
congenital heart disease
what are invasive dental procedures
procedures that involve significant gingival manipulation
what is usually prescribed for IE
amoxicillin 3g before procedure
clindamycin 300mg - 2 capsules 60 mins before procedure
Azithromycin - 500mg 60 mins before procedure
