Extraction Complications COPY Flashcards
Give some complications that can occur peri-operatively
Difficulty access
Abnormal resistance
Fracture of tooth, root, alveolar bone, jaw, tuberosity
Involvement in maxillary sinus
Loss of tooth
Damage to soft tissues, nerves, vessels or adjacent teeth
Haemorrhage
TMJ dislocation
Extraction of permanent tooth germ
Broken instrument
Wrong tooth….. oops
Why may access be difficult in a patient?
Patient can have trismus
Rescued oral opening - systemic sclerosis
Crowded or malpositioned teeth
Why might a tooth display abnormal resistance to removal?
Multi rooted teeth
Tooth ankylosed to bone
Hypercementosis
Thick cortical bone
Why might a tooth or root fracture when being removed
Caries
Poor tooth position
Fused, ankylosed, hypercementosed roots
where might alveolar bone fracture occur?
More typically buccal plate of canines and molars
Why might someone’s jaw fracture during surgery? What should be done?
Often due to impacted wisdom teeth, large cysts or strophic mandibles
Inform patient and take radiograph
Ensure analgesia
Refer via phone call
How can one diagnose an OAC?
Check tooth apices to see if apex lost in sinus
Check with direct vision
Bubbling or toothpaste coming our of nose
How would one manage an OAC?
If small
- inform patient
- encourage clotting
- suture margins
- antibiotics
- post-op instructions
If large
- close with buccal advancement mucoperiosteal flap
- antibiotics and nose blowing instructions
What is the condition where pressure is placed on a nerve leaving the epieneural sheath and axons maintained?
Neurapraxia
What is the condition where the continuity of the axon is affected but not the surrounding epineural sheath?
Axonotmesis
What is complete loss of nerve continuity?
Neurotmesis
Damage to nerves can result in which issues?
Anaesthesia
Paraesthesia (tingling)
Dysaesthesia (unpleasant sensation/pain)
Hypoaesthesia (reduced sensation)
Hyperaesthesia (increased sensation)
What local factors are the main cause for peri-operative bleeding?
Mucoperiosteal tears
Fractured alveolar bone plate
What systemic issues often can cause peri-operative bleeding
Liver disease - alcohol issues - clotting factors produced in liver
Medications such as warfarin or other anticoagulants
Haemophilia or Von willebrands
How would one control soft tissue peri operative haemorrhage?
Pressure with gauze
Sutures
LA with vasoconstrictor
Diathermy (cauterise or burn vessels)
Ligatures or haemostatic forceps (artery clips)
