Extraction of third molars 3 Flashcards
Who carries out the different aspects in the majority of third molar extraction cases?
3rd molars are assessed in GDP then referred on to specialist or dental hospital setting (could be OMFS unit in general hospital)
Which factors can influence patient decision about where to receive treatment?
Waiting times, cost, surgical experience can contribute to patient decision
What are the common treatment options for patients with third molar issues?
Referral for extraction
Clinical review
Removal of M3M
Extraction of maxillary third molar
Coronectomy- if close to IDC on radiograph
When may a clinical review be opted for by the patient?
Done if patient decides against surgery- involves reviewing signs and symptoms at check up
-> Radiographic monitoring- only if signs and symptoms (patients diagnostic bitewings can help monitor this)
What are some of the rarer treatment options for patients with third molar issues?
Operculectomy- if PC (not often as it grows back)
Surgical exposure- to encourage further eruption
Pre-surgical orthodontics
Surgical reimplantation/ autotransplantation- 8 used to fill 6 space if lost
What should be discusses with the patient prior to commencing third molar treatment?
Findings of assessment (M3M status)- treatment options (risks and benefits)
Risk of complications
Patients access to treatment/circumstances
Patient general health
When may surgical intervention for 8s be considered?
If patient is symptomatic and if disease is present (or they are at high risk of disease)
Ex: disease free/assymptomatic impacted 8s are not recommended for extraction
What should be considered if patient symptomatic but there is no disease evident?
TMJ/salivary gland disease
What are the methods of anaesthesia used in third molar surgery?
LA
Conscious sedation
GA
Which patient factors is need/eligibility for CS based off?
Anxiety- esp. if no treatment experience
Behaviour
Medical conditions
Complexity of treatment
What are the forms of conscious sedation used in third molar surgery?
IV- most common (very effective and used extensively for third molar removal)
-> if patient unable to be sedated with midazolam may be referred to anaesthetist lead sedation in hospital using propofol
*Oral sedation is not used routinely- no evidence
*IS- mostly for paeds extractions not 8s
When may GA be considered for 8 removal?
Extreme anxiety
Sedation is contraindicated
Other treatment is required
Genuine allergy to LA
How is consent given for the different means of anaesthesia?
GA and IV sedation: Written consent form (detailing risks/warnings)
LA: varies from between hospitals and practices
- Written consent form is best practice
Or
- Sticker in notes, patient signs it
What aspects of the procedure in removal of 8s is it important to let the patient know about beforehand?
Cutting gum- will not feel but will notice stitches after
Sectioning tooth- might need to cut into smaller pieces with a drill (like having a filling- vibrations)
Space may need to be created using drill
Sutures are usually dissolvable- if not arrange review for removal (rare)
Let them know about potential for iatrogenic damage
Atrophic mandible and cystic lesion/aberrant impaction can carry jaw fracture risk (as it is thin in this section)- stress that it is very rare and will be arranged to be fixed in hospital (can happen after treatment- dealt with quickly in the same way)
What are some of the post op complications that should be discussed with patients following third molar removal?
Pain- variable (recommend analgesia)
Swelling- max at 48hrs and can also 2 weeks
Bruising- settles within 1-2 weeks
Jaw Stiffness/limited mouth opening- stick to softer diet
Bleeding
Infection- rare but warn about signs and who to contact
Dry Socket (localised osteitis)
Nerve damage
Altered taste
