Failed Tooth XLA

Question 1

What questions to ask if suspect failed tooth XLA?

Answer 1

Ask about XLA - reason for XLA, if simple or difficult, any bone removal or sutures
Pain/ bad taste/ malodour
Difficulty opening
Smoking hx

Question 2

How to examine pt if suspected failed XLA?

Answer 2

EO - facial swelling and mouth opening
IO: appearance xla socket - flap/ sutures/ degree of healing, exposed bone

Question 3

What would OPT potentially show if failed XLA?

Answer 3

Retained fragments, bone sequestrum, fractured mandible

Question 4

How would explain to pt that they had a failed XLA at other practice?

Answer 4

Demonstrate duty of candour - be open and transparent about what has caused symptoms
Explain why in pain
Apologise and explain risks associated w/ extraction
Advised of further tx - reassure symptoms will improve following tx and long term unlikely to have issues

Question 5

How to mx pt who has had failed surgical XLA wisdom tooth?

Answer 5

Immediate: analgesia, ab prescription, chx mouthwash
referral to original clinician in secondary care
review pt 5-7 days to re-assess healing

Question 6

What are risks of just leaving the tooth?

Answer 6

Area may remain symptomatic
Infection may resolve and remain asymptomatic
Chronic infection can progress osteomyelitis
Denitgerous cyst may develop