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BDS 3: Oral Surgery > L1 Common Complications in Oral Surgery > Flashcards

L1 Common Complications in Oral Surgery Flashcards

1
Q

What extra-oral signs may a returning patient present with following oral surgery?

A
  • Lymphadenopathy
  • Swellings
  • Trismus (due to pain or true trismus)
  • Pyrexic (37.5 degrees or higher)
  • Low BP, low oxygen saturation and tachycardia indicative of sepsis
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2
Q

What intra-oral signs may a returning patient present with following oral surgery?

A

Surgical site:
- Erythema
- Pus
- Swelling
- Food debris
- Halitosis
Check sutures and clotting

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3
Q

What is the technical term for dry socket?

A

Acute alveolar osteitis

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4
Q

What are the risk factors for acute alveolar osteitis?

A
  • Smoking
  • Mandibular extraction (poorer blood supply than maxilla)
  • Oral contracpetive pill
  • Previous radiotherapy
  • Vasoconstrictors in LA
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5
Q

Describe the general features of acute alveolar osteitis.

A

Inflammation of the alveolar bone
- NOT an infection
- Usually presents 72 hours after extraction
- Thought to be due to loss of clot from socket, exposing alveolar bone to bacteria

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6
Q

How is acute alveolar osteitis treated?

A
  • Irrigate socket with 0.9% saline
  • Alveogyl placed in socket, broken up and placed in layers
  • No rinsing for 24 hours
  • Reinforce OHI
  • Smoking cessation
  • Analgesics: 1g paracetamol QDS, 400mg ibuprofen TDS
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7
Q

Why is chlorhexidine not used in the treatment of acute alveolar osteitis?

A

Risk of anaphylaxis and death

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8
Q

What are the signs and symptoms of post operative infection?

A
  • Generally feeling unwell
  • Painful socket
  • Worsening swelling
  • Bad taste
  • Lymphadenopathy
  • Pyrexic
  • Trismus
  • Gingival swelling
  • Frank pus
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9
Q

How is post-operative infection managed?

A
  • Establish drainage of pus
  • If pt refuses extraction, can try to get pus out through root canals or incision made in buccal sulcus
  • Suture removal if applicable, releases pressure and irritation
  • Only prescribe antibiotics is pt is systemically unwell or other signs
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10
Q

What antibiotics would be prescribed for infection?

A
  • 500mg amoxicillin TDS 5 days or 500-1000mg phenoxymethylpenicillin QDS
  • If allergic to pencillin: 300mg clindamycin QDS 5 days
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11
Q

What is Ludwig’s angina?

A

A severe bacterial inefction of the tissues of the neck and floor of the mouth.
Causes life-threatening swelling and can comprimise the airway.

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12
Q

What are the symptoms of Ludwig’s angina?

A
  • Trismus
  • Drooling
  • Difficulty swallowing
  • Pyrexia
  • Tongue pushed up
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13
Q

What should you consider if a patient returns with post-operative pain?

A
  • SOCRATES
  • Consider type of surgery and complexity e.g. 4 wisdom teeth removed under GA will cause more pain than a simple XLA
  • Check what painkillers they have taken and have they been taken regularly?
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14
Q

What painkillers are recommended post-op?

A
  • 1g paracetamol QDS and 400mg iburpofen TDS
  • Can consider co-codamol, 30mg codeine QDS for max. 5 days
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15
Q

What are the 3 types of post-operative bleeds?

A
  • Immediate: at time of surgery
  • Reactionary: a few hours later, usually when the vasoconstrictor of the LA has worn off or pt’s BP increases encouraging bleeding
  • Delayed: several days or up to 2 weeks later, usually bleeding secondary to infection (haematoma)
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16
Q

How is immediate bleeding managed?

A

Pt bites down on gauze for 5-10 minutes post extraction until haemostasis achieved

17
Q

What is the first line option for bleeding management?

A
  • Good light and suction, identify bleeding point and apply pressure
18
Q

What can a socket be packed with to achieve haemostasis?

A

An oxidised cellulose pack e.g. Surgicel
- Cut sheet into small squares and place into socket and suture
- This creates a meshwork for the clot to form on

19
Q

What other bleeding management techniques can be used (that are unlikely to be used in general practice)?

A
  • Diathermy cautery
  • Bone wax to occlude vessel opening in bone
  • Topical tranexamic acid: anti-fibrinolytic (prevents breakdown of fibrin)
  • Can also use tranexamic mouthwash or tablets
  • In A+E IV tranexamic and fluids would be given
20
Q

What should be considered before surgery with regards to bleeding risk?

A
  • Thorough medical and drug history
  • Social history: alcohol intake- impaired platelet function (liver disease), may need to request bloods for clotting screen
  • Clotting screen for pts with history of abnormal bleeding or on vit K antagonist (warfarin)
21
Q

What INR would not be suitable for dental extraction?

A

INR of 4 or above

22
Q

What guidelines are followed for the management of patients on anticoagulants and antiplatelets?

A

SDCEP guidelines 2022 ‘Management of patients taking anticoagulants and antiplatelets guidelines’

23
Q

Give examples of dental procedures unlikely to cause bleeding.

A
  • LA by infiltration, intraligamentry, inferior dental or mental nerve block
  • BPE
  • Supragingival removal of plaque, calculus and stain
  • Impressions and other prosthetics procedures
  • Fitting and adjustment of ortho appliances
24
Q

Give examples of dental procedures that are likely to cause bleeding but are low risk for post-op bleeding complications.

A
  • Simple extractions, 1-3 teeth with restricted wound size
  • Incision and drainage of intra-oral swellings
  • 6-PPC
  • RSD
  • Restorations with subgingival margins
25
Q

Give examples of dental procedures that are likely to cause bleeding that are high risk for post-op bleeding complications.

A
  • Complex extractions
  • Adjacent extractions that will cause a large wound
  • More than 3 extractions at once
  • Flap raising procedures
  • Gingival recontouring
  • Biopsies
26
Q

What is considered when deciding whether or not to leave fractured roots in?

A
  • Size of root, 5mm or less = consider leaving
  • Mobility, mobile = remove
  • Infected = remove
  • Medical history, immunocompromised = remove, haemophiliac less inclined to remove
  • Speak to patient and explain risks, gather their opinion, consider time and facilities, operator competence

BDS 3: Oral Surgery (3 decks)

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