OAC/OAF

Question 1

why may retained roots be kept rather than extracted

Answer 1

preserve bone height
close proximity to important anatomical structures
present for years with no pathology

Question 2

aetiology of retained roots (3)

Answer 2

trauma
gross caries
attempted extraction
coronectomy

Question 3

general surgical principles (4)

Answer 3

max access with minimal trauma
minimise trauma to dental papillae
no crushing
keep tissues moist
ensure flap margins and sutures lie on sound bone

Question 4

primary intention healing

Answer 4

occurs when wounds have been approximated e.g flap that has been sutured
heal relatively fast and less chance of pronounced scar

Question 5

secondary intention healing

Answer 5

wounds which have not or cannot be approximated
sees gradual filling of wound space from base up with granulation tissue which is then covered by epithelial cells
(all extractions)

Question 6

name 3 aims of suturing

Answer 6

reposition tissues
encourage healing by primary intention
cover bone
prevent wound breakdown
aid haemostasis

Question 7

how can tranexamic acid be used to aid haemostasis

Answer 7

can soak gauze in it then place in desired area
TA is an anti-fibrinolytic so prevents clot breakdown

Question 8

how long until an OAC progresses to an OAF

Answer 8

48-72 hours

Question 9

risk factors for OAC (5)

Answer 9

maxillary molars and premolars
lone standing molars
previous OAC
recurrent sinusitis
close relationship on radiograph
older patient

Question 10

peri-op signs of an OAC

Answer 10

bubbling of blood
bone at trifurcation of roots after Xla
valsalva test
change in suction sound
visible hole

Question 11

post op symptoms of an OAC

Answer 11

fluid from nose when drinking
difficulty drinking through a straw
issues smoking
nasal quality to speech and singing
halitosis
sinusitis symptoms

Question 12

if left untreated what can an OAF lead to

Answer 12

maxillary sinusitis

Question 13

post op instructions for an OAC

Answer 13

avoid nose blowing
dont stifle a sneeze
avoid inflating balloons
avoid sucking through straws
use steam inhalation

Question 14

discuss conservative treatment for a small OAC

Answer 14

• gentle irrigation of socket, debridement of any sharp bone and removal of local irritant factors e.g plaque
• suture
• consider placing surgical to help with clot formation

Question 15

surgical treatment for OACs >2mm

Answer 15

buccal advancement flap is first choice method for repair
(full thickness mucoperiosteal flap)
if OAF, existing fistula must be removed prior to flap being closed
periosteum must be cut to allow flap to fully cover hole.

Question 16

antibiotics for OAC should they be required

Answer 16

phenoxymethylpenicillin 500mg 4 times a day 5 days