ORAL SURG - Complications of Extractions Flashcards
2 types of pain.
neuropathic
inflammatory
anxiety and bone removal .. pain
increases
what can be taken to prevent pain?
paracetamol
non-steroidal anti-inflammatories
opioids
steroids
what are analgesias?
AKA painkillers
what analgesias are recommended for extraction WITHOUT bone removal?
1g paracetamol every 6 hours
maximum 4grams/24 hours
what analgesias are recommended for extractions WITH bone removal?
- 400mg ibuprofen every 6 hrs
if not enough
- 1g paracetamol w/ 60mg codeine every 6 hours
- max 4g paracetamol/24 hrs
what analgesias are recommended for complex surgeries - e.g. multiple tooth removal?
IV morphine
goes by patients verbal pain rating
what should the patient take for any mild pains?
paracetamol or ibuprofen
what should the patient take for mild-moderate pain?
paracetamol and ibuprofen
what should the patient take for moderate to severe pain?
paracetamol and ibuprofen and opioid
describe the post-op extraction swelling.
up to 72 hours
depends on procedure and on the patient
what should be asked in regards to bleeding?
- any conditions underlying bleeding issues
- pregnancy
- tonsil issues
what conditions are at risk when there is bleeding?
- liver disease
-idiopathic thrombocytopenia purpura (ITP) - haematological malignancy
- chronic renal failure
- heart failure leads to liver failure
- coagulation disorders
- chemotherapy
which medications cause risk when bleeding? (4)
- antiplatelets - aspirin and clopidrogel
- anti-coagulants - warfarin, dabigatran, apixaban
- cytotoxic drugs
- NSAIDS
what should be the expected bleeding post-op?
minimal
- pressure for 30 mins with wet gauze
- wait for definitive clot formation
if there is bleeding after 12 hours = excessive
what can be done if there is a capillary bleed?
apply pressure
what can be done if there is an arterial bleed?
apply pressure and consider cautery
what if there is a bony bleed?
consider bone wax
what is there is continuous bleeding and no haemostasis being achieved?
continue added pressure
contact local unit for advice
which 6 groups might there be risk of post-op infection?
- smokers
- extreme age
- inexperienced operators
- poor OH
- the type of surgery
- immunocompromised patients
5 signs of inflammation
heat - calor
redness - rubor
swelling - tumor
pain - dolor
loss of function - function leasa
what can be 4 systemic signs of an infection?
- tachycardia - more beats than usual
- lymphadenopathy - swelling of the lymph nodes
- pyrexia - fever
- blood picture - assess the blood and if there are any abnormalities
what is sepsis?
an life-threatening response to infection
describe the acronym SEPSIS for the sepsis signs and symptoms
S - slurred speech
E - extreme shiver or muscle pain
P - passing no urine in a day
S - severe breathlessness
I - it feels like you’re going to die
S - skin mottled or discoloured
what is alveolar osteitis?
dry socket, inflammation of alveolar bone
- when there is premature disintegration of the clot in the extraction socket
what are the risk factors for alveolar osteitis?
- surgical trauma
- smokers
- oral contraceptive pill
- experience of the operator
- prev history of dry socket
- nutrient deficient
- increased local fibrinolysis
symptoms of alveolar osteitis
- post op pain inside/around site of extraction
- pain increases
- disintegrated blood clot
- may have halitosis
how is alveolar osteitis managed?
- confirm diagnosis
- NSAIDS or paracetamol
- irrigate with saline
- dress with Alvogyl
what is alvogyl? what is it combined with?
a dressing is used to help control hemostasis, foster healing
combine with a fern plant from Sumatra
- anti-septic properties
describe the 3 ingredients of Alvogyl.
- Iodophorm - antimicrobial
- Butamben - anaesthetic
- Eugenol - analgesic
how do you reduce the risk of having extraction complications? (7)
- knowledge of anatomy
- discuss the risks and benefits
- know LA technique to avoid nerve damage
- informed consent
- post op phone calls
- post op advice
- appropriate referrals if necessary
