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3rd year dentistry > oral surgery > Flashcards

oral surgery Flashcards

1
Q

What influences the rate of absorption of local anaesthetic?

A

Blood flow in the tissue Concentration of the anaesthetic Amount administered

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2
Q

What is the onset time and duration time of Prilocaine?

A

Onset 3 minutes Duration 2 - 2 1/2 hours

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3
Q

What is the onset time and duration time of Lidocaine?

A

Onset 5 minutes Duration 1/2 - 2 hours

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4
Q

What is the onset time and duration time of Articaine?

A

Onset 5 minutes Duration 1 - 3 hours

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5
Q

Give four factors that affect the intrinsic factors of local anaesthetic…

A

Pregnancy pH Vasodilation Vasoconstriction

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6
Q

Explain how pregnancy can affect the intrinsic factors of local anaesthetic

A

progeserone can potentiate (increase) the nerve blocking effect of the LA therefore increasing its effectiveness

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7
Q

Explain how an alteration in pH can affect the intrinsic factors of local anaesthetic…

A

Inflammation and uraemia lower the tissue pH. This reduces the percentage of the neutral base form. A pH alteration can affect the binding to plasma and tissue proteins and seems relevant for the rapid appearance of tolerance during a repeat injection

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8
Q

Explain how vasodilation can affect the intrinsic factors of local anaesthetic…

A

intrinsic vasodilation (due to local processes in the surrounding tissue) causes rapid elimination from the area of injection. Eg, bupivaccain is a vasodilator

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9
Q

Explain how vasoconstriction can affect the intrinsic factors of local anaesthetic…

A

A vasoconstrictor masks the inherent vasodilatory properties of the LA and causes an increased effect that also lasts longer

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10
Q

What is the mode of action of local anaesthetics? ie how is anaesthesia achieved?

A

Local anaesthetics stop nerve conduction by blocking the voltage gated sodium channels. LA binds to a site in the sodium channel, blocks the channel and prevents sodium influx. This blocks action potential generation and propagation. Block persists so long as sufficient number of sodium channels are blocked.

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11
Q

What are the three components of a local anaesthetic molecule?

A

Aromatic region (hydrophobic) Ester or amide bond Basic amine side chain (hydrophillic)

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12
Q

Name four possible ingredients in a local anaesthetic solution

A
  • a hydrochloride base to increase solubility in aqueous solution (2-4%) -Reducing agent - Preservative(s) and fungicide - +/- vasoconstictor
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13
Q

Why are vasoconstrictors included in local anaesthetics?

A

most local anaesthetics are vasodilators, the increased blood flow will increase the ‘wash out’ of the LA. adding a vasoconstrictor will increase the duration of action (adrenaline or felypressin)

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14
Q

What is the maximum dose of lignocaine?

A

5mg per kg body weight 44mg per cartridge therefore 7 cartridges (approx 1 per 10kg body weight)

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15
Q

what is the maximum dose of articaine?

A

7mg per kg body weight 88mg in each cartridge therefore 5 cartridges

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16
Q

what is the maximum dose of prilocaine?

A

8mg per kg body weight 66mg per cartridge therefore 8 cartridges

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17
Q

Name 8 possible complications of local anaesthetic

A

-failure to achieve anaesthesia -prolonged anaesthesia -pain during or after injection -trismus -haematoma -intra-vascular injection -blanching -facial paresis -broken needle -infection -soft tissue damage -contamination

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18
Q

Give reasons for prolonged anaesthesia

A

direct trauma from needle multiple passes with same needle chemical trauma from direct injection different results depending on LA used

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19
Q

Describe and give causes of trismus

A

presentation within a few hours of IAN block, may severely restrict opening, may last for weeks or months. Caused probably by damage to medial ptterygoid. Injection too low? Too forceful? Management may include reassurance, muscle relaxant or anti-inflammatory

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20
Q

Describe and give causes of facial palsy

A

Presentation usually complete (whole half of face paralysed) Unilateral motor nerve paralysis within minutes of block Confirm temporal branch affected ie lower motor neuron distribution Caused by LA into parotid gland, injection too far posteriorly Test branches of facial nerve Reassure patient and cover eye with pad until blink reflex returns

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21
Q

What would be the signs/symptoms of an arterial injection with LA?

A

This is very rare skin blanching, visual and or aural disturbance

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22
Q

What would be the signs/symptoms of an intravenous injection with LA?

A

Palpitations, anxiousness, restlessness, headache, sweating, pallor. can be avoided by using a careful technique and slow administration

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23
Q

What post extraction advice should be given to a patient regarding pain?

A

-expect some post-op pain and that they will be sore when the LA wears off, but this is normal and varies person to person -painkillers can be taken prior to LA wearing off (paracetamol and ibuprofen best if possible), and should be taken for 1-3 days and then as and when required

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24
Q

What post extraction advice should be given to a patient regarding prevention of bleeding?

A
  • tell the patient that post op bleeding is unlikely but is a possibility - tell the patient not to explore the socket with their tongue, finger, toothbrush as this could dislodge the clot and result in bleeding - do not exercise that day and avoid strenuous activity that would increase BP - avoid very hot food - stick to a softer diet for a few days - avoid alcohol and smoking for at least 24 hours - gently rinse with warm salt water from the following day 4 x daily
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25
Q

what post extraction advice should be given to a patient regarding bleeding at home?

A
  • roll up a damp tissue or gauze and bite firmly for 20-30 minutes - If bleeding persists, bite on a fresh tissue/gauze for an hour - if bleeding persists, contact the practice or out of hours - if bleeding will not stop and the patient is unable to get an emergency appointment, they should go to their nearest A&E
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26
Q

what post extraction advice should be given to a patient regarding sensitivity?

A

may experience sensitivity of the teeth on either side of the extraction site and if this happens they should avoid extreme hot and cold in that area until it settles, which could take a few days to two weeks

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27
Q

what post extraction advice should be given to a patient regarding other symptoms to maybe expect?

A

pain and stiffness of the TMJ and muscles with limited mouth opening which should settle over the course of a few days to a couple of weeks. If it affects eating or lasts longer than two weeks, further advice should be sought. Swelling can be especially evident two days after extraction. If it gets worse or there is concern of infection, further advice should be sought. Bruising can occur and varies from person to person, but this is normal

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28
Q

What is the correct term for a dry socket?

A

alveolar osteitis

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29
Q

What two types of haemmorhage can occur post extraction?

A

*Immediate post operative period - reactionary and rebound bleeding which occurs within 48 hours of the extraction - caused by vessels opening up as the vasoconstrictive effects of the local anaesthetic wears off, sutures become loose/lost, or if the patient traumatises the socket *Secondary bleeding - often due to infections, commonly occurring 3-7 days post extraction - usually a mild ooze but can occasionally cause a major bleed

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30
Q

How do you stop bleeding after an extraction?

A

-apply firm even pressure with damp gauze -local anaesthetic with a vasoconstrictor can be administered -haemostatic aids; *surgical oxidised cellulose or gelatin sponge can be packed into the socket which acts as a framework for clot formation * Whiteheads varnish pack which contains iodoform, gum benzoin, storax, balsam tolu and ethyl ether *bone wax * thrombin liquid and powder *fibrin foam -surgical aids *suture the socket with interrupted/horizontal mattress sutures *ligation of vessels and diathermy may be used

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31
Q

What nerves are affected by an IDB?

A

*inferior alveolar nerve *lingual nerve *some branches of incisive and mental nerve may also be affected

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32
Q

What is the aim of suturing?

A

*to approximate and reposition the tissues * to compress the blood vessels *to cover the bone *to prevent wound breakdown *to achieve haemostasis *to encourage healing by primary intention

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33
Q

What are the four different types of sutures?

A

*Resorbable - monofilament (monocryl) - polyfilament (vicryl rapide) *non-resorbable -monofilament (prolene) - polyfilament (mersilk)

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34
Q

What are the different type of flap design?

A

*3 sided

*envelope

*rectangular

*semilunar

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35
Q

What are the general principles that should be adhered to when carrying out flap surgery?

A

*create maximal access with minimal trauma as larger flaps heal just as quickly as smaller ones

*wide based incision should be used for circulation

*use the scalpel in one firm continuous stroke

*do not create any sharp angles

*minimise trauma to dental papilla

*flap reflection should be down to bone and done cleanly

*avoid crushing the tissues

*keep tissues moist

*ensure the flap margins and sutures lie on sound bone

*make sure wounds are not closed under tension

*aim for healing by primary intention to avoid scarring

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36
Q

What handpiece and bur are used to cut bone and why?

A

*straight electrical handpiece with saline cooled bur

  • round or fissue tungsten carbide bur
  • air driven handpiece may lead to surgical emphysema and embolisms to form
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37
Q

List the indications for extractions

A
  • unrestorable teeth
  • symptomatic partially erupted teeth
  • traumatic position
  • orthodontic indications
  • interference with construction of dentures
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38
Q

What analgesics can be prescribed by a dentist?

A

*aspirin (NSAID)

*ibuprofen (NSAID)

*diclofenac (NSAID)

*paracetamol

*dihydrocodeine (opioid)

*carbamazepine

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39
Q

Describe the production of prostaglandins resulting in pain

A
  • trauma and infection lead to the breakdown of membrane phospholipids producing arachidonic acid
  • arachidonic acid can be broken down to form prostaglandins
  • prostaglandins sensitise the tissue to other inlammatory products which results in pain
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40
Q

What are the three mechanical principles for tooth elevation

A
  • wheel and axle (rotation
  • lever
  • wedge
  • all three actions can be used in combination with each other
  • excessive force should be avoided
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41
Q

What are the points of application for tooth elevation?

A
  • mesial
  • distal
  • buccal
  • inferior
  • superior
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42
Q

List four peri-operative complications

A

* difficulty gaining access

* abnormal resistance

* tooth fracture

* fracture of maxillary tuberosity or alveolar plate

* Jaw fracture

* OAC

* loss of tooth

* soft tissue damage

* haemorrhage

* dislocation of TMJ

* damage to adjacent teeth/restorations

* extraction of permanent tooth germ

* broken instruments

* wrong tooth

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43
Q

What are the criteria for a dento-alveolar surgery flap?

A

must be full thickness base must be wider than incision site must not split interdental papilla avoid important structures

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44
Q

What do you use to remove bone and why?

A

Must use an electric drill rather than air turbine as air turbine driven instruments can force air into the cavity and cause a surgical emphysema the drill is cooled with sterile water to reduce heat (>55* will kill bone) and reduce infection, increase visibility

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45
Q

What is the difference between Asepsis, antisepsis sterilisation and disinfection?

A

asepsis - avoidance of pathogenic material - aseptic technique in surgery antisepsis - application of agent which inhibits growth of microorganisms when in contact with them sterilisation - destruction or removal of all forms of life disinfection - inhibition or destruction of all pathogens

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46
Q

What types of extraction forceps are used?

A

upper anteriors - straight and narrow upper molars - 90* angle beak to cheek lower anteriors - 90* angle and narrow lower molars - 90* angle and two beaks cowhorns - for removal of teeth with splayed roots - penetrate bifurcation

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47
Q

What are elevators used for?

A

Elevators dilate the sockets. Always used to remove impacted teeth. Couplands, Cryers, Warick james

48
Q

What periosteal elevators are used?

A

These pull back the periosteum from the bone, they are blunt, curved instruments Howarths periosteal elevator

49
Q

What is the mitchells trimmer for?

A

this is a curette. this is used for finding a weak spot of bone overlying pathology to be removed

50
Q

What are dissecting forceps for?

A

They hold soft tissue without damamging it, Gillies dissectors.

51
Q

What order should you extract molar teeth (if all are going) and why?

A

Extract from the most posterior to the most anterior. Prevents a single standing tooth left in a weakened bone - reduces chance of alveolar or tuberosity fracture

52
Q

what different types of post-op bleeding are there?

A

immediate (at surgery no haemostasis achieved) reactionary ( within 48 hours - rise in BP) secondary (~7 days post op. infection and destruction of clot)

53
Q

If a patient comes in to your surgery the day after an Xn with bleeding, how would you deal with them?

A

Reassure the patient that it is ok and they wont bleed to death repeat a full Hx inc DH. Get pt to bite on gauze suction socket, clean pt identify source of bleeding - if coming from socket then squeeze the gingivaea of outer walls with finger and thumb. if stops, was gingival. if from bone vessels, needs packing can use bone wax, fibrin foam, sutures, collagen sponge, recall the next day

54
Q

What suture would you use for an extraction socket?

A

Resorbable suture, monofilament, 18mm curved tapered needle simple interrupted suture knot is tied twice one way and once the other (two surgeons knot, one locking knot)

55
Q

What is MRONJ and what can cause it?

A

medication related osteonecrosis of the jaw - non healing socket or wound >8 weeks, bone seen, halitosis caused by monoclonal antibody medications, RANK-L inhibitors, bisphosphonates and anti-angiogenics (VEG-F inhibiotors)

56
Q

What would you be looking for in someones history to see if they would be at riskof MRONJ?

A

A history of metastatic breast or bone cancer osteoporosis, Pagets disease

57
Q

What increases a patients risk of MRONJ?

A

Hx of MRONJ If they on Antiresorbtive or Antiangiogenic drugs for management of cancer on BPs for >5 years on denosumab in last 9 months + systemic glucocortioid or <5years BPs + systemic glucocorticoid

58
Q

What surgical options are there for impacted canines?

A
  1. removal 2. surgical exposure and ortho alignment (attaching a bracket and gold chain to re-position) 3. auto transplantation
59
Q

How would you distinguish a tooth with an apical abscess?

A

teeth with apical abscesses are TTP, non vital, discoloured, Hx of trauma or RCT. Radiograph shows well demarcated PA radiolucency with widening of the lamina dura

60
Q

how would you distinguish dry socket?

A

pain 2-4 days post extraction worse than preceeding toothache exposed bone is visible - no clot in socket socket looks inflamed

61
Q

How do you treat dry socket?

A

warm LA in socket so you can clean Alvogyl in socket CHX mw or hot salty MW, NSAIDs

62
Q

What is ludwigs andgina?

A

Medical emergency abscess and cellulitits spreading throught he submandibular space and sublingual space patient might complain of tongue being pushed up or problems swallowing soft tissues of FOM and neck are hard, airway is at risk

63
Q

What is denture hyperplasia?

A

non tumour soft tissue lump hyperplastic response to chronic trauma. rolls of tissue in the sulcus relating to denture flange. similar to FEP. complete excision, temporary removal of denture/relieve denture.

64
Q

What are warts/squamous papillomata?

A

non tumour soft tissue lump HPV infection. multiple pappilated pink asymtomatic lumps. excise and Bx

65
Q

What are Tori?

A

non tumour hard tissue lump bony exostoses. both jaws. developmental abnormality, not sinister

66
Q

What is Pagets disease of bone?

A

non tumour hard tissue lump skull, pelvis, long bones and jaws. max>mand hypercementosis of roots. replacement of bone abnormality. bone pain and cranial neuropathy occuts. Cotton wool appearance of bones. Avoid GA, treat with BPs

67
Q

What are odontomes?

A

compound - denticles in a sac complex - irregular mass of dental tissues treat as malpositioned/impacted teeth

68
Q

what is the difference betwen OAF and OAC?

A

OAC - oroantral communication. not lined by epithelium, can heal closed. acute OAF - fistula, lined by epithelium. needs removal of the lining and surgically closing. chronic

69
Q

what teeth are most likely to give OAC?

A

max 6/7/8

70
Q

How do you treat OAC

A

inform patient if small (<2mm) - encourage clot, suture, if large - lift buccal advancement flap - parallel incisions - full thickness score periosteal layer so it becomes stretchy advance over defect and suture close give ABs - 7 days amoxicillin 500mg TID post op instructions: steam inhalations. no blowing nose/sneezing/playing wind instrument/using straw for 2 weeks/give decongestants review after 6 weeks

71
Q

What does granulation tissue mean?

A

Granulation tissue is new connective tissue and microscopic blood vessels that form on the surfaces of a wound during the healing process. Granulation tissue typically grows from the base of a wound and is able to fill wounds of almost any size.

72
Q

What nerves do you need to anaesthetise to extract a lower permanent molar?

A

inferior alveolar nerve, long buccal, lingual nerve

73
Q

how to do check for IAN, long buccal and lingual nerve for anaesthesia?

A

check for altered sensation in the lower lip on that side, gingivae around the tooth (buccal and lingual side), altered sensation in that side of the tongue

74
Q

What are different IDB techniques?

A

Halsteads technique Indirect technique Anterior ramus technique (limited mouth opening) Gow-gates technique (long buccal at same time) Akinosi (limited mouth opening and long buccal at the same time)

75
Q

What principles of flap design should you adhere to when raising a mucoperiosteal flap?

A

Avoid vital structures full thickness of flap raised - not saw-toothed edges must close over bone base must be wider than the apex provide access to the surgical site be able to be closed at the end of surgery minimise trauma to papilla reflect flap clealy healing by primary intention

76
Q

What guidelines can you follow for determining the removal of a wisdom tooth?

A

NICE (guidance on the extraction of wisdom teeth) SIGN 43

77
Q

How would you judge the relationship of a root to the IAN?

A

Radiographically: 1. do the tramlines converge or disappear 2. is there a shadow across the root 3. loss of the cortical outline as it passes the root 4. deflection of the roots 5. bifid root apices 6. diversion of the canal 7. juxta apical area

78
Q

What information is given for consent?

A

must be written and verbal description of procedure in patient friendly terms risks/warnings - pain, swelling, bruising, bleeding, infection, dry socket, jaw stiffness, damage to adjacent, potential damage to nerves (specifically - permanent risk, temporary risk, what it will feel like, distribution), jaw fracture, anesthetic

79
Q

What are bisphosphonates and what are the risk categories?

A

anti resoptive drugs. If patient has Hx of MRONJ, on BPs for Tx of cancer, taken them >5 years and concurrent Tx with glucocorticoid puts patient in high risk

80
Q

When would you refer a patient at risk of MRONJ?

A

if an extraction socket has not healed within 8 weeks, or there is evidence of spontaneous MRONJ - refer to oral surgery/SCD

81
Q

You have a patient who is about to start treatment with BPs, how would you manage them?

A
  1. OH is imperative - consequences of not 2. examine dental tissues for evidence of active infection - Tx 3. examine prosthesis for trauma potential 4. teeth with poor prognoses/ poor long term retention XLa 5. educate pt on signs and symptoms of MRONJ 6. must be dentally fit before treatment starts
82
Q

Patient on BPs at high risk needs XLA. How would you manage them?

A

pre-operative rinse with CHX, atruamatic surgical technique, primary closure of soft tissues without stripping periosteum post-operative CHX until mucosa has healed. review patient until socket has healed. do not attempt further XLA until socket has healed

83
Q

How would you diagnose pt with MRONJ?

A

be on, or have been on, anti-resorptive medication exposed bone or probe bone through fistula of maxfacs region >8 weeks no obvious metastatic disease to the jaws

84
Q

Why might a patient be on anti-resorptive drugs?

A

osteoporosis prevention of skull fractures Paget’s disease of the bone, metastatic bone disease multiple myeloma renal cell carcinoma

85
Q

What radiographic views would you take to identify a root/tooth in the antrum?

A

OPT upper occlusal periapical

86
Q

What dental causes can sinusitis mimic?

A

• Periapical abscess • Periodontal infection • Deep caries • Recent extraction socket • MFPDS (myofacial pain syndrome) • Neuralgia or atypical facial pain

87
Q

What would you use to remove bone from a socket?

A

rongeurs (bone nibblers)

88
Q

which nerves are at risk of damage form 8s removal?

A

lingual IAN mylohyoid long buccal

89
Q

What would you use for soft tissue elevation and retraction?

A

Howarths periosteal elevator wards periosteal elevator buser periosteal elevator bowdler-henry rake retractor Lacks retractor minnesota retractor

90
Q

List some uses of elevators

A

• To provide a point of application for forceps • To loosen teeth prior to using forceps • To extract a tooth without the use of forceps • Removal of multiple root stumps • Removal of retained roots • Removal of root apices

91
Q

Where are the application points for an elevator and what actions would you use?

A

mesial, buccal and distal wheel and axle, wedge, lever

92
Q

What instruments could be used to debride a socket after extraction?

A

bone file mitchells trimmer victoria curette irrigation suction

93
Q

List post-op analgesia and doses

A

Ibuprofen – 200 or 400mg, 6 hourly or 3 times daily. Avoid in asthmatics, bleeding disorders/Warfarin, on other NSAIDs – see BNF. Note some asthmatics can take it but check, and if they’ve never had it don’t prescribe it. • Paracetamol 500mg tablets, 2 tabs 4-6 hourly, no more than 8 a day. Overdose serious. • Cocodamol – contains 8mg codeine and 500mg Paracetamol (stronger contains 30mg codeine/500mg Paracetamol). 2 Tabs 4-6 hourly, do not exceed 8 in a day.

94
Q

list some perioperative complications of surgery

A

tooth/root/adjacent lingual plate/alveolus/mandible # max tuberosity # OAC/loss of tooth into sinus trauma to IAN bleeding crush/puncture/laceration injuries to soft tissue burns

95
Q

list some postoperative complications of surgery

A

pain swelling bruising trismus para/ana/dysaesthesia altered taste infection dry socket port op bleeding haematoma osteomyelitis MRONJ/ORNJ actinomycosis

96
Q

what are post operative techniques for controlling bleeding?

A

• Post-operative – Pressure (finger or via swab or pack) – LA with vasoconstrictor infiltration in soft tissues, inject into socket, or on a swab – Diathermy – Haemostatic Agents – Surgicel/Kaltostat – Sutures – Bone wax smeared on socket wall with blunt instrument – Haemostatic forceps/ artery clips

97
Q

what are peri-operative techniques for controlling bleeding?

A

Peri-operative – Pressure – LA with vasoconstrictor – Artery forceps – Diathermy – Bone wax

98
Q

what are symptoms of OAC?

A

hollow suction nasal sounding voice air coming through mouth bubbling of blood pt hold nose and breathe out when you look in mouth you can see air

99
Q

what drugs can affect clot formation and how?

A

aspirin - prevents platelet aggregation warfarin - prevents formation of clotting factors herparin - reduces action of platelets NOACs; Dabigatran direct inhibitor of thrombin, apixaban/rivaroxaban direct factor Xa inhibitors

100
Q

What are the clinical features of trigeminal neuralgia?

A

*Severe spasms of pain ‘electric shock’ lasts seconds

*Usually unilateral

*More common in older age groups

*Trigger spot identified

*Females more than males

*Periods of remission

*Recurrences often greater severity

101
Q

What drug is used to manage trigeminal neuralgia?

A

Carbamazepine

102
Q

Name and describe the three types of debridement?

A

*Physical; bone file or handpiece to remove sharp bony edges. Mitchells trimmer or victorial curette to remove soft tissue debris

*Irrigation. Sterile saline/water into socket and under flap

*Suction. Aspirate under flap to remove debris. Check socket for retained apices etc

103
Q

Define anaesthesia

A

Numbness

104
Q

Define parasthesia

A

tingling

105
Q

Define dysaesthesia

A

unpleasant sensation/pain

106
Q

Define hypoaesthesia

A

reduced sensation

107
Q

Define hyperaesthesia

A

increased/heightened sensation

108
Q

Name some haemostatic agents

A

*LA with adrenaline

*surgicel (oxidised regenerated celluslose

*Gelatin sponge

*thrombin liquid and powder

*fibrin foam

109
Q

What is alveolar osteitis?

A

A dry socket

110
Q

What are some features of a dry socket?

A

Intense pain, keeping patient awake at night. Often starts 3-4 days post op and can take 7-14 days to resolve. It is inflammation affecting the lamina dura. The clot either fails to form or breaks down

111
Q

What are some predisposing factors of a dry socket?

A

*Risk increases from anterior to posterior

*Mandible more common

*smoking - reduced blood supply

*Oral contraceptive pill

*Excessive trauma during extraction

*Excessive mouth rinsing

*Family history/previous dry socket

112
Q

How should a dry socket be managed?

A

*Reassure patient

*LA block

*Irrigate socket with warm saline

*Curettage/debridement to encourage bleeding and new clot formation

*Antispetic pack eg BIP or alvogyl

113
Q

Describe osteoradionecrosis

A

condition seen in patients who have had radiotherapy of the head and neck. Bone within radiation beam becomes virtually non vital. Turnover of any remaining vital bone is slow and repair is ineffective.

114
Q

What is MRONJ?

A

Medication related osteonecrosis of the jaw.

Can be caused by bisphosphonates used to treat osteoperosis and malignant bone metastases. They inhibit osteoclast activity and so inhibit bone resorption and therefore bone renewal.

115
Q

What is infective endocarditis

A

inflammation of the endocardium, particularly affecting the heart valves or CMP caused by bacteria. Antibiotic prophylaxis is not routinely recommended.

116
Q

What is prescribed as a prophylaxis against infective endocarditis?

A

3g amoxicillin oral powder to be taken 60 minutes before treatment

117
Q

Name two drugs in which care must be taken when carrying out an extraction and explain why

A
  • Warfarin:
    — If a patient taking warfarin INR is not within target
    range if below <4 there is an increased change of
    bleeding as the drug is an anti-coagulant so it prevents
    clots from forming and growing,
    — It decreased blood clotting by blocking vitamin k
    epoxied reductase that reactivates vitamin K1. Without
    sufficient activation of this vitamin K, clotting factors II,
    VII, IX and X have decrease clotting ability. The anticlotting
    protein C and protein S are also inhibited.

— Due to the reduced clotting efficiency of the blood if
the INR is not in target range a blood clot cannot be
formed at the site of extraction which means the
socket will continue to bleed if there is not adequate
haemostasis.
- Clopidogrel:
— This is an anti-platelet prodrug where it’s active
metabolite then specifically and irreversibly inhibits the
P2Y12 subtype of the ADP receptor which is important
in the activation of platelet and the cross linking of
fibrin. Platelet inhibition therefore occurs and a fibrin
clot production is reduced.
— This reduces a clot being produced at the site of
extraction; however there is a less chance of
spontaneous bleed on patients on this drug alone
when compared with patients on dual therapy or
warfarin

3rd year dentistry (16 decks)

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