Oral Surgery

Question 1

give 4 post extraction complications

Answer 1

dry socket, pain, infection, swelling, bruising, trismus

Question 2

what is trismus

Answer 2

limited mouth opening due to muscle spasm

Question 3

what causes trismus

Answer 3

IDB injection into medial pterygoid or bleeding into medial pterygoid

Question 4

what is the dental term for dry socket

Answer 4

alveolar osteitis

Question 5

what is a dry socket and how is it thought to be caused

Answer 5

failure to production a blood clot, looks like bare bone, may be excessive mouth washing which washes clot away

Question 6

what are predisposing factors for alveolar osteitis

Answer 6

more posterior teeth, mandible more likely, female, oral contraceptive pill, smoker

Question 7

what are symptoms of dry socket

Answer 7

severe pain, worse than toothache, keeping up at night

bare bone - no clot formation but also no sign of infection, no pus or swelling

Question 8

how is dry socket managed

Answer 8

reassurance and support, gentle irrigation and removal of debris, can pack antiseptic pack into wound, local anaesthetic for relief, can debride but could make it worse

Question 9

if a patient presents with bleeding 24 hours after extraction, how do you manage them

Answer 9

calm patient down, reassure and clean them up
quick but thorough medical history - haemological condition, liver problem, medication
apply pressure, bite on damp gauze
provide LA with adrenaline - vasoconstrictor
pack homeostasis agent - surgicel - oxidised cellulose to provide framework for clot formation
suture wound
give the patient point of contact for if it starts again

Question 10

if you’re unable to achieve homeostasis yourself, what do you do

Answer 10

urgent hospital referral, refer to dental hospital or maxillofacial department if weekday, if weekend - a&e or on call maxillofacial

Question 11

what instructions should be given to patients post-op

Answer 11

avoid rinsing for a few hours after - if possible until the next day, then gentle rinsing with warm salty water
avoid excessive alcohol and sports
avoid hot foods
avoid trauma with fingers or tongue
if bleeding occurs - apply pressure by biting on damp gauze or tissue, for at least 30 minutes

Question 12

what are 4 indications for extraction

Answer 12

unrestorable tooth - gross caries, pulpal necrosis, periapical abscess
orthodontic reasons
symptomatic partial eruption - causing pericornitis, impacted
traumatic position

Question 13

give 4 peri-operative complications

Answer 13

abnormal resistance, tooth/root fracture, haemorrhage, TMJ dislocation, damage to nerves

Question 14

give 3 ways nerves can be damaged

Answer 14

crushing injury, transection, damage/cutting with LA injection