Oral surgery - POI

Question 1

What should you tell the patient about pain?

Answer 1

• pain is normal once LA has worn off
• begin painkillers before LA wears off
• optimal analgesia is achieved using ibuprofen and paracetamol at 2 hour intervals (if patient is safe to take them - “take what you would usually take for a sore head”)

Question 2

What should you tell the patient about bleeding?

Answer 2

• bleeding is unlikely but avoid disturbing socket (ie tongue, toothbrush)
• if the socket begins to bleed, bite on damp gauze for 20 mins and bleeding should stop
• if bleeding doesn’t stop after 1 hour of biting on fresh damp gauze, contact dentist or A&E out-of-hours

Question 3

What should you tell the patient about after-care that day?

Answer 3

• do not exercise that day or anything that will increase blood pressure
• avoid hot and hard foods (may burn patient due to LA or traumatise socket)
• try to eat on opposite side of mouth (normal/soft diet)
• do not drink alcohol for 24 hours
• do not rinse for at least 6 hours, next day is ideal
• do not smoke for 24 hours (or as long as possible)
• brush teeth as normal in the evening, being careful around socket to not disturb clot, spit don’t rinse

Question 4

What other symptoms should patients expect?

Answer 4

• adjacent teeth my be sensitive
• may experience trismus (pain/stiffness of the jaw)

Question 5

What should you tell the patient about swelling?

Answer 5

• individual response
• usually swells over 2 days then resolves within a week
• if the swelling persists or continues to get bigger, the patient should contact the dentist in case of infection
• patient should use ice with on/off technique rather than 30 mins straight (5 on, 5 off)

Question 6

What are the common side effects of an extraction?

Answer 6

• pain
• bleeding
• bruising
• swelling
• infection (less common)

Question 7

What should you tell patents about a surgical extraction?

Answer 7

• often sutures, they are usually resorbable so don’t require removal
• patient should leave sutures alone, do not pull at them
• chlorhexidine can be used if brushing is painful, can be used as an antiseptic

Question 8

How should you advise the patient to rinse?

Answer 8

• rinse gently with warm water (or saline)
• if using salt, dissolve a teaspoon of salt in a cup
• rinse 4 times daily, especially after eating
• do not vigorously rinse, hold water over socket, swirl gently

Question 9

What should you give to patient as part of their POI?

Answer 9

• written instructions with contact number
• gauze in case of bleeding

Question 10

What preventative advice can you give to patients who are at risk of MRONJ?

Answer 10

• maintain excellent OH (fluoride toothpaste and MW)
• do not smoke
• limit alcohol
• report any symptoms including exposed bone, sore teeth, non-healing lesions, pus or change in sensation ASAP
• review at 8 weeks

Question 11

Who should you be cautious of when recommending ibuprofen?

Answer 11

• peptic ulceration
• elderly
• pregnant or breastfeeding
• renal, cardiac or hepatic impairment
• asthma
• long term systemic steroids or taking other NSAIDs
• hypersensitivity reaction to NSAIDs
• medications (antidepressants, beta-blockers, diuretics)

Question 12

What is the recommended safe analgesic for renal patients?

Answer 12

Paracetamol - NO NSAIDs

Question 13

What is the recommended safe analgesic for liver patients?

Answer 13

Paracetamol