Oral Surgery - Post-operative Complications Flashcards
List common post operative complications. (8)
Pain, swelling and ecchymosis
Trismus
Haemorrhage
Prolonged effects of nerve damage
Dry socket
Sequestrum
Infection
Chronic OAF
List uncommon post operative complications. (5)
Osteomyelitis
Osteoradionecrosis
Medication induced osteonecrosis
Actinomycosis
Bacteraemia/infective endocarditis
How long can truisms last?
commonly 1/2 weeks
What causes truisms? (4)
Oedema from surgery
LA needle intointo medial pterygoid muscle
Bleeding into the master or medial pterygoid muscle
Damage to the TMJ
List the 3 main types of haemorrhage and how long after surgery they occur.
periopertaive
immediate post op = within 48 hours
secondary bleeding = 3-7 days
what is the common cause of secondary bleeding/haemorrhage?
infection
What are the post extraction instructions given In order to prevent haemorrhage?
avoid exercise, alcohol and any other activities that raise BP for 24 hours
Don’t explore socket with finger, tongue, TB
Don’t rinse for 24 hours then after that rinse regularly after eating (warm/warm salty water) and gently spit
Avoid very hot and hard foods for 24 hours and eat on the opposite side
what is dry socket?
localised osteitis = inflammation of the lamina dura
delayed healing not caused by infection
what causes dry socket?
when the clot partially/fully disappears or doesn’t form at all.
what are the symptoms of dry socket? (5)
Intense, dull aching, throbbing pain that keeps the patient up at night.
Pain can radiate to the ear
Bad smell
Bad taste
when does dry socket start to cause symptoms?
3/4 days after extraction
how long can dry socket last?
7-14 days
what predisposing factors make a patient more likely to develop dry socket? (7)
smoking/ex-smokers - reduced blood supply
previous ds
females
OCPs
the use of lots of LA with vasoconstriction
trauma during extraction
mouth rinsing post extraction
how do we manage dry socket? (8)
Check that there’s no tooth fragments/bony sequestra remaining and take radiograph to confirm
Reassurance that this is common
advise analgesics and hot salty mouthwashes
or
LA block
Irrigate socket with warm saline with regular appointments
Debride the socket to encourage new clots (controversial)
Antiseptic pack e.g. alvogyl: packed into the socket and it disintegrates itself. No sutures.
or
BIP paste/gauze packed into the socket, needs to be replaced as they don’t dissolve. Suture over the top.
do we prescribe antibiotics for dry socket?
Don’t prescribe antibiotics as its not an infection
is chlorhexidine used in fresh wounds?
no - can force the product into the bloodstream and cause anaphylaxis
what is sequestrum?
fragments of dead bone, amalgam or tooth which delays healing
What is osteomyelitis?
where a bacterial infection of the cancellous bone spreads to cortical bone then the periosteum.
what factor makes a patient more likely to develop osteomyelitis?
compromised host defences from diabetes, alcoholism, IV drug use, malnutrition and myeloproliferative disease.
what are the symptoms of osteomyelitis?
systemically unwell with a fever
altered sensation
can be similar to dry socket or localised infection
what dentally related predisposing factors make a patient more likely to develop osteomyelitis? (3)
fracture of the mandible
odontogenic infection
bad periodontal disease
how does osteomyelitis appear on a radiograph?
patchy or uniform radiolucency - moth eaten appearance
can be areas of radiopacity within radiolucent areas
what is osteoradionecrosis?
where the radiation causes endarteritis obliterates and leaves the bone non-vital.
bone turn over slows down and self-repair is ineffective
what structure is most commonly affected by osteoradionecrosis and why?
the mandible - only has one main artery
how can we prevent osteoradionecrosis related complications during dental treatment? (5)
most likely refer
Scaling and chlorhexidine mouthwash before extraction
Careful technique
Prescribe antibiotics, chlorhexidine and then review
Hyperbaric oxygen before and after the extraction:
Give vitamin E 6 weeks before extraction
how is hyperbaric oxygen used to prevent osteoradionecrosis?
increases tissue oxygen and increases vascular ingrowth to hypoxic areas.
Describe how medication causes medication related osteonecrosis? (MRONJ)
medication used to inhibit osteoclast activity i.e. Bisphosphonates
what structures are affected by MRONJ?
the jaws only
who is affected by MRONJ? (6)
those with Bisphosphonates for osteoporosis, padgets, malignancy
anti-angiogenic drugs
anti-resorptive drugs
(risk increases when taking these together or alongside steroids)
smokers
diabetes
what are high risk dental treatments for those with MRONJ?
Those who have had trauma from dentures
Those with infection
Those with periodontal disease
Impact on bone: extraction
how do we manage patients with MRONJ?
prevent invasive treatment where possible
extractions can be done in primary care
drug holidays when the medication is used for prevention
what Is actinomycosis?
A rare chronic bacterial infection which erodes through tissues (rather than following fascial planes/spaces)
who is affected by actinomycosis?
Only present in patients who’s host defences are compromised by diabetes, alcoholism, iV drug use, malnutrition and myeloproliferative disease etc
Or
Where the bacteria has been introduced into an area
what are the signs of actinomycosis? (3)
multiple skin sinuses
swellings
thick lumpy pus
