ORAL SURGERY PREP Flashcards
What is the best post-operative analgesic to prescribe for dental related pain?
Iburprofen NSAID
What are the main areas to cover when giving post-operative instructions after oral surgery?
- expect pain
- expect bruising/swelling (especially if a surgical)
- get on top of analgesia
- how to prevent bleeding
- how to stop bleeding if it occurs
- avoid smoking & alcohol
- may experience TMJ problems, teeth sensitivity
- rinses & when to start
What should a patient do before the anaesthetic wears off?
Take analgesia
(ibuprofen and paracetamol)
What must you warn the patient NOT to do before anaesthetic wears off?
Don’t eat foods (hot especially) until anaesthetic wears off incase you traumatise wound or soft tissues accidentally
In which groups do you need to be cautious when prescribing Ibuprofen?
- GIT problems
- elderly
- pregnancy
- renal, cardiac or hepatic impairment
- hypersensitivity to NSAIDs
- asthma
- already taking NSAIDs
- anticoag patients
- long term steroid patients
What dose of ibuprofen is recommended for dental pain post extraction?
2x 200mg ibuprofen tablets 4x a day
(after food)
What is the max dosage of ibuprofen?
2.4g daily
In which patients should paracetamol prescription be cautioned?
- hepatic impairment
- renal impairment
- alcohol dependence
What is the recommended paracetamol dose for post-operative dental pain?
2x 500mg paracetamol every 4-6 hours
What is the max dose for paracetamol?
4g daily (8 tablets)
How many tablets can cause serious paracetamol overdose?
20-30 tablets (10-15g)
How can patients prevent post-operative socket bleeding?
- avoid exploring socket with finger/tongue/toothbrush
- avoid exercise or excessive movements
- avoid hot/hard foods
- avoid alcohol
- do not rinse for 24 hours
What should patients do if they experience bleeding post-operatively after an extraction?
- bite on damp gauze/tissue for 20-30 mins
- if persists, replace and do this again for up to 1 hour
- if still persists, contact dental practise/out of hours dentist
- if unable to reach dentist, go to A&E
Why should patients avoid smoking after an extraction?
Can cause dry socket
When do patients tend to reach maximum swelling after a difficult extraction?
2 days after
You have performed a surgical extraction and have placed sutures, what information do you give to patients?
LEAVE THEM ALONE & DO NOT PULL
- sutures can be resorbable or non-resorbable
How long should you wait before and after eating when doing Chlorhexidine mouth rinses?
1 hour as Chlorhexidine can stain teeth but this is less likely if there’s no food particles on teeth
What should patient do if they experience swelling?
Use ICE PACKS (not heat as this will make worse)
- 5 minutes on/5 mins off/5 mins on
- do this for 1-2 hours
WHEN should you stand behind the patients right shoulder during oral surgery procedures?
Removing teeth from the
- lower right quadrant
- lower right molars & premolars
Name all the lower forceps used in oral surgery practise & what teeth they are used to extract:
- Lower universal forceps = 35-45 (also molar roots)
- Lower molar forceps = lower molars
- Cowhorn forceps = lower 6s
Name all the upper forceps used in oral surgery practise & what teeth they are used to extract:
- Straight upper forceps = 13-23
- Upper universal forceps = 15-25
- Upper molar forceps (right & left) = upper molars
- Bayonet forceps = upper 8s
What is the function of a luxator?
Break PDL around tooth to mobilise it
What scalpel blades are commonly used in oral surgery?
- Schwann-Morton Blade 11
- Blade 15
What is the typical Lidocaine LA solution used in OS?
2.2ml cartridge Lidocaine 2% [amide]
- 1:80,000 adrenaline
- 44mg per cartridge
What is the typical Prilocaine LA solution used in OS?
2.2ml Citanest 3% (prilocaine) [amide]
- Felypressin vasoconstrictor
- 66mg per cartridge
What is the typical Articaine LA solution used in OS?
2.2ml Articaine 4% [amide]
- 1:100,000 adrenaline
- 88mg per cartridge
What is the maximum safe dosage of Lidocaine WITH adrenaline?
4.4mg/kg
What is the maximum safe dosage of Lidocaine without adrenaline?
3mg/kg
What is the maximum safe dosage of Prilocaine 4%?
6mg/kg
What is the maximum safe dosage of Articaine 4%?
5mg/kg
How can LA administration accidentally cause trismus?
IDB too low and into medial pterygoid
What is the function of a periotome?
Severs the periodontal ligament
- thin, blade/like tip
- inserted between tooth & surrounding bone
- allows for controlled & gentle extraction to minimise trauma
What types of elevators are used in dentistry OS?
- Cryers (right & left)
- Warwick James (straight, right & left)
- Couplands (different sizes)
What are the three basic modes of action of elevators used in OS?
- wheel and axle
- lever
- wedge
What are the principles of use of elevators?
- avoid excessive force
- support the instrument to avoid injury
- direct applied force away from major structures
- never use adjacent tooth as fulcrum
- keep them sharp and in good shape
- establish force of application
What are the uses of elevators?
- provide a point of application for forceps
- loosen teeth prior to using forceps
- extract teeth
- removal of root stumps
- removal of retained roots
- removal of root apices
What debridement is used in Oral Surgery?
Physical = bone file or handpiece to remove sharp bony edges OR mitchell’s trimmer / victorias curette to remove soft tissue
Irrigation = sterile saline into socket & flap
Suction = aspirate socket & under flap to remove debris
When should non-absorbable sutures ALWAYS be used?
- closure of OAF
- extended retention periods required
What is the disadvantage of using polyfilament/multifilament sutures?
Prone to wicking
- oral fluids and bacteria can infiltrate the suture
What shape is the cross section of a suture needle?
Triangular
