ORS03 - Lecture 4 - Complications of Exodontia Flashcards
What risks do patients need to consent to? (11)
Pain
Bleeding
Swelling
Bruising
Infection
Reduced mouth opening
Damage to adjacent teeth
Dry socket
Inferior dental nerve damage
Oral sinus comminucation
Tuberosity fracture
What are the 3 types of complications?
Immediate (intra-operative) (7)
LA failure
Haemorrhage
Fracture of crown/roots
Damage to surrounding tissues (adjacent teeth/restorations, soft tissue, fractures)
Oral antral communication (OAC)
Loss/displacement of tooth -> antrum, stomach, lungs
Dislocation of TMJ
Early (post-op)
Prolonged anasthesia / paraesthesia
Pain
Swelling/bruising
Infection
Trismus
Haemorrhage (secondary from infection)
Dry socket
Developing OAC
Sensitive adjacent teeth
Delayed/late (post op)
Spread of infection
Osteonecrosis
Give examples of immediate (intra-operative) complications (6)
1) Haemorrhage
Haemostasis (blood clotting) should occur following extraction
However - it can be delayed due to -> anti-coagulants (warfarin), anti-platelets (warfarin), bleeding disorders.
Management -> bite on gauze, haemostatic agents (oxidsed cellulose/surgicel), sutures (horiztonal or cross mattress)
2) Fracture of crown/roots
Very common - occurs when the force on the tooth exceeds the mobility of tooth in socket
Higher risk -> brittle teeth (necrotic, RCT), heavily restored teeth, cruved teeth, bubous roots.
Fractured teeth can be removed surgically
3) Damage surrounding tissues
Adjacent teeth/restorations
Soft tissues
Fracture of alveolus - common in upper molars or splayed roots
Fracture of the tuberosity - common in upper 8’s or 7’s with large divergent roots. Need to check the crack extent into the alveolar bone.
Fracture of the mandible
4) Oral antral communication (OAC)
Most spontaneously close (but large ones can persist)
↑ Risk if upper molar roots are close to the floor of maxillary sinus
Tests -> hold nose and blow (look for bubbling in socket), good light and saline flush (visualise hole in base of socket), suction the socket (vascuous sound)
Management -> avoid nose blowing/long-haul flights, ephedrine nasal drops, steam inhalations
5) Dislocation of TMJ
Patient will not be able to close mouth -> occlusal derangment
Management - manipulate mandibe downwards (press premolars) and (chin) backwards to correct, if unsuccessful -> sedation/GP
Avoid by supporting the mandible
6) Loss/displacement of tooth into -> antrum/stomach/lungs
Give examples of early (post-operative) complications (5)
1) Pain and Swelling
Tissue damage -> release of prostaglandins which induce inflammation
Management -> ibruprofen and paracetamol (combine to reduce side effect)
2) Trismus (lockjaw)
Occurs 1-6 days post-operative but resolves with time
3) Dry socket
Loss of blood clot results in empty socket or socket filled with food debris
Symptoms - throbbing pain ↑ in severity , halitosis
Risk factors -> OCP, excessive rinsing, traumatic extractions, smoking, lower teeth, single tooth extractions
Management -> reassurance (not an infection), irrigate socket with saline, obtundant dressing, analgesics
4) Secondary/Reactionary Haemorrhage
Secondary = 7 days post op due to infection -> sudden ↑ INR if on warfarin, and clot dislodges.
Reactionary - 48 hours post op due to dislodgement/overexertion of blood clot
5) Prolonged Anaesthesia
Caused by damage to inferior alveolar or lingual nerve (nerve ischaemia)
↑ Risk -> using articaine or ID blocks/multiple injections
Can be permanent
Give examples of late/delayed post-operative complications (2)
1) Spread of Infection
Soft tissue = cellulitis (requires surgical drainage)
Bone = osteomyelitis, failure to heal, moth eaten appearance (radiograph), pain/malaise
2) Osteonecrosis
↑ Risk -> patients that use bisphosphonates (especially IV)
Can also occur post-radiotherapy -> osteoradionecrosis
What are Bisphosphonates? (2)
Drugs that ↓ bone turnover
Used to treat -> myeloma, osteoporosis, Paget’s disease, cancer (bone metastasis)
How do bisphosphonates affect oral surgery? (2)
↓ Healing
↑ Risk of osteonecrosis of jaw (post extraction)
What is the protocol in KCL for patients taking bisphosphonates (particularly IV)? (6)
TDS = 3/day
10ml Chlorhexidene mouthwash 30 seconds pre-operative
200mg Metronidazole TDS PO for 1 week or until mucosal healing achieved
Chlorhexidene mouthwash TDS until full mucosal healing achieved
Initial review 2/52 post extractions
Regular reviews till 6/12 post extractions
No dentures for atleast 4 months following full mucosal healing
