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BDS3 Lawrence > OS - Complications > Flashcards

OS - Complications Flashcards

1
Q

What are the 16 peri-operative complications?

A 
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Difficulty access 
Abnormal resistance 
Fracture of the tooth 
Fracture of the alveolar plate 
Fracture of the tuberosity 
Jaw fracture 
Involvement of the maxillary antrum 
Loss of tooth 
Soft tissue damage 
Damage to nerves 
Haemorrhage 
Dislocation of TMJ 
Damage to adjacent teeth and restorations 
Ex of the permanent tooth germ 
Broken instruments 
Wrong tooth
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2
Q

What are some possible reasons for the difficulty of access?

A

Trismus (decrease in mouth opening due to spasm of the M.O.M)
Lack of mouth opening
Crowded/malpositioned teeth

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3
Q

What are some possible reasons for abnormal resistance?

A 
Thicker cortical bone 
Curved and divergent roots 
Number of roots 
Ankylosis - trauma
Hypercementasis (linked with pituitary giantism, acromegaly and Paget's disease)
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4
Q

What is a possible reason for ankylosis?

A

Trauma and then boney healing has occurred

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5
Q

Reasons for possible tooth or root fracture in Ex

A

Grossly caries teeth and Forceps not being placed far enough down the tooth.

Root fractures can occur for the same reasons as abnormal resistance. Fused roots, hypercementosis, hooked or divergent roots

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6
Q

Where does a Fracture of the alveolar plate most often take place?

A

The canine or molar buttress.

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7
Q

Where does a fracture of the tuberosity most often take place?

A

In the PM and M maxillary region of the mouth.

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8
Q

Aetiology of tuberosity fractures?

A

Not got the proper support
Last standing molars
Ex from the back, forwards
Have the adequate support from alveolar bone

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9
Q

How would you diagnose a tuberosity fracture?

A

Noise - tear sound
More than one tooth moving
Tear of the palate as often sharp bone is created.

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10
Q

How to treat a tuberosity fracture?

A

don’t remove the tooth, stabilise it by treating pulp if necessary. Then stabilise the area with orthodontic wire. Allow the bone to heal before attempting to re Ex the tooth in min of 8 weeks time.

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11
Q

WHere is a jaw fracture more common?

A

In the mandible

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12
Q

Aetiologies of jaw fractures?

A

Present of cysts,
impaired vision
atrophic mandible
Edentulous patients

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13
Q

How do you minimise the chances of jaw fracture?

A

Prepare and risk assess
Take radiographs - to check the bone quality
Support the jaw and tooth fully when removing and avoid excessive force

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14
Q

Management of jaw fracture?

A

Must tell patient and refer straight away to MaxFax.
If you cant get referral that day then consider analgesia, antibiotics prophylaxis, extra LA and stabilise with ortho wire

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15
Q

What are the 3 ways maxillary antrum can be involved?

A

OAC and OAF
Root in antrum
tuberosity fracture

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16
Q

What can you do to diagnose and access the risk of OAC?

A

Take radiographs before - OPT or occlusal

Look at the maxillary teeth from 3’s back and if roots long and close to the maxillary antrum.

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17
Q

Management of acute OAC?

A

Inform patient
If small or sinus intact;
encourage clot formation, suture the margins, prescribe antibiotics and give the patient post-operative instructions.
If large, close with buccal advancement flap, antibiotics and nose blowing instructions.

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18
Q

Why shouldn’t you use an air generated drill?

A

Surgical emphysema

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19
Q

For surgical removal of a root in the antrum, what type of flap should you use?

A

Buccal advancement flap

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20
Q

What are the post-operative instructions for OAC and OAF?

A

Leave it alone
Do not rinse vigorously, gentle rinse the next day.
Continue to brush as normal
Avoid straws, wind instruments and sucking air into the area
closed mouth sneeze
Avoid nose blowing
Talk to the patient the next day and follow up at 6-8weeks

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21
Q

If you lose a tooth where should you look?

A 
The buccal mucosa 
in the flap 
Under the tongue 
suction bottle 
Radiograph the maxillary antrum 
Ask patient if swallowed anything and refer
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22
Q

What is neurapraxia?

A

Temporary damage to the nerves, axon still intact

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23
Q

What is axonotmesis?

A

Axon and myelin sheath are damaged

24
Q

What is neurotmesis?

A

Cut - complete damage of the nerve and loss of nerve transmission.

25
Q 
Define 
Anaesthesia 
Paraesthesia 
Dynathesia 
Hypoaesthesia 
Hyperaesthesia
A 
Anaesthesia - numbness
Paraesthesia - tingling
Dynathesia - pain 
Hypoaesthesia - reduced sensation
Hyperaesthesia - increased sensation
26
Q

What must you tell the patient before any Ex in relation to nerves?

A

Must tell the patient in simple terms about the risks of permanent and temporary damage.

27
Q

Reasons for haemorrhage?

A

Mucoperiosteals tears in a region of vessels or fractures of the alveolar plate/socket wall
Bleeding disorders, liver damage, medications

28
Q

management of soft tissue bleeding?

A 
PRESSURE 
LA (vasoconstrictor)
Diathermy 
Suture 
Clamps
29
Q

management of bleeding from the bone?

A 
PRESSURE 
LA
bone wax 
Diathermy 
surgicel - acts as a framework for clot formation
30
Q

Management for TMJ dislocation

A

Want to re-locate straight away if you can. Then give analgesia, and advice on supportive yawning.
If cannot reposition straight away then inject LA to the masseter (IO) and retry.
If this still doesn’t work then refer to maxfax or Aand E immediately

31
Q

Why should you relocate the TMJ immediately?

A

As muscles will start to spasm and make it much more difficult.

32
Q

What are some reasons for broken instruments?

A

Faulty instruments

Not using them for their appropriate function.

33
Q

What are the 13 postoperative complications?

A 
PTHPDSICOOMAB
Pain/swelling/bruising
Trismus 
Haemorrhage
Prolonged nerve damage
Dry socket (localised osteitis)
Sequestrum
Infective socket
chronic OAF and root in the antrum
Osteomyelitis 
Osteoradionecrosis 
MRONJ
Actinomycosis 
Bacterial infective endocarditis
34
Q

Pain, swelling and bruising are the most common post-Ex complication. How would you manage it and what would you say to the patient?

A

Would prescribe analgesia, tell them to ice it and say it should resolve completely in 1-2weeks post-Ex.

35
Q

Trismus is predominantly caused by a muscle spasm of which muscle?

A

Medial pterygoid

36
Q

What are some possible causes of trismus?

A

LA into the muscle tissue
surgery and formation of scar tissue
Due to haematoma
Damage to TMJ

37
Q

Management of postoperative bleeding?

A

Suction out all the blood and find the source of the bleed. While doing this take a brief history to rule out bleeding disorders, liver damage and medications.
Then once found bleed, apply pressure, LA (VC), surgicel, suture, diathermy and good post-operative instructions
Check-in on a patient at the end of the day and if still bleeding then A&E

38
Q

What can you do to prevent post-Ex haemorrhage?

A

Plan - Good risk assessment and thorough medical history
Atraumatic Ex
Achieve good haemostasis after Ex
Give good post-operative instructions

39
Q

What is 5 post-operative instruction that you should always tell the patient after an Ex?

A 
Do not rinse out your mouth straight after and avoid vigorously rinsing that day (clot) 
Avoid trauma (don't explore the socket with your tongue or fingers)
Avoid Hot food that day
Avoid excessive physical exercise and alcohol 
Advice on the use of damp gauze and bite down for 30minutes if it starts to bleed again before you call in for an emergency.
40
Q

What is a dry socket also referred to as?

A

Localised osteitis

41
Q

What is a dry socket?

A

Its when the clot doesn’t form properly and inflammation of the lamina dura occurs which results in intense pain.

42
Q

When does a dry socket occur? where does it occur more and how long does it last?

A

3-4 days after Ex
Posterior teeth of the mandible (females more also)
lasts 7-14 days (slow healing)

43
Q

Where can dry socket pain radiate?

A

The ear and down the side of the face

Keep Them awake at night as so intense.

44
Q

What are some predisposing factors for dry socket?

A 
Molar teeth 
mandible 
Females 
smoking 
excessive trauma during Ex
Excessive mouth rinsing post-Ex
Family history 
Had dry socket before 
LA used 
Oral contraceptive pill
45
Q

Management of Dry socket?

A

Support patient - reassure them it’s a side effect and that you took the right tooth.
Prescribe analgesia
Give LA to alleviate pain
Irrigate socket and teach them to rinse with warm salty water
Review every few days

46
Q

What is a sequestrum?

A

Refers to anything left in the socket, which shouldn’t be and will therefore prevent healing.

47
Q

If you leave some sequestra in the socket what can happen?

A

The socket can become infected

48
Q

what is osteomyelitis and who can it affect?

A

Inflammation of the bone marrow

Rare and usually only affect people how are medically or immunosuppressed.

49
Q

What types of antibiotics are good for osteomyelitis and odontogenic infections?

A

Penicillin

Clindamycin (allergy to penicillin)

50
Q

What is osteoradionecrosis?

A

This occurs in patients who have had radiotherapy for head and neck cancers. the beams cause the bones to become non-vital.

51
Q

WHere can ORN happen more often in the mouth and why?

A

the mandible as has a much poorer blood supply

52
Q

What are bisphosphates? and what are they used to treat?

A

Bisphosphates are used to inhibit bone remodelling and osteoclast activity so the bone isn’t resorbed.
Treats osteoporosis
Paget’s disease
bone cancers

53
Q

How many years do you have to be on bisphosphates before MRONJ is a problem?

A

5 years

54
Q

Risk factors that increase chances of MRONJ?

A 
Length of time on the drugs 
Steroids 
Diabetes 
smoking 
IV instead of orally
55
Q

What is actinomycosis?

A

Rare bacterial infection

56
Q

What are the at-risk groups for bacterial endocarditis?

A

Acquired valvular heart disease
Prosthetic heart valve or valve replacement
Structural congenital heart defects
History of IE

57
Q

What is the treatment for infective endocarditis?

A

Optimum OH and oral health before any treatment
Lease with their cardiologist if prophylaxis is necessary.
30mins before treatment take a single dose of antibiotics;
either amoxicillin 2g IV
Clindamycin 600mg IV

BDS3 Lawrence (39 decks)

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