OS- Complications & post-op instructions Flashcards
What do we advise for a patient to prevent bleeding:
- Leave the socket alone
- Avoid activities that increase blood pressure that day
- Avoid hot foods
- Avoid hard foods
- Eat on the other side of the mouth to where the extracton has occured.
- Avoid alcohol for 24 hours.
- Do not rinse out for the first 24 hours.
- Continue to brush teeth as normal.
What does this mean and why do we advise it
“Leave the socket alone”
You don’t want to irritate the socket with a toothbrush/ your finger/ your tongue.
This can disrupt the blood clot- causing bleeding.
What everyday activities can disrupt clot formation?
- Touching the socket.
- Eating Hard food.
- Alcohol
- Rinsing your mouth.
What is a dry socket?
This is a socket in which the blood clot has been removed. This is painful.
Discuss the use of chlorohexidine mouthwash?
This is used to keep the patient’s mouth clean.
It cannot be used in open wounds- so cannot be used for the first few days.
After that:
Patient uses a capful 3 times a day.
Cannot be used after brushing (will interact and wash the fluoride away)
Don’t eat 1hour before or 1 hour after mouthwash (as food can make staining more likely)
A patient calls up saying they are still bleeding after extraction, What should you advise them?
Use a clean wet tissue and put even pressure on the socket for 30 minutes.
If socket hasn’t stopped bleeding- put pressure on the socket for an hour.
Then call a&e.
We use a wet tissue so that the clot does not stick- and would be pulled out on removal.
Discuss some of the symptoms a patient can experience after extraction?
- Sensitivity of adjacent teeth-
- Swelling- if it doesn’t go down after a few days (could be an infection)
- Pain and stiffness of muscles of mastication
What should you tell a patient about rinsing their mouth post extraction?
The patient should not rinse their mouth for 24 hours after extraction.
Then they should rinse 4 times daily with warm or salt water.
Compare the different types of extraction complication
intra-operative- during the operation
Peri-operative-within an hour or so
Post-operative- hours or days after the procedure.
Long term-weeks and months after
What makes an extraction more difficult?
-
Difficulty of access:
- Trismus
- Reduced mouth opening
- Crowded or malpositioned teeth
-
Abnormal resistance:
- thick cortical bone
- Divergent or hooked roots
- Hypercementosis- extra cementum around the roots.
- Ankylosis (roots fused with bone)
What is the first thing you should do if you can’t get the tooth out?
Stop and wait a minute.
Constantly moving the tooth will cause an oedema around the inflamed PDL- this is counterproductive.
What can cause a fracture of the alveolar bone.
Mainly extraction of the canines or molars causing fracture of the buccal plate .
How do you deal with a fracture of the alveolar bone?
Dependent on blood supply (If it is still attached to the periosteum it has a blood supply)
If tooth has blood supply-
- Put bone back into position
- Smooth edges with a bone file.
- Suture the gum around it.
If tooth doesn’t have a blood supply
It is not going to heal- Disect periosteum and extract.
What can cause a jaw fracture?
Weakened mandible due to:
Cysts
Impacted wisdom teeth
Atrophic mandibles (thinner bone due to lost teeth)
How do you deal with a fractured mandible?
Inform the patient
Complete a post-op radiograph
Refer to a&e or Maxfax (tell them not to eat in case they go to theatre)
Provide analgesia
Stabilise the mandible.
If there is any reason for delay- give them antibiotics.
What signs should you look for to diagnose maxillary sinus involvement.
- Bone on the root.
- Blood bubbling around the socket.
- A tear in the palate (where sharp bits may have torn the overlying tissue. )
