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 causes a fracture of the maxillary tuberosity?
Single standing molars
Bone loss and unerrupted teeth.
How do you deal with a fractured tuberosity when the tooth has been sucessfully extracted?
Either-
Small bit of bone- Disect out the bone and close the wound.
Big bit of bone- put the bone back and stabilise (using splints or orthodontic wire welded with composite)
How do you deal with a fractured tuberosity when the tooth has not been sucessfully extracted?
- Stabilise the maxilla
- If the tooth is interfeering with occlusion- reduce the crown (It will be extracted anyway)
- Antibiotics and keep the mouth clean with antiseptic mouthwash
- Leave extraction for 8 weeks & ensure patient is keeping splint clean.
If tooth was being extracted due to pain- you still need to deal with the pain i.e. remove the pulp and dress. Otherwise wait until the bone is fixed.
Why do we stabilise fractures?
So that the bone heals with a bony union.
If the bone is not stabilised- fibrous healing will occur meaning the bone will be able to move.
What causes maxillary sinus involvement?
Oral antral communication.
Oral antral fistulas
Loss of root in the antrum
Fractured tuberosities.
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. )
How do we manage a small OAC/OAF?
Encourage clot
suture the margins
antibiotics.
How do we manage a large OAC or tear in the sinus lining?
Close the socket straight away (using a buccal flap of tissue- but you need to remove the underlying periosteum -white part- to make it elastic)
Antibiotics
Review- incase the closure breaks down.
How do we manage a root in the maxillary antrum?
Open access to the sinus using an electric handpeice
A- Suction the root out
B- Irrigate using saline to try and flush the tooth out.
C-Tuck ribbon gauze into the antrum and pull the root out when you remove the gauze.
Close like an OAC
Discuss the types of nerve sensation:
Anasthesia- Numbness
Parasthesia-Tingling
Dysthesia -Pain
Hyperaestheisa- Increased sensitivity
Hypoaesthesia- Decreased sensitivity
How do we manage soft tissue bleeds?
Pressure using a damp gauze
- Local anaesthetic with adrenaline (to constrict the BV)
- Cauterise (burning the ends of the BV to create a protein plug within it)
- ligate the vessel if it’s larger.
How do we manage bone bleeds?
Pressure- pack a swab into the socket.
Apply LA on a swab or inject it into the pocket
Use haemostatic agents (surgisel or kaltostat)
Pack it- sew gauze in.
What is dislocation of the TMJ?
When the jaw is out infront of the articular eminence.
How do we manage dislocation of the TMJ?
A-immediately relocate it
- Before the muscles spasm
- Move the jaw down (to jumpover the articular eminence) and back
- Provide anaesthesia
- Advise regarding supported yawning
B- Try LA into the masseter for some pain relief and try again.
C- If still unable- immediately refer.
What is vital if you break an instrument?
You need to find the broken part.
How do you stabilise the mandible?
Tie ortho wire around the crowns of the teeth on each side of the fracture- this prevents rubbing.
