Peri and Post Operative Complications Flashcards
What causes Difficult Access?
Trismus (limited mouth opening)
Reduced aperture of mouth (congenital/syndromes)
Crowded/malpositioned teeth (palatally/lingually)
TMJ spasm- cannot open mouth wide
What can cause Abnormal Resistance when extracting a tooth?
A thick cortical bone
Shape/form of the roots e.g. divergent roots or hooked roots
Hypercementosis
–excess build up of normal cementum on the roots (more work to loosen the tooth)
Ankylosis
–Tooth is directly bonded to the surrounding bone, there is no PDL
Where is the alveolar bone more likely to fracture?
Usually the buccal plate
Usually canine or molars
Where does the jaw normally fracture?
Mandible
What do you do if the jaw does fracture?
Inform the patient
Post-op radiographs
Refer (phone local maxillofacial surgeon and explain)
Ensure analgesia
Stabilise
If there is a delay in access to treatment, give antibiotics and can splint the teeth either side of the fracture to prevent the movement which causes pain
What are some signs of a jaw fracture?
Moving in 2 parts
Tear in gingivae
Teeth are no longer occluding like they were before extraction
Loud crunch or crack
What is an oro-antral communication (OAC)?
When extracting an upper tooth and you create a hole into the sinus (NAME FOR WHEN IT HAS JUST HAPPENED)
What is an oro-antral fistula (OAF)?
If an oro-antral communication (OAC) has been left for a period of time without being closed properly, the channel becomes epithelialised and you can have a tract that leads from the sinus to the oral cavity
HAS BEEN PRESENT FOR A WHILE FOR THIS TO OCCUR
How can an OAC be created?
Root being in the actual sinus
Root fracture occurs, when luxating can push root into the sinus
Fracturing the tuberosity
How can you tell if you have just created an OAC?
Bubbling of blood- sign of air passing from the sinus to the mouth
Nose holding test (careful as this can create an OAC)
–blow out gently against closed nostrils, if OAC is present patient can feel air escape into their mouth
–too much pressure can create an OAC
Direct Vision
–can see a hole, normally a bone
Blunt Probe
–more recommended for a fistula than directly after extraction
What are some risk factors for an OAC?
Extraction of upper molars and premolars
Close relationship of roots to sinus on radiograph
Last standing molars
Large bulbous roots
Older patients
Previous OAC
Recurrent sinusitis
What is the management of a small OAC or if the sinus in intact?
Encourage clot (can act to seal a small sinus)
Suture margins
Antibiotics always given (prevents sinusitis or chronic infections)
Post-op instructions
What is the management of a large OAC or if the lining is torn?
Close with buccal advancement flap
-pulling gum from buccal side over to the palatal side and stitching tightly for the gum to heal over properly
-2 vertical incisions and score the underside of the mucoperiosteum flap to give it more stretch and flexibility and secure it to the palatal
Prescribe antibiotics and give nose blowing instructions
-use decongestants or steam inhalation to prevent mucous build up
How can a tuberosity fracture occur?
Inadequate alveolar support
Extracting in wrong order
-take teeth out from back to front if multiple extractions
Single standing molar more likely to occur
How can you diagnose a tuberosity fracture?
Noise
Movement notes both visually or with supporting fingers
More than one tooth movement
Tear on palate
What is the management of a tuberosity fracture?
Dissect out and close wound or reduce and stabilise
-Put tooth and bone back into place (using splint) and ensure tooth is in occlusion, if it will not go back into occlusion reduce cusp size and place back in
Fixation
-splints, orthodontic wires
What can cause damage to the nerves?
Crush injuries
Cutting/shredding injuries
Transection
Damage from surgery or damage from LA
What is Neurpraxia?
Contusion of nerve/continuity of epineural sheath and axons maintained
What is Axonotmesis?
Continuity of axons but not epineural sheath disrupted
