Post Extraction Complications Flashcards
List methods to manage soft tissue bleeding
Pressure
LA with adrenaline
Haemostatic agents - surgicel
Sutures
Diathermy
List methods to manage bone bleeding
Pressure
LA into socket
Haemostatic agents - Surgicel
Bone wax
Pack
What is surgicel?
Oxidised cellulose
Acts as a framework for clot formation
Promotes haemostatis
If bleeding profusely post XLa, what must you rule out?
Bleeding disorders:
Haemophilia
VWD
Liver disease
Antiplacelets/anticoags
Protocol if excessive bleeding + pt has bleeding disorder
Contact haematologist
Protocol if excessive bleeding + pt is on warfarin
INR from GMP
Urgent referral to hospital
What tooth should you be wary to use surgicel for?
Lower 8 region as acidic - damage to IAN
List some examples of Haemostatic agents
La w adrenaline
Surgicel
Gelatin sponge
Fibrin foam
List some examples of systemic haemostat agents
Vitamin K
Tranexamic acid (anti-fibrinolytic)
How does tranexamic acid work?
Anti-fibrinolytic
Prevents clot breakdown/stabilises clot
List some damage to nerves that can occur (5)
Anaesthesia - numbness
Paraesthesia - tingling
Dysaesthesia - pain
Hypoaesthesia - reduced sensation
Hyperaesthesia - inc sensation
List management for a small/sinus intact OAC (4)
If small or sinus intact
- Encourage clot
- Suture margins
- Abx
- Post op instructions
List management of an OAF (4)
- Excise sinus tract
- Buccal advancement flap
- Buccal fat pad with buccal advancement flap
- Palatal flap
Tx for root in sinus
- Confirm radiographically by OPT, occlusal or PA
- Make a decision on retrieval from xray
Retrieval of root in sinus
- OAF approach/thru socket
- Flap design
- Suction
Small curettes - Irrigation
- Close as for OAC
Define osteomyelitis
Infection of bone Invasion of bacteria into cancellous bone causing ST inflammation and oedema
What jaw is osteomyelitis more common in?
Mandible as has one main artery supply - IA artery
Poorer bs more likely ot become ischaemic and infected
Predisposing factors to osteomyelitis
Immunocompromised
Dental infections + fractures of mandibles
Radiographic appearance of osteomyelitis
Moth eaten appearance
Antibiotic indicated to Osteomyelitis
Penicillin
OR
Clindamycin
Chronic osteomyelitis requires aggressive abx and surgical tx
Surgical tx for osteomyelitis
- Drain pus if possible
- Remove any non-vital teeth in area of infection
- Remove any loose pieces of bone
- Excision of necrotic bone
What is actinomyces
Rare bacterial infection
Define infective endocarditis
Infection of the endocardium
Particularly affecting the heart valves
What patients are at increased risk of IE
- Acquired valvular heart disease with stenosis
- Hypertrophic cardiomyopathy
- Structural congenital heart disease
- Valve replacement
- Prev IE
Name examples of structural congenital heart disease that are excluded from the increased risk
Atrial septal defect
Fully repaired ventricular septal defect
List examples of invasive dental procedures (8)
- Placement of matrix bands
- Subgingival restos
- Endo tx
-SSC - 6PPC
- Sub PMPR- Incise + drain abscess
- XLa’s
List examples of non invasive dental procedures
- Infiltrations/IDB
- BPE
- Supragingival PMPR
- Supragingival fillings
- Removal of sutures
When is amoxicillin contraindicated?
Allergy to penicillin
Side effects of amoxicillin (3)
- Hypersensitivity
- Anaphylaxis
- Abx related colitis
ABX dose for prophylaxis cover
Amoxicillin 3g oral powder
GIVE: 3g 60m before
ABX dose if penicillin contraindicated
Clindamycin capsules 300mg
GIVE: 600mg (2 capsules) 60 mins before procedure
Signs of IE (5)
Temp >38
Breathlessness
Weight loss
Fatigue
Chest pain
