post extraction complications 4 Flashcards
oral antral communication vs oral antral fistula
communication - acute phase, hole develops between oral mucosa and maxillary sinus. Can either self heal or require surgical fixation. If left untreated can lead to..
fistula - chronic condition where sinus tract forms between maxillary sinus and oral mucosa. Tract is epithelial lines and never closes
what might be seen at the site of an OAC peri operatively
bubbling of blood within the socket
name 2 possible management strategies of dealing with an OAC
surgical closure of area using a buccal advancement flap
suture a collagen framework in place to provide a barrier and promote healing
osteomyelitis
inflammation of bone marrow due to infection
signs and symptoms of osteomyelitis
In acute cases, patients often systemically unwell, but if chronic often no systemic symptoms
site of extraction often very tender and deep infections may see altered sensation due to pressure on the inferior alveolar nerve
radiographically - ‘moth eaten appearance’ of bone - some punched out darker lesions and some denser white areas
why is osteomyelitis more common in the mandible than the maxilla
mandible has a singular blood supply , maxilla has multiple
(maxilla has a much denser blood supply)
what happens during osteomyelitis microbiologically
invasion of bacteria into cancellous bone sees soft tissue inflammation and oedema in the closed bone marrow spaces
Oedema in closed space results in increased pressure and compromised blood supply
Due to compromised blood supply, involved area becomes ishcaemic and necrotic over time allowing bacteria to proliferate and spread as blood borne defences arent reaching tissues
can osteomyelitis resolve on its own
no - requires surgery or antibiotic and referal to oral surgery or oro-maxillo facial surgery
In the initial stages of osteomyelitis , what might the symptoms be confused with
dry socket
in general, what groups of people does osteomyelitis affect
those with a compromised immune system e.g diabetes, leukemia, nutritional deficiencies
osteoradionecrosis
seen in patients who have received radiotherapy to head and neck
bone that has been radiated becomes virtually non vital.
Causes endartritis (reduced blood supply) and turnover of any remaining vital bone is very slow with self repair ineffective
how can osteoradionecrosis (onset due to extraction) be prevented
- act before patient begins radiotherapy
- scaling and chlorhexidine mouthwash leading up to the extraction
- very careful extraction technique
- antibiotics and chlorhexidine mouthwash post extraction
- hyperbaric oxygen pre and post extraction (given in chamber in hospital)
what can bisphosphonates be used to treat
osteoporosis
malignant bone metastases
Pagets disease
how do bisphosphonates work
work by inhibiting osteoclast acitvity therefore inhibiting bone resorption and renewal
remain in system for many years once stopped
actinomycosis
rare bacterial infection
bacteria are introduced into an area of injury or susceptibility e.g minor oral trauma, grossly carious teeth, recent extraction
chronic infection that produces thick lumpy pus, multiple sinuses and swelling
