Post extraction surgical complications

Question 1

What are oral bisphosphonates used to treat?

Answer 1

Used to treat osteoporosis

Question 2

What are IV bisphosphonates used to treat?

What does this possess significant risk of?

Answer 2

Used to treat bone metastasis e.g. breast cancer

Significant risk of bisphosphonate induced osteonecrosis due to being extremely well absorbed into bone

Question 3

Give 2 examples of an immediate-local complications:

Answer 3

1. Fracture of crown/root/bone
2. Tissue tear

Question 4

Give 2 examples of immediate-distant complications:

Answer 4

1. Swallowed or inhaled tooth or instrument
2. Nerve damage

Question 5

Give 2 examples of delayed-local complications:

Answer 5

1. Dry socket
2. Osteonecrosis

Question 6

Give 2 examples of delayed-distant complications:

Answer 6

1. Spreading infection
2. Myofascial pain dysfunction

Question 7

Give examples of late-local and late-distant complications:

Answer 7

Late-local = Alveolar atrophy

Late-distant = Osteomyelitis

Question 8

List 5 post-operative instructions for extractions:

Answer 8

1. Avoid smoking and alcohol for 24 hours
2. Avoid eating and hot drinks whilst still numb
3. Do not rinse the area until 24 hours after extraction
4. Advice of pain relief - paracetamol and ibuprofen
5. Rinse regularly with warm salt water every few hours 24 hours after treatment

Question 9

List 4 conditions related to blood dyscrasias:

Answer 9

1. Haemophilia A and B
2. Von Willebrand’s disease
3. Thrombocytopenia
4. Leukaemia

Question 10

Haemorrhage-primary

How long should you ask the patient to bite down on gauze for post-extraction?

When should the patient be dismissed?

Answer 10

10-15 minutes

Only when all bleeding has ceased can patient be dismissed

Question 11

Haemorrhage-reactionary - what is this?

How is this treated?

Answer 11

The disturbance of the blood clot - typically within 24 hours of extraction

Treatment - Apply pressure to socket for 20-30 minutes with damp gauze/bite pack

-Haemostatic drug e.g. adrenaline in bite pack in contact with site

-Suture socket

Question 12

Haemorrhage-Secondary:

When does this occur?

How is it treated?

Answer 12

Occurs 4-7 days post-extraction due to bacterial infection in socket

Treatment - same as reactionary haemorrhage, can use antimicrobial mouthwash e.g. chlorhexidine
-antibiotics can be prescribed if there is systemic involvement

Question 13

What is a haemostatic agent which can be placed in socket to encourage healing?

Answer 13

Alveogel and gelatamp

Question 14

What is dry socket? (alveolar oseitis)

Answer 14

Local inflammation of the alveolus due to fibrinolysis and loss of blood clot

Pain and exposed bone after a recent extraction

Question 15

How is dry socket treated?

Answer 15

Rinse out socket of any debris and irrigate with saline/Corsodyl and dress with a sedative material e.g. alvogyl

Question 16

What is oroantral communication? (OAC)

Answer 16

An abnormal communication between the oral cavity and antrum (sinus) - direct hole

Question 17

What is an Oro-antral fistula? (OAF)

Answer 17

Epithelialized tract between the oral cavity and the antrum

Question 18

List 3 causes of OAC/OAF:

Answer 18

1. Recent maxillary posterior extractions
2. Loss of lamina dura on maxillary posterior teeth
3. Elderly patients presenting with large bulbous roots with more bone expansion - possible fracture of thin sinus floor

Question 19

How are OAC/OAF treated?

Answer 19

OAC can heal spontaneously or persist as an OAF

Suture with or without pack

Potential flap surgery

Question 20

Is OAC a risk for extraction of deciduous teeth and why?

Answer 20

It is not considered a risk due to presence of developing permanent teeth and the small size of the developing sinus