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MOS Lecture Slides > Post extraction/surgical complications > Flashcards

Post extraction/surgical complications Flashcards

1
Q

What should be the ideal INR for patients on warfarin ?

A

between 2-4 - ideally constant
the INR should be performed at a minimum of 72 hours prior to dental surgery

(3 days)

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2
Q

Give examples of conditions which need further considerations prior to dental surgery

A
  • poorly controlled angina, asthma, diabetes, epilepsy
  • pregnancy (possible induction of labour?, risk of DVT)
  • immunocompromised patients
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3
Q

Oral bisphosphonates are often prescribed for …

A

osteoporosis

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4
Q

Give examples of oral bisphosphonates used to treat osteoporosis

A
  • Alendronic acid/alendronate (fosamax)
  • disodium etidronate (didronel)
  • Ibandroate (bonviva)
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5
Q

Briefly describe absorption of oral bisphosphonates

A

poorly absorbed into bone

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6
Q

Give examples of IV bisphosphonates

A
  • Zoledronate (zometa)
  • Ibandroate
  • Pamidronate
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7
Q

Briefly describe the absorption of IV bisphosphonates

A

extremely well absorbed into bone

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8
Q

Outline the uses of IV bisphosphonates

A

to control bone metastases of certain cancers e.g. breast cancer

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9
Q

Outline the suggested protocol for XLA for a patient on oral bisphosphonates

A
  • antiseptic mouthwash
  • XLA as normal
  • monitor
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10
Q

Outline the suggested protocol for XLA for a patient on IV bisphosphonates

A
  • pre/post antibiotics
  • antiseptic mouthwash
  • close monitoring
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11
Q

Antibiotics only reduce the risk of ________ infection

A

secondary

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12
Q

What are the eating instructions given to a patient who suffers from hypoglycaemic episodes undergoing MOS ?

A
  • eat before coming to appt
  • post-op: do not eat for the next 2 hours
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13
Q

Outline the bioloical process that occurs before a vaso-vagal syncope

A
  • stress- brief tachycardia
  • vasodilation
  • increased vagal tone
  • bradycardia
  • hypotension
  • decreased cerebral blood flow
  • syncope
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14
Q

What does a syncope refer to ?

A

temporary loss of consciousness

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15
Q

What are the signs/symptoms of a vaso-vagal syncope ?

A
  • light-headedness
  • nausea
  • sweating
  • tinnitus
  • weakness and visual disturbances
  • fitting
  • incontinence
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16
Q

What treatment is appropriate for a vaso-vagal syncope?

A
  • call for help
  • lie flat
  • reassure
  • monitor
  • oxygen if prolonged (15L/min)
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17
Q

Outline instances which may lead to increased need for glucose

A
  • pain
  • lack of sleep
  • anxiety
  • stress
  • infection
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18
Q

Outline the symptoms of hypoglycaemia

A
  • shakiness
  • tachycardia
  • sweatiness
  • pallor
  • confusion
  • aggression
  • light headedness
  • collapse
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19
Q

What is the normal blood sugar range?

A

4-6mmol/L

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20
Q

What is the blood glucose range for hypoglycaemia ?

A

<3mmol/L

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21
Q

What treatment can be offered for a patient experiencing a hypoglycaemic attack?

A
  • call for help
  • reassure
  • glucose drink/hypostop/can also give long carbohydrate to prevent a dip
  • monitor
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22
Q

Outline immediate local complications of MOS

A
  • fracture- crown/root/bone
  • soft tissue tear- gingiva or alveolar mucosa
  • haemorrhage
  • OAC
  • fractured instrument (luxators)
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23
Q

Outline immediate regional/distant complications of MOS

A
  • crushed/burnt lip
  • nerve damage
  • lacerated tongue or palate (from using luxators)
  • swallowed/inhaled tooth or instrument
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24
Q

Outline delayed local complications of MOS

A
  • alveolar osteitis (dry socket)/local infection
  • delayed or secondary haemorrhage
  • osteonecrosis
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25
Q

Outline delayed regional/distant complications of MOS

A
  • spreading infection
  • myofascial pain dysfunction
  • injection haematoma
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26
Q

What could be a potential cause of delayed/secondary haemorrhage?

A
  • LA wearing off
  • pt touching the site
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27
Q

What increases risk of osteonecrosis?

A
  • immunomodulators
  • bisphosphonates
  • steroids (impaired wound healing)
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28
Q

Outline late local complications of MOS

A

alveolar atrophy

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29
Q

Outline late regional/distant complications of MOS

A
  • osteomyelitis
  • actinomycosis
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30
Q

Outline POI/warnings following XLA/MOS

A
  • numbness due to LA; be careful with lip/tongue/cheek
  • avoid hot drinks, hard foods until numbness has worn off
  • protect socket
  • do not gargle for 24 hours
  • no excessive exercise
  • avoid smoking
  • avoid alcohol
  • keep mouth clean
  • advice on pain relief- paracetamol/ibuprofen
31
Q

What should smoking be avoided following XLA?

A
  • can delay clot formation
  • leads to infected socket
32
Q

Why should alcohol be avoided following XLA?

A
  • can cause clot to break down
  • leads to bleeding
33
Q

What instructions should be given to pt for 24 hours after XLA/MOS?

A
  • rinse regularly every few hours with warm salt water
  • pain relief
  • advice on bleeding if occurs post- op
34
Q

What is the appropriate concentration of salt water that can be used for rinsing ?

A

9g/L
0.09%

35
Q

Bruising and swelling will always occur in the same place. True or false

A

false

36
Q

According to guidelines when is it okay to leave a fractured tooth behind ?

A
  • <5mm tooth left
  • No periapical lesion
  • no PMH/anatomy
37
Q

According to guidelines, when is it appropriate to remove a fractured tooth?

A
  • > 5mm tooth left
  • periapical lesion
  • PMH issue
38
Q

If you lead a fractured tooth behind , what must you do ?

A
  • warn patient
  • document
39
Q

What is the most frequently inhaled or swallowed tooth?

A

upper 8

40
Q

Why should you avoid using dry gauze to control a haemorrhaging site?

A

this is because it will have clotting tags which will dislodge the clot when removed

41
Q

If bleeding continues after the use of gauze for 10 minutes with pressure, what should you do ?

A
  • haemostatic agent
  • suture
42
Q

How long should you leave a non-resorbable suture in and why?

A
  • 7-10 days
  • to allow secondary mesh to form
43
Q

Give examples of haemostatic agent that does not contain animal product

A

surgicel

44
Q

Give examples of haemostatic agents that contain animal product

A
  • hemocollagene
  • gelatamp
45
Q

What is tranexamic acid ?

A

anti-fibronolytic agent
prevents the break down of the clot

46
Q

If there have been many reasonable attempts to control bleeding and it continues, what should you do?

A

refer to haematology unit

47
Q

What investigations can be undergone in the haematology unit?

A
  • FBC- particularly platelet count
  • INR
  • APPT (activated partial thromboplastin time)
48
Q

What does the INR monitor?

A

extrinsic part of the coagulation cascade

49
Q

What does the APTT monitor?

A

intrinsic part of the coagulation cascade

50
Q

When can nerve injury (ID, mental, lingual) occur?

A
  • during LA
  • surgical trauma
51
Q

In what ways can LA cause nerve injury?

A
  • direct trauma from injection needle
  • intraneural haematoma
  • neurotoxicity of LA- localised chemical damage to the nerve
52
Q

What region of the face can be tested the superior alveolar nerve injuries?

A

premaxillary region of V2

53
Q

What region of the face can be tested for inferior alveolar and mental nerve injuries?

A

the mental region of V3

54
Q

Outline factors that affect the risk of IAN damage

A
  • expertise of surgeon
  • difficulty depth- crown at CE junction of second molar
  • mesial or horizontal impaction
  • time taken for procedure
  • sectioning tooth several times
  • surgical technique employed
  • whether roots are completely formed or not
  • roots close to NV bundle as defined on x-ray
  • increasing age of patient
  • distal bone removal
  • intra-operative visualisation of mandibular canal
55
Q

What is the most common cause of lingual nerve injury?

A

third molar surgery

56
Q

88% of lingual nerve injuries associated with 3rd molar surgeries resolve. True or false

A

True

57
Q

What are some reasons for persistence of peripheral sensory nerve injuries?

A
  • severity of injury
  • increased age of patient
  • time elapsed since injury
58
Q

Why are lingual nerve injuries likely to occur in 3rd molar surgeries?

A

operators going more lingual on their flap
more likely to cause damage this way

59
Q

What is alveolar osteitis?

A

local inflammation of th alveolus due to fibrinolysis and loss of blood clot

59
Q

Why do guidelines insist on the necessity of a pre-operative neurosensory evaluation prior to placement of dental implants?

A

thsi is because nerve injuries related to dental implant treatment is becoming an increasing problem

60
Q

What are the features of alveoolar osteitis?

A
  • pain after recent extraction
  • exposed bone after recent extraction
  • infective component
  • traumatic component
61
Q

How is alveolar osteitis managed?

A
  • rinse out debris
  • irrigate with saline
  • dress with sedative material e.g. alveogyl (contains eugenol)
62
Q

Outline instances where fracture of the bone at tooth extraction is more likely

A
  • greater force is used
  • force is applied in directions not likely to displace teeth
  • force is applied suddently
  • bone is thinner or more bone is removed
  • bone is removed (osteogenesis imperfecta/pagets disease)
  • root is large
  • root form makes tooth resistant to extraction
  • true ankylosis
63
Q

What is a fistulae ?

A

epithelialised channel

64
Q

Give a sign for the presence of an OAC

A

some bubbling may be visible

65
Q

What must you avoid in the presense of an OAC?

A
  • Nose blowing
  • smoking
66
Q

What sort of OAC defect may heal spontaneously? What treatment should be offered if an OAC is suspected to heal spontaneously?

A
  • if the defect is less than 5mm
  • treatment should be directed at preserving the blood clot
67
Q

Suggest ways that a clot may be preserved in an OAC

A
  • suture with or without pack
  • use existing denture to support clot
68
Q

Suggest treatments for OAC/OAF

A
  • surgery- buccal advancement flap/rehmanns flap
  • palatal rotation flap
  • buccal fat pad
69
Q

What surgical instrument can lead to mandibular fractures?

A

cow-horns

70
Q

What is osteomyelitis?

A

inflammation/swelling in bone

71
Q

What are the clinical features of osteomyelitis?

A
  • signs of infection
  • reduced sensitivity in lower lip
  • tenderness and mobility of adjacent teeth
  • patchy or irregular bone loss
  • sequestration- bone left unbound and loose
  • periosteal thickening
  • subperisoteal new bone
  • pathological fracture
72
Q

What bacterial is responsible for actinomycosis?

A

actinomyces israeli

73
Q

Actinomycosis should be included in risks for what type of patients?

A

immunocompromised

MOS Lecture Slides (7 decks)

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