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BDS2 CLINICAL Oral Surgery > Post-op instructions > Flashcards

Post-op instructions Flashcards

1
Q

What should post extraction instructions consist of

A

Expect pain & how to deal with it
How to avoid/deal with bleeding
Things that will help/delay healing
Other post operative symptoms that are to be expected

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2
Q

What should you tell patients regarding pain

A

expect it when LA wears off
its normal
its variable
it will settle over the next few days

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3
Q

What should you tell px regarding pain relief

A

normal pain killers should keep it under control
can start taking PK before anesthetic wears off (1-2 hours)
get on top of pain before it starts

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4
Q

How long should patients use regular analgesia

A

1-3 days

then use as required

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5
Q

What is the best pain killer to take for dentoalveolar pain

A

ibuprofen

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6
Q

When should ibuprofen be taken

A

after food

not on an empty stomach

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7
Q

When should you be cautious when prescribing ibuprofen

A

Previous or active peptic ulceration/ gastro-oesophageal reflux disease (GORD)/
The Elderly
Pregnancy & lactation
Renal, cardiac or hepatic impairment
History of hypersensitivity to Aspirin & other NSAIDs
Asthma (do not give Ibuprofen to patients with asthma unless they have taken it before with no problems)
Patient taking other NSAIDs
Patients on long term systemic steroids

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8
Q

What is the dose for ibuprofen

A

200, 400mg or 600mg tablets
(Dental use: 200mg or 400mg tabs)
1.2 – 1.8g daily in 3 – 4 divided doses preferably after food
Max. dose 2.4g daily
Child: reduced dose, depends on age/weight (see BNF)

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9
Q

When is paracetamol useful for dentoalveolar pain

A

in px who take ibuprofen
it is more centrally mediated
has no effect on bleeding time
less irritating to GI

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10
Q

What is something to be aware of with paracetamol

A

It is described as a “safe analgesic” although it causes severe problems in overdose

REFER PATIENT TO A&E IF OVERDOSE

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11
Q

What are cautions for paracetamol

A

Hepatic impairment
Renal impairment
Alcohol dependence

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12
Q

What is the dose for paracetamol

A

500mg tablets

Max. Dose 4g daily (8 tablets)
Children: Depends on weight/age – see BNF

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13
Q

What should you warn patients of regarding paracetamol

A

Always warn patient with regard to maximum dose and emphasize that they should not exceed this!

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14
Q

What is the paracetamol overdose

A

As little as 10-15g (20-30 tablets) or 150mg/kg of paracetamol taken within 24 hours may cause severe hepatocellular necrosis, and less frequently, renal tubular necrosis

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15
Q

What is the dose for cocodamol

A

Doses: 8mg Codeine 500mg Paracetamol

30mg codeine 500mg Paracetamol

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16
Q

What should you warn for patients taking cocodomol

A

Do not take with paracetamol

Tell patients to check what is in any over the counter brand name medications they buy – they may contain paracetamol – and if they take them with paracetamol this can lead to accidental overdose

17
Q

What is the best regime for analgesia

A

Ibuprofen and Paracetamol interspersed

18
Q

What should patients not do after being discharged

A

Do not explore the socket with finger/ tongue/ toothbrush

Avoid anything that increases BP

Avoid hot/hard foods

Avoid alcohol that day and for next 24h

Don’t rinse after

19
Q

Why should hot foods be avoided

A

The patient will still be numb and may burn the lip or tongue with hot food/drinks and not realise it has happened
heat causes vasodilation and may encourage bleeding

20
Q

Why should hard foods be avoided

A

may traumatise the socket. If patient is still numb they may not feel the injury occurring. Also the trauma from hard/sharp foodstuffs may result in bleeding

21
Q

Why should alcohol be avoided

A

Alcohol may affect a healthy clot formation and result in bleeding or delay the healing process

22
Q

Why should you not rinse

A

this may disturb the clot and start bleeding (or result in dry socket/slow healing socket, (which can be extremely painful) because healing clot has been removed)

23
Q

When they start rinsing what should they rinse with

A

warm water or warm salty water
rinse 4 times a day
rinse gently

24
Q

What should patients do regarding oral hygiene

A

clean teeth as normal
will help healing
if there are problems around operative site then use damp tissue/gauze or cotton buds until it is possible to brush and floss in the area again

25
Q

What should chlorohexidine not be prescribed for

A

OPEN WOUNDS

can get into bloodstream –> anaphylaxis risk

26
Q

When can you advise on a chlorohexidine mouthwash

A

If it is difficult to keep the mouth clean you may give or advise on the use of chlorhexidine mouthwash

27
Q

If it bleeds at home what should be done

A

bite on gauze for 20-30 mins
if persists bite on fresh gauze - 1 hour
if persists contact practice during day or out of hours contact
TELL PATIENT WHO TO CONTACT BEFORE LEAVING
if they can’t get to you or dental emergency team then nearest a&e

28
Q

Why should the gauze be damp when placing on bleeding socket

A

). If it is dry it may stick to the clot and pull it out when removed from the mouth. This will start the socket bleeding again

29
Q

Why should pressure of gauze not be too firm

A

will result in a rebound bleed as vessels open up again when the pressure is released

30
Q

What should patients do regarding smoking

A

Avoid smoking for as long as possible

31
Q

Why should px avoid smoking after surgery

A

Smokers are at risk of delayed healing/ dry sockets even if they avoid smoking for a few hours after the extraction

32
Q

What other symptoms are expected

A 
sensitivity on either side of extraction site 
TMJ pain
limited mouth opening 
swelling
bruising
33
Q

What should px do if they experience sensitivity post extraction

A

they should avoid extremes of hot/cold in the area until it settles. It may settle in a few days or in 1-2 weeks. If it does not settle they should seek your advice

34
Q

When should px contact you regarding swelling

A

If the swelling continues to increase in size or the patient is worried that there may be an infection they should get in touch with you

35
Q

What should patients be told regarding sutures

A

Tell the patient to leave them alone and not to pull at them

36
Q

What should patients know regarding antiseptic mouthwashes

A

A capful 2-3 times a day

If it nips/ causes discomfort – dilute it with water

Do not use straight after tooth brushing as it may interact with toothpaste and wash toothpaste away

do not use after just eating due to risk of staining

37
Q

What should patients be advised of regarding swelling

A

use ice pack for 5 mins off 5 mins on

don’t use heat packs - more swelling

38
Q

What should patients be informed of regarding biopsies

A

May be sutures present

May experience swelling

Biopsy sites tend to feel a bit “raw”. You can describe to the patient that they will feel some post-op pain and it may feel like a healing ulcer

39
Q

Why are written instructions a good idea

A

The patient often forgets bits (or most!) of what you’ve just said – written instructions reinforce your verbal instructions

make sure px knows who to contact in emergency

BDS2 CLINICAL Oral Surgery (2 decks)

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