Post-op instructions Flashcards
What should post extraction instructions consist of
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
What should you tell patients regarding pain
expect it when LA wears off
its normal
its variable
it will settle over the next few days
What should you tell px regarding pain relief
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
How long should patients use regular analgesia
1-3 days
then use as required
What is the best pain killer to take for dentoalveolar pain
ibuprofen
When should ibuprofen be taken
after food
not on an empty stomach
When should you be cautious when prescribing ibuprofen
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
What is the dose for ibuprofen
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)
When is paracetamol useful for dentoalveolar pain
in px who take ibuprofen
it is more centrally mediated
has no effect on bleeding time
less irritating to GI
What is something to be aware of with paracetamol
It is described as a “safe analgesic” although it causes severe problems in overdose
REFER PATIENT TO A&E IF OVERDOSE
What are cautions for paracetamol
Hepatic impairment
Renal impairment
Alcohol dependence
What is the dose for paracetamol
500mg tablets
Max. Dose 4g daily (8 tablets)
Children: Depends on weight/age – see BNF
What should you warn patients of regarding paracetamol
Always warn patient with regard to maximum dose and emphasize that they should not exceed this!
What is the paracetamol overdose
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
What is the dose for cocodamol
Doses: 8mg Codeine 500mg Paracetamol
30mg codeine 500mg Paracetamol
What should you warn for patients taking cocodomol
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
What is the best regime for analgesia
Ibuprofen and Paracetamol interspersed
What should patients not do after being discharged
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
Why should hot foods be avoided
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
Why should hard foods be avoided
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
Why should alcohol be avoided
Alcohol may affect a healthy clot formation and result in bleeding or delay the healing process
Why should you not rinse
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)
When they start rinsing what should they rinse with
warm water or warm salty water
rinse 4 times a day
rinse gently
What should patients do regarding oral hygiene
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
What should chlorohexidine not be prescribed for
OPEN WOUNDS
can get into bloodstream –> anaphylaxis risk
When can you advise on a chlorohexidine mouthwash
If it is difficult to keep the mouth clean you may give or advise on the use of chlorhexidine mouthwash
If it bleeds at home what should be done
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
Why should the gauze be damp when placing on bleeding socket
). 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
Why should pressure of gauze not be too firm
will result in a rebound bleed as vessels open up again when the pressure is released
What should patients do regarding smoking
Avoid smoking for as long as possible
Why should px avoid smoking after surgery
Smokers are at risk of delayed healing/ dry sockets even if they avoid smoking for a few hours after the extraction
What other symptoms are expected
sensitivity on either side of extraction site TMJ pain limited mouth opening swelling bruising
What should px do if they experience sensitivity post extraction
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
When should px contact you regarding swelling
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
What should patients be told regarding sutures
Tell the patient to leave them alone and not to pull at them
What should patients know regarding antiseptic mouthwashes
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
What should patients be advised of regarding swelling
use ice pack for 5 mins off 5 mins on
don’t use heat packs - more swelling
What should patients be informed of regarding biopsies
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
Why are written instructions a good idea
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
