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BDS2 Oral Surgery > Post Op instructions > Flashcards

Post Op instructions Flashcards

1
Q

What 3 treatments do you usually give post-op instructions for after oral surgery?

A
  • Post extraction (non-surgical)
  • Post surgical
  • Post biopsy/soft tissue
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2
Q

Why are post-op instructions often done poorly or not at all? (3 points)

A
  • Time pressures/next patient waiting
  • Operator tired after procedure/stressed after procedure
  • Patient stressed/upset after procedure
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3
Q

Why does taking a bit of time to give post-op instructions actually save you time later on?

A

If patients know what to expect the vast majority of them will not phone you or come back to the practice with concerns over routine post-op symptoms

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4
Q

What may happen is a patient does not know what to expect after a procedure?

A
  • They will often panic over things that are normal
  • This will result in patients contacting OR coming to the practice OR attending other dental emergency clinics
  • WHEN THERE IS NO NEED TO
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5
Q

What are the general post-extraction instructions that need to be given? (4 points)

A
  • Expect pain & how to deal with it
  • How to avoid/deal with bleeding
  • Things that will delay/help healing
  • Other post-op symptoms that are to be expected
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6
Q

What should you tell a patient about pain after a dental extraction? (4 points)

A
  • Tell them to expect post-op pain
  • Will be sore when LA wears off (this is normal)
  • Tell them it is very variable
  • Let them know it will settle over next few days
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7
Q

What should you tell a patient about painkillers after dental extraction? (3 points)

A
  • Normal pain killers should keep pain under control
  • Can give advice or tell them to take painkillers they would take for a headache
  • They should start painkillers before LA wears off (usually 1-2 hours)
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8
Q

For how long after a dental extraction should a patient take regular anaesthesia?

A
  • For 1-3 days

- Then use analgesia as required

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9
Q

One form of analgesia is Ibuprofen. What type of drug is this?

A
  • An NSAID
  • Not everyone can take these
  • Made sure the patient knows to take it after food/not on an empty stomach
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10
Q

Who should you not prescribe ibuprofen to? (8 points)

A
  1. Previous or active peptic ulceration/ GORD
  2. The elderly
  3. Pregnancy and lactation
  4. Renal, cardiac and hepatic impairment
  5. History of hypersensitivity to aspirin & other NSAID’s
  6. Asthma (do not give to patients with asthma unless they have taken it before with no problems
  7. Patient is taking other NSAID’s
  8. Patients on long term systemic steroids
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11
Q

What is the recommended dosage for ibuprofen?

A
  • 200, 400 or 600mg tablets
  • 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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12
Q

Paracetamol is also useful for dentoalveolar pain, especially in patients who can’t take ibuprofen. Why is this a good alternative? (4 points)

A
  • Different mode of action to NSAID’s
  • Mainly centrally mediated
  • No effects on bleeding time
  • Less irritant to GIT
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13
Q

Paracetamol is described as a ‘safe analgesic’ but when can it cause severe problems?

A
  • In overdose
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14
Q

What are 3 cautions of paracetamol?

A
  1. Hepatic impairment
  2. Renal impairment
  3. Alcohol dependence
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15
Q

What is the dosage of paracetamol?

A
  • 500mg tablets

Adults: 1-2 tablets (0.5-1g) every 4-6 hours

Max dose 4g daily (8 tablets)

Children: depends on weight/age - see BNF

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16
Q

What must you warn patients about with paracetamol?

A

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

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17
Q

What can paracetamol overdose cause?

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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18
Q

If a patient has had an overdose on paracetamol what should you do?

A

Refer them to A&E straight away

19
Q

Co-codamol is often used by patients, what is the dosage fo r this?

A

Doses:

8mg Codeine, 500mg Paracetamol

30mg Codeine, 500mg Paracetamol

20
Q

What other analgesic should not be taken with paracetamol?

A

Co-codamol

21
Q

Don’t force the patient to use your suggested analgesia, let them use what they are comfortable with, but what is one of the best regimes of analgesia?

A
  • Ibuprofen and Paracetamol
  • Take 400mg Ibuprofen, then 2 hours later take 1g Paracetamol, then around 4 hours after this take 400mg Ibuprofen, then 2-4 hours later take another 1g Paracetamol and so on. But do not exceed recommended doses
22
Q

What should you advise the patient about post-op bleeding? (3 points)

A
  • It is unlikely but a possibility
  • Do not explore the socket with finger/tongue/ toothbrush - this will disturb the clot and may result in bleeding
  • Do not exercise that day/avoid rushi ng about/ avoid anything that increases BP which may result in bleeding
23
Q

Why should the patient avoid hot/hard foods after oral surgery?

A

Hot foods:

  • 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

Hard foods:

  • 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

Otherwise:

  • Eat and drink normally but keep it to the other side of the mouth for a few days AND
  • Stick to a softer diet for a few days
24
Q

To prevent post-op bleeding the patient should avoid drinking alcohol that day or for the next 24hrs. Why is this?

A
  • Alcohol may affect a healthy clot formation and result in bleeding or delay the healing process
25
Q

How should a patient go about rinsing their mouth to prevent post-op bleeding?

A
  • Do not rise for several hours - may disturb clot and start bleeding
  • After this they should start rinsing gently with warm water or warm salty water
  • Rinse around 4 times a day, especially after eating
  • Rinse gently and do not spit out too forcefully
26
Q

The evening after an extraction should the patient brush their teeth?

A
  • Brush teeth as normal but don’t rinse. Just spit toothpaste out
  • Continue to clean teeth as normal
  • Keeping the mouth as clean as possible will help with healing
27
Q

If there are problems cleaning around the operative site what should you use until it is possible to brush and floss in the area again.

A
  • Use damp tissue/gauze or cotton buds

- Brush/floss the rest of the teeth as normal

28
Q

If a post-op site bleeds at home what should you do?

A
  • Roll up some gauze or tissue, make it damp and bite on it for 20-30 mins
  • If bleeding persists bite on a fresh piece again - this time for up to an hour
  • If bleeding persists contact your practice if it is during the day/week or the out of hours emergency contact you have in place at nights and weekends
  • If they cannot get the bleeding to stop and cannot get you or a dental emergency team they should go to their nearest A&E
29
Q

When treating post-op bleeding at home you need to make sure the gauze or tissue is damp. Why is this?

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
30
Q

When applying pressure to a post-op site it should be firm and even. What problems can occur if it is not?

A
  • Not too firm or this will result in a rebound bleed as vessel open up again when the pressure is released
31
Q

Why should someone avoid smoking for as long as possible after an oral extraction?

A
  • Smokers are at risk of delayed healing/ dry sockets even if they avoid smoking for a few hours after the extraction
  • But it may be helpful to avoid smoking for as long as possible after the procedure
32
Q

Patients may experience sensitivity of the adjacent teeth after an oral extraction. What should they do if this happens?

A
  • 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
33
Q

Patients may experience some pain and stiffness associated with the TMJ/muscles of mastication. What advice should you give them on this?

A
  • May experience limitation in mouth opening
  • This should settle over the course of a few days/1-2 weeks
  • If it prevents eating they should seek your advice
  • If it lasts longer than normal they should seek your advice
34
Q

Swelling is a symptom the patient may expect after an oral procedure. It is more common after a difficult extraction or surgical procedure. How long does it take to reach its max swelling and what should the patient do if it continues to swell?

A
  • Normally takes around 2 days to reach max swelling then resolves over the next few days/weeks
  • 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

Do people get bruising post-op?

A
  • Some people bruise more easily and more markedly than others. Bruising is variable
  • Can be more marked with more difficult procedures/ more difficult extractions/ surgical extractions
  • If the patients know it is a possibility they don’t panic
36
Q

There are often sutures after surgical extractions. Tell the patient to leave them alone and not to pull at them. What should they do if they come out or are painful?

A
  • If they come out and area is not bleeding or overly painful they should just leave them
  • Sutures can become uncomfortable as the area heals. If this occurs, even if they are dissolving sutures, tell the patient they can come back early and have them removed
  • Tell the patient if they are resorbable (dissolving) sutures or non resorbing and require another visit for suture removal
37
Q

Antiseptic mouthwashes are more likely to be advised/provided after a surgical procedure. What is an example of this?

A
  • Chlorhexidine mouthwash
38
Q

How much antiseptic mouthwash should a patient take a day following surgical extraction?

A

A capful 2-3 times a day

39
Q

If a patient is taking antiseptic mouthwash following surgical extractions and it nips/causes discomfort what should the patient do?

A
  • Dilute it with water
40
Q

Why should a patient not use antiseptic mouthwash straight after brushing their teeth?

A

Do not use straight after toothbrushing as it may interact with toothpaste and wash toothpaste away - taking away the benefits of toothpaste

41
Q

The patient should not use antiseptic mouthwash just before or after eating. Why should the patient leave at least an hour before and after use with regard to eating?

A
  • Chlorhexidine can stain the teeth - this is less likely if you don’t have food particles in the teeth
  • If it does stain this is not a major problem. The dentist can polish it off/remove the staining
42
Q

If you think there is a chance of swelling after surgical extractions advise the patient on the use of ice packs/cold packs. Why should they not use heat packs?

A
  • This results in more soft tissue swelling
43
Q

What is the process of using an ice-pack after a surgical extraction?

A
  • Bag of frozen peas/veg wrapped in a tea towel or ice cubes in a poly bag/ cold pack. Place on the area 5 mins on/ 5 mins off/ 5 mins on etc for 1-2 hours after the procedure
  • Put it on and off. Do not leave it on the whole time. It is too cold to do this
44
Q

Why is it good practice to follow verbal instructions up with written instructions?

A
  • The patient often forgets bits of what you have said - written instructions reinforce your verbal instructions

BDS2 Oral Surgery (3 decks)

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