post-op instructions

Question 1

why are post-op instructions important?

Answer 1

px will panic if no clear instructions

don’t know what to expect eg pain

Question 2

what is the best method of delivery?

Answer 2

verbally with written summary

Question 3

why are post op instructions missed/done poorly?

Answer 3

time pressures/px waiting
operator tired/stressed after procedure
px stressed/upset after procedure

Question 4

why do instructions save time

Answer 4

if px know what to expect, most wont phone/return with routine concerns

Question 5

what instructions should be given post extraction?

Answer 5

expect pain and how to deal with it
how to avoid/deal with bleeding
things that will help/delay healing
other post-op symptoms to be expected

Question 6

how should you explain pain?

Answer 6

to expect
when LA wears off
normal
variable
settle over next for days unless dry socket
regular pain killers
give advice on pain relief
before la wears off 1-2 hours
better chance of control
use regularly for 1-3 days then prn

Question 7

what painkillers can be taken post extraction?

Answer 7

ibuprofen

• only if suitable
• after food

Question 8

who cant take ibuprofen?

Answer 8

peptic ulceration/GORD
elderly
pregnant/lactating
renal/cardiac/hepatic impairment
hypersensitivity to NSAID
asthma- unless used before
other NSAID use
long term systemic steroids

Question 9

what is the dose of ibuprofen?

Answer 9

1.2-1.8g daily in 3-4 divided doses after food

max 2.4g

Question 10

when is paracetamol advised?

Answer 10

px who cant take ibuprofen
centrally mediated
no effect on bleeding
less irritant to GIT

Question 11

who cant take paracetamol?

Answer 11

hepatic impairment
renal impairment
alcohol dependence

Question 12

what is the dose of paracetamol?

Answer 12

1-2 tab every 4-6 hours

max 4g daily

Question 13

what is the best dental pain relief regime?

Answer 13

ibuprofen/paracetamol interspersed

Question 14

how to prevent bleeding?

Answer 14

don’t explore socket with finger/tongue/toothbrush
-disturbs clot
no exercise/ anything that increases bp
avoid hot/hard foods/alcohol
no rinsing until next day, then warm/salty water 4x gently
evening brush don’t rinse

Question 15

what should px do if bleeding occurs?

Answer 15

roll tissue/guaze make damp and bite for 20-30mins
if persists fresh guaze for 1 hour
if persists contact practice
if unavailable A&E

Question 16

what other symptoms of extraction are normal?

Answer 16

sensitivity of adjacent teeth
tmj stiffness
-1-2 weeks
swelling
-max 2 days then goes down
-use ice pack short periods
bruising

Question 17

what else may be included in surgical post-op instructions

Answer 17

sutures
leave alone, don’t pull
if they come out w/o bleeding/pain all good
if become uncomfortable dentist can remove
inform if resorbable

Question 18

how should you advise chlorhexidine

Answer 18

capful 2-3x day
if nips dilute
not after brushing/eating