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Oral Surgery > Post Op Instructions (BDS2) > Flashcards

Post Op Instructions (BDS2) Flashcards

1
Q

Why might post-op instructions be done poorly?

A
  • time pressures
  • operator tired/stressed
  • patient stressed/upset
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2
Q

How will giving good post-op instructions save you time later on?

A

-if patients know what to expect the vast majority will not phone or come back into the practice with concerns

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3
Q

If patients do not know what to expect after a procedure, how might they react?

A
  • will often panic over things that are normal (pain etc)
  • contact you regarding normal symptoms
  • coming to practice for extra emergency appointments or attending other dental emergency clinics (when there is no need to)
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4
Q

What should be covered in post extraction instructions?

A
  • to expect pain and how to deal with it
  • how to avoid/deal with bleeding
  • things that help/delay healing
  • other post operative symptoms that are to be expected
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5
Q

What should you tell patients about pain post-op?

A
  • tell the to expect pain and this is normal
  • tell them it’ll be sore when the LA wears off
  • some people don’t experience pain, some a lot
  • it is very variable
  • it should settle over the next few days
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6
Q

What should you tell the patient about controlling the pain?

A
  • normal painkillers should control them
  • use regular analgesia for 1-3 days then use analgesia as required
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7
Q

When should the patient start analgesia?

A

Before the LA wears off (the next 1-2 hours)

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8
Q

What is the best analgesic for post-operative pain?

A

NSAIDs (ibuprofen)

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9
Q

Not everyone can take NSAIDs, what should you be cautious about when prescribing ibuprofen?

A

1 - previous or active peptic ulceration/GORD

2 - the elderly

3 - pregnancy and lactation

4 - renal, cardiac or hepatic impairment

5 - history of sensitivity to aspirin and other NSAIDs

6 - asthma

7 - patient taking other NSAIDs

8 - patients on long-term systemic steroids

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10
Q

What is the ibuprofen dose?

A

1.2 - 1.8g daily in 3-4 doses

(eg 400mg 4 times a day)

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11
Q

What analgesic is useful for patients who cant use Ibuprofen?

A

Paracetamol

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12
Q

How does paracetamol effect bleeding time or GIT?

A
  • no effect on bleeding time
  • less irritant to GIT
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13
Q

Is paracetamol an NSAID?

A

No - has a different action
used to be included under NSAIDs but in reality is a simple analgesic without anti-inflammatory action

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14
Q

When should you be cautious about prescribing paracetamol?

A

1 - hepatic impairment

2 - renal impairment

3 - alcohol dependence

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15
Q

What is the dose for paracetamol?

A

1-2 500mg tablets every 4-6 hours (max 8 tabs a day)

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16
Q

If you become aware of a patient that has taken too much paracetamol (overdose) what should you do?

A

refer to A&E immediately

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17
Q

Apart from paracetamol and ibuprofen, what other analgesia is often used by patients?

A

cocodamol

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18
Q

What can’t cocodamol be taken with?

A

paracetamol

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19
Q

You can’t force a patient to use your suggested analgesia but what is one of the best regimes for pain control?

A

Ibuprofen and paracetamol interspersed
e.g. take 400mg Ibuprofen, then 2 hours later 1g of paracetamol then a few hours later ibuprofen and repeat but dont exceed recommended doses

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20
Q

What should you tell the patient about the likelihood of post-op bleeding?

A

It is unlikely but a possibility

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21
Q

What should you tell the patient with regards to preventing bleeding post op? (food and drink)

A
  • avoid hard/hot foods
  • stick to a softer diet for a few days
  • eat and drink normally but keep it to the other side of the mouth for few days
  • avoid alcohol for that day
22
Q

What else should be avoided in order to prevent bleeding?

A
  • exercise/rushing about/anything that increases blood pressure that may result in bleeding
  • dont explore the socket with finger/tongue/toothbrush
  • this will disturb the clot and may result in bleeding
23
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 happening
  • heat causes vasodilation and may encourage bleeding
24
Q

Why should hard foods be avoided?

A
  • May traumatise the socket
  • if P still numb may not feel the injury occurring
  • also trauma from the food may result in bleeding
25
Q

What is the advice regarding rinsing post-op?

A
  • don’t rinse out for several hours or until the next day
  • after this start rinsing gently with warm water or warm salty water
  • rinse gently and do not spit out too forcefully
26
Q

Why should you not rinse out for several hours post op?

A

it may disturb the clot and start bleeding (or result in dry socket)

27
Q

Describe the salty water that should be used to rinse out the wound post op.

A
  • should be at the temp of a cup of tea or just below
  • dissolbe a teaspoonful of salt in a glasss or cup of warm water
28
Q

How often should the wound be rinsed out?

A

around 4 times a day, especially after eating

29
Q

The evening after surgery, how should teeth be brushed?

A

-brush as normal but DONT rinse (just spit out toothpaste)

30
Q

If there is difficulty cleaning around the operative site, what should be done?

A
  • use damp tissue/gauze or cotton buds until it is possible to brush and floss in the area again. Brush/floss the rest of the teeth as normal
  • advise regarding chlorohexidine mouthwash can be given if hard to keep mouth clean
31
Q

Why should the patient try to keep the mouth as clean as possible post-operative?

A

keeping the mouth as clean as possible will help with healing

32
Q

Why is chlorohexidine mouthwash not recommended in an open wound? When can it be used?

A
  • incidents of anaphylaxis episodes
  • can be used after a few days if want
33
Q

What is classed as bleeding?

A

oozing from the wound ( not just blood in saliva)

34
Q

What do you do if the wound does bleed at home?

A
  • roll up some tissue or gauze, make it damp and bite on it for 20-30 mins
  • if continues to bleed repeat and bite for an hour
35
Q

What do you do if it keeps bleeding after an hour?

A
  • contact practise if within hours or the out of hours emergency contact (which you will provide them the details of)
  • if cant get bleeding to stop and cant contact you or the out of hours team then go to nearest A&E
36
Q

Why should the gauze be damp when trying to stop bleeding?

A

If dry may stick to the clot and pull it out when removed from the mouth causing bleeding to restart

37
Q

What kind of pressure should be applied with the gauze?

A

-firm and even but not too firm

38
Q

What might happen if too firm a pressure is applied in an attempt to stop post-op bleeding?

A

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

39
Q

What is the post-operative advice regarding smoking?

A

Avoid smoking for as long as possible after the procedure

40
Q

Why should smoking be avoided for as long as possible post-op?

A

-they are risk of delayed healing (vasoconstriction) and dry sockets even if they avoid smoking for a few hours after the extraction

41
Q

What other symptoms can be expected post-op?

A
  • sensitivity of the adjacent tooth
  • TMJ/muscles of mastication pain/stiffness
  • limited mouth opening
  • swelling
  • bruising
42
Q

What advice should be given regarding possible sensitivity

A
  • tell them they may experience sensitivity of the teeth on either side of the extraction site
  • if it happens they should avoid the extremes of hot/cold in the area until it settles
  • may settle in a few says or in 1-2 weeks
  • if it doesnt settle seek advice from you
43
Q

Describe the swelling that might occur after an extraction.

A

-some people swell more than others -

swelling more common after difficult extraction or surgical procedure

  • normally takes around 2 days to reach max swelling then resolves over the next few days/weeks
  • if swelling continues to increase in size or the patient is worried there may be an infection they should get in touch
44
Q

What bruising might occur after surgery? (how much, when is it more common, why should you tell patients)

A
  • some people bruise more easily and more markedly than others
  • is variable
  • can be more marked with more difficult procedures/extractons
  • if the p knows its a possibility they don’t panic
45
Q

What do surgical extractions/procedures often involve that normal extractions don’t?

A

sutures

46
Q

What advice should be given regarding sutures and what to do if they come out?

A
  • tell P to leave them alone and not to pull at them
  • if they come out and the area is not bleeding or overly painful they should just leave them
47
Q

What is more common post surgical extractions/procedures?

A

bruising and swelling

48
Q

If you think there is a chance of swelling what should you advice the use of?

A

Ice packs (NOT heat pack - increases swelling)

49
Q

What advice should be given regarding ice packs?

A

-wrap it in a tea towel/ice in poly bag etc -place on for 5 mins then off for 5 mind (too cold to leave on for full time)

50
Q

What do biopsies tend to feel like?

A

A bit ‘raw’

51
Q

What should accompany spoken instructions?

A

Written instructions

52
Q

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

A

-the patient often forgets bits

Oral Surgery (9 decks)

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