Post Op Instructions (BDS2) Flashcards
Why might post-op instructions be done poorly?
- time pressures
- operator tired/stressed
- patient stressed/upset
How will giving good post-op instructions save you time later on?
-if patients know what to expect the vast majority will not phone or come back into the practice with concerns
If patients do not know what to expect after a procedure, how might they react?
- 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)
What should be covered in post extraction instructions?
- 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
What should you tell patients about pain post-op?
- 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
What should you tell the patient about controlling the pain?
- normal painkillers should control them
- use regular analgesia for 1-3 days then use analgesia as required
When should the patient start analgesia?
Before the LA wears off (the next 1-2 hours)
What is the best analgesic for post-operative pain?
NSAIDs (ibuprofen)
Not everyone can take NSAIDs, what should you be cautious about when prescribing ibuprofen?
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
What is the ibuprofen dose?
1.2 - 1.8g daily in 3-4 doses
(eg 400mg 4 times a day)
What analgesic is useful for patients who cant use Ibuprofen?
Paracetamol
How does paracetamol effect bleeding time or GIT?
- no effect on bleeding time
- less irritant to GIT
Is paracetamol an NSAID?
No - has a different action
used to be included under NSAIDs but in reality is a simple analgesic without anti-inflammatory action
When should you be cautious about prescribing paracetamol?
1 - hepatic impairment
2 - renal impairment
3 - alcohol dependence
What is the dose for paracetamol?
1-2 500mg tablets every 4-6 hours (max 8 tabs a day)
If you become aware of a patient that has taken too much paracetamol (overdose) what should you do?
refer to A&E immediately
Apart from paracetamol and ibuprofen, what other analgesia is often used by patients?
cocodamol
What can’t cocodamol be taken with?
paracetamol
You can’t force a patient to use your suggested analgesia but what is one of the best regimes for pain control?
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
What should you tell the patient about the likelihood of post-op bleeding?
It is unlikely but a possibility
What should you tell the patient with regards to preventing bleeding post op? (food and drink)
- 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
What else should be avoided in order to prevent bleeding?
- 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
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 happening
- heat causes vasodilation and may encourage bleeding
Why should hard foods be avoided?
- May traumatise the socket
- if P still numb may not feel the injury occurring
- also trauma from the food may result in bleeding
What is the advice regarding rinsing post-op?
- 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
Why should you not rinse out for several hours post op?
it may disturb the clot and start bleeding (or result in dry socket)
Describe the salty water that should be used to rinse out the wound post op.
- 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
How often should the wound be rinsed out?
around 4 times a day, especially after eating
The evening after surgery, how should teeth be brushed?
-brush as normal but DONT rinse (just spit out toothpaste)
If there is difficulty cleaning around the operative site, what should be done?
- 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
Why should the patient try to keep the mouth as clean as possible post-operative?
keeping the mouth as clean as possible will help with healing
Why is chlorohexidine mouthwash not recommended in an open wound? When can it be used?
- incidents of anaphylaxis episodes
- can be used after a few days if want
What is classed as bleeding?
oozing from the wound ( not just blood in saliva)
What do you do if the wound does bleed at home?
- 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
What do you do if it keeps bleeding after an hour?
- 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
Why should the gauze be damp when trying to stop bleeding?
If dry may stick to the clot and pull it out when removed from the mouth causing bleeding to restart
What kind of pressure should be applied with the gauze?
-firm and even but not too firm
What might happen if too firm a pressure is applied in an attempt to stop post-op bleeding?
Can result in a rebound bleed as vessels open up again when the pressure is released
What is the post-operative advice regarding smoking?
Avoid smoking for as long as possible after the procedure
Why should smoking be avoided for as long as possible post-op?
-they are risk of delayed healing (vasoconstriction) and dry sockets even if they avoid smoking for a few hours after the extraction
What other symptoms can be expected post-op?
- sensitivity of the adjacent tooth
- TMJ/muscles of mastication pain/stiffness
- limited mouth opening
- swelling
- bruising
What advice should be given regarding possible sensitivity
- 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
Describe the swelling that might occur after an extraction.
-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
What bruising might occur after surgery? (how much, when is it more common, why should you tell patients)
- 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
What do surgical extractions/procedures often involve that normal extractions don’t?
sutures
What advice should be given regarding sutures and what to do if they come out?
- 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
What is more common post surgical extractions/procedures?
bruising and swelling
If you think there is a chance of swelling what should you advice the use of?
Ice packs (NOT heat pack - increases swelling)
What advice should be given regarding ice packs?
-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)
What do biopsies tend to feel like?
A bit ‘raw’
What should accompany spoken instructions?
Written instructions
Why is it good to follow up verbal advice with written instructions?
-the patient often forgets bits
