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BDS2 - Oral Surgery > post operative instructions > Flashcards

post operative instructions Flashcards

1
Q

why is giving post-operative instructions important

A
  • they are as important, if not more so that the procedure itself
  • if the patient feels like they know what they need to do then they won’t panic as much
  • they give patients a feeling of security
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2
Q

what is the best way to give post-operative instructions

A
  • verbal instructions followed up with a written summary of the same thing
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3
Q

why are post-operative instructions often done poorly, or not at all?

A
  • time pressure/next patient waiting
  • operator tired after procedure/stressed after procedure
  • patient stressed/ upset after procedure
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4
Q

why must you spend a little time to give good post-operative instructions

A
  • a little time spent giving post-operative instructions will actually save you time later
  • 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-operative symptoms
  • if you tell the patient what to expect they won’t panic as much
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5
Q

what can happen if you do not give post-operative instructions and so patient won’t know what to expect after a procedure

A
  • they will often panic over things that are normal
  • this will result in patients contacting the practice
  • or patient will come into the practice for extra emergency appointments
  • or they could attend other dental surgeries when they don’t need to
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6
Q

why must you warn the patient about pain

A
  • patient will panic otherwise

- need to warn about pain and how to deal with it and how it can be variable for different patients

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7
Q

what are the main things that you need to tell the patient about post extraction

A
  • expect pain and how to deal with it
  • how to avoid/deal with bleeding
  • things that will help it/delay healing
  • other post-operative symptoms that are to be expected
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8
Q

what must you tell the patient todo after LA wears off

A
  • tell them the rough time of when the LA will wear off and to expect pain when this happens
  • tell them to take painkillers before the LA wears off
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9
Q

when will pain settle

A
  • tell patient pain will settle over the next few days

- can take 1-2 weeks for those with a dry socket

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10
Q

what is a dry socket

A
  • slow healing socket
  • there is no swelling or pus = looks like a normal socket
  • can have a bad smell, greyish colour in the area
  • usually will get better in a few weeks
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11
Q

what painkillers should the patient take

A
  • should take the normal painkillers they would for things such as a headache
  • paracetamol and ibuprofen are the best painkillers for any dental related pain
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12
Q

how long should the patient take the painkillers

A
  • tell patient to use painkillers regularly for 1-3 days then only use as required
  • take a combo of both paracetamol and ibuprofen
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13
Q

what is ibuprofen

A
  • an NSAID
  • one of the best painkillers for dentoalveolar pain
  • needs to be taken on a non-empty stomach
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14
Q

what are the cautions for using ibuprofen

A
  • patients with pervious or active peptic ulceration/GORD
  • the elderly
  • pregnancy and lactation
  • renal, cardiac or hepatic impairment
  • history of hypersensitivity to aspiring and other NSAIDs
  • asthma = do not give ibuprofen to patients with asthma unless they’ve had it before with no problems
  • patients taking other NSAIDs
  • patients on long term systemic steroids
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15
Q

what is the dose of ibuprofen

A
  • 200mg, 400mg or 600mg tablets
  • dental use = 200 or 400
  • 1.2 to 1.8g daily in 3-4 divided doses preferably after food
  • max dose = 2.4g daily
  • reduced dose for children = based on age and weight
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16
Q

what is paracetamol

A
  • not a NSAID = different mode of action although it is named under NSAIDs but doesn’t have anti-inflammatory properties
  • mainly centrally mediated
  • also used for dentoalveolar pain
  • acetaminophen
  • no effects on bleeding time
  • less irritant to GIT
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17
Q

is paracetamol safe

A
  • it is described as a safe analgesic although it causes severe problems in overdose
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18
Q

what are cautions of paracetamol

A
  • hepatic impairment
  • renal impairment
  • alcohol dependence
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19
Q

what is the dose of paracetamol

A
  • 500mg tablets
  • adults = 1-2 tablets every 4-6 hours
  • maximum dose = 4g daily (8tablets)
  • children = depends on weight/age
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20
Q

what is the warning with paracetamol

A
  • always warn patients with regards to maximum dose and emphasise that they should not exceed this
21
Q

what can cause paracetamol overdose

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
  • refer to A&E
22
Q

what are the doses of co-codamol

A
  • 8mg codeine 500mg paracetamol

- 30mg codeine 500mg paracetamol

23
Q

what can’t you take co-codamol with

A
  • paracetamol as it already has some in it and so it could lead to accidental overdose
24
Q

what is the best regime for pain

A
  • ibuprofen and paracetamol interspersed
  • take 400mg ibuprofen, then 2 hours later take 1g paracetamol, then around 4 hours after this take 400mg ibuprofen, then 2-4 bourse later another 1g paracetamol and so on
  • but do not exceed recommended doses
25
Q

what is the best thing you can do for the patient for bleeding

A
  • best thing to do is prevent bleeding

- tell the patient that bleeding is unlikely but possible = can be avoided by not disturbing area

26
Q

how can bleeding be prevented

A
  • do not explore the socket with finger or tongue = will disturb the formed clot
  • do not exercise that day or doing anything that increases blood pressure which may result in bleeding
  • avoid hot foods = patient will still be numb and may burn themselves and heat causes vasodilation and may encourage bleeding
  • avoid hard foods = may traumatise socket and cause bleeding
  • avoid alcohol for that day = may affect a health clot formation and result in bleeding or delay in healing process
  • do not rinse out for several hours or until next day as may disturb clot or result in dry socket
27
Q

how can healing be promoted

A
  • rinse gently with warm salty water few days after = water at temp of cup of tea or just below and use teaspoonful of salt
  • rinse around 4 times daily after eating
  • don’t spit out too forcefully
  • continue to clean teeth as normal
28
Q

what can you use if it is difficult to clean around the area

A
  • use damp tissue/gauze or cotton buds until it is possible to burst and floss in that area again
29
Q

what can you advise if patient finding it difficult to keep mouth clean

A
  • advise use of chlorohexidine mouthwash
  • but don’t use this on open wounds as can cause anaphylaxis
  • don’t use on first day or two after tooth removed
30
Q

what should patient do if it does bleed at home

A
  • if socket noosing and bubbling then that is not normal
  • roll up some tissue or gauze and dampen it and bite on it for 20-30 mins
  • do this till bleeding stops
  • if bleeding doesn’t stops, contact practice or out of hours service if at night or weekend
  • go to A&E if can’t get it to stop
31
Q

why must you use damp tissue when trying to stop bleeding

A
  • if it is dry then it may stick fo the clot and pull it out when removed from the mouth = this will start the bleeding again
32
Q

what pressure must be used when biting down on tissue to stop bleeding

A
  • should be firm and even

- not too firm or this will result in a rebound bleed as vessels open up again when the pressure is released

33
Q

what is the advice for smoking when healing

A
  • avoid smoking for as long as possible

- smokers are at risk of delayed healing/dry sockets even if they avoid smoking for a few hours after the extraction

34
Q

what are some other symptoms to expect after operation

A
  • sensitivity of adjacent teeth
  • some pain and stiffness with TMJ/muscles of mastication
  • swelling
  • bruising
35
Q

what should you tell patient if they experience sensitivity to adjacent teeth

A
  • 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
36
Q

what may patient experience with TMJ after operation

A
  • can experience some pain and stiffness with TMJ and muscles of mastication
  • they 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
37
Q

what can patients experience with swelling

A
  • some people swell more than others
  • swelling is more common after a difficult extraction or surgical procedure
  • it normally takes around 2 days to reach maximum swelling then reduces
38
Q

when should patient get in touch with you for swelling

A
  • if after 2/3 days the swelling continues to increase or patient is worried about an infection
39
Q

what is the normal swelling

A
  • post-op normal swelling occurs a couple days after operation but infection swelling occurs 2-3 days after surgery
  • tiny bit of swelling is normally just post-op
40
Q

what should patient do for swelling

A
  • put a cold pack on swelling and have it on and off for 5 mins
  • if its too cold however it can cause damage and so need intervals with and without it
41
Q

what can patient do if swelling is worrying

A
  • sit/sleep upright
42
Q

what can patient experience wit bruising

A
  • some people bruise more easily than others
  • brushing is variable
  • can be more marked with more difficult procedures/more difficult extractions/surgical extractions
  • if patient knows its a possibility then they won’t panic as much
43
Q

what must you tell patient about for sutures

A
  • tell patient to leave them alone
  • if they come out and there is no bleeding or pain they should just leave them
  • tell the patient that sutures can be uncomfortable as the area heals
  • tell patient they are resorbable sutures or non-resorbing and require another visit for removal
44
Q

what is OAC/OAF

A
  • oral antra communication/fistula
  • sometime when you remove upper teeth you can create a communication with the air sinuses = would need to use dissolving sutures here to make sure it doesn’t reopen
45
Q

what can be done if patient is finding sutures uncomfortable

A
  • tell patient they can come back early and have them removed
46
Q

what mouthwashes are more likely to be advised after surgical procedures

A
  • antiseptic
  • e.g. chlorohexidine
  • patients should be advised how to use them = a capful 2/3 times a day
  • if it nips then dilute with water
  • don’t use straight after brushing teeth as it may interact with toothpaste and wash toothpaste away taking away the benefits of it
  • don’t use just before or after eating = leave at least an hour, it can stain teeth if food on them
47
Q

why must you not use heat packs for swelling/bruising

A
  • this results in more soft tissue swelling
48
Q

what are the instructions for after soft tissue biopsies/surgery

A
  • as the same as for extractions and surgeries
  • biopsy sites tend to be a bit raw = you can describe to the patient that why will feel some post-op pain and it may feel like a healing ulcer
  • may experience swelling
  • may be sutures present
49
Q

why is it good to use written instructions too

A
  • the patient often forgets bits (or most) of what you’ve said = written instructions reinforce your verbal instructions
  • however, written instructions should not replace verbal instructions
  • make sure the patient knows who/where to contact in emergency

BDS2 - Oral Surgery (2 decks)

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