post operative instructions Flashcards
why is giving post-operative instructions important
- 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
what is the best way to give post-operative instructions
- verbal instructions followed up with a written summary of the same thing
why are post-operative instructions often done poorly, or not at all?
- time pressure/next patient waiting
- operator tired after procedure/stressed after procedure
- patient stressed/ upset after procedure
why must you spend a little time to give good post-operative instructions
- 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
what can happen if you do not give post-operative instructions and so patient won’t know what to expect after a procedure
- 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
why must you warn the patient about pain
- patient will panic otherwise
- need to warn about pain and how to deal with it and how it can be variable for different patients
what are the main things that you need to tell the patient about post extraction
- 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
what must you tell the patient todo after LA wears off
- 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
when will pain settle
- tell patient pain will settle over the next few days
- can take 1-2 weeks for those with a dry socket
what is a dry socket
- 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
what painkillers should the patient take
- 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
how long should the patient take the painkillers
- tell patient to use painkillers regularly for 1-3 days then only use as required
- take a combo of both paracetamol and ibuprofen
what is ibuprofen
- an NSAID
- one of the best painkillers for dentoalveolar pain
- needs to be taken on a non-empty stomach
what are the cautions for using ibuprofen
- 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
what is the dose of ibuprofen
- 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
what is paracetamol
- 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
is paracetamol safe
- it is described as a safe analgesic although it causes severe problems in overdose
what are cautions of paracetamol
- hepatic impairment
- renal impairment
- alcohol dependence
what is the dose of paracetamol
- 500mg tablets
- adults = 1-2 tablets every 4-6 hours
- maximum dose = 4g daily (8tablets)
- children = depends on weight/age
what is the warning with paracetamol
- always warn patients with regards to maximum dose and emphasise that they should not exceed this
what can cause paracetamol overdose
- 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
what are the doses of co-codamol
- 8mg codeine 500mg paracetamol
- 30mg codeine 500mg paracetamol
what can’t you take co-codamol with
- paracetamol as it already has some in it and so it could lead to accidental overdose
what is the best regime for pain
- 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
what is the best thing you can do for the patient for bleeding
- best thing to do is prevent bleeding
- tell the patient that bleeding is unlikely but possible = can be avoided by not disturbing area
how can bleeding be prevented
- 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
how can healing be promoted
- 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
what can you use if it is difficult to clean around the area
- use damp tissue/gauze or cotton buds until it is possible to burst and floss in that area again
what can you advise if patient finding it difficult to keep mouth clean
- 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
what should patient do if it does bleed at home
- 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
why must you use damp tissue when trying to stop bleeding
- 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
what pressure must be used when biting down on tissue to stop bleeding
- 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
what is the advice for smoking when healing
- 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
what are some other symptoms to expect after operation
- sensitivity of adjacent teeth
- some pain and stiffness with TMJ/muscles of mastication
- swelling
- bruising
what should you tell patient if they experience sensitivity to adjacent teeth
- 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
what may patient experience with TMJ after operation
- 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
what can patients experience with swelling
- 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
when should patient get in touch with you for swelling
- if after 2/3 days the swelling continues to increase or patient is worried about an infection
what is the normal swelling
- 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
what should patient do for swelling
- 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
what can patient do if swelling is worrying
- sit/sleep upright
what can patient experience wit bruising
- 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
what must you tell patient about for sutures
- 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
what is OAC/OAF
- 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
what can be done if patient is finding sutures uncomfortable
- tell patient they can come back early and have them removed
what mouthwashes are more likely to be advised after surgical procedures
- 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
why must you not use heat packs for swelling/bruising
- this results in more soft tissue swelling
what are the instructions for after soft tissue biopsies/surgery
- 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
why is it good to use written instructions too
- 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
