Post Operative Instructions (bds2) Flashcards
What are the 3 types of post op instructions?
Post extraction instructions (non surgical)
post surgical instructios
Post biopsy/soft tissue surgery instructions
What is important following the procedure?
Clear post op instructions both verbal and written to ensure pt remembers
Why are post op instructions important?
Pt will know what to expect and won’t phone us or come back to surgery with concerns
What must pt know to expect following a procedure?
Expect some pain - dont disguise the fact this will occur
What do we tell pts to expect post op?
Pain once the LA wears off
How is it best to manage post operative pain?
Advise pt to take analgesics prior to LA wearing off (whilst you are still numb)
We give advice on pain killers or tell pt to take them as they normally would for a headache
when should post op analgesics be taken?
Within 1-2 hours of leaving surgery and should be used for 1-3 days regularly then use as required
How long should analgesics be used following a procedure?
1-3 days regularly
then as required after
What should we tell pt about pt?
Undersell it but make sure they know it is expect and normal - some patients will experience no pain, some will experience some pain it is very variable which is why we advise pain killers
How long does it take pain to settle?
1-3 days but for dry socket can be 1-2 weeks
What analgesia can we provide advice on?
Ibuprofen
Paracetemol
Cocodamol
What is ibuprofen?
Its a non steroidal anti inflammatory pain killer that is most effective for dentoalveolar pain!!
What is the best pain killer for dentoalveolar pain?
Ibuprofen
When is ibuprofen taken?
After food, NOT on empty stomach
What are contraindications to ibuprofen?
Those with hypersensitivity to aspirin or any other NSAID
Those taking low dose aspirin daily
Those on any other NSAIDs
Pts pregnant or lactating
Those with GORD or PUD unless proton pump inhibitor is co prescribed
caution in the elderly
renal cardiac or hepatic impairments
asthma pt - unless they have taken it before with no issues
Those on ORAL ANTICOAUGS such as warfarin
those on long term steroids
What is ibuprofen dose in adults?
400mg tablets 1x4 daily (max dose is 2.4g)
If a pt is on low dose aspirin what can’t we prescribe and why?
Ibuprofen due to increased risk of GIT side effects
What is paracetamol?
Simple analgesic with no anti-inflammatory activity. instead it is anti-pyretic
When is paracetamol a good post op analgesic?
When ibuprofen can’t be taken
Does paracetamol affect bleeding time?
NO
Also less irritating to git
What are some cautions with paracetamol?
pts with
hepatic impairment
renal impairment
alcohol dependence
What is the dose of paracetamol in adults?
500mg tablets take 1-2 up to 4x daily
can be taken every 4 hours but max dose is 4g
What is the overdose for paracetamol?
10-15g
20-30 tablets
150mg/kg
What can paracetamol OD lead to?
Hepatic damage (severe hepatocellular necrosis or renal tubular necrosis) that can be Fatal - A&E immediately
What is co-codamol?
Analgesic containing paracetemol and codeine used in severe pain
What is the dosage of ibuprofen?
200, 400mg tablets
if 200 mg then take 1-2 tablets up to 4x day
if 400mg then 1 tablet up to 4x day
What is the max dosage of ibuprofen?
it is 2.4g so we can increase the dose if needed to this but generally 1.2-1.7g daily
What is the dosage of paracetamol?
500mg tablets 1-2 up to 4x daily
Max dose 4g daily (8 tablets)
What are the dosages of codeine available?
8mg codeine and 500mg paracetemol
30mg codeine 500mg paracetamol (prescription only)
can take 1-2 tablets 4x day
How do we prevent post op bleeding?
Take a good pt history to check for any bleeding problems or medication that may increase likelihood
What advice to we give to pt to avoid any bleeding when they leave?
Avoid exploring socket with your finger or tooth brush - want to let everything heal up and a clot will form
Dont exercise that day or do anything that will inc your BP as this can cause bleeding
Avoid hot and hard foots
- hot foods as you are still numb so there is risk of burning tongue or lips without knowing and can also cause vasodilation which can encourage bleeding
- hard foods can disrupt the clot, traumatise socket if still numb and can cause more bleeding
otherwise eat and drink normally but try keep to other side of mouth for a few days
avoid alcohol that day as it can disrupt clot formation and result in bleeding and affect the healing process
Why should pt avoid hot/hard foods?
whilst numb - burn risk
can cause vasodilation which can encourage bleeding
Why should pt avoid hard foods?
Can injure socket when numb
which can lead to more bleeding
What diet should pt follow after extraction?
soft diet if possible for next few days, keep to other side of mouth
How can the pt help assist healing?
No rinsing out for at least several hours but ideally until next day to avoid disturbing healing clot which will lead to bleeding
After a day rinse with warm water or warm salt water (tea spoon salt and water in mug)
and do this 4x daily - good after eating
brush normally but dont rinse
keep mouth clean
brush all teeth as normal but if difficult around xla site then can use damp gauze and cotton buds until normality
can use CHX 2-3 days after xla
no forceful spitting
What advice do we give to pt if bleeding does occur at home?
Dont worry - roll up some tissue or gauze and dampen it then bite down for 20-30 mins
applying firm and even pressure
Why must gauze be damp if bleeding occurs?
To prevent it sticking to clot and when we remove it it can remove the clot
Why do we not want gauze pressure to be too firm?
As it can cause rebound bleed as vessels re open when pressure is released
If bleeding persists after damp gauze for 30 mins what advice do we give?
Bite on fresh piece for up to an hour
if bleeding persists after 30 mins of gauze then another hour what is the advice?
Call us here at the practice or call out of hours emergency contact number - pt must know how to contact and how as this is reassuring
What if bleeding is excessive?
if excessive and won’t stop –> a and e
What is the smoking advice follow xla?
Very important to avoid smoking for as long as possible as smokers are at increased risk of delayed healing and dry socket
what does a dry socket look like?
no swelling or pus - can look bare and often we can see bone or can even look normal but very painful
What are some other symptoms pt may experience post xla?
adjacent teeth sensitivity - avoid extremes of hot and cold until it settles but if it doesn’t settle contact me
pain and stiffness in tmj/muscles of mastication
limited mouth opening
swelling g
brusing
Why advice do we have for teeth near xla site feeling sensitive?
Avoid extremes of hot or cold for 1-2 days and if it doesn’t settle feel free to contact me
How long does it take for limited mouth opening to return to normal?
1-2 weeks
When should pt contact us about limited mouth opening?
if preventing eating or lasting longer than 1-2 weeks
What can a pt experience with regards to swelling after xla?
Different in each pt - if a difficult xla then more common
How long does it take to reach max swelling?
2 days normally then it will resolve over next few days/weeks
When does normal non infective swelling occur?
takes 48 hrs to reach peak
What is infective swelling?
This develops 2-3 days after surgery and contact us if this happens
What should we tell pt about brushing?
Can happen dont worry!
What are post surgical instructions?
Same however with some additional information (relating to sutures, antiseptic mouthwashes)
What must we tell the pt about sutures?
Leave hem be and don’t pull at them
What happens if sutures come out?
if the area isn’t bleeding or overly painful then just leave then UNLESS ITS OAC OR OAF THEN THIS CANT BE LEFT AND YOU NEED TO CONTACT US
When would the pt need to contact us if sutures come out?
if bleeding
extreme pain
or if oac or oaf closure
what different between resorbing and non resorbing stitches?
resorbing will dissolve themselves and dont need return visit whereas non resorbing need pt to return for removal
What mouthwash is good following surgical procedures?
Chlorohexidine
How often should pt use CHX post surgery?
2-3 times a day with capful
What advice can we give if CHX is nippy?
dilute with water
When should CHX be used?
Any time but not straight after brushing as will wash away F
dont use just before or after eating - leave at least an hour as it can stain the teeth if food particles are on teeth
What can we do about CHX staining?
can polish it away
What is much more common post surgical procedure?
Swelling and brusing - important pt knows this so they dont panic
Advice for swelling and bruising?
cold packs - 5 mins on 5 mins off for 1-2 hours after procedure
NO HEAT PACKS - can cause more soft tissue swelling
What is soft tissue surgery/biospy advice?
Same advice as before for xla and surgical procedures - may be sutures present and may experience swelling
biopsy sites can feel raw - may feel like a healing ulcer
What can biopsy healing sites feel like?
healing ulcer
What must we provide alongside verbal instructions?
Written instructions - pts may forget what we say as it can be stressful
