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BDS3 OSCE > Post-operative instructions for extraction > Flashcards

Post-operative instructions for extraction Flashcards

1
Q

What is a mnemonic that can be used for post-op extraction

A

PADABC

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2
Q

What does PAD ABC stand for

A

Pain and analgesia
Associated symptoms
Dry socket
Avoid
Bleeding
Cleaning

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3
Q

What should we tell the patient regarding post extraction pain

A
  • normal
  • take painkillers
  • should settle in a few days
  • if gets worse after day 3 or 4 then visit dentist
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4
Q

What associated symptoms may the patient be told to expect

A
  • swelling
  • bruising
  • jaw stiffness
  • sensitivity of teeth either side of the extraction side
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5
Q

What can we tell the patient about swelling

A
  • it takes 2-3 days to reach max swelling
  • if it gets worse after day 3 contact dentists
  • can recommend use of ice packs
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6
Q

What can be said to the patient regarding sensitivity of adjacent teeth

A

should settle in 1-2 weeks

avoid hot and cold extremes until then

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7
Q

What is dry socket also known as

A

localised/alveolar osteitis

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8
Q

What is the cause of dry socket

A
  • delayed healing following extraction
  • clot is lost to expose bare bone
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9
Q

When does dry socket tend to start

A

3-4 days post extraction

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10
Q

How long does dry socket take to resolve

A

7-14 days

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11
Q

What % of extractions will result in dry socket

A

2-3%

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12
Q

Extraction of what tooth has highest risk of dry socket

A

lower wisdom teeth

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13
Q

What is the advice and management around dry socket

A
  • check its definitely dry socket - look for sequestra
  • advise of analgesia and hot salty mouth wash
  • reassure
  • LA
  • irrigate with warm saline
  • curettage/debridement to encourage bleeding
  • antiseptic pain (BIP) or alvogyl
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14
Q

What is the risk with curettage/debridement of dry socket

A

will produce more bare bone and remove any remaining clot to allow for new clot formation

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15
Q

What does BIP / alvogyl do

A

soothes pain and prevents food packing

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16
Q

What is BIP

A

bismuth substrate and iodoform pack

it is antiseptic and astringent

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17
Q

What does BIP come as

A

paste/impregnated gauze

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18
Q

What is alvogyl

A

mixture of LA and antiseptic

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19
Q

What are symptoms of dry socket

A
  • severe dull aching pain - sometimes radiates to ear
  • sleep disturbance
  • sensitive exposed bone
  • smell/bad odour
  • patient complaining of bad taste in mouth
20
Q

What are the predisposing factors for dry socket

A
  • location of extraction - lower arch higher risk & molars higher risk
  • smokers
  • females
  • OCP
  • LA with vasoconstrictor
  • excessive mouth rinsing
  • previous dry socket
21
Q

What should patients avoid doing post extraction

A
  • drinking alcohol
  • smoking
  • exercise
  • exploring socket
  • hard/hot foods
  • drinking through straw
  • rinsing
  • pulling at sutures
22
Q

How long should patient avoid alcohol post extraction

23
Q

Why should px avoid alcohol post extraction

A

affects clot formation and healing process

24
Q

How long should px wait to smoke

A

go for as long as possible without smoking

25
Why should patient avoid smoking post extraction
nicotine causes vasoconstriction of BV impairing the healing and increasing likelihood of infection increased risk of dry socket
26
How long should px wait to exercise
don't exercise on day of extraction
27
Why should px avoid exercise after the extraction (for rest of day)
raises BP
28
Why should px avoid exploring the socket
may dislodge clot
29
Why should px avoid hot and hard foods
hot causes vasodilation and may cause burns if numb hard foods can traumatise socket
30
Why should px avoid using a straw post extraction
suction can dislodge blood clot
31
How long should px wait to rinse
until next day
32
Why should px wait until next day to rinse
can disturb clot
33
What should px do if they bleed
* bite down firmly on damp gauze for 20 minutes but not too hard - risk of rebound blood
34
If after biting down firmly on damp gauze for 20 minutes doesn't stop bleeding, what should px do
repeat for 1hr
35
If after 1 hour of using damp gauze, bleeding doesn't stop, what should px do
call dentist, out of hours or visit A&E
36
How should patient clean post extraction
* rinse mouth 4x a day with warm salty water especially after eating * continue to brush teeth as normal * if operative site is difficult to clean use damp gauze
37
What analgesic is best for post-op pain
ibuprofen
38
What is the max dose for paracetamol
4g daily
39
What is 1 dose of paracetamol
1g
40
What is max dose for ibuprofen
2.4g
41
What is one dose of ibuprofen (for dental pain anyway)
400mg
42
What are the cautions for ibuprofen?
* take after food caution with patients who have * renal impairment * cardiac impairment * hepatic impairment * are on other NSAIDs * are on steroids * have GORD
43
What are the cautions for paracetamol
* Don’t exceed recommended dose as can be lethal * Cautious in pts with hepatic impairment, renal impairment, alcohol dependence * If taking co-codamol, can’t also take paracetamol
44
What is the mode of action for paracetamol
Main site of action is the reduction of prostaglandins in pain pathways of CNS but exact mode of action still unclear
45
How does ibuprofen work
inhibits cox 1 and 2 this reduces prostaglandin production
46
What are the main differences between an infected socket and a dry socket in terms of symptoms?
- both painful - infected socket may see pus discharging - Infected socket may have lymph node involvement and a fever - dry socket they may be able to see the bone

BDS3 OSCE (65 decks)

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