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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

A

24h

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
Q

Why should patient avoid smoking post extraction

A

nicotine causes vasoconstriction of BV impairing the healing and increasing likelihood of infection

increased risk of dry socket

26
Q

How long should px wait to exercise

A

don’t exercise on day of extraction

27
Q

Why should px avoid exercise after the extraction (for rest of day)

A

raises BP

28
Q

Why should px avoid exploring the socket

A

may dislodge clot

29
Q

Why should px avoid hot and hard foods

A

hot causes vasodilation and may cause burns if numb

hard foods can traumatise socket

30
Q

Why should px avoid using a straw post extraction

A

suction can dislodge blood clot

31
Q

How long should px wait to rinse

A

until next day

32
Q

Why should px wait until next day to rinse

A

can disturb clot

33
Q

What should px do if they bleed

A
  • bite down firmly on damp gauze for 20 minutes but not too hard - risk of rebound blood
34
Q

If after biting down firmly on damp gauze for 20 minutes doesn’t stop bleeding, what should px do

A

repeat for 1hr

35
Q

If after 1 hour of using damp gauze, bleeding doesn’t stop, what should px do

A

call dentist, out of hours or visit A&E

36
Q

How should patient clean post extraction

A
  • 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
Q

What analgesic is best for post-op pain

A

ibuprofen

38
Q

What is the max dose for paracetamol

A

4g daily

39
Q

What is 1 dose of paracetamol

A

1g

40
Q

What is max dose for ibuprofen

A

2.4g

41
Q

What is one dose of ibuprofen (for dental pain anyway)

A

400mg

42
Q

What are the cautions for ibuprofen?

A
  • take after food

caution with patients who have

  • renal impairment
  • cardiac impairment
  • hepatic impairment
  • are on other NSAIDs
  • are on steroids
  • have GORD
43
Q

What are the cautions for paracetamol

A
  • 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
Q

What is the mode of action for paracetamol

A

Main site of action is the reduction of prostaglandins in pain pathways of CNS

but exact mode of action still unclear

45
Q

How does ibuprofen work

A

inhibits cox 1 and 2

this reduces prostaglandin production

46
Q

What are the main differences between an infected socket and a dry socket in terms of symptoms?

A
  • 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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