Postoperative extraction complications Flashcards
What are the potential post-operative extraction complications
- pain/swelling/ecchymosis
- trismus/limited mouth opening
- haemorrhage
- prolonged effects of nerve damage
- dry socket
- sequestrum
- infected socket
- chronic OAF/root in antrum
what are less common post-operative extractions
- osteomyelitis
- osteoradionecrosis
- medication induced osteonecrosis
- actinomycosis
- bacteraemia/infective endocarditis
what is the most common post extraction complication
pain
how do you manage pain
make sure patients know it is normal to experience discomfort after an extraction
warn patients and advise/prescribe analgesia
Rough handling causes more pain
- laceration of tissues
exposed bone
-incomplete extraction of tooth
when should you be concerned about post-operative swelling
if it only begins about three days after the extraction
what can cause post-operative trismus
related to surgery - oedema or muscle spasm
related to giving LA - IDB ( if needle goes into medial pterygoid, it can cause a bleed and a haematoma. Or the muscle may go into a spasm resulting in limited mouth opening
Bleed in muscle - haematoma in medial pterygoid or masseter
damage to TMJ - oedema/join effusion
How do we initially deal with a patient who’s returned with bad post-operative bleeding
- put pressure on immediately
- calm the patient
- clean patient, remove bowls of blood etc
- take a thorough but rapid history
- rule out bleeding disorder and question anti platelet medication
- refer urgently if there is a bleeding disorder
- Remove the large jelly-like clot
- identify where bleeding is from
what type of haemorrage can occur post operatively
immediate post-operative period - within 48 hours, vessels that have been shut down open up and LA vasoconstriction effects wear off. Sutures also loosen or patient traumatises with finger/tongue
Secondary bleeding - often due to infection at 3-7 days. Usually mild ooze of blood
how do we manage/ stop haemorrhage
- pressure with finger or damp gauze packs
- local anaesthetic with vasoconstrictor
- haemostatic aids (surgicel - oxidised cellulose acts as a framework for clot formation)
- bone wax in socket
- suture the socket
ligation of vessels/diathermy
what post extraction instructions should you give to a patient who has been bleeding
- Do not rinse for several hours
- Avoid trauma - don’t explore socket with tongue or fingers
- Avoid hot food
- Avoid excessive exercise and alcohol (increases blood pressure)
- Give advice on control of bleeding (damp gauze, pressure for 30 minutes, points of contact if bleeding continues)
what is the proper name for dry socket
alveolar osteitis
what is the definition of dry socket
a condition occurring after tooth extraction which results in a dry appearance of the exposed bone in the socket, due to disintegration or loss of the blood clot
what is the main feature of dry socket
intense pain, described as worse than toothache and keeps patient awake at night
what is the aetiology of dry socket
- starts 3-4 days after extraction
- takes 7-14 days to resolve if you do nothing
- inflammation affecting the lamina dura (socket wall)
- some say cot does not form, others say it forms then breaks down
- ensure you help with pain control
what are the symptoms of dry socket
- dull aching pain (moderate to severe)
- usually throbs and can radiate to patient’s ear
- can keep patient awake at night
- exposed bone is sensitive and source of pain
- characteristic bad smell
- patient complains of bad taste in mouth
