Pre and Post-op Instructions

Question 1

What risks do you need to tell someone about, regarding extraction of an upper molar?

Answer 1

Pain, bleeding, bruising, swelling.
Communication with the maxillary sinus
Fracture of the tuberosity
Fractured tooth- retained root
Surgical access
Damage to adjacent teeth/restorations
Damage to nerves
Soft tissue damage
Sutures
Dry socket- more common in lower
Infection

Question 2

What risks do you need to tell someone about, regarding extraction of a lower molar?

Answer 2

Pain, bleeding, bruising, swelling
Jaw stiffness
Limited mouth opening
Damage to nerves
Fractured tooth- retained root
Surgical access
Damage to adjacent teeth/restorations
Soft tissue damage
Sutures
Dry socket
Infection

Question 3

Why is a dry socket more common in the lower arch?

Answer 3

Thicker bone in the mandible, blood vessels are constricted, so less blood supply to the lower teeth. Bone becomes necrotic.

Question 4

What post-op instructions should be given to the patient with regards to pain?

Answer 4

Expect pain once the local anaesthetic wears off in a few hours.
Some people experience more pain than others.
This will settle over the next few days.
Take painkillers that you usually would- use this regularly for 1-2 days, then as required.
Recommended regime- 400mg ibuprofen, then 2 hours later take 1g paracetamol, 4 hours later take 400mg ibuprofen, then 204 hours later take 1g paracetamol.

Question 5

What post-op instructions should be given to the patient with regards to bleeding?

Answer 5

Avoid eating anything too hot
Chew on opposite side of the mouth.
Stick to a softer diet for a few days.
Avoid eating anything too sharp
No alcohol for the rest of the day
Avoid smoking for as long as possible.
No exercise or anything stressful for the rest of the day.
Avoid touching the socket with your finger or tongue.
Do not rinse that day, from the next day, rinse with warm salty mouth rinses four times a day.
Brush teeth as normal that night.
If you cannot brush, use chlorhexidine.
Wrap damp gauze into a sausage shape and bite down on it for 20-30 minutes, then an hour, then call the practice or A&E.

Question 6

What post-op instructions should be given with regards to bruising and swelling?

Answer 6

Bruising and swelling will reach its maximum after 2-3 days.
Start at the site of extraction and then gravity will work its way down.
It will go down after a few days.

Question 7

What other things should the patient expect?

Answer 7

Jaw stiffness- should settle after a few days to a few weeks.
Sensitivity of adjacent teeth.

Question 8

Describe the pain pathway.

Answer 8

Tissue injury causes injury to the phospholipid cell membrane, causes release of arachidonic acid.
COX-1 and COX-2 are produced which causes production of prostaglandin.
Prostaglandin sensitises the tissues to make them more susceptible to feeling the pain.
5-lipoxygenas pathway also activated- produces leukotrienes- causes pain and inflammation.