Prevention & management of extraction complications Part 2 Flashcards
Do bacteria or salivary enzymes lyse blood clots prior to maturation/organization?
Salivary enzymes
What body part can you look at on a pt to see if bruising is a problem?
Hands
______ is a record of prothrombin time and a standardized control
(due to laboratory differences across nation)
International Normalized Ratio
What is the normal INR?
1
If INR is above _____, needs med consult
3
Direct pressure of socket with moistened gauze, folded to fit over socket
• Pressure for at least _____ -_____ min
30 – 45 mins
• Absorbable gelatin sponge • Acts as a physical tamponade, increases in size to exert internal pressure of bone • Acts as lattice for clot to form on • Liquefies in 2-5 days • Least expensive • Held in place with figure of eight suture • Can be used with topical thrombin
Gelfoam
What other hemostatic measure can be used with gelfoam?
Thrombin
Can you use thrombin with surgicel?
Nope
• Oxidized regenerated cellulose
• Promotes coagulation better than gelfoam
• Can be packed into socket under pressure (does increase in size
but not to the extent of gelfoam)
• Acts as lattice for clot to form on
• Bactericidal due to low pH
• More expensive
• CAN NOT be used with topical thrombin →thrombin is
inactivated
• Packed into socket and stabilized with figure of eight suture
SURGICEL®, ACTCEL ®
- Avitene®, CollaPlug®, Collatape®
- Promotes platelet aggregation
- Good for patients with qualitative platelet defects
- Can be packed into socket
- Very expensive
- Figure of eight suture placed to stabilize
Collagen
• Comes in separate powder and liquid vials, mix together
and then placed
• Great for coagulation factor defects
• Thrombin bypasses extrinsic and intrinsic systems and
directly convert fibrinogen (factor 1) to fibrin (factor 1a)
• Used with gelfoam
• Inactivated by oxidized cellulose
Thrombin
- Blood escaping into tissue spaces, more specifically subcutaneous tissue space
- Usually seen in elderly patients, due to
- Decreased tissue tone
- Increased capillary fragility
- Weaker cellular attachment
- Is not dangerous, does not cause pain, does not increase risk of infection
ECCHYMOSIS!!!
What is sometimes dangerous, causes pain and can get infected unlike ecchymosis?
Hematoma
– original hole into the sinus through the socket
Perforation
– epithelialized tract that forms after the unsuccessful attempt at health of the
perforation, weeks out
Fistula
Oroantral communications can result in what 2 things?
- Oroantral fistulas (OAF)
* Chronic sinusitis
CAUSES OF _________
• Severe pneumatization
• Should be caught on pre-operative radiologic evaluation in an attempt
to prevent
• Difficult or island maxillary molar extraction
• Bony floor of sinus comes out with tooth
• Inappropriate elevator technique with subsequent pushing root or
instrument through sinus
• Bur sectioning molar furcation
OA COMMUNICATIONS
____ OA communication
• No additional treatment, good prognosis
• Place patient on “sinus precautions” – avoid pressure changes
• No blowing nose forcibly
• No sucking on straws
• No smoking
• Protect blood clot with figure of eight suture over socket
• Antibiotics for short duration (3-5 days)
• Nasal decongestants
• Saline nasal spray
< 2 mm opening
____ OA communication
• Sinus precautions
• Pack gelfoam and secure with figure of eight suture over packing
• Antibiotics for 5-7 days
• Augmentin vs PCN vs amoxicillin
• Afrin (oxymetazoline) nasal decongestant
• Keeps sinus nasal ostium patent to allow normal sinus drainage through naris, thus prevent infection
• Careful as excessive use can lead to rhinitis medicamentosa
• Saline nasal spray
2 – 6 MM OPENING
\_\_\_\_ OA communication • Sinus precautions • Sinus medications • Referral to OMS for closure • Buccal mucosal advancement flap • Palatal finger flap coverage • Buccal fat pad advancement
> 6 MM OPENING
• Causes:
• Excessive force with elevator, most often with
impacted third molar
• Straight elevator use, can also occur with cross
bar elevator
• Prevention:
• Controlled forces and finesse
• Attention to mandibular flexing during luxation
• Treatment:
• Refer to OMS for open reduction and internal
fixation vs closed reduction
Mandibular fracture
