Referral guidelines Flashcards
When should you consider refering an extraction of a permanent tooth, which is not an 8?
- Unsuccessful initial attempt
- Abnormal morphology requiring surgical
- Requires histopathological analysis (suspected cyst)
- Increased risk of damage to anatomy
- Reduced access
- Medically compromised
When should you consider refering an extraction of a wisdom tooth?
- One or more episodes of pericoronitis
- Unrestorable caries
- Impaction on the sevent causing caries
- Risk of caries in 8 or adjacent tooth
- Periapical pathology
- Prior to orthognathic surgery
- Prior to chemo/radiotherapy
What procedures not related to cancer may you refer to oral surgery for?
- Suspected malgnancy biopsy
- Closure of OAF or OAC
- Root in antrum retreival
- Pre-prosthetic surgery plan
When would you refer for TMD?
If initial conservative measures have failed.
What oral cancer signs warrent an immediate 2-week referal?
- Non-healing ulcer lasting more than 3 weeks
- Lump or swelling elsewhere in mouth
- Persistent soreness of throat or mouth
- Dysphagia
- Numbness of tongue or other areas
- Swelling of the jaw causing poorly fitting dentures
- Unexplained loosening of teeth
- Voice changes
- Mass or lump in neck
- Unexplaiend weight loss
What medical conditions may lead you to refer an XLA patient to oral surgery?
High MRONJ risk
High ORN risk
Unstable CVS disease
Uncontrolled diabetes
What are the risks of performing XLA on a patient with high blood pressure - and how would you manage this risk?
Bleeding and MI risk
Manage by:
- Checking how well controlled it is
- Asking for recent BP readings
- Considering postponing for >160/100mmHg
- Avoiding LA contraining adrenaline
What are the risks of performing XLA on a patient with angina - and how would you manage this risk?
Risk of angina attack or MI
Managed by:
- Having GTN spray readily available
- Asking about frequency of attacks
What are the risks of performing XLA on a patient with a chronic cardiac condition, or a heart defect - and how would you manage this risk?
Increased risk of infective endocarditis
Managed by:
-Explaining the risk and symptoms
- Record discussion in the notes
- Liase with patient’s cardiologist
- Check SDCEP
- Consider ABx prophylaxis
- Reinforce prevention
What are the risks of performing XLA on a patient with liver disease - and how would you manage this risk?
Bleeding due to reduced coagulation factor production, reduced platelet production if spleen involved, reduced drug processing capability, and immunocompromised.
Managed by:
- Consulting the patients physician
- Considering a coagulation screen and FBC
- Consulting the BNF for medications
What are the risks of performing XLA on a patient with kidney disease - and how would you manage this risk?
Immunocompromised and bleeding risk due to platelet disfunction.
Managed by:
- Liasing with patients physician
- Consider Us + Es and FBC
- Dialysis patients are best treated day after
- Checking BNF for medications
What are the risks of performing XLA on a patient with diabetes - and how would you manage this risk?
Hypoglycaemic event and poor wound healing.
Manged by:
- Morning appts, as blood glucose is more stable
- Checking patients blood glucose is between 5-15mmol/L
What are the risks of performing XLA on a patient with epilepsy - and how would you manage this risk?
Risk of seizure due to stress
Managed by:
- Ensuring patient has eaten before the surgery
- Enqieuire about seizure history
- Risks/benefits of IV sedation, effects of reversal agent
What are the risks of performing XLA on a patient with a bleeding disorder - and how would you manage this risk?
Prolonged bleeding due to clotting factor abnormality
Managed by:
- Considering a factor assay
- Checking factor VIII levels are between 50-75% (Haem A)
- Local haemostatic aids are readily available
- Booking patient early in the day
- Considering referal for patients with a higher bleeding risk
What are the risks of performing XLA on a patient on anti-coagulent therapy - and how would you manage this risk?
Prolonged bleeding
Managed by:
- Checking INR is below 4 if warfarin
- Local haemostatic agents are present
- Considering referal
For high bleeding risk patients:
- INR checked 24 hours before procedure
- Apixa + dapiga miss morning dose
- Rivoroxaban delay mornign dose 4 hours after procedure
