Returning patient

Question 1

4 main causes for pt for return post extraction

Answer 1

dry socket
bleeding
infection
pain

Question 2

incdience of dry socket

Answer 2

1-20% of routine extractions

up to 30% of 3rd molar extractions

Question 3

cause of dry socket

Answer 3

blood clot leaving site –> exposure of alveolar bone

Question 4

risk factors for dry socket

Answer 4

• smoking
• the pill
• local infection (ANUG/ pericoronitis)
• traumatic extraction
• compromised pt: diabetes, immunosuppression, altered bone metabolism eg pagets

Question 5

symptoms of dry socket

Answer 5

few days after extraction:
-pain, not relieved with analgesics
-bad taste/ halitosis
NO SWELLING/ FEVER

Question 6

tx of dry socket

Answer 6

• poss radiograph to check for rr
• irrigate socket with saline/ chlorhexidine
• obtundant pack

Question 7

name obtundant packs

Answer 7

• alveolgyl
• ZOE (needs removal)
• BIPP(BIOP?) (bismuth subnitrate and iodoform paste)
• lidocaine based gels/ ointments

Question 8

alveogyl ingredients

Answer 8

25.7 g butamben (LA)
15.8 g iodoform (disinfectant)
13.7g eugenol (antiseptic and anaesthetic)
+ olive oil, spearmint, sodium lauryl suphate ,calcium carbonate, penghawar djambi fern, purified water

Question 9

cause of bleeding

a. within 24 hours
b. >24hrs

Answer 9

a. within 24 hours: clotting deficiency/ extraction trauma

b. >24hrs: infection

Question 10

local area management of post=extraction bleeding

Answer 10

• LA with vasocontrictor (adrenaline)
• sutures
• haemostatic aids (surgicel/ fibrin blocks)
• bone wax (if bleed is from bone)

Question 11

amoxicillin dose

a. adults
b. 5-18yo
c. 1-5yo
d. 1 month-1 yr

Answer 11

HALVE EACH TIME
DOSE CAN BE DOUBLED IN SEVERE INFECTION
a. adults: 500mg/ 8 hours 
b. 5-18yo: 250 mg/ 8 hrs
c. 1-5yo: 125mg/8 hrs
d. 1 month-1 yr: 62.5mg/8hrs

Question 12

how long to prescribe antibiotics for

Answer 12

5 days

Question 13

alternatives to amoxicillin and when to use them

Answer 13

• phenoxymethylpenicillin
• penicillin allergy–> clarithromycin
• lymph involvement/ fever/ malaise–> adjunct metronidazole (400mg 3 times a day-5 days) OR if allergic to metronidazole –> clindamycin (300mg 4 times a day)