The Returning Patient Flashcards
When taking a history of a returning patient what should you include?
Medical and dental history
What was the precipitating procedure
What advice have they already been given
Offer reassurance and stabilise any bleeding
What are the reasons a patient might return after an extraction?
Dry socket
Bleeding
Infection
Pain
What are things to look out for when examining a returning patient?
First what is their general appearance
Extra oral: temperature, swelling, lymphadenopathy, Trismus
Intra oral: site of surgery, swelling, bleeding, suppuration, halitosis
What is dry socket, and what is it also known as?
May also be called alveolar osteitis
It is inflammations of the bone usually post extraction. It is thought to be caused by loss of the blood clot leaving the bone exposed to the oral environment.
Routine extractions: 1-20% incidence
Surgical 3rd molar extractions: up to 30% incidence
What are the symptoms of dry socket?
Onset a few days after extraction
Very painful and associated with a bad taste and odour
Not relieved by analgesics
Not associated with pyrexia, swelling or infection
What is the cause of dry socket?
The cause is unknown!!!
But there are several factors linked to its occurrence:
Smoking, oral contraceptive, local infection (ANUG or pericoronitis), excessive trauma at time of extraction, patient compromised in some way (diabetes, immune suppression, radiotherapy, altered bone metabolism pagets)
How would you treat dry socket?
First examine the socket, it may need a radiograph to check for retained roots.
Irrigate the socket with saline or chlorhexidine
Pack the socket - usually alveogyl at BDH
What might cause a patient to have prolonged bleeding after extraction?
In first 24hrs: the trauma of extraction or the patient may have a clotting deficiency
Delayed: usually caused by an infection
How would you manage a patient with prolonged bleeding??
Assess the patient for vital signs and airway
Consider the amount of blood loss and if there is a need for fluids/resuscitation
Review medical history and history of extractions
Local measures: compressive sutures and bone wax if bleed is coming from bone
What antibiotics would be prescribed for dental infection?
5 days of Amoxicillin (500mg 3xday) OR Phenoxymethylpenicilin (500-1000mg 4xday)
True penicillin allergy: 5 days of Clarithromycin (500mg 2xday)
If severe infection or it is spreading add on: 5 days of Metronidazole (400mg 3xday)
Alternative to metronidazole if allergic: 5 days of Clindamycin (300mg 4xday)
What are suitable analgesics for dental pain?
Paracetamol and ibuprofen
If that isn’t enough can consider: codeine phosphate added in or switching to another NSAID such as naproxen or diclofenac
Diclofenac should not be used in people with: ischaemic heart disease, cerebrovascular disease, peripheral arterial disease, heart failure
During pregnancy paracetamol is preferred
