Wound healing Flashcards
Inflammation Creates & stabilizes the
blood clot signals for cells to clean up the wound
Vasodilation allows for
inflammatory mediators to rush in to start healing.
4-5 day mark, —- happens
proliferation
Tissues laid down on blood clot to form provisional matrix upon which bone will be laid
proliferation.
Collagen and capillaries form on
fibrin of hemostasis
Epithelialization
not a stage of wound healing - tooth extraction site should look healed around 3-4 weeks max. Younger pts will heal quicker.
Remodeling
1st year to fill up socket - ongoing process. Replacement of collagen matrix with woven bone, then mature bone.
Proliferation
setting up matrix in socket.
Lamina dura, radioluscency after
extraction
lamina dura resorbed at
4-6 months
Week 3 - socket should look
healed over.
1 pack a day
vasoconstriction all day long.
Radiation therapy
> 5000cGy (a TON)
You will see radiation induced fibrosis
Turnover rate of surviving bone is slowed and can be ineffective in self-repair
Radiation effects are
lifelong - never gets better.
Anti-resorptive drugs
treagtment of bony metastasis of solid tumors and osteolytic lesions of MM. Potent osteoclastic inhibition.
Anti-resorptive drugs of concern - High dose, potent
Nitrogen containing bisphosphonates, RANKL inhibitors.
Suppression of host defenses
Uncontrolled diabetes, alcoholism (protein priorities elsewhere in body), malnutrition, chronic systemic steroid use (autoimmune issue patients), myeloproliferative disease (not turning out adequate numbers of WBC/mature WBCs)
Dry socket
localized alveolar osteitis
Loss, lysis, or breakdown of the blood clot prior to its maturation into granulation tissue
• Not an infection!
Dry socket signs
3-5 days post-op
• Increase in quantity and/or change in quality of pain
• Recommended pain medication ineffective
• Malodor, foul taste
Granulation tissue is —– in color, and is made up with
Reddish pink
Blood vessels, tiny capilaries, collagen
Dry socket color
gray/brown clot or complete absence of clot.
• +/- food debris
• +/- adjacent soft tissue inflammation
Maxilla
more trabecular, spongy, incredibly unlikely to get dry socket.
Oral contraceptives can increase likelihood of
dry socket.
Surgical time (longer procedure)
increases likelihood of dry socket.
Copious irrigation of surgical site with saline will
decrease risk of dry socket.
Dry socket treatment is to
make things feel better during healing (it’ll happen naturally). Irrigate and place palliative dressing, use iodoform gauze, eugenol (woo). Packing changed QD or QOD until pain has resolved.
Dry socket resolved in
3-5 days most times.
If patients do not respond to dry socket treatment
osteomyelitis - acute infection of marrow space in bone.
Osteomyelitis
bone infection, medical and surgical tissue, can lead to significant morbidity.
Iodoform gauze does
NOT dissolve - has radiographic strip to confirm that it is there. Needs to be removed.
