OACs and retained roots Flashcards
causes of retained roots
gross caries
trauma
coronectomy
attempted extraction
why do teeth fracture?
thick cortical bone - less expansion of socket so harder to ext root shape - divergent, bulbous, apical hooks root number ankylosis - often LEs - chance increases with age - beware with elderly caries prev RCT - can make root weaker/more brittle alignment
why do retained roots not always need to be removed?
preserve bone height e.g. future implant
near vital anatomical structures e.g. IDC
present for a number of years with the absence of PA pathology
discussing retained roots w pt
give pts the option
can be left alone and monitored to ensure no caries/PA pathology, however if becomes carious or infected recommend removal
- document discussion w pt
OAF
epithelialised pathological unnatural communication between oral cavity and maxillary sinus
when OAC fails to close spontaneously, remains patent and gets epithelialised
migration of oral epithelium into the defect
epithelialisation usually occurs when the perforation persists for at least 48-72hrs
U3-8
how does an OAC occur?
routine forceps ext surgical ext tuberosity fracture dentoalveolar/periapical infections of molars implant dislodgement into MS trauma maxillary cysts or tumours ORN dehiscence following implant failure
risk factors for OAC
extraction of upper molars and premolars close relationship of roots to sinus on radiograph large bulbous roots last standing molars older pt prev OAC recurrent sinusitis
pre-op signs of OAC
size of tooth and radiographic position of roots in relation to antrum
peri-op signs of OAC
bone removed at trifurcation bubbling at socket Valsalva test - pt pinches nose and blows gently, see bubbling at socket change in suction sound (high pitched) direct vision
post-op signs of OAC
brown unilateral discharge fluid from nose when drinking salty discharge difficulty smoking/drinking through straw non-healing socket
radiographic signs of OAC
break in floor of sinus
cloudy sinus
root fragment
management of OAC
inform pt, gain consent to monitor, close or refer
if small (<2mm) may heal spontaneously close (or refer for closure) with BAF if >2mm
conservative advice
consider decongestant/nasal drops
consider ABs
management of OAC - conservative advice
no nose blowing, do not stifle sneezes do not agitate area HSMW or CHX rinse avoid using straws smoking cessation advice steam inhalations with menthol crystals
management of OAC - decongestant/nasal drops
ephedrine nasal drops 0.5% 10ml TDS
management of OAC - ABs
if any signs of infection consider ABs
amoxicillin 500mg TDS 7 days
