complications

Question 1

how do we minimise/ prevent TMj dislocation

Answer 1

non dominanat hand supporting the mandible
supported by headrrest

Question 2

if the jaw appears disloacted to the right what side of TMJ disloaction is this

Answer 2

left TMJ disloaction

Question 3

what is alveolar osteitiis

Answer 3

dey socket

Question 4

what are the 2 mechanisms of dry socket forming

Answer 4

complete absence of blood clot/ formation of an initial clot which is subsequently lost

inflamed alveolar bone/ release of tissue activators

Question 5

is alvolar osteitis an infection

Answer 5

no it is inflmmation

Question 6

what are the risk factors for dry socket

Answer 6

women
smoking - vasoconstriction
trauma
medications (OCP, antipsychotics , antidepressants)
anatomy
infection
inadequate oral hygeiene
poor aftercare
spitting/ sucking/ coughing / sneezing

Question 7

how does sry socket present

Answer 7

2-3 days post LA
worsening pain
dull aching throb
simple analgesics not helping
bad taste
discharge
halitosis

Question 8

when does dry socket present

Answer 8

after XLA
inset 2-3 days

Question 9

what is the mx of dry socket

Answer 9

LA ideally
explore socket - may find a void or debris (sequestrum)
irrigate - saline
sedative dressing

may find a blood clot - not dry socket
can do nothing and will go away on its own but very painful

Question 10

what is sequestrum

Answer 10

small pieces of bone lost in the XLA site

Question 11

what pts are at increased risk of MRONJ

Answer 11

those on bisphosphonates

Question 12

what are the 2 classes of bisphosphonates

Answer 12

RANKL inhibitors
anti- angiogenics

Question 13

who can develop ORN (osteoradionecrosis)

Answer 13

people who have had radiotherapy for cancer of head and neck

Question 14

how does ORN present

Answer 14

non-healing bone
severe pain
recurrent pain
recurrent infections
halitosis/ foul smell
orofacial fistula
suppration
pathological fracture

Question 15

what can cause trismus

Answer 15

pain muscular
haematoma
infection
chronic limitation
trauma
neoplasia
TMJ degeneration/ osteoarthritis
soft tissue fibrosis

Question 16

how could you gain access to someone with pain related trismus

Answer 16

pt wont open mouth bc its too painful
Administration of LA would elevate pain and possibly allow access into the oral cavity

Question 17

what is sepsis

Answer 17

an extreme response to an infection]occurs when a pre-existing infection initiates a systemic sequence of events

Question 18

what may happen if you fail to recognise sepsis early

Answer 18

can result in rapid progression leading to tissue damage, organ failure and death

Question 19

what are the most common initial sites of pathogenesis

Answer 19

lungs
abdomen
bloodstream
renal or genitourinary tract

Question 20

what are the temp readings which would inidate spesis

Answer 20

> 38
<36

Question 21

what heart rate reading would indiacte sepsis

Answer 21

> 90 / min
130 = high risk

Question 22

what respiratory rate would indicate sepsis

Answer 22

> 20 breaths/min
25 = high risk

Question 23

what white cell count would indicate sepsis

Answer 23

> 12
<4

Question 24

what BP reading would indicate sepsis

Answer 24

<100 systolic

Question 25

what signs would indicate red flag sepsis

Answer 25

altered mental state/ confusion unable to stand/ collapse unable to catch breath/ speak fast breathing skin pale, mottles, ashen or blue rash wont fade (even when pressed) recent chemo oliguria

Question 26

what does SEPSIS stand for when dx sepsis

Answer 26

Slurred speech Extreme shivering Passed no urine all-day Severe breathlessness Illness so bad feel like dying Skin mottled/ discoloured

Question 27

what are the 6 key things you need to do if someone has sepsis (BUFALO)

Answer 27

Blood cultures Urine output Fluid resuscitation Antibiotics IV Lactate measurement Oxygen - to correct hypoxia

Question 28

with any pt what 4 things should we look at before XLA with regards to bleeding

Answer 28

vascular abnormalities platelet deficit - number platelet deficit - quality or function clotting mechanism

Question 29

what are some hereditary conditions which could lead to abnormal bleeding

Answer 29

haemophilia VIIII & IX factor XIIII vW disease ehlers danlos (vascular)

Question 30

what are some acquired bleeding disorders

Answer 30

medications liver disease alcoholism haematological malignancy

Question 31

what are the two main oral medications which can lead to bleeding disorders

Answer 31

antiplatlets anticoagulants

Question 32

what medication may someone on dialysis be getting injected daily which could lead to bleeding issues

Answer 32

heparin

Question 33

name some antiplatelets

Answer 33

clopidogrel asprin / NSAIDs prasugrel

Question 34

name some NOACs

Answer 34

apixaban rivaroiban edoxaban dabigatran

Question 35

what should a pts INR be for XLA

Answer 35

<4

Question 36

what should you get a pt to do to promote stopping the bleeding

Answer 36

firm pressure - can bite

Question 37

what can bone wx or crush be used for

Answer 37

bony bleeds

Question 38

what can electrocautery or silver nitrate be used for

Answer 38

soft tissue bleeding

Question 39

if there is excessive bleeding what can you do surgically

Answer 39

suture apply pressure

Question 40

when should you refer a bleeding issue

Answer 40

ongoing severe haemorrhage If you have reached the extent of your capabilities and can't help them decrease BP increased HR fluid loss

Question 41

what is haematoma

Answer 41

severe bruising

Question 42

for XLA where are we likely to see haematoma

Answer 42

buccal space

Question 43

when is haematoma most often seen

Answer 43

blunt trauma

Question 44

what is the normal time for bleeding to stop after XLA

Answer 44

2-5 mins