Complications Of Exodontia

Question 1

What are the risks of exodontia?

Answer 1

Question 2

What are the 3 categories for surgical complications?
Surgical complications can be :

Answer 2

Question 3

Immediate intraoperative complications include?
(7)

Answer 3

Question 4

Haemorrhage- coagulation process

Answer 4

Primary haemostasis
Secondary haemostasis

Question 5

Haemorrhage- coagulation process
Primary haemostasis - what happens in primary haemostasis?

Answer 5

Question 6

Haemorrhage- coagulation process
Secondary haemostasis - what does it involve?

Answer 6

•Formation of fibrin through the coagulation cascade

•Defects in the coagulation cascade manifest as more serious bleeding than primary haemostasis defects.

Question 7

Secondary haemostasis pathways?

Answer 7

Extrinsic pathway
Intrinsic pathway
Common pathway

Question 8

Secondary haemostasis
What does extrinsic pathway involve?

Answer 8

Question 9

Secondary haemostasis
What does intrinsic pathway involve?

Answer 9

Question 10

Secondary haemostasis
What does common pathway involve?

Answer 10

Question 11

Question 12

Bleeding
When should haemostasis usually occur
If prolonged bleeding occurs in normal patient what can be done

Answer 12

Question 13

What is haemostasis

Answer 13

Stopping of blood

Question 14

What is a haemostatic measure

Answer 14

Way to stop bleeding

Question 15

Haemorrhage - local heamostatic measures
What are local heamostatic measures?

Answer 15

Question 16

What is a coagulopathy?

Answer 16

A condition that affects how your blood clots

Question 17

Haemorrhage
Examples of different coagulopathies?
(6)

Answer 17

Soft tissue bleed (vessel/ Inflamed tissue/ periodontal disease)
Bone bleed
Anti-platelet medication (aspirin, clopidogrel)
Warfarin
Bleeding disorders (haemophilia, Von Willebrand disease, thrombocytopenia), liver or kidney disease
Combination warfarin AND bleeding disorder, liver/kidney disease

Question 18

Haemorrhage
How would you manage a patient with Soft tissue bleed (vessel/ Inflamed tissue/ periodontal disease)

Answer 18

Ligate, suture or bipolar in pic

Question 19

Haemorrhage
How would you manage a patient with bone bleed?

Answer 19

Question 20

Haemorrhage
How would you manage a patient with Anti-platelet medication (aspirin, clopidogrel) ?

Answer 20

Local haemostatic measures

Question 21

Haemorrhage
How would you manage a patient with warfarin ?
(For tooth extractions/ exodontia )

Answer 21

Question 22

Haemorrhage
How would you manage a patient with Bleeding disorders (haemophilia, Von Willebrand disease, thrombocytopenia), liver or kidney disease

Answer 22

Question 23

Haemorrhage
How would you manage a patient with Combination warfarin AND bleeding disorder, liver/kidney disease?

Answer 23

Question 24

Question 25

Soft tissue injury How can it be caused? (2) How can it be prevented? (2)

Answer 25

Question 26

Fracture of tooth/ root Why might a tooth or root fracture occur? (4) How to manage?

Answer 26

•Normal part of process of tooth extraction •Brittle teeth (previous RCT) •Grossly carious/ heavily restored •Curved apex •Inappropriate use of elevators/forceps

Question 27

Displacement of root in antrum How do we retrieve it?

Answer 27

For understanding - antrum is another way of saying maxillary sinus aka root could go to maxillary sinus Understanding - Oroantral communication - unnatural space that forms between maxillary sinus and oral cavity following extraction of antral teeth

Question 28

Caldwell Luc Procedure

Answer 28

Question 29

Fracture of bone May be caused by? (5) Management?

Answer 29

Fracture of Buccal / lingual cortical plate + alveolus is what is being referred to by fracture of bone Replacing - as in puttting it back

Question 30

Fracture of maxillary tuberosity Causes? Management - when small fragment attached to tooth ? - when large fragment of bone?

Answer 30

Question 31

Question 32

Oro-antral communication Incidence ? Risk factors? What can develop?

Answer 32

Oroantral fistula for understanding is an epithelialised pathological unnatural communication between oral cavity and maxillary sinus. - develops when Oroantral communication fails to close spontaneously

Question 33

Treatment of oroantral communication What is antral regime

Answer 33

Question 34

Treatment of oroantralcommunication pt 2 How do we treat OAFs? OAF - essentially when OAC doesn’t close + epithelised now

Answer 34

Concurrently = at the same time Line 3 means refer to ENT if sinusitis persists where they can do FESS

Question 35

Surgical closure of Oroantral fistula

Answer 35

Question 36

Look at answers for more diagrams

Answer 36

Question 37

Dislocation of TMJ How can this be avoided? What happens to the patient? Management? Prevention?

Answer 37

Avoid by always supporting the mandible Patient will not be able to close mouth and occlusal derangement. Manipulate mandible manually downwards and backwards to correct +/- IV sedation or GA. Prevention with use of mouth props (Pt may have flat articular eminence)

Question 38

Dislocated jaw/tmj

Answer 38

Question 39

Everything up to now has been Immediate Intraoperative complications

Question 40

Early post-operative What are Early post-operative complications that can occur? (10)

Answer 40

Question 41

Pain and swelling What is most post op pain? What causes swelling? What is given for the pain and what are contraindications for that?

Answer 41

Contraindications for NSAIDS: asthmatics, kidney disease

Question 42

Trismus Occurs when? Causes? Management if it doesn’t resolve?

Answer 42

Question 43

Dry socket Common in? Occurs when? Causes? Management

Answer 43

Question 44

Dry socket risk factors (6)

Answer 44

Question 45

Delayed haemorrhage Reactionary haemorrhage Occurs when? What is reactionary haemorrhage in response to? Delayed haemorrhage occurs when? What is delayed haemorrhage in response to? Management?

Answer 45

Question 46

Prolonged anaesthesia Follows what? Risk increases with? Is it permanent?

Answer 46

Question 47

Late lost operative Late post operative complications include?

Answer 47

Question 48

Bisphosphonates What are Bisphosphonates ? What conditions are Bisphosphonates used for? (3) What can they do in regards to extraction?

Answer 48

Question 49

BISPHOSPHONATES - extra from oral surgery consultant clinic year 4 What is a major risk factor for patients who take Bisphosphonates ?

Answer 49

MRONJ - medically related osteonecrosis of the jaw Clinical sign of MRONJ - exposed bone and delayed healing

Question 50

Bisphosponates What are the 2 risk categories for bisphosphonates and developing MRONJ? Explain what makes a patient high risk? (3)

Answer 50

1- High and low risk 2- HIGH RISK: 1. IV bisphosponates as opposed to oral 2. Taking bisphosphonates more than 5 years 3. bisphosphonates taken for cancer bisphosphonates stay in system for every so MRONJ risk is present even if patient no longer on bisphosphonates

Question 51

Bisphosphonates Low risk management

Answer 51

Question 52

Bisphosphonates High risk management

Answer 52

Question 53

Examples of Bisphosphonates

Answer 53

Alendronic acid