Complications of extraction

Question 1

What are risk factors for dry socket?

Answer 1

• Smoking
• Oral contraceptives
• Female gender
• Traumatic extraction
• Bacterial involvement
• Bone/root fragments

Question 2

What are the typical features of a patient with dry socket?

Answer 2

Recent extraction in the past 1-3 days with increasingly severe pain over this period
Pain may radiate around affected side of face

Question 3

What are the typical findings on examination?

Answer 3

At the extraction site there will be an empty socket with bare bone and no visible blood clot, there may be food packing into the socket that causes distinct halitosis, gingival margin may be inflamed.

Question 4

Investigations for dry socket

Answer 4

Clinical of the socket is diagnostic

Question 5

Management of dry socket

Answer 5

Can be performed with or without LA
Any bony fragments should be removed and copious irrigation of socket with saline or chlorhexidine is required to remove food or debris.
Once clean a medication (Alveogyl) should be placed into the socket to help soothe and encourage healing.
A suture may also be placed

Question 6

When is post extraction bleeding considered abnormal?

Answer 6

• If it lasts longer than 12 hours after the extraction
• If it causes the patient to seek help from their dentist or attend a hospital emergency department
• A large haematoma or ecchymosis forms within the oral soft tissues
• Patient requires a blood transfusion

Question 7

What are risk factors for post extraction bleeding?

Answer 7

• Mandibular extraction
• Traumatic extraction
• Bone bleeding
• Coagulation disorders
• Platelet disorders
• Medication related (anti-coagulant or anti-platelet drugs)

Question 8

What questions should you ask if you suspect abnormal bleeding?

Answer 8

• Time and date of extraction
• Duration of bleeding
• Volume of bleeding
• Relevant past medical history (bleeding disorders)
• Relevant medication history (antiplatelets, anticoagulants)

Question 9

What are you examining when looking at a bleeding area?

Answer 9

• patency of the airway
• rate/volume of bleeding from socket
• clot formation

Question 10

Investigations for abnormal bleeding

Answer 10

Usually clinical
If bleeding heavy - blood tests may be needed
If airway compromised - MRI may be required once airway secured

Question 11

How to manage abnormal bleeding?

Answer 11

Firm pressure with damp gauze over the socket for 10 minutes
Pack socket with surgicel and suture in place

Question 12

What are risk factors for MRONJ and osteoradionecrosis?

Answer 12

• Treatment with anti-angiogenic and or anti-resorptive drugs eg bisphophonates
• Use of anti-resorptive drugs and glucocorticoids
• Radiotherapy to the head and neck region

Question 13

When is nerve damage determined as permanent?

Answer 13

6 months

Question 14

What can nerve injury cause?

Answer 14

Pain, tingling sensation, numbness in tongue, lower lip, chin, teeth and gums.

Question 15

What nerve supplies the posterior 1/3rd of the tongue - sensory and taste?

Answer 15

Glossopharyngeal

Question 16

What nerve supplies the sensory aspect of the anterior 2/3 of the tongue?

Answer 16

Lingual nerve - arises from the mandibular division of trigeminal nerve

Question 17

What nerve supplies taste to the anterior 2/3 of tongue?

Answer 17

Chorda tympani - branch of facial nerve VII

Question 18

What are the symptoms of lingual nerve damage?

Answer 18

Tingling sensation in the tongue, numb areas of the tongue, distinct loss of taste or altered taste perception, difficulty speaking, pain or a burning sensation in the tongue and drooling.

Question 19

What does an ID block anaesthetise?