Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

aa BDS M6 - Oral surgery > Complications of extractions > Flashcards

Complications of extractions Flashcards

1
Q

What do we do to prevent TMJ dislocation during extractions?

A
  • support with non-dominant hand
  • McKesson’s mouth prop if patient struggling to support jaw themselves (bites down to counteract pressure during extraction)
  • alternative approach or abandoning procedure if patient has TMJ issues or is at risk of dislocation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What alternative approach might be used to extract a tooth for a patient at risk of TMJ dislocation?

A

surgical approach - raise flap, remove bone etc. to reduce amount of pressure needed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

If a TMJ dislocation occurs how is this treated?

A

reduce the dislocation
- sit patient down, against wall if possible
- thumbs intraorally on the external oblique ridges bilaterally with fingers curled under inferior border of mandible extraorally
- exert downward pressure on mandible with aim of pushing joint back over the articular eminence to reinstate it in glenoid fossa
- hold mouth closed for a period

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are some of the bone related postoperative complications?

A
  • alveolar osteitis - ‘dry socket’
  • sequestrum
  • exposed bone
  • MRONJ
  • ORN
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is alveolar osteitis?

A

dry socket
- inflammation of the bone in the alveolus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the prevalence of dry socket?

A

0.5% to 68% range

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What % of routine extractions does dry socket affect?

A

0.5% to 5%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Extraction of which teeth are more affected by dry socket?

A

mandibular molars

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What % of impacted 3rd molars are affected by dry socket after extraction?

A

1% to 37.5%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the most commonly reported % incidence of dry socket?

A

<5%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

In what age is dry socket reportedly most common?

A

4th decade

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the pathogenesis of dry socket?

A
    • complete absence of blood clot
    • formation of initial clot which is subsequently lysed
    • inflamed alveolar bone
    • release of tissue activators - plasmin precursor (plasminogen) in plasmin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the risk factors for dry socket?

A
  • women
  • smoking - vasoconstriction
  • trauma
  • medications - OCP, antipsychotics, antidepressants
  • anatomy - mandibular third molars
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are some additional factors (other than standard risk factors) which may increase chance of dry socket?

A
  • infection
  • inadequate oral hygiene
  • poor after care
  • ??spitting, sucking through a straw, coughing or sneezing??
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What surgical factors may increase risk of dry socket?

A
  • flap extent and design
  • surgical trauma
  • experience of the surgeon
  • perioperative patient stress
  • focal fibrinolytic activity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the presentation of dry socket?

A
  • after an extraction
  • onset anytime, usually 2-3 days
  • worsening pain cf better
  • refractory to analgesia
  • dull aching throb (severe)
  • bad taste
  • discharge
  • halitosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the management of dry socket?

A
  • LA ideally
  • gentle exploration of socket
  • remove debris
  • sequestrum?
  • irrigation - saline
  • sedative dressing - alvogel
  • establish new blood clot?
  • do nothing?
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are sequestrum?

A
  • small (usually) fragments of bone which have become detached from the extraction site
  • radiograph may be useful
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

How is a sequestrum managed?

A
  • if small, LA and remove with tweezers
  • if large, LA and may require exploration of the socket
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What may occur if a sequestrum is large?

A

possible for the entire socket alveolus to become a sequestrum and become ejected

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Other than bone, what else may be exfoliated from an extraction site (sequestrum)?

A

small shards of tooth/enamel/dentine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

If soft tissue trauma during an extraction is more severe at the crestal area, what may happen?

A

large areas of exposed bone, if they persist may require reduction to get them below mucosal level

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What area is it common for exposed bone to be visible?

A

lingual posterior mandible due to prominence, thin mucosa and thin cortical plate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are bisphosphonates?

A

antiresorptive medication used to treat osteoporosis, bone metastasis, primary malignancy, Paget’s disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What are some common bisphosphonates?

A
  • alendronate
  • ibandronate
  • zoledronate
  • pamidronate
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What type of bisphosphates pose a higher risk of MRONJ?

A

IV infusions used for treating malignancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Other than bisphosphonates, which other drugs can be linked to MRONJ?

A
  • RANKL inhibitors e.g. denosumab
  • anti-angiogenics e.g. bevacizumab, sunitinib, aflibercep
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What does ORN stand for?

A

osteo radioncerosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What causes ORN?

A

can occur in irradiated patients - head and neck cancer
- secondary to trauma
- 10-35% of cases occur spontaneously

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What is the incidence of ORN?

A

5-15%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What happens during ORN?

A

avascular bone which is at risk fo similar types of processes to MRONJ, irreversible

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What is the risk of ORN following dental extraction?

A

~6%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Where does ORN happen more commonly, mandible or maxilla?

A

mandible

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

How does ORN present?

A
  • non-healing bone
  • severe pain
  • recurrent infections
  • halitosis/foul smell
  • oro-facial fistula
  • suppuration
  • pathological fracture
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

How is ORN managed?

A

exceptionally difficult to manage
- one option is to resect and replace with graft
- symptom management - irrigation, antibiotic therapy
- accept pathological fracture
- HBO (hyperbaric oxygen therapy) prior to surgery
- pentoxyphylline/tocopherol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What are the mechanisms of trismus?

A
  • pain
  • muscular
  • haematoma
  • infection
  • chronic limitation
  • trauma
  • neoplasia
  • TMJ derangement/osteoarthritis
  • soft tissue fibrosis
  • normal for some people
37
Q

What is the average normal mouth opening distance?

A

30-40mm

38
Q

What is sepsis?

A

Sepsis is an extreme body response to an infection. It is a life-threatening medical emergency. Sepsis occurs when a pre-existing infections (can be at any site, most often lung, skin, GI or urinary - but any infection) initiates a systemic sequence of events.

39
Q

What is septic shock?

A

a subset of sepsis in which underlying circulatory and cellular metabolic abnormalities are profound enough to increase mortality substantially

40
Q

Why is sepsis important in dental practice?

A

failure to recognise or implement appropriate treatment can result in rapid progression leading to tissue damage, organ failure, and death

41
Q

What is the epidemiology of sepsis/who is more at risk of sepsis? (long list)

A
  • less common in women
  • higher in non-whites
  • age >75yrs
  • recent trauma, surgery, invasive procedure
  • indwelling line, IVDU, broken skin
  • HIV/aids
  • cirrhosis
  • asplenia
  • autoimmune disease
  • solid organ transplant
  • neutropenia
  • solid or haematological cancer
  • inflammatory disorder
  • primary immunodeficiency
  • possibly alcohol and smoking
42
Q

What are the main sites of infection which lead to sepsis?

A
  • lungs (64%)
  • abdomen (20%)
  • bloodstream (15%)
  • renal or genitourinary tract (14%)
43
Q

Of those cases which have positive microbiology, what are the common bacteria associated with sepsis?

A
  • 47% of isolates were gram +ve (S aureus 20%)
  • 62% gram -ve (20% pseudomonas spp and 6% E. coli)
  • 19% fungal
44
Q

How do you recognise sepsis?

A

consider sepsis in any patient presenting with a source of infection and two or more:
1. tempt >38 degrees or <36 degrees
2. heart rate >90 (high risk >130/min)
3. resp rate >20 (high risk >25 breaths/min)
4. WCC >12 or <4 (x10’’12/ml)
5. BP systolic <100 (high risk <90 mmHg)

45
Q

What tools are available to help you recognise sepsis?

A

sepsistrust.org screening tools

46
Q

What patient categories does the sepsis trust screening tools split into?

A
  • adults
  • 5-11yo
  • <5 yo
  • pregnant pt
47
Q

What are the red flags for sepsis?

A
  • altered mental state/confusion
  • unable to stand/collapse
  • unable to catch breath/speak
  • fast breathing
  • skin pale, mottled, ashen or blue
  • rash that won’t fade
  • recent chemotherapy
  • oliguria
48
Q

What are the amber flags for sepsis?

A
  • behaviour change/reduced activity
  • immunosuppressed
  • trauma, surgery/procedure last 8 weeks
  • breathing harder than normal
  • reduced urine output
  • temp <36 degrees
  • wound infection
  • no urine 12-18 hours
49
Q

What is the SEPSIS pneumonic?

A

Slurred speech
Extreme shivering
Passed no urine in a day
Severe breathlessness
Illness so bad feels like they’re dying
Skin mottled/discoloured/ashen, rash that doesn’t blanch with pressure, cyanosis of lips/skin/tongue

50
Q

How do you manage sepsis?

A

The sepsis six
1. give O2 to keep SATS above 94%
2. take blood cultures
3. give IV antibiotics
4. give a fluid challenge
5. measure lactate
6. measure urine output

(give 3 things, take 3 things)

51
Q

What does BUFALO stand for in sepsis management?

A

Blood cultures + septic screen, U&Es
Urine output - monitor hourly
Fluid resuscitation
Antibiotics IV (microbiology)
Lactate measurement
Oxygen - to correct hypoxia

52
Q

What issues may flag up in the pre-operative assessment that indicate bleeding risk?

A
  1. vascular abnormalities
  2. platelet deficit - number
  3. platelet deficit - quality/function
  4. clotting mechanism
53
Q

Broadly speaking, if platelet level is 50x10’’9L, what would likely present?

A

petechial haemorrhage

54
Q

Broadly speaking, if platelet level is 20-50x10’’9L, what would likely present?

A

petechial haemorrhage + ecchymosis

55
Q

Broadly speaking, if platelet level is <20’’9L, what would likely present?

A

melaena, haematemesis, haematuria

56
Q

What is the normal platelet level range?

A

150-450 thousand platelets per microlitre

57
Q

What is eccyhmosis?

A

bruising

58
Q

What is malaena?

A

blood in the stool

59
Q

What is haematemesis?

A

vomiting of blood

60
Q

What is haematuria?

A

blood in the urine

61
Q

What are some of the main hereditary bleeding risks?

A
  • Haemophilia VII and IX
  • Factor XIII
  • vW disease
  • Ehlers Danlos (vascular)
62
Q

What are common acquired bleeding risks?

A
  • medications
  • liver disease
  • alcoholism
  • haematological malignancy (lymphoma, leukaemia)
63
Q

What liver cell type is majorly involved in the synthesis of coagulation factors?

A

hepatocytes

64
Q

Why may liver disease result in increased bleeding?

A

either via
- deficiency in several coagulation factors
- abnormal structure and function of fibrinogen
- impaired clearance of activated clotting factors leadings to disseminated intravascular cooagualtion or increased fibrinolysis

65
Q

Why can alcoholism/prolonged alcohol misuse lead to bleeding risk?

A
  • can lead to liver cirrhosis which can affect coagulation factors
  • may have alcohol induced thrombocytopenia (platelet deficit)
66
Q

For what common medical conditions/PMH may a patient be taking an associated anticoagulant or antiplatelet medication?

A
  • DVT
  • PE
  • cardiac syndromes
  • AF
  • MI
  • IHD
  • CVA - ischaemic stroke
  • TIA
  • surgical patients at risk of thromboembolism
  • pregnancy
67
Q

What medications fall under acquired bleeding risks?

A
  • antiplatelet
  • anticoagulants
    • coumarins (e.g. warfarin)
    • parenteral heparin
    • LMW heparin
    • NOACs / non-vit K anticoagulants
68
Q

What are examples of parenteral medications (acquired bleeding risk)?

A
  • heparin sodium
  • LMW heparin
  • dalterparin sodium
  • enoxiparin
  • tinzaparin
69
Q

What are some examples of antiplatelet drugs?

A
  • clopidogrel
  • aspirin/NSAIDs
  • prasugrel
  • ticagrelor
  • dipyridamole
70
Q

What are some of the common NOACs?

A
  • apixaban
  • rivaroxaban
  • edoxaban
  • dabigatran
71
Q

What are the common coumarins?

A
  • warfarin sodium
  • acenoxoumarol
  • phenindione
72
Q

For patients taking warfarin, what must their INR be to be suitable for procedure?

A

<4

73
Q

What is ‘primary’ bleeding?

A
  • intra-operative, soft/hard tissues
  • prolonged - platelet deficit
74
Q

What is ‘reactionary’ bleeding?

A

2-3 hours post-op bleeding, possible link to LA having worn off

suspect platelet deficiency if prolonged

75
Q

What is ‘secondary’ bleeding?

A

up to 14 days post-op, probably due to inflammatory processes linked to infection

76
Q

How would you manage primary bleeding of soft tissues?

A

pressure, suture, diathermy

77
Q

How would you manage primary bleeding of hard tissue?

A

bone wax, BIPP pack

78
Q

What length of time does normal bleeding post extraction last?

A

2-5 minutes

  • firm biting pressure/digital pressure can be helpful
79
Q

How does abnormal bleeding present?

A

increased volume, extended duration

80
Q

What is required for management of abnormal (increased) bleeding?

A
  • sufficient expertise
  • good light
  • physical access
  • suction
  • availability of materials/instruments
81
Q

How is abnormal bleeding managed?

A
  • pressure - immediate general
  • suture - pressure locally
  • bone wax (if bleeding from bone)
  • crush (if bleeding from bone)
  • electrocautery (soft tissue)
  • silver nitrate
  • haemostatic agents
  • antifibrinolytics (tranexamic acid)
  • Vit K?
82
Q

What are some haemostatic agents?

A
  • gelatin
  • collagen
  • cellulose based
  • adhesives
  • topical thrombin
83
Q

What is tranexamic acid?

A

an antifibrinolytic

84
Q

If you have a patient bleeding when should you refer?

A
  • ongoing severe haemorrhage
  • reached the extent of capabilities
  • decreased BP (100/60)
  • increased HR >100bpm
    (fluid loss)
85
Q

What guidelines should be followed regarding patients on anticoagulants or antiplatelet drugs?

A

SDCEP guidelines

86
Q

When may haematomas present in the dental setting?

A
  • following blunt trauma
  • following mandibular third molar removal or surgical removal or maxillary third molars causing swelling of the cheek
87
Q

What causes a haematoma?

A

a persistent arteriolar bleed into soft tissue/anatomic space when potential route of escape has closed up e.g. socket has clotted

88
Q

What are the risks of haematomas?

A
  • risk of bleeding
  • culture medium for bacterial growth, can lead to infection
  • bleeding into anatomic (potential spaces) can be very dangerous, causing swelling of FOM or around airway etc.

aa BDS M6 - Oral surgery (10 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions