Extraction complications Flashcards by Alistair Stoddart

what are the 3 types of extraction complications and when do they take place

Immediate/ intra-operative/ peri-operative
-Happens during extractions

Immediate post-operative/ short term post-operative
- Happens shortly after extractions

*Long term post-operative
-Happens a while after extractions

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What peri-operative complications can happen

Difficult access
*Abnormal resistance
*Fracture of tooth/root
*Fracture of alveolar bone
*Jaw fracture
*Involvement of the maxillaryantrum
*Fracture of tuberosity
*Loss of tooth
Soft tissue damage
*Damage to nerves/vessels
*Haemorrhage
*Dislocation of TMJ
*Damage to adjacentteeth/restorations
*Extraction of permanent toothgerm
*Broken instruments
*Wrong tooth

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What causes difficult Access

Trismus

Reduced aperture of mouth

Crowded/malpositioned teeth

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What could the causes be of abnormal resistance

Thick cortical bone

Shape/form of roots e.g.divergent roots/hooked roots

Number of roots e.g.3 rooted lowermolars

Hypercementosis

Ankylosis

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What could cause tooth/root fracture

Caries

Alignment

Size

root morphology

*Fused
*Convergent or divergent
*Extra root(s)
*Hypercementosis
*Ankylosis

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Where does fracture of alveolar bone normally occur

Buccal plate

Usually in canines or molars

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Where does a jaw fracture normally happen

Usually mandible

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What could cause a fracture in the mandible

Often impacted wisdom tooth (takes up bone space), large cyst (takes up bone space) or atrophic mandible

Application of force used

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If a jaw fracture occur what must you do

*Inform patient
*Post-op radiograph
*Refer (phone call)
*Ensure analgesia
*Stabilise
*If delay, antibiotic

Tell patient not to eat

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What could you do to help improve difficult access

ask patient to move nad good lighting

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If there is a fracture in the alveolar bone how would you assess it

Is bone still attached to the periostium
How big is the fracture and the chunk of bone fractured off
Can it be sutured back on
See if the fracture is jaggy but use a instrument to assess that not your fingers

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If the alveolar fracture is big with no attachment/ blood supply/ cant stabilise it what do you do

Try and retain it first but if not possible surgically remove it

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How could you help to prevent jaw fracture

Use proper technique and support the mandible when extracting

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What is the term used for involvement of the maxillary antrum

Oro-antral fistula (OAF)/communication (OAC)

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How could you cause a OAC/F

Tooth getting extracted already sits in the maxillary antrum so when extracted it creates a hole

If you are taking a tooth out and only 2 of the roots come out leaving 1 behind, and when you go in with your elavator to try and remove thte 3rd root you push it up instead into the sinus

Fractering the tuberosity

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What is the differences between OAF and OAC

OAF
-Hole has been there a while and a thin layer of epithelium has grown over it

OAC
-When its just a hole so youve just created it

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How do you diagnose a OAC/F

Size of tooth

Radiographic position of roots in relation to antrum

Bone at trifurcation of roots

Bubbling of blood at the socket

Nose holding test (careful as can create an OAC)

Direct vision

Good light and suction - suction might start to create a echo

Blunt probe (take care not to create an OAC)

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What is the nose holding test

The patient is asked to close his nostrils and blow gently down the nose with the mouth open. Presence of OAF appears as a whistling sound as air passes down the fistula into the oral cavity

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What are the risk factors of Involvement of Maxillary Antrum

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Extraction of uppermolars and premolars

Close relationship of roots to sinus on radiograph

Last standing molars

Large, bulbous roots

Older patient

Previous OAC

Recurrent sinusitis

What are the types of Involvement of Maxillary Antrum

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Chronic

Acute (just happened)

How do you manage Involvement of Maxillary Antrum

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Inform patient and depends on what type:

If small or sinus intact
–Encourage clot
–Suture margins
–Antibiotic
–Post-op instructions

If large or lining torn
–Close with buccal advancement flap
–Antibiotics and nose blowing instructions

What nose blowing instructions do you give to patients with OAC

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Avoid blowing your nose or sneezing with pinched nostrils as both actions increase the pressure in the sinus and could cause the repaired wound to breakdown, so if sneezing do it with mouth open

What is the aetiology of fracture of the tuberosity

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Singlestanding molar

Unknown unerupted molar wisdom tooth

Pathological gemination

Extracting in wrong order

Inadequate alveolar support

How do you prevent a fracture of tuberosity happening

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Use proper support when extracting

Take teeth out back to front

How do you diagnose fracture of tuberosity

–Noise –Movement noted both visually or with supporting fingers –More than one tooth movement –Tear on palate

How do you manage a tuberosity fracture

Dissect out and close wound or reduce and stabilise Reduction: Fingers or forceps Fixation: -Orthodontic buccal arch wire spot welded with composite -Arch bar -Splints

If you loose a tooth doing surgery what do you do

Stop Where - patients bib/mouth/cloths, floor -Ask if patient felt anything -If cant find assumed swallowed Suction Radiograph

If patient did swalllow tooth what do you do

refer to A&E and you must keep patient calm and have proper comunication

Is soft tissue damage a common complication

yes

How do you minimise soft tissue damage

Using right instrument and technique Initially place foreceps on crown then move down Application point -Make sure elevator/luxator is in space and then apply a small bit of presseure to make sure it doesnt slip Controlled pressure Sufficient but not excessive force

When does damage to nerves occur

Anytime but patient will only notice once LA wears off

How does damage to nerves occur and what type of injuries can they be

damage to nerve during surgery with drill or forceps needle placement You can crush the nerve, cut/shred the nerve, transect the nerve all with an instrument or the needle

What is neurapraxia

In neurapraxia, the nerve fiber is not actually damaged or severed but rather compressed

What is axonotmesis

the connective tissue surrounding the axon and the myelin sheath that insulates it remain intact, but the axon itself is damaged Its crushed

What is neurotmesis

Complete loss of nerve continuity/nerve transected

Name the type of feelings that can occur after nerve damage and what they are

Anaesthesia- numbness Paraesthesia- tingling Dysaesthesia- unpleasant sensation/pain Hypoaesthesia- reduced sensation Hyperaesthesia- increased/heightened sensation

What may cause damage to a vessel

Sharp bone

What is the sign of a vein injury

Lots of bleeding

Whats the sign of a artery injury

Spurting blood

What is the sign of arterioles

Spurting/pulsating bleed

How may a haemorrhage happen

Most bleeds due to local factors – mucoperiosteal tears or fractures of alveolar plate/socket wall Very few bleeds due to undiagnosed clotting abnormalities (haemophilia/von Willebrands) Some due to Liver Disease (alcohol problems) – clotting factors made in liver Some due to medication – Warfarin/ antiplatelet agents (e.g. Aspirin/Clopidogrel)

How would you manage a haemorrhage in soft tissue

–Pressure (mechanical –finger/biting on damp gauze swab) –Sutures –Local Anaesthetic with adrenaline (vasoconstrictor) –Diathermy (cauterise/burn vessels precipitate proteins which form proteinaceous plug in vessel) –Ligatures/haemostatic forceps (artery clips) for larger vessels

How may you stop a haemorrhage in bone

–Pressure (via swab) –LA on a swab or injected into socket –Haemostatic agents –Blunt instrument –Bone Wax –Pack

How would you manage a TMJ dislocation

Relocate immediately (analgesia and advice on supported yawning) If unable to relocate try local anaesthetic into masseter intra-orally If still unable to relocate – immediate referral

How may damage to adjacent teeth occur

Hit opposing teeth with forceps Crack/Fracture/move adjacent teeth with elevators Crack/fracture/remove restorations/crowns/bridges on adjacent teeth

How do you manage damage to adjacent teeth

Temporary dressing/restoration Arrange definitive restoration If large restoration next to extraction site warn patient of the risk

What is extrtaction of perm. tooth germ and how may it happen

Extraction of permanent tooth germ e.g. when removing deciduous molars resulting in extraction or damage to developing permanent premolar Very rare

Extraction complications Flashcards

(47 cards)