Extraction Complications 3

Question 1

what is ecchymosis

Answer 1

bruising

Question 2

what is the most common complication of an extraction

Answer 2

pain

Question 3

what causes a higher chance of post operative pain

Answer 3

laceration/ tearing of soft tissues
leaving bone exposed
incomplete extraction of tooth

Question 4

why does swelling occur post operative

Answer 4

it is oedematous so it is soft - not firm and is made worse by surgical technique

Question 5

what patients are more at risk of bruising

Answer 5

those on antiplatelet or anticoagulant medication

Question 6

what is trismus

Answer 6

jaw stiffness - inability to fully open the mouth

Question 7

what are causes of trismus

Answer 7

related to surgery - oedema and muscular spasm
related to giving LA - IDB goes through medial pterygoid
haematoma - medial pterygoid clot that organises and fibroses
damage to TMJ

Question 8

what is a joint effusion

Answer 8

swelling with the capsule of a joint

Question 9

how do you manage trismus

Answer 9

monitor
gentle mouth opening exercises
trismus screw - between central incisors and turn to increase the space

Question 10

what is warfarin

Answer 10

a vitamin K antagonist

Question 11

how do you treat a patient taking warfarin

Answer 11

do not stop the warfarin
check INR within 24 hours before surgery (under 4)

Question 12

how should you treat a patient who is taking aspirin alone

Answer 12

treat without interrupting medication

Question 13

how should you treat a patient taking clopidogrel/ dipyridamole

Answer 13

treat without interrupting medication and space treatment out

Question 14

how should you treat patients taking DOACs

Answer 14

you need to assess if patient is low or high bleeding risks (depends on number of extractions)
try treat early in the day
miss or delay morning dose
continue with their medication 4 hours after haemostasis achieved

Question 15

what is immediate post-op period bleeding

Answer 15

reactionary/ rebound bleeding
occurs within 48 hours
LA wears off and blood vessels expand

Question 16

what is secondary bleeding

Answer 16

often due to infection
commonly 3-7 days post op

Question 17

what are haemostatic agent examples

Answer 17

adrenaline containing LA
oxidised regenerated cellulose - surgicel

Question 18

what is surgicel

Answer 18

an oxidised regenerated cellulose to pack socket and encourage clotting

Question 19

why do you need to be careful with oxidised regenerated cellulose

Answer 19

they are acidic and can potentially damage IAN

Question 20

what are examples of systemic haemostatic aids

Answer 20

vitamin K
tranexamic acid

Question 21

how does systemic vitamin K work to aid haemostasis

Answer 21

necessary for formation of clotting factors

Question 22

how do anti-fibrinolytics like tranexamic acid work to aid haemostasis

Answer 22

prevents clot breakdown and stabilises clot

Question 23

how can tranexamic acid be given

Answer 23

tablets
mouthwash

Question 24

what is an exuberant clot

Answer 24

clot grows above the surface of the adjacent teeth - this can be traumatised when the patient occludes the teeth
treatment - debride

Question 25

what are post operative instructions

Answer 25

do not rinse mouth for several hours avoid trauma avoid hot food avoid excess physical exercise and alcohol

Question 26

how long can it take for nerve damage to improve

Answer 26

18 months

Question 27

what are the three types of sensory change

Answer 27

anaesthesia paraesthesia dysaesthesia

Question 28

what are the two sensation changes a patient might experience

Answer 28

hypoaesthesia hyperaestheisa

Question 29

what is alveolar osteitis

Answer 29

dry socket can see areas of exposed bone where clot has disappeared

Question 30

what is the feature of alveolar osteitis

Answer 30

intense pain starts 3-4 post extraction inflammation affecting the lamina dura bad taste/ odour

Question 31

what are predisposing factors to dry socket

Answer 31

molars more common smoking OCP patient has had previous dry socket

Question 32

how is dry socket managed

Answer 32

supportive - systemic analgesia LA irrigate socket with warm saline curette/ debridement antiseptic pack - alvogyl no antibiotics as no active infection

Question 33

what is alvogyl

Answer 33

a fibrous brown past which helps to heal a socket

Question 34

what is sequestrum

Answer 34

usually bits of read bone that haven't been removed it prevents healing

Question 35

how does an infected socket present

Answer 35

pus discharge check for remaining tooth/ bony sequestra consider antibiotics and take radiographs