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BDS3 ORAL SURGERY > Post Extraction Complications > Flashcards

Post Extraction Complications Flashcards

1
Q

What are the common post-extraction complications?

A
  • pain/swelling/ecchymosis (bruising)
  • trismus
  • haemorrhage / post op bleeding
  • prolonged nerve damage effects
  • dry socket
  • sequestrum (pus/fluid leak)
  • infected socket
  • chronic OAF
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2
Q

what are some less common post-op complications?

A
  • osteomyelitis
  • osteoradionecrosis (ORN)
  • medication induced osteonecrosis
  • actinomycosis
  • bacteraemia/infective endocarditis
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3
Q

How can pain occur pos-extraction?

A

Due to:
- laceration/tearing of soft tissues
- leaving bone exposed
- incomplete extraction of tooth

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4
Q

Why does swelling occur?

A
  • rough handling of soft tissue
  • pulling flaps
  • crushing tissues with instruments
  • tearing of periosteum
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5
Q

What is trismus?

A

Jaw stiffness/inability to open mouth fully

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6
Q

What can cause post-extraction trismus?

A
  • related to surgery
  • related to giving LA (IDB)
  • haematoma
  • damage to TMJ
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7
Q

If a patient is on warfarin, what must you check before you go ahead with the procedure?

A

Check INR within 24 hours prior to surgery
- you want INR to be below 4

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8
Q

If a patient is on aspirin, can you extract teeth?

A

Treat without interrupting medication
- use local haemostatic measures

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9
Q

If a patient is on clopidogrel/dipyridamole, can you extract teeth?

A

Treat without interrupting medication
- expect prolonged bleeding
- limit initial treatment area
- strongly consider suturing & packing

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10
Q

If you are treating a patient on Apixaban, what would you advise them to do before an extraction?

A
  • miss morning dose
  • take dose usual time in evening
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11
Q

If you are treating a patient on Rivaroxaban, what would you advise them to do before an extraction?

A
  • delay morning dose until 4 hours after haemostasis has been achieved
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12
Q

What is the main cause of secondary bleeding after an extraction? How does it present?

A
  • often due to infection
  • commonly 3-7 days
  • usually a mild ooze but occasionally can be a major bleed
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13
Q

What haemostatic agents can be used to stop bleeding?

A
  • adrenaline containing LA
  • surgicel / equitamp
  • haemocollagen sponge
  • thrombin liquid and powder
  • floseal
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14
Q

What systemic haemostatic aids can be used to stop bleeding?

A
  • vitamin K
  • anti-fibrinolytics
  • missing blood clotting factors
  • plasma or whole blood
  • desmopressin
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15
Q

How is post-operative bleeding managed?

A
  • get pressure on immediately
  • calm anxious patient
  • take a thorough but rapid history while dealing with bleed
  • get inside mouth/good light & suction
  • remove clot
  • identify where bleeding from
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16
Q

What should you do if you cannot arrest haemorrhage?

A

Urgent hospital referral

17
Q

What post extraction instructions should be given to patient?

A
  • do not rinse until next day
  • avoid trauma
  • avoid hot food that day
  • avoid excessive physical exercise & excess alcohol
  • advice on control of bleeding
18
Q

What does neurapraxia mean?

A

contusion of nerve/continuity of epineural sheath and axons maintained

19
Q

What does axonotmesis mean?

A

continuity of axons but not epineural sheath disrupted

20
Q

What does neurotmesis mean?

A

complete loss of nerve continuity/nerve transected

21
Q

What is dry socket?

A

Localised Osteitis - inflammation affecting lamina dura
- often starts 3-4 days after extraction
- takes 7-14 days to resolve

22
Q

What are the symptoms of dry socket?

A
  • Dull aching pain
  • usually throbs & can radiates to patients ear & can keep them awake
  • exposed bone is sensitive
  • characteristic smell/bad odour
  • patient complains of bad taste
23
Q

What predisposing factors make a patient more likely to develop dry socket?

A
  • molars more common
  • mandible more common
  • smokers
  • female
  • oral contraceptive pill
  • extensive trauma
  • excessive mouth rinsing post extraction
24
Q

How is dry socket managed?

A
  • systemic analgesia
  • irrigate socket with warm saline
  • debridement
  • antiseptic pack (alvogyl)
25
Q

What is sequestrum?

A
  • usually bits of dead bone coming through gingivae
  • can also be parts of amalgam/tooth
  • delays healing must be removed

BDS3 ORAL SURGERY (8 decks)

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