Post Op instructions Flashcards
(44 cards)
What 3 treatments do you usually give post-op instructions for after oral surgery?
- Post extraction (non-surgical)
- Post surgical
- Post biopsy/soft tissue
Why are post-op instructions often done poorly or not at all? (3 points)
- Time pressures/next patient waiting
- Operator tired after procedure/stressed after procedure
- Patient stressed/upset after procedure
Why does taking a bit of time to give post-op instructions actually save you time later on?
If patients know what to expect the vast majority of them will not phone you or come back to the practice with concerns over routine post-op symptoms
What may happen is a patient does not know what to expect after a procedure?
- They will often panic over things that are normal
- This will result in patients contacting OR coming to the practice OR attending other dental emergency clinics
- WHEN THERE IS NO NEED TO
What are the general post-extraction instructions that need to be given? (4 points)
- Expect pain & how to deal with it
- How to avoid/deal with bleeding
- Things that will delay/help healing
- Other post-op symptoms that are to be expected
What should you tell a patient about pain after a dental extraction? (4 points)
- Tell them to expect post-op pain
- Will be sore when LA wears off (this is normal)
- Tell them it is very variable
- Let them know it will settle over next few days
What should you tell a patient about painkillers after dental extraction? (3 points)
- Normal pain killers should keep pain under control
- Can give advice or tell them to take painkillers they would take for a headache
- They should start painkillers before LA wears off (usually 1-2 hours)
For how long after a dental extraction should a patient take regular anaesthesia?
- For 1-3 days
- Then use analgesia as required
One form of analgesia is Ibuprofen. What type of drug is this?
- An NSAID
- Not everyone can take these
- Made sure the patient knows to take it after food/not on an empty stomach
Who should you not prescribe ibuprofen to? (8 points)
- Previous or active peptic ulceration/ GORD
- The elderly
- Pregnancy and lactation
- Renal, cardiac and hepatic impairment
- History of hypersensitivity to aspirin & other NSAID’s
- Asthma (do not give to patients with asthma unless they have taken it before with no problems
- Patient is taking other NSAID’s
- Patients on long term systemic steroids
What is the recommended dosage for ibuprofen?
- 200, 400 or 600mg tablets
- 1.2-1.8g daily in 3-4 divided doses preferably after food
- Max dose 2.4g daily
Child:
- Reduced dose, depends on age/weight (see BNF)
Paracetamol is also useful for dentoalveolar pain, especially in patients who can’t take ibuprofen. Why is this a good alternative? (4 points)
- Different mode of action to NSAID’s
- Mainly centrally mediated
- No effects on bleeding time
- Less irritant to GIT
Paracetamol is described as a ‘safe analgesic’ but when can it cause severe problems?
- In overdose
What are 3 cautions of paracetamol?
- Hepatic impairment
- Renal impairment
- Alcohol dependence
What is the dosage of paracetamol?
- 500mg tablets
Adults: 1-2 tablets (0.5-1g) every 4-6 hours
Max dose 4g daily (8 tablets)
Children: depends on weight/age - see BNF
What must you warn patients about with paracetamol?
Always warn patient with regard to max dose and emphasize that they should not exceed this
What can paracetamol overdose cause?
As little as 10-15g (20-30 tablets) or 150mg/kg of paracetamol taken within 24 hours may cause severe hepatocellular necrosis, and less frequently, renal tubular necrosis
If a patient has had an overdose on paracetamol what should you do?
Refer them to A&E straight away
Co-codamol is often used by patients, what is the dosage fo r this?
Doses:
8mg Codeine, 500mg Paracetamol
30mg Codeine, 500mg Paracetamol
What other analgesic should not be taken with paracetamol?
Co-codamol
Don’t force the patient to use your suggested analgesia, let them use what they are comfortable with, but what is one of the best regimes of analgesia?
- Ibuprofen and Paracetamol
- Take 400mg Ibuprofen, then 2 hours later take 1g Paracetamol, then around 4 hours after this take 400mg Ibuprofen, then 2-4 hours later take another 1g Paracetamol and so on. But do not exceed recommended doses
What should you advise the patient about post-op bleeding? (3 points)
- It is unlikely but a possibility
- Do not explore the socket with finger/tongue/ toothbrush - this will disturb the clot and may result in bleeding
- Do not exercise that day/avoid rushi ng about/ avoid anything that increases BP which may result in bleeding
Why should the patient avoid hot/hard foods after oral surgery?
Hot foods:
- The patient will still be numb and may burn the lip or tongue with hot food/drinks and not realise it has happened
- Heat causes vasodilation and may encourage bleeding
Hard foods:
- May traumatise the socket. If patient is still numb they may not feel the injury occurring. Also the trauma from hard/sharp foodstuffs may result in bleeding
Otherwise:
- Eat and drink normally but keep it to the other side of the mouth for a few days AND
- Stick to a softer diet for a few days
To prevent post-op bleeding the patient should avoid drinking alcohol that day or for the next 24hrs. Why is this?
- Alcohol may affect a healthy clot formation and result in bleeding or delay the healing process
