post operative instructions Flashcards
(49 cards)
1
Q
why is giving post-operative instructions important
A
- they are as important, if not more so that the procedure itself
- if the patient feels like they know what they need to do then they won’t panic as much
- they give patients a feeling of security
2
Q
what is the best way to give post-operative instructions
A
- verbal instructions followed up with a written summary of the same thing
3
Q
why are post-operative instructions often done poorly, or not at all?
A
- time pressure/next patient waiting
- operator tired after procedure/stressed after procedure
- patient stressed/ upset after procedure
4
Q
why must you spend a little time to give good post-operative instructions
A
- a little time spent giving post-operative instructions will actually save you time later
- 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-operative symptoms
- if you tell the patient what to expect they won’t panic as much
5
Q
what can happen if you do not give post-operative instructions and so patient won’t know what to expect after a procedure
A
- they will often panic over things that are normal
- this will result in patients contacting the practice
- or patient will come into the practice for extra emergency appointments
- or they could attend other dental surgeries when they don’t need to
6
Q
why must you warn the patient about pain
A
- patient will panic otherwise
- need to warn about pain and how to deal with it and how it can be variable for different patients
7
Q
what are the main things that you need to tell the patient about post extraction
A
- expect pain and how to deal with it
- how to avoid/deal with bleeding
- things that will help it/delay healing
- other post-operative symptoms that are to be expected
8
Q
what must you tell the patient todo after LA wears off
A
- tell them the rough time of when the LA will wear off and to expect pain when this happens
- tell them to take painkillers before the LA wears off
9
Q
when will pain settle
A
- tell patient pain will settle over the next few days
- can take 1-2 weeks for those with a dry socket
10
Q
what is a dry socket
A
- slow healing socket
- there is no swelling or pus = looks like a normal socket
- can have a bad smell, greyish colour in the area
- usually will get better in a few weeks
11
Q
what painkillers should the patient take
A
- should take the normal painkillers they would for things such as a headache
- paracetamol and ibuprofen are the best painkillers for any dental related pain
12
Q
how long should the patient take the painkillers
A
- tell patient to use painkillers regularly for 1-3 days then only use as required
- take a combo of both paracetamol and ibuprofen
13
Q
what is ibuprofen
A
- an NSAID
- one of the best painkillers for dentoalveolar pain
- needs to be taken on a non-empty stomach
14
Q
what are the cautions for using ibuprofen
A
- patients with pervious or active peptic ulceration/GORD
- the elderly
- pregnancy and lactation
- renal, cardiac or hepatic impairment
- history of hypersensitivity to aspiring and other NSAIDs
- asthma = do not give ibuprofen to patients with asthma unless they’ve had it before with no problems
- patients taking other NSAIDs
- patients on long term systemic steroids
15
Q
what is the dose of ibuprofen
A
- 200mg, 400mg or 600mg tablets
- dental use = 200 or 400
- 1.2 to 1.8g daily in 3-4 divided doses preferably after food
- max dose = 2.4g daily
- reduced dose for children = based on age and weight
16
Q
what is paracetamol
A
- not a NSAID = different mode of action although it is named under NSAIDs but doesn’t have anti-inflammatory properties
- mainly centrally mediated
- also used for dentoalveolar pain
- acetaminophen
- no effects on bleeding time
- less irritant to GIT
17
Q
is paracetamol safe
A
- it is described as a safe analgesic although it causes severe problems in overdose
18
Q
what are cautions of paracetamol
A
- hepatic impairment
- renal impairment
- alcohol dependence
19
Q
what is the dose of paracetamol
A
- 500mg tablets
- adults = 1-2 tablets every 4-6 hours
- maximum dose = 4g daily (8tablets)
- children = depends on weight/age
20
Q
what is the warning with paracetamol
A
- always warn patients with regards to maximum dose and emphasise that they should not exceed this
21
Q
what can cause paracetamol overdose
A
- 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
- refer to A&E
22
Q
what are the doses of co-codamol
A
- 8mg codeine 500mg paracetamol
- 30mg codeine 500mg paracetamol
23
Q
what can’t you take co-codamol with
A
- paracetamol as it already has some in it and so it could lead to accidental overdose
24
Q
what is the best regime for pain
A
- ibuprofen and paracetamol interspersed
- take 400mg ibuprofen, then 2 hours later take 1g paracetamol, then around 4 hours after this take 400mg ibuprofen, then 2-4 bourse later another 1g paracetamol and so on
- but do not exceed recommended doses
25
what is the best thing you can do for the patient for bleeding
- best thing to do is prevent bleeding
| - tell the patient that bleeding is unlikely but possible = can be avoided by not disturbing area
26
how can bleeding be prevented
- do not explore the socket with finger or tongue = will disturb the formed clot
- do not exercise that day or doing anything that increases blood pressure which may result in bleeding
- avoid hot foods = patient will still be numb and may burn themselves and heat causes vasodilation and may encourage bleeding
- avoid hard foods = may traumatise socket and cause bleeding
- avoid alcohol for that day = may affect a health clot formation and result in bleeding or delay in healing process
- do not rinse out for several hours or until next day as may disturb clot or result in dry socket
27
how can healing be promoted
- rinse gently with warm salty water few days after = water at temp of cup of tea or just below and use teaspoonful of salt
- rinse around 4 times daily after eating
- don't spit out too forcefully
- continue to clean teeth as normal
28
what can you use if it is difficult to clean around the area
- use damp tissue/gauze or cotton buds until it is possible to burst and floss in that area again
29
what can you advise if patient finding it difficult to keep mouth clean
- advise use of chlorohexidine mouthwash
- but don't use this on open wounds as can cause anaphylaxis
- don't use on first day or two after tooth removed
30
what should patient do if it does bleed at home
- if socket noosing and bubbling then that is not normal
- roll up some tissue or gauze and dampen it and bite on it for 20-30 mins
- do this till bleeding stops
- if bleeding doesn't stops, contact practice or out of hours service if at night or weekend
- go to A&E if can't get it to stop
31
why must you use damp tissue when trying to stop bleeding
- if it is dry then it may stick fo the clot and pull it out when removed from the mouth = this will start the bleeding again
32
what pressure must be used when biting down on tissue to stop bleeding
- should be firm and even
| - not too firm or this will result in a rebound bleed as vessels open up again when the pressure is released
33
what is the advice for smoking when healing
- avoid smoking for as long as possible
| - smokers are at risk of delayed healing/dry sockets even if they avoid smoking for a few hours after the extraction
34
what are some other symptoms to expect after operation
- sensitivity of adjacent teeth
- some pain and stiffness with TMJ/muscles of mastication
- swelling
- bruising
35
what should you tell patient if they experience sensitivity to adjacent teeth
- they should avoid extremes of hot/cold in the area until it settles
- it may settle in a few days or in 1-2 weeks
- if it does not settle, they should seek your advice
36
what may patient experience with TMJ after operation
- can experience some pain and stiffness with TMJ and muscles of mastication
- they may experience limitation in mouth opening
- this should settle over the course of a few days/1-2 weeks
- if it prevents eating, they should seek your advice
- if it lasts longer than normal, they should seek your advice
37
what can patients experience with swelling
- some people swell more than others
- swelling is more common after a difficult extraction or surgical procedure
- it normally takes around 2 days to reach maximum swelling then reduces
38
when should patient get in touch with you for swelling
- if after 2/3 days the swelling continues to increase or patient is worried about an infection
39
what is the normal swelling
- post-op normal swelling occurs a couple days after operation but infection swelling occurs 2-3 days after surgery
- tiny bit of swelling is normally just post-op
40
what should patient do for swelling
- put a cold pack on swelling and have it on and off for 5 mins
- if its too cold however it can cause damage and so need intervals with and without it
41
what can patient do if swelling is worrying
- sit/sleep upright
42
what can patient experience wit bruising
- some people bruise more easily than others
- brushing is variable
- can be more marked with more difficult procedures/more difficult extractions/surgical extractions
- if patient knows its a possibility then they won't panic as much
43
what must you tell patient about for sutures
- tell patient to leave them alone
- if they come out and there is no bleeding or pain they should just leave them
- tell the patient that sutures can be uncomfortable as the area heals
- tell patient they are resorbable sutures or non-resorbing and require another visit for removal
44
what is OAC/OAF
- oral antra communication/fistula
- sometime when you remove upper teeth you can create a communication with the air sinuses = would need to use dissolving sutures here to make sure it doesn't reopen
45
what can be done if patient is finding sutures uncomfortable
- tell patient they can come back early and have them removed
46
what mouthwashes are more likely to be advised after surgical procedures
- antiseptic
- e.g. chlorohexidine
- patients should be advised how to use them = a capful 2/3 times a day
- if it nips then dilute with water
- don't use straight after brushing teeth as it may interact with toothpaste and wash toothpaste away taking away the benefits of it
- don't use just before or after eating = leave at least an hour, it can stain teeth if food on them
47
why must you not use heat packs for swelling/bruising
- this results in more soft tissue swelling
48
what are the instructions for after soft tissue biopsies/surgery
- as the same as for extractions and surgeries
- biopsy sites tend to be a bit raw = you can describe to the patient that why will feel some post-op pain and it may feel like a healing ulcer
- may experience swelling
- may be sutures present
49
why is it good to use written instructions too
- the patient often forgets bits (or most) of what you've said = written instructions reinforce your verbal instructions
- however, written instructions should not replace verbal instructions
- make sure the patient knows who/where to contact in emergency
