XLA & wisdom teeth Flashcards
(18 cards)
What is included in a referral to secondary care?
Patient demographics - name address, DoB, contact details
Referrers details - name, practice, contact details
Reason for referral - what referring for
Background - medical history, X-rays taken, history of presenting complaint
Assessment - own personal assessment of problem
Recommendation - what you would like to happen, advice, tx etc
What are the complications to warn patient of when having XLA of lower wisdom teeth?
Pain
Swelling
Bleeding
Bruising
Infection
Dry socket
Jaw stiffness
Damage to adjacent teeth
Root # and may have to leave part of the roots in situ
Temporary/permanent numbness, prolonged nerve pain, tingling due to nerve damage (<1% permament- lasts over 18 months and 10-20% have temporary
What would you tell a patient about process of having surgical XLA of lower wisdom teeth under LA?
Pt will be awake and aware of what is happening
Involves LA to get area numb
Incision of the gum to peel it back to gain access to the tooth - if can XLA from here they will
Potential removal of some bone to gain further access to tooth involves some water spray
If not working- will section the tooth into parts for XLA most commonly crown and then separate roots
Cleaning of the socket by either scraping or suction
Sutures will then be placed to sew gum back together and post op instructions given
What would you tell patient about having coronectomy of lower wisdom teeth?
Performed when there is an increased risk to the IAN with surgical removal
The crown of the tooth is removed 3-4mm below enamel level with the deliberate retention of the root adjacent to the IAN
Pulp is left in place untreated
What are the specific warnings to give patient before performing coronectomy?
If the root is mobilised during crown removal the entire tooth must be removed
Leaving roots behind could result in an infection although it is rare
Can get a slow healing/painful socket
The roots may migrate later and begin to erupt through the mucosa and may require XLA
Give the post-op instructions following XLA?
No vigorous exercise
No alcohol for 24 -48 hrs
No smoking for 48 hours
Avoid agitating with tongue or fingers
Analgesia advice
Normal for bleeding- give gauze pack and advise to bite on damp gauze if starts again
Signs of infection advice- pain and/or bad taste after 3 days
May bruise
May have some jaw stiffness - soft diet for a few days
Rinsing with warm salty water 2/3x a day from day after XLA
LA will wear off after few hours- be careful not to burn self while still numb
How would you explain pericoronitis to a patient?
When wisdom teeth are erupting they can become stuck under the gum. As this area is difficult to clean, plaque from the mouth can cause infection of soft tissue surrounding the tooth leading to pain and swelling
What are the risk factors for pericoronitis?
Partial eruption and vertical/distoangular inpaction
Opposing 7/8’s causing mechanical trauma
Upper respiratory tract infections
Stress and fatigue
Poor oral hygiene
Insufficient space between the ascending ramus of jaw and the 7
A full dentition
What are the signs and symptoms of pericoronitis?
Pain- increases, pain on chewing
Swelling
Bad taste
Pus discharge
Occlusal trauma to operculum
Evidence of cheek biting
Limited mouth opening
Malaise
Regional lymphadenopathy
Dysphagia
What is the treatment of pericoronitis?
Incision of abscess if required
Irrigation with warm saline under operculum
XLA of upper 3rd molar if traumatising operculum
If systemically unwell- prescribe antibiotics (metronidazole (no alcohol) or amoxicillin
Discuss XLA of the tooth
What are the reasons for XLA of 8’s?
Caries
Infection
Pericoronitis
Cyst formation
Cheek biting
Periodontal disease
8’s causing resorption of 7’s
What are the IO checks for 8’s surgery?
Soft tissue check
7’s prognosis
Eruption status of 8’s
Condition of remaining dentition
Occlusion
Oral hygiene
Caries/periodontal status
What is included in an OPT assessment of 8’s?
Presence or absence of disease
Anatomy of 8’s
Depth of impaction
Orientation of impaction
Working distance for surgeon (distance from 7 to ramus of mandible)
Follicular width
Periodontal status
Any other pathology
What are the 3 depths of impaction?
Superficial- crown of 8 sits at same height of 7
Deep- 8 sits at same height of roots of 7
Moderate- crown of 8 sits between crown and roots of 7
What are the types of impaction for 8’s?
Vertical
Mesially
Distally
Horizontal
Transverse
Aberrant
What are the signs from OPT that a lower 8 could be close to IAN?
Interruption of tram lines
Diversion/deflection of canal
Deflection of root
Darkening of root where canal crosses
Narrowing of canal
Narrowing of root as it crosses canal
Dark bifid root
Juxta apical area- radiolucency around the root but lamina dura is intact
Provide the discussion you may have with a patient about nerve damage during surgical XLA of lower 8’s?
Damage would create a sensory deficit rather than appearance
Usually temporary 10-20% but counted as temporary until 18 months
Damage can be permanent in about 1%
2 nerves run close together that supply sensation to lips, cheek, tongue, taste
What 3 relationships between roots and IAN are at increased risk of damage
Diversion of canal
Darkening of the root where crosses canal
Interruption of white tram lines
