Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

Complications & management

1,435 views

Published on

  • Be the first to comment

Complications & management

  1. 1. COMPLICATIONS AND MANAGEMENT
  2. 2. COMPLICATIONS AND MANAGEMENT PREOPERATIVE INTRAOPERATIVE POSTOPERATIVE
  3. 3. PRE-OPERATIVE COMPLICATIONS MEDICAL HISTORY Consider allergies, bleeding disorders etc. DENTAL HISTORY Consider if the patient has had difficult extractions in the past, are they anxious etc. INFECTION, ACCESS AND VISIBILITY?
  4. 4. INTRA-OPERATIVE COMPLICATIONS FAILURE OF LOCAL ANAESTHETIC FAILURE TO REMOVE THE TOOTH TRAUMA TO HARD TISSUES TRAUMA TO SOFT TISSUES DISPLACEMENT OF TEETH DISPLACEMENT OF TMJ ORO-ANTRAL COMMUNICATIONS
  5. 5. FAILURE OF LOCAL ANAESTHETIC Acute infections prevent the Local Anaesthetic from working Reasons why LA doesn’t work when there is an acute infection…… Acutely inflamed tissues are more vascular, therefore the solution is removed more quickly from the site. The acidic conditions impedes the dissociation of the active components. Inflammation increases the nerve threshold and therefore a higher concentration of LA solution is needed to anaesthetise the nerve. MANAGEMENT Consider block injections; the infra-orbital block, the posterior superior alveolar block, the ID block. Increase the LA solution given or a use concentrated LA solution such as 5% lignocaine. • Intra-ligamentary injections down the periodontal membrane will help If you have absolute failure of anaesthesia, prescribe antibiotics and analgesics . Wait for 34 days to allow the infection to progress from acute to chronic before attempting extraction. You might want to consider GA
  6. 6. FAILURE TO REMOVE THE TOOTH • INCORRECT FORCEPS/ELEVATORS • BONE SCLEROSIS • DIVERGENT ROOTS • HYPERCEMENTOSIS • BLADES OF THE FORCEPS NOT THE RIGHT WIDTH FOR THE POINT OF ASSESS THE CAUSE CONTACT OF DIFFICULTY • APPLICATION OF CORRECT ELEVATORS/FORCEPS • FOR MOLAR TEETH, DIVIDE THE TOOTH AND DELIVER ROOTS INDEPENDENTLY • SURGICAL REMOVAL POSSIBLE SOLUTIONS
  7. 7. Fracture of the alveolar buccal plate can occur when leaning buccally to deliver the tooth . Convergent roots or ankylosed roots may retain alveolar bone when delivering the tooth. IF THE FRACTURED BONE HAS LOST ITS PERIOSTEAL ATTACHMENT: The blood supply has been lost thus the fragment should be removed to avoid necrosis and infection of the bone. MANAGEMENT Occurs when the alveolar bone gets included in the forceps. MANAGEMENT FRACTURE OF THE ALVEOLAR BONE TRAUMA TO HARD TISSUES IF THE FRACTURED BONE IS STILL ATTACHED TO THE PERI-OSTEUM: Squeeze the socket together and push the fractured bone into its original position
  8. 8. TRAUMA TO SOFT TISSUES Protect the lower lip so that it doesn’t get crushed by handles of the forceps or burnt by a surgical hand piece. Damage to the gingivae should be avoided by good technique. Always ensure that the forceps are applied subgingivally. Uncontrolled and careless use of forceps can traumatise the tongue and floor of mouth . DAMAGE TO SOFT TISSUES
  9. 9. DISPLACEMENT OF TMJ DISLOCATION OF THE TMJ Usually caused by not supporting the mandible adequately during the extraction. Using props and gags in the mouth which are too large can also displace the TMJ. MANAGEMENT IMMEDIATELY REPLACE THE DISLOCATED TMJ Stand in front of the patient. Place your thumbs on the external oblique ridge intra-orally. Place your forefingers behind the angle of the mandible extra-orally. Manoeuvre the TMJ back into position by pushing down with your thumbs and up with your fingers. Post-op instructions should include a soft diet for 1 week, and advise not to open their mouth too wide.
  10. 10. ORO-ANTRAL COMMUNICATIONS • OAC: Is a communication between the oral cavity and the antrum which is not lined by an epithelium. • OAF: Is a communication between the oral cavity and the antrum which is lined by an epithelium. • It takes ~48 hours for the epithelium tract to form.
  11. 11. ORO-ANTRAL COMMUNICATIONS CAUSES DIAGNOSIS • When the roots of the upper posterior teeth are in close proximity to the antral floor. • When the extraction of upper posterior teeth has been traumatic. • Bulbous curved long roots • Surgical extractions. • Hypercementosis / Ankylosis of upper posterior teeth which make extractions difficult. • Antral pneumatisation around a lone standing tooth. • Cysts/infection associated with upper posterior teeth. • Neoplasm • If you suspect an OAC, ask the patient to blow whilst you occlude the nose: Bubbling indicates an OAC. • Patients complain of nasal regurgitation of liquids which is unilateral • Altered nasal speech • Bad taste (can also be from a dry socket) • Unilateral nasal discharge • Recurrent sinusitis on the affected side TREATMENT • ANTRAL REGIME: • Antibiotics • Analgesics • Decongestants • Mucolytics • CLOSURE WITH A FLAP: • Buccal Advancement Flap • Buccal Fat Pad • Palatal Rotation Flap
  12. 12. POST-EXTRACTION COMPLICATIONS HAEMORRHAGE PAIN INFECTION
  13. 13. HAEMORRHAGE REACTIONARY HEMORRHAGE When the vasoconstrictor from the local anaesthetic wears off, there is a rebound effect with vasodilatation to cause bleeding. MANAGEMENT: Visualise the site of haemorrhage. Apply pressure with gauze or use a local anaesthetic with vasoconstrictor….Use surgicel and place a suture if need be!!
  14. 14. HAEMORRHAGE
  15. 15. PAIN Most patients will suffer from pain after an extraction. Therefore, recommend simple analgesia. Use SOCRATES to diagnose post-op pain.
  16. 16. PAIN Causes of post-extraction pain include: • Pain from the extraction. • Dry socket. • Retained root or bone spicules. • Damage to adjacent teeth causing pulpal pain. • Damage to adjacent soft tissues which are then sore. • Dislocated mandible. • Bony fractures.
  17. 17. INFECTION DRY SOCKET It results from the failure of the clot being retained due to vigorous rinsing or lytic organisms breaking down the clot. Dry sockets occur more frequently in patients who smoke. Classically presents as severe throbbing pain +/- lymphadenopathy. It tends to have an onset of 3-5 days after extraction. Grey/White bone is visible. MANAGEMENT Irrigate the socket with Chlorhexidine, and pack in alvogyl. Review in a few days time
  18. 18. COMPLICATIONS AND MANAGEMENT PREOPERATIVE INTRAOPERATIVE POSTOPERATIVE

×