Nausea Postoperative nausea resulting from oral surgery can occur when the patient swallows blood either during the procedure or postoperatively (Dobbeleir et al., 2018). The use of narcotics or antibiotics may also cause nausea. Patients should be instructed to take all prescribed Dislocation of the condyles Lengthy oral surgical procedures may cause dislocation of the condyles. The shorter the time between the surgical procedure and the condylar reduction, the more likely its success. With passing time, the muscles tend to tighten, making a reduction more difficult. The potential for dislocation can be lessened by using a bite block during surgery, as well as limiting the length of the surgery. Another technique for mandibular extractions is to employ the assistant to use a sling grasp to stabilize Fibrinolytic alveolitis (dry socket) Fibrinolytic alveolitis, alveolar osteitis, or dry socket syndrome is an oral surgical complication often presenting between the first and fifth day postoperatively (Rohe & Schlam, 2022). It is usually characterized by sharp, constant, throbbing pain that often radiates into the ear and keeps the patient awake at night. Usually, the pain subsides immediately after surgery and then increases significantly on the second or third postoperative day. The etiology of dry socket appears to be the result of high fibrinolytic activity in and around the extraction site. This activity results in lysis of the alveolar blood clot, with subsequent exposure of the bone. This may be the result of trauma, subclinical infection, inflammation of the marrow space of the bone, or other factors. Contributing factors include age, gender, oral contraceptive use, tobacco use, preexisting infection or inflammation, and type and number of extractions (Garola et al., 2021; Rohe & Schlam, 2022). While ranges of 0.5%–5% and as high as 68% have been reported, it is sufficient to note that dry sockets occur at a higher rate upon the extractions of impactions of mandibular third molars compared to the routine extractions of other teeth (Garola et al., 2021; Rohe & Schlam, 2022). Prevention of dry socket syndrome requires the dentist to minimize trauma and bacterial contamination at the surgical site. The dentist should perform atraumatic surgery with clean, full-thickness incisions and atraumatic soft-tissue reflection. The length of time involved in removing the tooth should also be considered. Following the surgical procedure, the wound should be thoroughly debrided and irrigated using large quantities of sterile saline. The incidence of dry socket can also be
antibiotics and analgesics with food to help eliminate nausea. Codeine phosphate and erythromycin are common causes of drug-related nausea. Codeine can be replaced by synthetic agents, and erythromycin can be replaced with an enteric-coated version. the mandible. Should the jaw require manual reduction by the dentist, their hands should be kept off the occlusal surfaces of the teeth. As the jaw is reduced with downward and backward motions, the teeth may snap into occlusion. Thus, the dentist’s hands should remain in the oral vestibule at all times. The patient should be advised to refrain from yawning or opening their mouth widely and should remain on a soft diet for one week. decreased by preoperative and postoperative antimicrobial mouth rinses, such as chlorhexidine (Rohe & Schlam, 2022). Well-controlled studies indicate that the incidence of dry socket after extractions, including impacted mandibular third molar surgery, can be reduced when chlorhexidine is used (Cho et al., 2017; Halabi et al., 2018; Shaban et al., 2014). It takes between 10 and 14 days for the epithelium to migrate into and cover the exposed bony walls of the alveolus. Any interim treatment is palliative. The dentist must first irrigate the socket with saline to verify that it is devoid of a clot. Sometimes the patient must be given an anesthetic block. Thorough irrigation is critical because the clot can break down or dissolve but remain in the socket. On quick inspection, the dental practitioner may not see the clot and may mistakenly rule out fibrinolytic alveolitis. After irrigation, some form of iodoform gauze containing a sedative, such as eugenol, and a topical anesthetic may be placed to sedate and anesthetize the nerve fibers exposed in the alveolar bony socket. A variety of commercially prepared medications are available. The practitioner packs the treated gauze into the socket with cotton pliers. Typically, the patient is instructed to take an anti-inflammatory such as ibuprofen in combination with acetaminophen for pain. The iodoform-treated gauze should be changed frequently until over-the-counter analgesic medication is sufficient to control pain. When the patient is asymptomatic, the practitioner should provide a Monoject syringe to irrigate the socket with warm salt water to keep it clean. Further measures to prevent dry socket are included in Table 1.
Table 1: Measures that may Prevent Dry Socket 1. Perform an initial patient consultation before scheduling oral surgery.
2. Acquire a complete medical history, a clinical examination, and current radiographs. In addition, review risks such as smoking and oral contraceptive use. Women who are on oral contraceptives should be scheduled on days 23 through 28 of the menstrual cycle. 3. Give an antibacterial mouth rinse preoperatively and postoperatively to decrease bacterial contamination. 4. Avoid local anesthesia via periodontal ligament injection. 5. Exclude trauma to the site as much as possible during the surgical procedure to limit fibrinolytic activity. 6. Inspect the socket for loose debris, and gently irrigate the extraction site with profuse amounts of sterile saline. 7. Insert a small amount of antibiotic, such as tetracycline or clindamycin, into the socket. 8. Encourage the patient to avoid smoking in the immediate postoperative period. 9. Keep the surgical technique consistent to eliminate other factors that may result in a higher incidence of dry socket.
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