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Risco e prevenção da alveolite fibrinolítica numa exodontia dos terceiros molares mandibulares impactados
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Abstract(s)
A alveolite fibrinolítica ou alveolite seca é uma das complicações pós-operatórias, que podem ocorrer numa extração dentária, variando a sua incidência entre 1% e 5%, em que 30% ocorrem na extração dos molares mandibulares impactados. A alveolite seca acontece quando 24h após a cirurgia, o coágulo não se forma ou forma-se parcialmente, ficando osso exposto no alvéolo. A dor é característica entre o primeiro e o terceiro dia
após a extração e pode acontecer só no alvéolo e nas estruturas anatómicas adjacentes, como também irradiar para o ouvido do lado da extração, pode ser acompanhada de halitose ou não.
Os fatores de risco associados ao desenvolvimento da alveolite são: a má higiene oral, o tabagismo, uso de contracetivos orais, grau de impactação dos molares mandibulares, a técnica cirúrgica, experiência do operador, infeção pré-existente, imunocomprometidos, idade, género e stress.
O tabaco é uma causa frequente, atrasa a cicatrização do coágulo e a regeneração alveolar. É recomendado não fumar imediatamente após a extração e durante as primeiras 24 horas.
Também não é permitido bochechar, movimentos de sucção nas primeiras 24 horas.
O uso de contracetivos orais aumenta a atividade fibrinolítica o que leva a um maior risco de alveolite seca. A idade atrasa a cicatrização e o metabolismo é mais lento.
A técnica também influencia o tratamento. Uma cirurgia de um molar inferior incluso envolve técnicas mais traumáticas como, a odontoseção e a osteotomia.
Antigamente havia maior risco de alveolite seca porque não havia prescrição de antibióticos nem antes, nem depois da extração. A antibioticoterapia diminui consideravelmente o risco da alveolite.
A terapêutica da alveolite fibrinolítica pode ser feita com gel ou colutórios de clorohexidina, colocação de antibióticos no alvéolo, irrigação com soro e curetagem, laserterapia e botox.
Fibrinolytic alveolitis or dry socket is one of the postoperative complications that occur in tooth extraction, with an incidence varying between 1% to 5%, with 30% occurring in the extraction of impacted mandibular molars. Dry socket occurs when after surgery after 24 hours, the clot does not form or partially forms, leaving bone exposed in the socket. Pain is characteristic between the first and third day after extraction and can occur only in the alveolus and adjacent anatomical structures, as well as radiate to the ear on the side of extraction and may or may not be accompanied by halitosis. The risk factors associated with dry socket are poor oral hygiene, smoking, use of oral contraceptives, degree of impaction of mandibular molars, surgical technique, operator experience, pre-existing infection, immunocompromised patients, age, gender and stress. Tobacco is a common cause delaying clot healing and alveolar regeneration. It is recommend not smoking immediately after extraction and for the first 24 hours. Mouthwash and sucking movements are also not allowed for the first 24 hours. The use of oral contraceptives increases fibrinolytic activity which leads to a greater risk of dry socket. Age delays healing and metabolism is slower. The technique also influences the treatment, surgery for an impacted lower molar involves more traumatic techniques such as odontosection and osteotomy. In the past, there was a greater risk of dry socket because antibiotics were not prescribed either before or after extraction. Antibiotic therapy considerably reduces the risk of dry socket. Dry socket therapy consists of chlorhexidine gel or mouthwash, placement of antibiotics in the socket, irrigation with serum and curettage, laser therapy and botox.
Fibrinolytic alveolitis or dry socket is one of the postoperative complications that occur in tooth extraction, with an incidence varying between 1% to 5%, with 30% occurring in the extraction of impacted mandibular molars. Dry socket occurs when after surgery after 24 hours, the clot does not form or partially forms, leaving bone exposed in the socket. Pain is characteristic between the first and third day after extraction and can occur only in the alveolus and adjacent anatomical structures, as well as radiate to the ear on the side of extraction and may or may not be accompanied by halitosis. The risk factors associated with dry socket are poor oral hygiene, smoking, use of oral contraceptives, degree of impaction of mandibular molars, surgical technique, operator experience, pre-existing infection, immunocompromised patients, age, gender and stress. Tobacco is a common cause delaying clot healing and alveolar regeneration. It is recommend not smoking immediately after extraction and for the first 24 hours. Mouthwash and sucking movements are also not allowed for the first 24 hours. The use of oral contraceptives increases fibrinolytic activity which leads to a greater risk of dry socket. Age delays healing and metabolism is slower. The technique also influences the treatment, surgery for an impacted lower molar involves more traumatic techniques such as odontosection and osteotomy. In the past, there was a greater risk of dry socket because antibiotics were not prescribed either before or after extraction. Antibiotic therapy considerably reduces the risk of dry socket. Dry socket therapy consists of chlorhexidine gel or mouthwash, placement of antibiotics in the socket, irrigation with serum and curettage, laser therapy and botox.
Description
Dissertação para obtenção do grau de Mestre no Instituto Universitário Egas Moniz
Keywords
Alveolite fibrinolítica Alveolite seca Prevenção Tratamento