Dental Extraction – Complications

Complications of Dental Extractions include

  1. Intraoperative
  2. Postoperative

Intraoperative

  1. Inability to move the tooth
  2. Fracture of the tooth

In both these cases, take a radiograph and consider transalveolar method.

3. Fracture of alveolar process – if large piece of bone fractures, replace the bone in position with the periostium intact. Suture the mucosa.

4. Fracture of maxillary tuberosity – check oroantral communication and if present, manage accordingly. If tuberosity has periosteal attachment, reposition it back and suture.

5. Fracture of Jaws – reduction and fixation

6. Mucosal laceration – avoid by holding instruments with proper support. Manage by approximation and suturing.

7. Luxation of adjacent tooth – replace the luxated tooth to its original position and splinting made for a period of 3 – 6 weeks.

8. Oroantral communication – small opening, no treatment, do good suturing of the extraction site. Large opening needs surgical closure and coverage of opening by stent/other materials till healing.

9. Displacement of tooth into the facial spaces – removal of the tooth/root indicated.

10. Nerve injury – patient should be informed and routine follow up done.

11. Hemorrhage – if from soft tissue, (pressure pack/LA pack/sutures/cautery) if from artery, (ligation) if from bone (gel foam/oxidised cellulose/ bone wax)

12. Dislocation of jaw – avoided by supporting the jaw during extraction.

13. Root tip left – leave if deeply buried, give antibiotics and review. However if large pieces of root remains, remove.

Postoperative

  1. Hemorrhage

a) primary – occurs due to inadequate hemostasis at surgery.

b) reactionary – occurs within 48 hours due to rise in BP or slippage of sutures.

C) secondary – 7 days postoperatively usually due to infection

Agents used as packs –

  1. Resorbable mesh (oxidised cellulose)
  2. Transexemic acid
  3. Adrenaline
  4. Epsilon amino capriac acid
  5. Bismuth iodine paraffin paste
  6. Whiteheads varnish

2. Pain and swelling – edema maximum on second day and then it subsides. Administration of anitobiotics and analgesics.

3. Dry socket (Alveolar osteitis) – loss of blood clot and socket appears empty and dry. Irrigation of the site and placement of obtundent dressing.

Dr Iswarya V

General Practitioner,

Trivandrum

Reference :

Oxford Clinical Dentistry