Common peri-operative exodontia complications

Question 1

What nerves can be damaged during extraction of lower third molars and sometimes lower second molars

Answer 1

Inferior alveolar nerve and Lingual nerves

Question 2

What is oroantral communication (OAC)

Answer 2

This can happen after extraction when the maxillary sinus opens into the oral cavity after extraction

Question 3

What precautions need to be taken if an OAC does happen

Answer 3

• Avoid nose blowing
• Sneeze with the mouth open
• No use of wind instruments
• No blowing up balloons
• No smoking

Question 4

What can be prescribed if an OAC occurs

Answer 4

decongestants like nasal drops and steam inhalations ± antibiotics if systemic involvement

Question 5

What can you do if you expect an extraction to be prolonged or if the patient has a history of TMD to avoid trauma to the TMJ/dislocation

Answer 5

Bite on a mouth prop

Question 6

What should be done if there is a fractured tooth or apex

Answer 6

• Check if the whole tooth/root is removed from the socket by checking the apices
• If suspected then investigate the socket but careful not to dislodge the fragment into the maxillary sinus or lingual tissue space

Question 7

When can a retained root be retained and why

Answer 7

Only if it is very small < 3mm because the risk of removing it outweighs the benefits

Question 8

What should be done if there is a fracture of the alveolar bone

Answer 8

• If completely loose may need to remove fragment

Question 9

What should be done if there is a fracture of the mandible

Answer 9

• If technique is good and mandible is supported it shouldn’t happen
• Needs urgent referral to OMFS trauma clinic