Complications of extractions Flashcards
List the 7 types of complications that occur during the extraction of primary teeth
- Fracture of the tooth
- Damage to adjacent or opposing teeth
- Extraction of the wrong tooth
- Soft tissue injuries
- Swallowing of aspiration of the tooth or tooth fragment
- Fracture of the alveolar process
- Post operative: haemorrhage
For the complication of fractured teeth, state:
- Instances when crown fractures are unavoidable (3)
- Instances when root fractures are unavoidable (3)
Instances when crown fractures are unavoidable:
· Badly broken down teeth
· Extensive caries
· Large existing restoration
Instances when root
fractures are unavoidable:
· Morphology: slender, delicate and divergent/splayed
· Deep sub-gingival caries
· Resorption by erupting permanent successor
For the complication of fractured teeth, state:
- Common causes (6)
- Management
- Prevention (5)
Common causes · Excessive force · Maladaptation of the forceps onto the tooth · Using the wrong forceps · Incorrect extraction movements · Incorrect forceps handling · Rushing
Management
· All tooth fragments should be removed if possible, especially if large and mobile
· Take a periapical radiograph to check the size and position of any root fragments
· If the root fragment is small and in close proximity to the permanent successor i.e. root tip, it can be left behind
· If a root fragment is to be left, the patient/parent MUST be informed and also explained the possible outcomes; Resorbed, Remain or Exfoliate
· Inform the patient/parent of what has happened and document it in the clinical notes
· If the root fragment is large and non-mobile, a PA should be taken to assess the size and position of the fragment and patient is referred to a dentist or specialist
Prevention
· Never use excessive force
· Adapt and seat the forceps onto the tooth correctly
· Use the appropriate forceps for the tooth being extracted
· Use the appropriate extraction movements
· Always have a firm grasp of the forceps during the extraction
For the complication of damage to the adjacent/ opposing teeth, state:
- The three types of damage that occurs
- The four main causes
The three types of damage that occurs:
· Fracture or dislodgement of adjacent or opposing restorations
· Fracture of adjacent or opposing teeth
· Luxation of adjacent teeth
The four main causes:
· Incorrect positioning or alignment of the forceps
· Incorrect forceps used
· Use of uncontrolled force, excessive force or strong tractional force
· Use of adjacent teeth as a fulcrum
For the complication of damage to the adjacent/ opposing teeth, state:
- Management
- Prevention
Management
· Inform the patient and parent of what has happened and document it in the clinical notes
· Restore/repair the fractured tooth or restoration as appropriate
Prevention
· Recognise the potential to fracture or dislodge adjacent restorations
· Warn the patient and parent of the risk preoperatively
· Never use the adjacent teeth as a fulcrum
· Never use uncontrolled or excessive force or strong tractional (pulling) force
· Force should only ever be applied to the tooth being extracted
· Ask the assistant to warn the clinician if they notice force is being applied to adjacent teeth
For the complication of extraction of the wrong teeth, state:
- The four main causes
- Management
- Prevention
The four main causes:
• Wrong patient (different patients sharing the same name)
• Radiographs not orientated correctly
• Incorrect treatment plan or dental charting
• Negligence
Management:
· Inform the patient and parent of what has happened and document it in the clinical notes
· Do not replant primary teeth
Prevention:
· Verification of patient information on arrival
· Visually confirm with the patient/parent and your assistant which tooth is going to be extracted
· Ensure radiographs are correctly orientated
· Time out to ensure correct patient, correct site and correct procedure
For the complication of soft tissue injuries, state:
- The three main causes
- The two types of soft tissue injuries
The three main causes:
• Lack of adequate attention to the delicate nature of the mucosa
• Lack of adequate access and visualisation
• Use of excessive or uncontrolled force
The two main types of soft tissue injuries:
· Puncture wounds
· Bruising
For the complication of soft tissue injuries, state:
- Management
- Prevention
Management:
· Inform the patient and parent of what has happened and document it in the clinical notes
· For minor superficial wounds use local measures to achieve haemostasis such as applying direct pressure to the wound
· If the wound is large or deep, refer to dentist/specialist for assessment as further management may be required
Prevention:
· No use of excessive or uncontrolled force
· Always have a good, stable finger rest when using instruments such as a flat plastic
· Use the fingers and thumb to retract the soft tissues (lips, cheek, tongue) during the extraction
For the complication of swallowing/ aspiration of tooth/ tooth fragments, state:
- The 2 main causes
- Management
- Prevention
Causes:
• Sudden release of the forceps during delivery of the tooth
• Sudden fracture of the tooth (usually the crown)
Management:
• Ask patient to immediately spit out the tooth or tooth fragment
• Suction tip can be used to retrieve the tooth or tooth fragment
• If the tooth is not retrieved then the patient MUST be referred for a chest x-ray to determine the specific location of the tooth
• Inform the patient/parent of what has happened and document it in the clinical notes (including what was done i.e. referral for a chest x-ray)
Prevention:
• Always maintain a firm grasp of the forceps
• Place a piece of gauze across the back of the patient’s mouth to protect the pharynx and catch any debris that might otherwise be swallowed or aspirated
For the complication of fracture of the alveolar process, state:
- The 3 main causes
- Management
- Prevention (3)
Causes:
• Excessive force
• Uncontrolled force
• Inappropriate extraction movements (sudden or jerky)
Management:
• If the bone has been completely removed from the tooth socket along with the tooth, it should not be replaced
• If the fragment of bone that has fractured or come out with the tooth is large, referral to a dentist/specialist is required for assessment because further management such as suturing may be needed
• Small fragments should be carefully retrieved using tweezers and the socket compressed as normal
• Inform the patient and parent of what has happened and document it in the clinical notes (including what was done i.e. referral to dentist/specialist)
Prevention:
• Never use uncontrolled or excessive force
• Avoid sudden or jerky extraction movements
• Support the alveolar process with firm finger pressure while the tooth is being extracted. This is the role of the non-dominant or non-operative hand
For the POST operative complication of bleeding, state:
- The 2 main causes
- Management
- Prevention (5)
Causes:
• Bleeding disorders
• Paediatric patients tend to explore the extraction site with their tongue or fingers and may eat on or brush the extraction site, all of which can cause post-operative bleeding
Management:
• Patient should be instructed to open the sterile packet of gauze given to them, roll it up and place it over the area and bite firmly. The patient should sit quietly for 20 minutes biting firmly on the gauze. If the bleeding persists despite this, refer to a dentist/specialist for management ASAP
Prevention:
• Ascertain whether or not the patient suffers from a bleeding disorder or has a history of problems with bleeding. This should be part of the pre-operative assessment
• Referral to a dentist/specialist for management if concerned about the potential for excessive bleeding
• Use atraumatic extraction technique and local haemostatic measures
• Check that haemostasis is achieved before discharging the patient
• Give clear and concise post-operative instructions to the patient/parent on what to do if post-operative bleeding occurs and provide sterile packets of gauze for the patient to take home
