Complications of tooth extraction Flashcards
3 stages of complications
Preoperative (anticipation): medical history related problems, anatomical factors
Perioperative (immediate): fracture of bone or tooth, creation of oro-antral communication, bleeding
Postoperative (delayed/ late): pain, swelling, bleeding, dry socket, other infection
Complications may arise at
The site of surgery -e.g. bleeding from lacerated gingiva -damage to an adjacent tooth or restoration Distant site -e.g. burnt or crushed lip -endocarditis (bacteria in blood)
Complications may be
Minor -e.g. removal of small amount of alveolar bone with tooth during extraction Serious -e.g. permanent sensory deficit General -pain, swelling, bleeding Specific to the procedure -lingual/ ID nerve injury in 3rd molar removal
Anticipation: failure to complete or fractured tooth
Previous history Age, size of px Root filled teeth Bruxism Heavily restored/ carious/ broken down teeth Abnormal anatomy, ankylosis
Management of failed extraction: anticipatory phase
- don’t start unless you can complete or have contingency plan
- warn px
- make referral to colleague
Failure to complete extraction: immediate
Resistance to movement
Fracture of crown
Fracture of root
Management of failed extraction: immediate phase
Assess - is it you or is it the tooth
Use different instruments/ technique
-e.g. different forceps, elevators, luxators, transalveolar surgical approach
Management of failed extraction: postoperative phase
Palliate - dressing/ extirpation/ antibiotics?
Proceed immediately to surgical removal or complete later
Refer
Trans-alveolar approach
Raise a muco-periosteal flap Remove bone Section roots Elevate roots Close flaps with sutures
Pain and swelling
Expected - not complication? To minimise -careful extraction technique -NSAIDs -post-op advice
Consent
Px needs to be informed about complications
Analgesics
Paracetamol 500mg - 1g 6 hourly (max 8 per day) Co-codamol 500/8mg - as above Co-codamol 500/30mg - as above NSAIDs -aspirin 300-900mg 6 hourly -ibuprofen 200-400mg 8 hourly -diclofenac 25-50mg 8 hourly -use with caution in elderly, pxs with allergies, asthma, bleeding problems, kidney disease and gastric problems
Trismus
Limitation of mouth opening Several causes -inflammatory swelling and pain -haematoma -abscess -cellulitis (trauma/ cancer)
Signs and symptoms of infection
Pain and swelling Trismus +/- Difficulty swallowing Lymphadenopathy Pyrexia Tenderness Tense tissues or fluctuation if abscess formation
Anticipation and prevention of infections
Pre-existing infection Chlorhexidine mouthwash pre-op Wound care Antibiotics if -infection present -px compromised -post-op infection likely or potentially serious
Treatment of infections
Drain abscess
Antibiotics
Bone infections
Antibiotics, debridement
Bleeding
> risk in pxs with -clotting disorders/ anticoagulants -platelet disorders/ antiplatelet drugs Most problems are local and not systemic (trauma/ infection) Primary, secondary or reactionary
Management of bleeding
Pre-op precautions e.g. INR
Apply pressure
Suture across socket
Haemostatic dressing in socket
Dry sockets
Localised osteitis More likely -smokers -lower extractions -pxs on the OCP Painful Develops typically a few days post extraction
Management of dry sockets
Px education
Irrigate socket
Dress socket
Antral complications
May occur following removal of upper and posterior teeth
More likely in lone standing teeth and where the maxillary antrum is large
Types of antral complications
Oro-antral communications
Fistula formation
Root or tooth into sinus
Anticipation of antral complications
Anatomical features
Age
