Complication and management of tooth extraction

1. COMPLICATION ANDCOMPLICATION AND
MANAGEMENT OF TOOTHMANAGEMENT OF TOOTH
EXTRACTIONEXTRACTION
• AHMED KHALIL IBRAHIM
• University of Georgia

2. Dealing with local complications

3. Complications of tooth extraction
• Local complications
• Immediate:
• Failure of LA
• Failure to move the tooth
• Fracture of tooth, alveolus, mandible
• Oro-antral communication
• Displacement in soft tissues
• Hemorrhage
• TMJ dislocation
• Damage nerve

4. Complications of tooth extraction
• 1-Failure of Anesthesia:
• too small a dose
• Improper injection technique:
• Not waiting long enough for anesthesia to act
• Before commencing the surgery
• 2-Failure to -remove the tooth with
either forceps or elevator

5. 3-Fracture of a tooth
• 1-Fracture of the crown of a tooth
• Weakened tooth- caries or large restoration
• Improper application of the forceps
• Excessive force
• 2-Root fracture:
Root pattern
Faulty technique
• 3-Fracture of Alveolar Process:
• Fracture of the Buccal or Lingual Cortex
• Cause
• Inadequate exposure & excessive force

6. • 4-Fracture of Maxillary
Tuberosity
• 5-Fracture of Mandible
• 6-Loosening or
Extraction of Adjacent
Tooth
• 7-Extraction of the
wrong tooth
• Damage to
• Gum , lips , tongue ,
palate ,
• floor of the mouth.

7. 4-Displacement
of a tooth into
maxillary sinus

8. 6-Hemorrhage
• Pressure packs
• Use of LA solution with
vasoconstrictors
• Socket suturing
• Hemostatic forceps
• Splints
• Thermal measures-
cautery , hot saline
packs
 Firm gauze roll should
be placed upon the
socket & patient asked
to bite upon it .
 Horizontal mattress

9. 7-Dislocation of TMJ
 Application of excessive force
 Failure to support the mandible while extracting a difficult
tooth
 More likely to occur under general anesthesia when
mastication muscles are relaxed

10. 8-Injury to Inferior Alveolar Nerve
Excessive extraction force in
case of curved roots
•-Sectioning the tooth all the
way inferiorly
•Prevention
•-Proper exposure & bone
removal
•-Controlled force
•-Careful setioning, leaving a
shell of the tooth

11. 9-Injury to the Lingual Nerve
• -Placement of the
retromolar incision far
lingually
• -Sectioning the tooth all
the way to the lingual
cortex
• Prevention
• -Proper incision
• -Careful sectioning, leaving
a shell of the tooth

12. 10-Injury Mental nerve :
Prevention:
The nerve injury can be prevented by
Careful surgical technique –
• Proper placement of incision,
• Careful bone removal
• Retraction and less manipulation
Management :
Patient should be warned preoperatively about the
possible consequences and the probable outcome on
• Tongue & floor of mouth damage can be prevented by
effective use of left hand.

13. 11-Aspiration of tooth/root
• Under GA – more common
• Anaesthetic should be stopped
immediately & patient’s head brought
forwards.
• After cough reflex has returned the mouth
is examined & pack carefully removed &
inspected
• Radiographs – socket & chest

15. 12-Damage to adjacent tissues
Damage to the gum can be avoided by
careful selection of forceps & good
technique.
The lower lip may be crushed between the
handles of the forceps & anterior teeth.
Skilled use of operators left hand.
Instruments should be allowed to cool
before use after being sterilized.

16. 13-Oroantral communications
 An oroantral communication is created by the
extraction of maxillary tooth where
 The roots extend well beyond the maxillary sinus floor
 The extraction is difficult and traumatic
 There is a lone standing molar
 The tooth is ankylosed
 The periapical pathology e.g cyst or granuloma
extending beyond the sinus floor

17. Complications of tooth
extraction
• Delayed
• Exessive pain, swelling,
• Bleeding
• Dry socket
• A. osteomyelitis
• Infection
• Oro-antral fistula
• Failure of the socket to heal

18. Swelling and pain
• Swelling is common after certain dental procedures,
particularly tooth removal (extraction) and periodontal
surgery. Holding an ice pack—or better yet, a plastic bag
of frozen peas or corn (which adapts to the shape of the
face)—to the cheek can prevent much of the swelling.
Ice therapy can be used for the first 18 hours. Cold
should be held on the cheek for 25-minute periods and
then removed for 5-minute periods. If swelling persists or
increases after 3 days or if pain is severe, an infection
may have developed, and the person should contact the
dentist.

19. Facial Swelling
• A-The post-extraction swelling May be due to
traumatic edema which develops as a result of
excessive retraction of flaps or rotary burr
traumatize the soft tissues. The traumatic edema can
be prevented by the application of cold fomentation
in the first day after extraction
• B-Infection of the wound A more serious case of
postoperative swelling is infection of the wound. The
treatment of such infection is by the use of mouth
washes and antibiotic therapy. If fluctuation is
present the pus should be evacuated before
beginning antibiotic therapy

20. Facial Swelling

21. bleeding
• Post Extraction bleeding usually occurs in the small vessels.
Any clots extending out of the socket are removed with gauze,
and a 4-in gauze pad (folded) or a tea bag is placed over the
socket. Then the patient is instructed to apply continuous
pressure by biting for 1 h. The procedure may have to be
repeated 2 or 3 times. Patients are told to wait at least 1 h
before checking the site so as not to disrupt clot formation.
They also are informed that a few drops of blood diluted in a
mouth full of saliva appear to be more blood than is actually
present. If bleeding continues, the site may be anesthetized by
nerve block or local infiltration with 2% lidocaine containing
1:100,000 epinephrine.

22. Osteomyelitis
• Osteomyelitis is an infection of the bone
and is usually caused by bacteria. When
osteomyelitis occurs in the mouth, it
typically occurs as an infection of the
lower jaw. People usually have a fever,
and the affected area is tender and
swollen. dentists use an x-ray to make the
diagnosis. People with osteomyelitis need
to take antibiotics for an extended period
of time.

23. Osteomyelitis

24. TRISMUS
• Trismus is defined as inability to open the mouth due
to mouth spasm.
• Trismus may complicate dental extraction . It may be
caused by post-operative edema , hematoma
formation or inflammation of the soft tissues. A
mandibular block injection may be followed by trismus
this is either due to infection or trauma from the
needle The treatment of the trismus varies with the
underlying cause . Hot saline mouth washes, gives
relief in mild cases but most patients require the
administration of antibiotic

25. Dry Socket ( Alveolar osteitis )
• (The most frequent painful complication of extraction )
• A dry socket (exposure of the bone in the socket,
causing delayed healing) may develop after a lower back
tooth has been extracted and the normal blood clot in the
socket is lost. Typically, discomfort lessons for 2 or 3
days after the extraction and then suddenly worsens,
sometimes accompanied by an earache. Although the
condition goes away by itself after 1 to 2 weeks, a dentist
can place a dressing soaked with an anesthetic in the
socket to eliminate the pain. The dentist replaces the
dressing every 1 to 3 days until no more pain is felt after
the gauze has been left out for a few hours.
• Dry sockets are much more common among smokers.

26. Oro-antral fistula
• The oroantral fistula (OAF) is a pathological
communication between the oral cavity and the
maxillary sinus; depending on the location it can
be classified as alveolo-sinusal, palatal-sinusal
and vestibulo-sinusal.

27. Title
• Late:
• Chronic osteomyelitis
• Osteoradionecrosis
• Nerve damage
• Chronic pain

28. Complications of tooth
extraction
• Systemic complications
• Immediate
• Faint
• Hypoglycemia
• Hyperventilation/panic attack
• Addisonian crisis
• Respiratory obstruction

29. AHMED ALBAYATI