COMPLICATION AND COMPLICATION AND MANAGEMENT OF TOOTH MANAGEMENT OF TOOTH

EXTRACTIONEXTRACTION

• AHMED KHALIL IBRAHIM • University of Georgia

Dealing with local complications

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

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

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

• 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.

4-Displacement of a tooth into

maxillary sinus

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 suture

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

8-Injury to Inferior Alveolar NerveExcessive 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

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

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.

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

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.

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

Complications of tooth extraction

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

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.

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

Facial Swelling

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.

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.

Osteomyelitis

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

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.

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.

Title

• Late:• Chronic osteomyelitis• Osteoradionecrosis• Nerve damage• Chronic pain

Complications of tooth extraction

• Systemic complications• Immediate• Faint• Hypoglycemia• Hyperventilation/panic attack• Addisonian crisis• Respiratory obstruction

AHMED ALBAYATI