COMPLICATIONS OF TOOTH EXTRACTION AND ITS MANAGEMENT

BY MUHAMMAD SHARIQ FINAL YEAR BDS

PRESENTATION OUTLINE

1)Problems with a tooth being extracted2)Injuries to adjacent teeth.3)Post operative bleeding4)Oroantral communications5)Injuries to adjacent structures6)Delayed healing and infection.7)Injuries to ossoeous structures8)Soft tissue injuries.9)Swelling.10)Fracture of mandible.

PROBLEMS WITH A TOOTH BEING EXTRACTED

1)Root Fracture

2)Root Displacement

3)Tooth loss into Phayrnx

INJURIES TO ADJACENT TEETH

1)Fracture or dislodgement of an adjacent restoration.

2)Luxation of adjacent tooth

3)Extraction of wrong tooth

POST OPERATIVE BLEEDINGPREVENTION:

1)Obtain a history of bleeding2)Use of atraumatic surgical technique3)Obtain good hemostasis at surgery.4)Provide excellent patient instructions.

OROANTRAL COMMUNICATION Oroantral Communication (OAC) is an abnormal communication between

the maxillary sinus and the oral cavity.

PREVENTION:1)Conduct a thorough preoperative radiographic examination.2)Use surgical extraction early and section roots3)Avoid excessive apical pressure on maxillary posterior teeth.

INJURIES TO ADJACENT STRUCTURES

1)Injury to regional nerves

2)Injury to Temporomandibular joint.

DELAYED HEALING AND INFECTIONS 1)INFECTIONS:

a)Most common cause of delayed wound healingb)Seen usually which involves reflection of soft tissue flaps and bone removal.c)Careful asepsis an thorough wound debridement can prevent thisd)Prophylactic antibiotic can be given.

2)WOUND DEHISCENCE: a)Use aseptic technique b)Perform atraumatic technique c)Close the incision over intact bone. d)Suture without tension.

3)DRY SOCKET(ALVEOLAR OSTEITIS): a)Severe pain without usual signs of infection(Fever ,erythema etc). b)Pain develops after 3 or 4 day after removal of teeth(usually lower molar) c)Fibrinolytic activityLysis of blood clotExposure of bonepain d)Treatment= Irrigation and placement of medicated dressing(Alvogel) e)Alvogyl = Eugenol(anesthetic), Benzocaine/Butamben(anesthesia), Idoform(Antimicrobial)

INJURIES TO OSSEOUS STRUCTURES

1)Fracture of the alveolar process a)Thorough preoperative clinical and radiographic examinations b)Donot use excessive force c)use surgical technique to reduce the force required. D)buccal corticol plate over maxillary canine an molars, Portions of floor of maxillary sinus, Labial bone over mandibular incisors.

2)Fracture of maxillary tuberosity a)Maxilary tuberosity fractures most commonly result from extraction of the second molar, if it is last tooth in the arch. b)Finger support can be used during fracture if bone is attached to peri osteum c)If mobile Splint the teeth and defer sugery for 6-8 weeks Section crown from the roots. D)If completely separated ->smooth sharp edges of remaining bone and suture remaining soft tissue.

SOFT TISSUE INJURIES

1)TEAR OF A MUCOSAL FLAP: a)creating adequately sized flaps. B)Using controlled amount of retraction force. C)Creating releasing incisions when indicated.

2)PUNCTURE WOUNDS: If a punture wound does occur in the mucosa the ensuring treatment is primarily aimed at preventing infection and allowing healing to occur usually by secondary intention.

3)STRETCH OR ABRASION: a)By rotating shank of bur or by metal retractor. B)If in oral mucosaregular oral rinsing heal in 4-7 days. C)If on skinanbiotic oinment can be used.

SWELLING

1)Extraction of multiple impacted teeth with reflection of soft tissue and removal of bone may result in moderately large amounts of swelling. And can reach to its maximum in 36-48 hours after surgery.

2)Increase swelling after third day may be an indication of infection.

3)Initially ice packs and later on on 3rd or 4rth post surgical day heat may help t oresolve swelling more quickly.

4)Patient reassurance an counselling about edema is necessary.

Reason: a)Excessive soft tissue manipulation. B)Bone tissue removal. C)Extended surgical time.

FRACTURE TO MANDIBLE

Associated almost exclusively with the surgical removal of impacted third molar.

Usually result of the application of force exceeded that needed to remove a tooth .

The fracture must be adequately reduced and stabilized.

THANKYOU ANY QUESTIONS??