complications of tooth extraction.pptx FIRM B.pptx
- 1. complications of tooth extraction FIRM B NAMES 1. CHILEMBO LYTON 2. BENJAMIN MWANSA 3. KONDWANI NDOLO 4. ISABEL CHANDA 5. TAIZYA SINYANGWE 6. MALAMBO BUSIKU 7. NSANGISHA
- 2. Introduction Tooth extraction is one of the most commonly performed procedures in oral and maxillofacial surgery. Although it is generally considered safe, a variety of complications may occur depending on the difficulty of the extraction, the patient’s systemic health, and operator skill. These complications can be broadly categorized into early, intermediate, and late types based on their time of onset. Early complications typically arise intraoperatively or within hours (e.g., bleeding, fractures, oro-antral communication), intermediate complications develop within a few days (e.g., swelling, trismus, infection, dry socket), while late complications may appear weeks to months later (e.g., delayed healing, chronic osteomyelitis, osteoradionecrosis, nerve injury sequelae). Understanding these complications, their causes, and management is essential for safe clinical practice and improved patient outcomes.
- 3. 1. Early Complications (during or immediately after extraction; minutes to hours)
- 4. A. Ineffectiveness of local anesthesia Local anesthesia often fails due to improper injection site, insufficient dosage, or not allowing enough time for the anesthetic to take effect before starting the procedure. When standard infiltration or regional nerve blocks do not provide adequate numbness, alternative methods such as intra-ligamentary, intra-osseous, or intra- pulpal injections might be necessary. However, if there is an active infection near the tooth, these techniques should be avoided because injecting anesthetic into infected tissue can risk spreading the infection further.
- 5. B. Inability to mobilize the tooth When a tooth resists reasonable attempts to loosen it using forceps or elevators, this often signals that the surrounding bone is particularly dense and rigid, or that the tooth's root anatomy is blocking its removal. Applying excessive force with the instruments risks breaking the tooth or causing undue fatigue for both the clinician and the patient. To identify the exact cause of the obstruction, a radiographic image should be obtained before surgically lifting a mucoperiosteal flap to remove bone or section the tooth as necessary
- 6. C. Fracture involving the tooth or its root during extraction. The causes of root fructure are the following; i. Applying excessive pressure or force to the tooth. ii. Teeth compromised by decay or extensive dental restorations. iii. Incorrect force application, such as not securing enough of the root or using forceps with blades too broad to create proper two-point contact on the root. iv. Rushing the procedure due to impatience or frustration. v. Root shapes or structures that are naturally unfavorable for extraction or stress
- 7. C. Fracture involving the tooth or its root during extraction CONTINUED Experiencing a tooth fracture can be frustrating, but it’s rarely catastrophic and is something even seasoned dentists encounter. The crucial step in handling this challenge is to carefully evaluate the situation. Ideally, all root fragments should be extracted; however, some apical pieces may be challenging or risky to remove due to their close proximity to the inferior dental nerve or the floor of the maxillary sinus. These small root tips are often best left undisturbed, as they seldom cause any issues. Generally, root fragments from vital teeth that are under 5 mm in length can be safely retained in the jaws of healthy individuals. Conversely, larger root remnants, or those associated with necrotic pulp tissue or periapical radiolucencies, should be surgically removed to prevent complications.
- 8. D.Breakage of the alveolar bone, including the maxillary tuberosity Fracturing of the alveolar bone is a frequent issue encountered during tooth extractions. Often, extracted teeth show fragments of alveolar bone still attached. This can happen if the forceps accidentally grasp part of the bone, or due to the shape of the tooth roots, the alveolar socket, or underlying bone conditions. Notably, extracting canines often leads to fractures of the labial plate. When an alveolar fragment loses more than half of its periosteal connection, it should be carefully removed. This is done by holding the fragment with hemostatic forceps and gently separating the surrounding soft tissue using a periosteal elevator
- 9. D.Breakage of the alveolar bone, including the maxillary tuberosity CONTINUED Occasionally, during the removal of an upper molar, the maxillary tuberosity along with the surrounding bone may become detached and move together with the tooth. If such a fracture occurs, immediately discontinue use of the forceps and create a large buccal mucoperiosteal flap. Carefully separate the fractured tuberosity and tooth from the palatal soft tissues using blunt dissection, then elevate the injured area. Finally, close the soft tissue flaps with mattress sutures that evert the edges, ensuring they remain in place for a minimum of 10 days to promote proper healing. A fracture in the mandible can occur during tooth extraction if too much force is applied or if underlying pathological conditions have weakened the jawbone. It is crucial to avoid using excessive pressure when removing teeth to prevent such complications.
- 10. E. Fracture or partial dislocation (subluxation) of neighboring teeth Accidental displacement of a tooth adjacent to the extraction site is preventable. This complication often arises from incorrect use of the elevator tool. To avoid this, place a finger on the neighboring tooth during elevation to provide support and to sense any force being applied to it.
- 11. F. Temporomandibular Joint (TMJ) Dislocation Some individuals are prone to frequent dislocations of the temporomandibular joint, and any history of repeated episodes should be taken seriously. This issue can arise as a complication during mandibular tooth extractions but is often avoidable. To prevent dislocation, it is crucial to provide firm support to the lower jaw throughout the extraction process. The operator’s left hand should stabilize the jaw, while additional upward pressure beneath the mandibular angles should be applied by the anesthetist or an assistant using both hands. Therefore, when a dislocation occurs, it must be promptly corrected. The clinician positions themselves facing the patient, placing their thumbs inside the mouth on the external oblique ridges beside any existing mandibular molars. Simultaneously, their fingers rest externally beneath the lower edge of the mandible. Applying downward force with the thumbs and upward force with the fingers effectively relocates the dislocated joint.
- 12. G. Displacement of the tooth or root fragments into adjacent tissues Although uncommon, this complication can be quite serious. During extraction, a tooth or a fragment may inadvertently slip beneath a mucoperiosteal flap into the lingual pouch, passing through the delicate lingual cortical bone near the lower third molar area. Alternatively, displacement can occur into the infratemporal fossa behind the maxillary tuberosity in the upper molar region. Such displacement often results from incorrect use of forceps or attempting to elevate a root without sufficient access. If any portion of the tooth or root is missing after extraction, it is crucial to obtain additional radiographs of the socket and adjacent structures to locate the displaced fragment. During an extraction, if a tooth or root fragment disappears from sight, it might have migrated to one of several locations:1) Accidentally swallowed into the stomach or inhaled into the lungs. In such cases, the patient should be promptly referred to a hospital for abdominal and chest X-rays.2) Forced into the maxillary sinus (antrum).3) Embedded within adjacent soft tissue spaces. 4)Unintentionally trapped by the suction device.5) Remaining lodged within the tooth socket.
- 13. 2. Intermediate Complications (1–7 days post-extraction) 1. Severe or lingering discomfort Normal pain subsides within 48–72 hours. Persistent severe pain may indicate dry socket or infection. Swelling (edema) 2. Inflammatory response to trauma or infection. Peaks at 48–72 hours, then subsides. Prolonged swelling suggests infection. 3. Restricted jaw movement (trismus) Due to trauma, inflammation, hematoma, or infection in muscles of mastication. Patient struggles to open the mouth, affecting speech and eating.
- 14. Intermediate Complications (1–7 days post-extraction) con’t 4. Episodes of bleeding (secondary hemorrhage) Occurs hours to days later due to dislodged clot, infection, or slippage of a ligature. May be mild oozing or frank bleeding. 5. Dry socket (alveolar osteitis) Occurs 2–4 days after extraction. Blood clot is lost or fails to form, leaving exposed bone. Characterized by severe throbbing pain radiating to ear, foul odor, and empty socket with bare bone. 6. Acute osteomyelitis Infection spreads into alveolar bone. Presents with severe pain, swelling, pus, fever, and possibly sequestrum formation.
- 15. 7. Infection spreading to adjacent soft tissues Bacterial spread may cause cellulitis, abscess, or even Ludwig’s angina. Leads to swelling, tenderness, fever, and risk of airway compromise. 8. Oro-antral fistula If early oro-antral communication fails to close, it epithelializes to form a fistula. Leads to recurrent sinusitis, regurgitation of fluids into nose, and foul discharge.
- 16. 3. Late complications 1. Delayed Healing Healing may be prolonged due to systemic factors (e.g., diabetes mellitus, anemia, malnutrition, immunosuppression) or local factors (infection, poor oral hygiene, smoking, trauma). Socket may remain unhealed for weeks with persistent pain or granulation tissue. 2. Dry Socket Sequelae (Alveolar Osteitis) Usually an early complication (2–4 days), but persistent pain and delayed socket epithelialization can become a late complication if untreated. The exposed bone may later predispose to chronic infection. 3. Chronic Osteomyelitis Infection may extend into the alveolar bone leading to chronic osteomyelitis, especially in patients with low immunity or following extraction of a tooth in an irradiated jaw. Presents with pain, swelling, pus discharge, sequestration, or fistula formation.
- 17. 4. Osteoradionecrosis / Medication-Related Osteonecrosis In patients with a history of head and neck radiotherapy or those on bisphosphonates/antiresorptive drugs, extraction sites may fail to heal. Leads to persistent exposed necrotic bone, secondary infection, and chronic pain. 5. Fracture Sequelae Unrecognized fractures of the alveolar bone, mandible, or tuberosity during extraction may cause:Nonunion/malunion, Chronic pain or difficulty chewing, Sinus complications if maxillary tuberosity is involved. 6. Nerve Injury Sequelae Lingual nerve, inferior alveolar nerve, or mental nerve injury may result in: Persistent paresthesia, dysesthesia, or anesthesia which may be temporary or permanent.
- 18. REFERENCES Bouloux, G.F., Steed, M.B. & Perciaccante, V.J., 2007. Complications of third molar surgery. Oral and Maxillofacial Surgery Clinics of North America, 19(1), pp.117–128. Jerjes, W., Upile, T., Shah, P., Nhembe, F., Gudka, D., Kafas, P., McCarthy, E., Abbas, S., Patel, S. & Rob, J., 2010. Risk factors associated with injury to the inferior alveolar and lingual nerves following third molar surgery—revisited. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology, 109(3), pp.335–345. Alexander, R.E., 2000. Dental extraction wound management: A case against medicating postextraction sockets. Journal of Oral and Maxillofacial Surgery, 58(5), pp.538–551. Hupp, J.R., Ellis, E. & Tucker, M.R., 2019. Contemporary Oral and Maxillofacial Surgery. 7th ed. St. Louis: Elsevier. Malden, N.J. & Faulkner, J.A., 1997. Complications of exodontia. Dental Update, 24(3), pp.116–120.
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