Minor Oral Surgery Presentations…

Name: Posolok CHAUKACourse: BOH/BDS IIIDate: Fri/21/05/13

Complications of Exodontia!

Definition

Exodontia: the removal or extraction of teeth and associated fragments.

Teeth extracted for number of reasons; - Often tooth is badly decayed - Fractured and causes chronic infection and

discomfort. Hence complications may arise before, during

and after extraction of tooth/teeth.

Categories:Complications can be classified into 4 groups;

1)Pre-operative2)Operative3)Post-operative4)Persistant

Pre-operativePre-operative complications are the problems that may be encountered before treatment

LocalSystemic

Local During insertion of the needles when administering LA these complications could occur.Intravascular InjectionIncorrect Anatomical SitePain Needle Breakage

Systemic Anxietyconditions in which anxiety dominates a person’s

life or experiences in particular situations Systemic disorders (Medical) AnaphylaxisAllergic response a substance causing the body

to be intensely sensitized. Flushing, itching, nausea, vomiting, swelling of

the mouth and tongue, obstruction of airway may occur

OperativeAre the problems that may occur during treatment

LocalSystemic

Local

Anaesthesia failure - Pain will still be present Haemorrhage- The escape of blood from a blood vessel,

externally or internally

Fracture of;• Roots• Maxilla tuberosity;• Mandible

There may be a displacement of;Teeth/RootsSoft Tissues- Surgical empysema (air in soft tissues producing crackling)Buccal SpaceSublingual/Submandibular SpaceInfratemporal Fossa

Maxillary Antrum Nasal Cavity- Inhalation Oro-Antral Communication TMJ Dislocation

Systemic Fainting (Syncope)loss of consciousness due to a decrease

in blood pressure resulting in insufficient blood supply to the brain

Epileptic FitA disorder of the brain causing sudden

onset of seizures. Acute Hypertensive Crisis Cardiac Arrest

Post-OperativeAre the problems that may occur after treatment.LocalSystemic

LocalPainHaemorrhage InfectionLip TraumaWound InfectionNeedle Track Infection

Continued..HaematomaTrismusDry socketOsteomyelitisPathological fracture

Systemic Hypovolaemic ShockAllergy

Persistent A problems that may persist way long after treatment.

Neurological- Motor-Sensory

Scar Formation

Reference British Dental Journal 2003; 194:453-

455

Clark. Henry, B. Jnr., 1985, “Practical Oral Surgery”, Lea & Fibiger, Philadelphia

www.exodontia.info (2010) (taken from ‘pubmed’ search on exodontia)

www.myhealth.gov

Thank you for Listening!!

Local

2. Teeth: extraction of wrong tooth; loosening of adjacent teeth.

Take good radiographs and review beforehand Before operating: compare radiographs, written

records and appearance of tooth in mouth to make sure

Local Complications (a) Accidents: unintended injury caused

by surgical instruments to:

1. Soft tissues: mutilation of cheek, lip, gingiva, & tongue can be avoided by using careful operating technique with good retraction and illumination

Accidents Cont… 3. Bone: accidental fracture of the mandible-done

when too much force used with elevators. When an audible crack is heard, operation stopped and pt treated for fracture of mandible. Tooth may be extracted after healing is complete.

fracturing of floor of sinus; happens when extracting very solid upper molar lying against a large or thin-walled antrum. If this occurs, try to preserve the fractured portion of maxilla. If completely detached, must be removed with repair of antral perforation-fistula does not develop (bleeding & suppuration)

Accidents Cont… Fracturing off of maxillary tuberosity: if good soft

tissue attachment-leave fragment in place; if completely detached-must be removed (loss of blood supply)

Fracturing of lingual plate: in lower 3rd molar region result of poor attempts at splitting impacted tooth. If segment small and nearly detached-carefully remove; if large-leave in place. Heal slow & painful as tongue moves over it!

Accidents Cont… (b) Foreign Body Problems: 1.Broken Injection Needles 2. Debris, e.g. amalgam, cement or tooth

structure Operation must proceed with good visibility

& caution ensuring all foreign bodies removed from mouth immediately after use or detachment

Post-op radiographs taken when possibility of debris in extraction wound (open and remove)

Accidents Cont… 3. Loss of tooth or root in anatomical

space: -soft tissue compartments-bony compartments

Most commonly: loss of tooth/root into maxillary sinus.

2 methods of removal:-1. remove through socket-2. Caldwell-Luc method (through canine fossa)

Figure 2:

Caldwell-Luc Operation:

A. Incision

B. Entrance to antrum in canine fossa

C.Removal of tooth fragment

D.Construction of naso-antral window

E. Insertion of iodoform-gauze dressing

F. Closure

(Clark, 1985)

Figure 1:

• (A) 3rd molar lost in maxillary sinus

• (B) After removal via Caldwell-Luc operation

(Clark, 1985)

Local Complications Cont…C. Haemorrhage: 2ndry haemorrhage

associated with sepsisPrescribe antibiotics to combat infection‘Ecchymosis’: deep purplish pigmentation

of face & neck due to blood seepage into tissues. Healing occurs normally.

‘Haematoma’: excessive blood clot. Develops in chewing muscles, tissue spaces etc &may start on face, slump into submandibular region and further down neck & chest.

Haematoma formation outside socket may require drainage

If facial swelling does not resolve after a few days, may be bleeding into cheeks (feels firm). Leads to Trismus & bruising. Resolves in time.

Local Complications Cont… D. Post-Operative Infections: infection after

operation; 2-4 days later. Deep throbbing pain, bad breath & unpleasant

taste in mouth Occurs more in smokers; women on

Contraceptive pills; persons on drugs e.g. steroids, or if bone fragment removed to aid tooth extraction

Can be: 1. Soft tissue Infections2. Bone Infections

Post-Op Complications Cont…1. Soft tissue infections. May Be:(a) abscess formation beneath flap or

within woundDue to entrapped bone specs or such

foreign matter in wound. Wound must be reopened and drainage established

(b) Needle abscess: leads to severe Trismus, dysphasia, pain & severe infection

Under GA; incision &drainage along LA needle path heavy flow of foul pus

Prevention via drying mucosa, using germicide and sterile needles, syringes & solutions

Post-Op Complications Cont… 2. Bone Infections: (a) Dry Socket: pt has pain due to loss of blood

clot exposing bone to air, food, fluids Symptoms: pain beginning 2-4 days after

extraction: steady, severe & radiating. Remains of blood clot irritate socket wall, bad odour, lasts 10-14 days.

Occurs mostly in smokers, pt who excessively sneezes, coughs, sucks or spits in 1st 24 hours; contraceptive pill users & people who don’t follow POI

Post-Op Infections cont… Prevention: contraceptive pill-users should

schedule extractions during last week of menstrual cycle (days 23-28) when oestrogen levels lowest; pts avoid drinking with straw; smoking; avoid excessive mouth rinsing & chewing on that side for 1st 24hours: salt-water rinses from 2nd day

New update: oral contraceptives pain after extraction; users more susceptible to post-op pain & dry socket (British Dental Journal, 2003)

Cont… (b) Denuded bone: soft tissue covering bone

becomes displaced due to improper suturing. Bone exposed to fluids of mouth; osteitis results

(c) Osteitis & Osteomyelitis: Osteitis: inflammation of bone Osteomyelitis: inflammation of bone marrow

Systemic Complications: (a) Syncope: severe disturbance of

circulatory system- sudden onset: BP, pallor, sweat, loss of consciousness

Many causes esp. ‘psychic shock’ i.e. hearing bad news; watching the operation

When occurs in dental chair, lower head & maintain this position till circulation returns and pt regains consciousness

Cont…(b) Allergic & Drug Reactions:Symptoms: nausea, vomiting, diarrhoea,

oedema, asthma, bleeding, dizziness, unconsciousness

Acetylsalicylic acid & Pentobarbital sodium: drugs that have low incidence of toxic effects-used for routine procedures

(c) Bacteraemia: Special care for pts with valvular heart

disease-may develop ‘bacterial endocarditis’

Prevented via antibiotics before and after extraction

Systemic Complications Cont…(c) Weight Loss: esp. in pts with multiple

extractions with body weakness:-mouth sore, cannot eat

Pts must eat proper, well-balanced meals & keep up intake so surgical wounds can heal & repair well!

(d) Death: Mostly due to complications under GAAlways a risk-can be sudden &

unexpected…ALWAYS BE PREPARED 4 WORST-CASE

SENARIO!

References British Dental Journal 2003; 194:453-

455

Clark. Henry, B. Jnr., 1985, “Practical Oral Surgery”, Lea & Fibiger, Philadelphia

www.exodontia.info (2010) (taken from ‘pubmed’ search on exodontia)

www.myhealth.gov