Complications of Extraction
Cards (13)
- Pre-extraction:
- Medical history
- Management problems
- Find out about any medications they're taking and plan treatment accordingly
- Dental diagnosis
- Treatment plan
- Anaesthesia
- Failure of LA (due to operator error or technique, or infection too because it can alter the pH of the LA)
- Choice of LA
- During extraction:
- Wrong tooth
- Pre-needle checklist
- Fractured crown
- Fractured roots
- Fractured bone
- Alveolus
- Maxillary tuberosity (near upper 7 and 8)
- Jaw (mandible/maxilla)
- Misplaced
- Inhaled teeth - need to get x-ray to find where in lungs it is
- Ingested teeth - still need x-ray though to check in case it was inhaled
- Pieces of tooth can be displaced in the soft tissues, which can cause an infection if left
- Antrum - teeth near antrum can end up being pushed into it
- Post-extraction:
- Early sequaelae
- Haemorrhage
- Infection
- Dry socket
- OAC
- Late sequaelae
- Bone sequestration
- Osteonecrosis
- Osteomyelitis
- OAF - oroantral fistula
- Post-extraction - early sequaelae:
- Haemorrhage
- Apply pressure to the wound for 5-10 mins
- Pack with surgicel/kaltostat
- Suture - decreases blood flow and aids haemostasis
- Admission to hospital
- Observation
- Further investigation
- Transfusion for blood loss
- Post-extraction - early sequaelae:
- Infection
- Happens >48 hours after initial treatment; takes time for infection to occur and pus to form
- Patients complain of pain, swelling, high temperature, bad taste, and difficulty swallowing
- Remove cause then drain pus and prescribe antibiotics
- Post-extraction - early sequelae:
- Dry socket - aka alveolar osteitis
- Inflammatory condition of the bone of the extraction socket - not a true infection
- Occurs when blood clot fails to organise and the clot is subsequently lost quickly
- No swelling but extraction socket is empty and contains no blood clot - therefore then filled with debris from inside the mouth and is acutely painful to palpate
- Management:
- Irrigate socket to remove debris with chlorhexidine mouthwash/saline
- Socket then packed with alvogyl - doesn't need to be removed - antiseptic
- Post-extraction - early sequelae:
- OAC
- Oroantral communication hole
- Hole between the mouth and the antrum
- Post-extraction - late sequelae:
- Bone sequestration
- Bone fragments broken away during extraction
- Usually resorbed or quickly exfoliated, but sometimes larger pieces can become necrotic and form sequestrae - these can exfoliate naturally but often need to be surgically removed and are prone to infection
- Post-extraction - late sequelae:
- Osteonecrosis (dead bone)
- Can be a result of radiotherapy above the clavicle
- Bisphosphonate medication can lead to osteonecrosis of the jaw
- Can lead to delayed healing or areas of exposed bone in the mouth
- Post-extraction - late sequelae:
- Osteomyelitis
- Deep infection in bone - rare occurrence
- OAF
- Oroantral fistula
- When the OAC hole epithelialises and forms a permanent hole
- OAC/OAF:
- Hole between mouth and sinus
- Risk of air/fluid passing between mouth and sinus, which leads on to nose
- Tell pt not to blow nose for 2 weeks and sneeze with mouth open - check again in 2 weeks to assess healing and ensure no fistula formation
- Infection risk
- Management
- Surgery
- Conservative
- Avoiding complications:
- Assessment
- Pre-extraction
- Awareness
- During extraction
- Ensure pt knows risks beforehand; easier for them to accept if warned ahead of time
- Aftercare
- Post-extraction
- Post-op care:
- Compress socket
- Digitally (with fingers)
- Reduces dead space
- Achieve haemostasis
- Pressure
- Post-op instructions
- No rinsing for 24 hours
- No alcohol/hot beverages
- No smoking for 24 hours
- No vigorous exercise (increases blood pressure, could prompt excessive bleeding)
- Avoid eating whilst numb (could damage tissues)
- Pressure packs to stop bleeding
- Analgesics
- Warm salt water mouthwash after 24 hours
- Contact number