RISK•Potential complications of tooth extraction

include postoperative infection, temporary numbness from nerve irritation, jaw fracture, and

jaw joint pain. An additional complication is called dry socket. When a blood clot does not properly form in the empty tooth socket, the

bone beneath the socket is exposed to air and contamination by food particles; as a result, the extraction site heals more slowly than is normal

or desirable .

Infection

Antibiotics may be given by the dentist after tooth extraction to prevent the occurrence of infection. Symptoms of infection include swelling, intense pain and continuous bleeding even after 48 hours has passed.letely.

Bleeding

–The gauze piece should be left for up to two hours after the extraction to allow the blood to clot successfully. Those who have blood problems (such as hemophilia) and those who are taking non-steroidal analgesics or aspirin should inform their dentists before the tooth extraction procedure, as there may be bleeding complications that may arise.

Retained Roots

–This can occur when a part of the tooth root is left or is not removed comp

Dry socket

–A dry socket may result when the blood clot on the area where the tooth is extracted is removed, exposing the tooth-less socket fluids, food and air. This condition can be severely painful, and is more likely to happen in cases when the extraction involves a tooth in the lower jaw.

Sinus Perforation

• –This can happen when tooth extraction involves the back teeth, which are in close

proximity to the sinus area. Although a thin ridge of bone separates the roots of the teeth

and the sinus, there are instances when a piece of the sinus can be removed along with

the tooth root

Jaw Fracture

• –Occurring very rarely, this problem may result from too much pressure applied during

the extraction of the tooth. A fragile bone structure surrounding the tooth to be

extracted can also result to this complication

•If a sinus perforation occurs at the time of surgery, it is usually detected immediately and repaired immediately while a patient is still under general anesthesia. Generally, sinus

exposures can be expected to heal from that point naturally, with little or no additional treatment. However, if an exposure should occur, you will be instructed to take a few special

precautions in order to promote a speedy recovery:

Avoid blowing your nose forcefully for at least 21 days. The pressure could disrupt the natural healing process. Instead, you will be advised to use nasal decongestants as necessary.

Avoid any other blowing action that involves the nasal cavity. This includes any blowing up balloons, musical instruments, scuba diving, and even strenuous exercise.

Avoid drinking through a straw for 21 days as well as any carbonated beverages.

You will instructed to also perform open mouth sneezing if the urge should arise.

Antibiotics are also usually always prescribed too since there can be travel of bacteria from the oral cavity up into the sinus cavity from the perforated area.

•Fractured Tuberosity  .The upper molars can, from time to

time, be fused with the bone around them so that in removing the molar tooth, the bony socket within which

the tooth sits (tuberosity) comes with it. This can make the

mouth-sinus communication larger (see above) and sometimes, the adjacent teeth and their bony sockets

comes attached with the extracted tooth.

Closure of the ‘hole’ is followed with antibiotics, painkillers & decongestants. Nose-blowing is forbidden for a week

afterwards (at least).

Mouth-Sinus Communications.

• Upper molar and premolar teeth often have their roots in close proximity to the sinus.

In removing these teeth, there is a chance that a ‘hole’ can

be made between the mouth & the sinus (this is sometimes not evident at the time of operation but may develop several weeks afterwards). If this ’hole’ persists

or is left un-repaired, every time you drink, fluid can come out of the nose and you may develop a marked sinusitis.

This ‘hole’ if small enough, can spontaneously close. It can be assisted in this by ‘cover plates’ that prevents food &

fluids going into the sinus allowing the hole to close naturally. However, ‘holes’ above a certain size need to be

surgically closed.

Bleeding into Cheeks.

• Swelling that does not resolve within a few days may be due to bleeding into

the cheek. The cheek swelling will feel quite firm. Coupled

with this, there may be limitation to mouth opening and

bruising. Both the swelling, bruising and mouth opening

will resolve with time.

Trismus:

• Jaw joints and chewing muscles may become sore after tooth extraction and it may become difficult for patient to

open the mouth. • Loss of a tooth: If an extracted tooth slips out of the

forceps, it may be swallowed or inhaled. The patient may be aware of swallowing it, or they may cough, which

suggests inhalation of the tooth. The patient must be referred to for a chest Xray in hospital if a tooth cannot be found. If it has been swallowed, no action is necessary as it usually passes through the alimentary canal without doing any harm. But if it has been inhaled, an urgent operation is

necessary to recover it from the airway or lung before it causes serious complications such as pneumonia or a lung

abscess

displacement of tooth or part of tooth into the maxillary sinus (upper teeth

only).•In such cases, almost always the tooth or tooth

fragment must be retrieved. In some cases, the sinus cavity can be irrigated with saline (antral

lavage) and the tooth fragment may be brought back to the site of the opening through which it

entered the sinus, and may be retrievable. At other times, a window must be made into the

sinus in the Canine fossa--a procedure referred to as "Caldwell-Luc."

Nerve injury• :This is primarily an issue with extraction of third molars, but can occur

with the extraction of any tooth should the nerve be close to the surgical site. Two nerves are typically of concern, and are found in duplicate (one

left and one right): 1. the inferior alveolar nerve, which enters the mandible at the mandibular foramen and exits the mandible at the sides

of the chin from the mental foramen. This nerve supplies sensation to the lower teeth on the right or left half of the dental arch, as well as sense of

touch to the right or left half of the chin and lower lip. 2. The lingual nerve (one right and one left), which branches off the mandibular branches of the trigeminal nerve and courses just inside the jaw bone, entering the

tongue and supplying sense of touch and taste to the right and left half of the anterior 2/3 of the tongue as well as the lingual gingiva (i.e. the gums

on the inside surface of the dental arch). Such injuries can occur while lifting teeth (typically the inferior alveolar), but are most commonly

caused by inadvertent damage with a surgical drill. Such injuries are rare and are usually temporary, but depending on the type of injury (i.e.

Seddon classification: neuropraxia, axonotmesis, & neurotmesis), can be prolonged or even permanent.

Sinus exposure and oral-antral communication

• :This can occur when extracting upper molars (and in some patients, upper premolars). The maxillary sinus sits right above the roots of maxillary molars and

premolars. There is a bony floor of the sinus dividing the tooth socket from the sinus itself. This bone can range from thick to thin from tooth to tooth from

patient to patient. In some cases it is absent and the root is in fact in the sinus. At other times, this bone may be removed with the tooth, or may be perforated during surgical extractions. The doctor typically mentions this risk to patients,

based on evaluation of radiographs showing the relationship of the tooth to the sinus. It is important to note that the sinus cavity is lined with a membrane called the Sniderian membrane, which may or may not be perforated. If this membrane

is exposed after an extraction, but remains intact, a "sinus exposed" has occurred. If the membrane is perforated, however, it is a "sinus communication". These two

conditions are treated differently. In the event of a sinus communication, the dentist may decide to let it heal on its own or may need to surgically obtain

primary closure—depending on the size of the exposure as well as the likelihood of the patient to heal. In both cases, a resorbable material called "gelfoam" is

typically placed in the extraction site to promote clotting and serve as a framework for granulation tissue to accumulate. Patients are typically provided with

prescriptions for antibiotics that cover sinus bacterial flora, decongestants, as well as careful instructions to follow during the healing period.

Bruising:

•Bruising may occur as a complication after tooth extraction. Bruising is more common in

older people or people on aspirin or steroid therapy. It may take weeks for bruising to

disappear completely.

Prolonged bleeding• :The dentist has a variety of means at their

disposal to address bleeding; however, it is important to note that small amounts of blood

mixed in the saliva after extractions are normal, even up to 72 hours after extraction. Usually,

however, bleeding will almost completely stop within eight hours of the surgery, with only

minuscule amounts of blood mixed with saliva coming from the wound. A gauze compress will significantly reduce bleeding over a period of a

few hours.

•Infection: The dentists may opt to prescribe antibiotics pre- and/or post-operatively if they

determine the patient to be at risk.