complication of exodontia presented by a 3rd year dental student at SMHS, UPNG!

1. Minor Oral Surgery Presentations…
Name: Posolok CHAUKA
Course: BOH/BDS III
Date: Fri/21/05/13
Complications of
Exodontia!

2. 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.

3. Categories:
Complications can be
classified into 4 groups;
1)Pre-operative
2)Operative
3)Post-operative
4)Persistant

4. Pre-operative
Pre-operative complications are the
problems that may be encountered
before treatment
Local
Systemic

5. Local
During insertion of the needles
when administering LA these
complications could occur.
Intravascular Injection
Incorrect Anatomical Site
Pain
Needle Breakage

6. Systemic
 Anxiety
conditions in which anxiety dominates a person’s
life or experiences in particular situations
 Systemic disorders (Medical)
 Anaphylaxis
Allergic 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

7. Operative
Are the problems that may occur
during treatment
Local
Systemic

8. 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

9. There may be a displacement of;
Teeth/Roots
Soft Tissues
- Surgical empysema (air in soft tissues
producing crackling)
Buccal Space
Sublingual/Submandibular Space
Infratemporal Fossa

10.  Maxillary Antrum
 Nasal Cavity
- Inhalation
 Oro-Antral Communication
 TMJ Dislocation

11. Systemic
 Fainting (Syncope)
loss of consciousness due to a decrease
in blood pressure resulting in insufficient
blood supply to the brain
 Epileptic Fit
A disorder of the brain causing sudden
onset of seizures.
 Acute Hypertensive Crisis
 Cardiac Arrest

12. Post-Operative
Are the problems that may
occur after treatment.
Local
Systemic

13. Local
Pain
Haemorrhage
Infection
Lip Trauma
Wound Infection
Needle Track Infection

14. Continued..
Haematoma
Trismus
Dry socket
Osteomyelitis
Pathological fracture

15. Systemic
Hypovolaemic Shock
Allergy

16. Persistent
A problems that may persist way long after
treatment.
Neurological
- Motor
-Sensory
Scar Formation

17. 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

18. Thank you for Listening!!

19. 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

20. 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

21. 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)

22. 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!

23. 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)

24. 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)

25. 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)

26. Figure 1:
• (A) 3rd
molar lost in maxillary
sinus
• (B) After removal via
Caldwell-Luc operation
(Clark, 1985)

27. Local Complications Cont…C. Haemorrhage: 2nd
ry haemorrhage
associated with sepsis
Prescribe 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.

28. 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 Infections
2. Bone Infections

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

30. 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

31. 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)

32. 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

33. 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

34. 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

35. 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 GA
Always a risk-can be sudden &
unexpected…
ALWAYS BE PREPARED 4 WORST-CASE
SENARIO!

36. 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