Complications of tooth removal

Complications of tooth removal

Attila Szűcs DDS

Semmelweis University

Department of Oral and Maxillofacial Surgery


The aftermath of complication can be:

-temporary

-permanent

The dentist can be

-guiltless (malpractice)

-guilty


During the preparation for extraction

During the extraction

After the extraction

Complications during the preparation for extraction

Malinidication

Complications of anaesthesia

Prevention

-History (general and dental)

-Clinical examination

-Radiographs

-Accurate indication, treatment plan

-Careful surgical intervention

-Supervision after extraction

-Effective assistance


Complications during the tooth extraction

Fracture of root

Injury of surrounding soft tissues

neighbouring teeth

alveolar bone

maxillary sinus

jaws and TMJ

nerves

Swallowing, aspiration of the tooth

Complications after the extraction

Haemorrhage

Trismus

Inflammation in the head and neck region:

Dry socket

Maxillary sinusitis

Abscess formation

Lymphadenitis

Cellulitis

Inflammations in different part of the body(e.g. endocarditis)

Fracture of the root

Level -cervical

-medium

-apical

-root among the soft tissues

Removal by forceps

elevator

dissection

surgical

other methods

Injury of surrounding soft tissues

Attached gingiva

Lip

Angulus oris

Injury of teeth

Neighbouring teeth (fracture or luxation)

Antagonist teeth

Germ of permanent tooth

Injury of alveolar bone

Molar tooth extraction

Younger age patients

Prevention: surgical tooth removal

Therapy: correction of sharp bone edges&oral mucosa, sutures

2006 nov. 13. extraction 2007. Febr. cont. pain, i.o. radiograph 2007. March occlusal radiograph, removal of sequester 2009. Recall, extrations, (+myeloma multiplex bisphophonate th.)

2007. 02. 2007. 02. 2007. 03.

2007. 01.

2009. 09.

Injury of maxillary sinus

Bony wall

Bony wall+mucosa Root in the maxillary sinus

Dg :

Blowing the nose

bucca

different signs

Injury of maxillary sinus Treatment:

closure:

-surgical way: by Wassmund (buccal) or Pichler (palatal) flap immediately,

maximum 24 (48) hours

-or tissue adhesive

+ antibacterial treatment

Wassmund flap

-base: stretching of the flap

-advantage:

simple surgical technique

-disadvantage:

narrow down the vestibulum

difficult to use in case

of injured marginal gingiva

Palatal flap

(Pichler)

-base: rotation of the flap

-advantage: intact vestibulum

-disadvantage: secondary wound healing

-requires more surgical experience

Root in the maxillary sinus

Localisation:

Inside the maxillary sinus

Between the mucosa and the bony wall of maxillary sinus

Dg: extraoral X-ray image (OP, PA)

Removal

surgical way by curette instruments, lavage, gauze rip, thin suction tip or by endoscope

Injury of jaws

Fracture of tuber maxillae

treatment: -interrupt the extraction,

splinting the teeth

-surgical root removal without

or with removal of

the broken bone segment +

closing of maxillary sinus

Fractura tuber maxillae I.

Fractura tuber maxillae II.

Fractura tuber maxillae III.

Fractura tuber maxillae IV.

Injury of jaws

Fracture of mandible

treatment: conservative or surgical

management of the fracture

Fracture of alveolar bone

treatment: removal of sharp bone edges, correction of soft tissues

Injury of TMJ

Overloading of TMJ

Luxation of TMJ

treatment: reposition, keep the joint at rest

Injury of neighbouring nerves

Mental nerve

Inferior alveolar nerve

Lingual nerve

Long buccal nerve

Nasopalatal nerve

Injury of inferior alveolar nerve I.

Localisation mandibular canal

Swallowing, aspiration of the tooth

Swallowing - doesn’t need treatment

Aspiration – urgent transport to

otolaryngology

Complications after the extraction

Haemorrhage

Trismus

Inflammation in the head and neck region:

Dry socket

Maxillary sinusitis

Abscess formation

Lymphadenitis

Cellulitis

Inflammations different part of the body(e.g. endocarditis)

Haemorrhage after the extraction

Good blood suply

Difficulty in dressing

Rinsing, eating


History:

Familiar

Previous tooth removal

Medical treatment

Liver diseases

alcoholism


Origin:

medical treatment: – anticoagulant (cumarin)

– Antithrombotic (salicylic acid, clopidogrel)

– antibacterial th. (disturbing vit. K metabolism )

– tumor chemotherapy

alcohol


Treatment (may be modified by the origin)

calm the patient, check the wound, bite on a gauze tampon

Stitching „8” shaped, fibrine or gelatine sponge; tissue adhesives

Medicinal treatment (Tbl. or inj. Dicynone, inj. Styptanon, tbl, inj, mouthwash Exacyl-tranexamic-acid)

Medical examination

90% 70% 50% 35% 20%

4

3,5

2

Anticoagulant treatment

Tooth extraction can be done,

- If Prothrombin value >20%, or INR<3,5 (>35%, or INR<2 ?...)

- or Syncumar substitution by low molecular weight heparin

INR - Prothombin level(%) -- CORRELATION

Dry socket

Diagnosis: symptoms + X-ray image

Treatment:

Conservative: rinsing the socket+local

medicinal (e.g. Alvogyl-Septodont …)

Surgical: excochleation, removal of foreign body (root, piece of filling or broken instrument)

In both cases painkiller necessary, NO antibiotics

Trismus

Origin: injection (local anaesthesia)

tooth removal (lower molar teeth)

Reflectory

treatment: excercises (opening the mouth)

medicinal th: painkiller, muscle

relaxant, physicotherapy)

Inflammatory (abscess formation)

treatment: antibiotic tr, incision…

Inflammation in head and neck region

Maxillary sinusitis: upper molar teeth

antibacterial th.

Abscess formation: wet bandage, antibact. th., incision (if necessary)

Lymphadenitis : similar

Cellulitis: intensive th. in the wards

Inflammation different part of the body

Prophylactic antibiotic treatment for risk patients!

Thank you for your attention!

Complications of tooth removal

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