Complications of exodontia

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

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Complications of exodontia

  1. 1. Minor Oral Surgery Presentations… Name: Posolok CHAUKA Course: BOH/BDS III Date: Fri/21/05/13 Complications of Exodontia!
  2. 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. 3. Categories: Complications can be classified into 4 groups; 1)Pre-operative 2)Operative 3)Post-operative 4)Persistant
  4. 4. Pre-operative Pre-operative complications are the problems that may be encountered before treatment Local Systemic
  5. 5. Local During insertion of the needles when administering LA these complications could occur. Intravascular Injection Incorrect Anatomical Site Pain Needle Breakage
  6. 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. 7. Operative Are the problems that may occur during treatment Local Systemic
  8. 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. 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. 10.  Maxillary Antrum  Nasal Cavity - Inhalation  Oro-Antral Communication  TMJ Dislocation
  11. 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. 12. Post-Operative Are the problems that may occur after treatment. Local Systemic
  13. 13. Local Pain Haemorrhage Infection Lip Trauma Wound Infection Needle Track Infection
  14. 14. Continued.. Haematoma Trismus Dry socket Osteomyelitis Pathological fracture
  15. 15. Systemic Hypovolaemic Shock Allergy
  16. 16. Persistent A problems that may persist way long after treatment. Neurological - Motor -Sensory Scar Formation
  17. 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. 18. Thank you for Listening!!
  19. 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. 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. 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. 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. 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. 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. 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. 26. Figure 1: • (A) 3rd molar lost in maxillary sinus • (B) After removal via Caldwell-Luc operation (Clark, 1985)
  27. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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

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