COMPLICATIONS AND
MANAGEMENT
COMPLICATIONS AND
MANAGEMENT
PRE-
OPERATIVE
INTRA-
OPERATIVE
POST-
OPERATIVE
PRE-OPERATIVE COMPLICATIONS
MEDICAL HISTORY
Consider allergies, bleeding disorders etc.
DENTAL HISTORY
Consider if the pat...
INTRA-OPERATIVE COMPLICATIONS
FAILURE OF LOCAL ANAESTHETIC
FAILURE TO REMOVE THE TOOTH
TRAUMA TO HARD TISSUES
TRAUMA TO SO...
FAILURE OF LOCAL ANAESTHETIC
Acute infections prevent the Local Anaesthetic from working
Reasons why LA doesn’t work when ...
FAILURE TO REMOVE THE TOOTH
• INCORRECT
FORCEPS/ELEVATORS
• BONE SCLEROSIS
• DIVERGENT ROOTS
• HYPERCEMENTOSIS
• BLADES OF...
TRAUMA TO HARD TISSUESFRACTUREOFTHEALVEOLARBONE
Occurs when the
alveolar bone gets
included in the
forceps.
Fracture of th...
TRAUMA TO SOFT TISSUES
DAMAGE
TO SOFT
TISSUES
Damage to the gingivae
should be avoided by
good technique. Always
ensure th...
DISPLACEMENT OF TMJ
Usually caused by not
supporting the
mandible adequately
during the extraction.
Using props and gags i...
ORO-ANTRAL COMMUNICATIONS
• OAC: Is a communication between the oral
cavity and the antrum which is not lined by an
epithe...
ORO-ANTRAL COMMUNICATIONS
CAUSES
•When the roots of the upper
posterior teeth are in close
proximity to the antral floor.
...
POST-EXTRACTION COMPLICATIONS
HAEMORRHAGE
PAIN
INFECTION
HAEMORRHAGE
REACTIONARY HEMORRHAGE
When the vasoconstrictor from the local
anaesthetic wears off, there is a rebound
effec...
HAEMORRHAGE
PAIN
Most patients will suffer from pain after an
extraction. Therefore, recommend simple analgesia.
Use SOCRATES to diagn...
PAIN
Causes of post-extraction pain include:
• Pain from the extraction.
• Dry socket.
• Retained root or bone spicules.
•...
INFECTION
It results from the failure of the clot being retained due to vigorous
rinsing or lytic organisms breaking down ...
COMPLICATIONS AND
MANAGEMENT
PRE-
OPERATIVE
INTRA-
OPERATIVE
POST-
OPERATIVE
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  1. 1. COMPLICATIONS AND MANAGEMENT
  2. 2. COMPLICATIONS AND MANAGEMENT PRE- OPERATIVE INTRA- OPERATIVE POST- OPERATIVE
  3. 3. PRE-OPERATIVE COMPLICATIONS MEDICAL HISTORY Consider allergies, bleeding disorders etc. DENTAL HISTORY Consider if the patient has had difficult extractions in the past, are they anxious etc. INFECTION, ACCESS AND VISIBILITY?
  4. 4. INTRA-OPERATIVE COMPLICATIONS FAILURE OF LOCAL ANAESTHETIC FAILURE TO REMOVE THE TOOTH TRAUMA TO HARD TISSUES TRAUMA TO SOFT TISSUES DISPLACEMENT OF TEETH DISPLACEMENT OF TMJ ORO-ANTRAL COMMUNICATIONS
  5. 5. FAILURE OF LOCAL ANAESTHETIC Acute infections prevent the Local Anaesthetic from working Reasons why LA doesn’t work when there is an acute infection…… Acutely inflamed tissues are more vascular, therefore the solution is removed more quickly from the site. The acidic conditions impedes the dissociation of the active components. Inflammation increases the nerve threshold and therefore a higher concentration of LA solution is needed to anaesthetise the nerve. MANAGEMENT Consider block injections; the infra-orbital block, the posterior superior alveolar block, the ID block. Increase the LA solution given or a use concentrated LA solution such as 5% lignocaine. • Intra-ligamentary injections down the periodontal membrane will help If you have absolute failure of anaesthesia, prescribe antibiotics and analgesics . Wait for 3- 4 days to allow the infection to progress from acute to chronic before attempting extraction. You might want to consider GA
  6. 6. FAILURE TO REMOVE THE TOOTH • INCORRECT FORCEPS/ELEVATORS • BONE SCLEROSIS • DIVERGENT ROOTS • HYPERCEMENTOSIS • BLADES OF THE FORCEPS NOT THE RIGHT WIDTH FOR THE POINT OF CONTACTASSESS THE CAUSE OF DIFFICULTY • APPLICATION OF CORRECT ELEVATORS/FORCEPS • FOR MOLAR TEETH, DIVIDE THE TOOTH AND DELIVER ROOTS INDEPENDENTLY • SURGICAL REMOVAL POSSIBLE SOLUTIONS
  7. 7. TRAUMA TO HARD TISSUESFRACTUREOFTHEALVEOLARBONE Occurs when the alveolar bone gets included in the forceps. Fracture of the alveolar buccal plate can occur when leaning buccally to deliver the tooth . Convergent roots or ankylosed roots may retain alveolar bone when delivering the tooth. MANAGEMENT IF THE FRACTURED BONE HAS LOST ITS PERI- OSTEAL ATTACHMENT: The blood supply has been lost thus the fragment should be removed to avoid necrosis and infection of the bone. MANAGEMENT IF THE FRACTURED BONE IS STILL ATTACHED TO THE PERI-OSTEUM: Squeeze the socket together and push the fractured bone into its original position
  8. 8. TRAUMA TO SOFT TISSUES DAMAGE TO SOFT TISSUES Damage to the gingivae should be avoided by good technique. Always ensure that the forceps are applied subgingivally. Protect the lower lip so that it doesn’t get crushed by handles of the forceps or burnt by a surgical hand piece. Uncontrolled and careless use of forceps can traumatise the tongue and floor of mouth .
  9. 9. DISPLACEMENT OF TMJ Usually caused by not supporting the mandible adequately during the extraction. Using props and gags in the mouth which are too large can also displace the TMJ. DISLOCATION OF THE TMJ IMMEDIATELY REPLACE THE DISLOCATED TMJ Stand in front of the patient. Place your thumbs on the external oblique ridge intra-orally. Place your forefingers behind the angle of the mandible extra-orally. Manoeuvre the TMJ back into position by pushing down with your thumbs and up with your fingers. Post-op instructions should include a soft diet for 1 week, and advise not to open their mouth too wide. MANAGEMENT
  10. 10. ORO-ANTRAL COMMUNICATIONS • OAC: Is a communication between the oral cavity and the antrum which is not lined by an epithelium. • OAF: Is a communication between the oral cavity and the antrum which is lined by an epithelium. • It takes ~48 hours for the epithelium tract to form.
  11. 11. ORO-ANTRAL COMMUNICATIONS CAUSES •When the roots of the upper posterior teeth are in close proximity to the antral floor. •When the extraction of upper posterior teeth has been traumatic. •Bulbous curved long roots •Surgical extractions. •Hypercementosis / Ankylosis of upper posterior teeth which make extractions difficult. •Antral pneumatisation around a lone standing tooth. •Cysts/infection associated with upper posterior teeth. •Neoplasm DIAGNOSIS • If you suspect an OAC, ask the patient to blow whilst you occlude the nose: Bubbling indicates an OAC. • Patients complain of nasal regurgitation of liquids which is unilateral • Altered nasal speech • Bad taste (can also be from a dry socket) • Unilateral nasal discharge • Recurrent sinusitis on the affected side TREATMENT • ANTRAL REGIME: • Antibiotics • Analgesics • Decongestants • Mucolytics • CLOSURE WITH A FLAP: • Buccal Advancement Flap • Buccal Fat Pad • Palatal Rotation Flap
  12. 12. POST-EXTRACTION COMPLICATIONS HAEMORRHAGE PAIN INFECTION
  13. 13. HAEMORRHAGE REACTIONARY HEMORRHAGE When the vasoconstrictor from the local anaesthetic wears off, there is a rebound effect with vasodilatation to cause bleeding. MANAGEMENT: Visualise the site of haemorrhage. Apply pressure with gauze or use a local anaesthetic with vasoconstrictor….Use surgicel and place a suture if need be!!
  14. 14. HAEMORRHAGE
  15. 15. PAIN Most patients will suffer from pain after an extraction. Therefore, recommend simple analgesia. Use SOCRATES to diagnose post-op pain.
  16. 16. PAIN Causes of post-extraction pain include: • Pain from the extraction. • Dry socket. • Retained root or bone spicules. • Damage to adjacent teeth causing pulpal pain. • Damage to adjacent soft tissues which are then sore. • Dislocated mandible. • Bony fractures.
  17. 17. INFECTION It results from the failure of the clot being retained due to vigorous rinsing or lytic organisms breaking down the clot. Dry sockets occur more frequently in patients who smoke. Classically presents as severe throbbing pain +/- lymphadenopathy. It tends to have an onset of 3-5 days after extraction. Grey/White bone is visible. MANAGEMENT Irrigate the socket with Chlorhexidine, and pack in alvogyl. Review in a few days time DRY SOCKET
  18. 18. COMPLICATIONS AND MANAGEMENT PRE- OPERATIVE INTRA- OPERATIVE POST- OPERATIVE

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