exodontia complications in brief

1. SREE BALAJI DENTAL COLLEGE AND HOSPITAL,CHENNAI
DEPARTMENT OF ORAL AND MAXILLOFACIAL SURGERY
COMPLICATIONS OF EXODONTIA
PRESENTEDBY
ANDREWGNANAMUTtU
III BDS
GUIDEDBY
DR.SARAVANAkumar MDS ;PHD

2. EXTRACTION
 An ideal tooth extraction is the
orderly procedure of removal of
whole tooth or tooth root in a
painless manner so that the
investing tissues incur minimal
trauma and the resultant wound
heals uneventfully
 Extraction of tooth may look simple
but it may lead to many
complications if done without a
proper planning and execution.

3. SOURCES OF COMPLICATION
Surgical complications may arise from either one or a
combination of the following factors.
 THE PATIENT - Medically compromised patient. leading to an
persistent hemorrhage or delayed healing.
 THE CLINICIAN
-level of training , skills and experience.
-attitudes towards total patient care.
 THE SURGICAL PROCEDURE
risk depends on :
-complexity of the procedure.
-local anatomy of the surgical site
-proximity of important vital structures.

4. COMPLICATIONS OF TOOTH EXTRACTION
LOCAL COMPLICATIONS
Failure to secure
anaesthesia
Fracturing the tooth
Oro-antral communication
Soft tissue injury
 Trismus
Hemorrhage
Dry sockets
Postoperative swelling

5. SYSTEMIC COMPLICATIONS
Syncope
Cardiac arrest
Anaphylaxis
Epileptic seizures
Respiratory arrest

6. LOCAL COMPLICATIONS
FAILURE TO SECURE ANAESTHESIA
CAUSES:
Failure of the needle to reach the target area
while injecting.
Insufficient solution.
Intravascular injection.
Administering a local anaesthetic that has
passed its expiry date.
PREVENTION:
Avoid faulty technique
Sufficient dosage of LA must be injected

7. FRACTURING THE TOOTH
Fracturing of tooth includes fracture of
 Crown of tooth being extracted.
 Root of tooth being extracted.
 Maxillary tuberosity.
 Alveolar process.
 Adjacent tooth.
 Mandible.

8. FRACTURE OF THE CROWN OF A TOOTH
CAUSES:
 Weakened tooth- caries or large
restoration
 Improper application of the forceps
 Excessive force
MANEGMENT:
 proper application of forceps or elevator
will deliver the tooth or Transalveolar
method

9. FRACTURE OF THE ROOT OF A TOOTH
CAUSES:
 Root pattern
 Faulty technique
MANEGMENT:
 Decide whether to leave or not?
 Radiographic examination & transalveolar
extraction.

10. Fracture of Maxillary Tuberosity
Cause:
•Excessive force
Prevention:
•Proper support and controlled force
Management :
•If still attached; dissect and remove the tooth
•If detached; smooth bone edges & suture

11. Fracture of Alveolar Process
Fracture of the Buccal or Lingual Cortex
Cause:
•Inadequate exposure & excessive force
Prevention :
•Adequate bone removal & exposure

12. FRACTURE OF AN ADJACENT OR OPPOSING
TOOTH
Precautions :
 Careful pre-op examination (carious, heavily
restored, loose, line of withdrawal)
 No force should be applied to any adjacent
tooth
 Other teeth should not be used as fulcrum for
an elevator.
 Any loose, heavily restored tooth should be
noted & brought to the notice of anesthetist.

13. Fracture of the Mandible
Cause :
•Excessive force
Prevention:
•Proper bone removal & controlled force

14. Oro-antral communication
Causes:
•Large antrum
•Lone-standing tooth in an atrophic maxilla
•Large splayed roots
•Fracture of tuberosity
•History of antral involvement
Prevention :
•Proper preoperative radiographic
evaluation
•Proper bone removal
•Controlled force

15. SOFT TISSUE INJURY
Causes
•careless use of rotatory instruments (like burs while bone
cutting.)
•injudicious used of instruments, improper elevation of
flap or the exercise of excessive force.
Prevention
•Take extreme care during the handling of the rotary or
other hand instruments.
• Properly retract the cheek and lips during dental
procedures.

16. Management
 If the tear or abrasion is large, suturing
should be done for closure.
 Scars produced due to thermal injuries
can be managed by the application of
petroleum jelly or topical
antiseptic/analgesic

17. TRISMUS
 Inability to open mouth due to muscle spasm.
CAUSES:
 Caused by post operative edema, hematoma
formation or inflammation of soft tissue.
 Trauma to muscles (medial pterygoid,
temporalis, and masseter) during insertion of the
needle.
TREATMENT:
 Antibiotics
 Heat theraphy

18. HAEMORRHAGE
Bleeding is a common sequel of oral surgery.
There are three types of Post-operative bleeding:-
 Primary – Occurs continuously just after the surgery
 Reactionary – Haemorrhage restarts after a period of about three
hours.
 Secondary – Occurs after few days of the procedure
Prevention
 A proper medical history of patient to detect any systemic disorders..
 Avoid incision, flap opening or soft tissue trauma.
Management
 After extraction of tooth, apply digital pressure continuously for 2-4
minutes
 If bleeding continues from the socket, then pack the bony socket with
Gelfoam, fibrin foam, surgical or bone wax
 Put a gauze piece at the site of bleeding to stop bleeding and facilitate
clot formation.

19. DRY SOCKET
 It is a post extraction condition characterized by intense pain
and dysgeusia loss of taste and halitosis beginning from 3rd
day after extraction.The pain occurs due to exposure of nerve
endings to the oral cavity due to dislodgement of the
clot,leaving the bare bone exposed
CAUSES:
 Traumatic extractions
 Infections
 Vasoconstrictor agents in L.A
MANAGEMENT:
 Perform extraction atraumatically
 Preoperative oral hygiene measures to reduce plaque
 Post-operatively,avoid vigorous mouth rinsing for 24 hours after
extraction
TREATMENT:
 Alleviation of pain
 Induction of granulation and speedy resolution.

20. POSTOPERATIVE SWELLING
EDEMA :
 If the soft tissues are not handled carefully during an extraction
traumatic edema may be formed.
 The use of blunt instrument, the excessive retraction of badly
designed flap, or a bur becoming entangled in the soft tissues
predispose to this condition.
 If sutures are tied too tightly post operative swelling due to edema or
haematoma formation may cause sloughing of the soft tissues and
breakdown of the suture line.
 Usually both conditions regress if the patient uses hot saline mouth
baths frequently for 2-3 days.
INFECTION :
 pain and swelling
Mild - hot saline mouth baths
Severe – antibiotic & analgesics

21. SYSTEMIC COMPLICATION
SYNCOPE
DEFINITION:
 Sudden transient loss of consiousness due to cerebral ischaemia.
CLINICAL SIGNS AND SYMPTOMS:
EARLY:
Feeling of
warmth.
Loss of color:Pale
/ashen gray skin
tone.
Heavy
prespiration.
Nausea.
Rapid heart rate
LATE:
Hyperapnea.
Yawning.
Coldness in hands and
feet.
Hypertension.
Bradycardia.
Visual disturbances.
Dizziness.
Loss of consiousness.

22. TREATMENT:
Immediately stop treatment.
Loosen tight clothing.
Place the patient in Supine position.
Monitor pulse: If pulse is normal – Sprinkle cold
water ; Carry a gauge dipped in aromatic spirit of
ammonia close top patient’s nostrils.
If Bradycardia: Inject atropine 6mg I.V or Inject
mephentramine 10-30 mg I.M.
If patient still not responding support respiration [
start oxygen ], call physician.

23. CARDIAC ARREST
CAUSES:
 Myocardial infarction.
 Sudden cardiac arrest.
 Airway obstruction.
 Drug overdose.
 Anaphylaxis.
 Seizure disorders.
 Acute adrenal insufficiency.
TREATMENT:
 Recognition of unconsciousness.
 Summon assistance and position the victim.
 Assessment of circulation and chest
compression, if needed.
 Assessment and maintenance of airway.
 Assessment of breathing and ventilation , if
needed.
 Rescue breathing.
 Defibrillation.

24. ANAPHYLAXIS
Generalized Anaphylaxis:
 This is an acutely life threatening allergic
reaction.
 Clinical death can occur within a few minutes.
 Generalized anaphylaxis can develop after
administration of an antigen by any route but is
more common after parenteral administration.

26. TREATMENT:
EPINEPHRINE(0.3ml OF 1: 1000) IM/IV
HISTAMINE -50 mg
CHLORPHENARAMINE-IO mg
CORTICOSTEROID-100 mg (HYDROCORTISONE
-IV)

27. SEIZURES [ EPILEPSY ]
DEFINITION:
 A recurrent paroxysmal disorder of cerebral function
marked by sudden , brief attacks of altered
consciousness , motor activity or sensory phenomena.
 Convulsive seizures are the most common form of
attack.
CAUSES:
 Infection.
 Trauma.
 Cerebral degenerative disease.
 Tumor.
 Vascular disease.

28. PREVENTION:
 Adequate patient evaluation and preparation , care in
selection of local anaesthetic agents , and use of the
proper administration technique go far in preventing toxic
reaction.
TREATMENT:
Carbemazepine [ tegretol ] 600-1800 mg.
Phenobarbital 60-120 mg.
Valproic acid [Depakene ] 750-3000 mg

29. RESPIRATORY ARREST
Skelton Muscles become flaccid and
pupils dilate
MANAGEMENT:
Lay the patient flat on the floor
Remove any foreign bodies by pulling the
mandible upwards and forwards, to extend
neck fully
Compress pt. nostril with thumb and
finger, mouth-to-mouth resuscitation be
performed to raise the chest every 3-4
sec.
Check carotid pulse.

30. Conclusion
Complications should be diagnosed as soon as they
occur & dealt promptly and effectively