Complications of Teeth Extractions

By Vishaal on Tuesday, December 4, 2007 with 0 comments

Complications during an extraction.

Even a simple extraction may get complicated for various reasons. Among these reasons there are anatomical influences (retention, a tooth’s bent, anomalous number of roots, hypercementosis of roots), uneasiness of a patient, unsatisfactory equipment of a dentist’s office etc. The most frequent complications are the following:

  1. Breaking of a tooth’s crown, breaking an alveolus wall.

  2. Luxation or sub-luxation of an adjacent tooth.

  3. Opening of the maxillar sinus during extractions of premolars or molars in the upper jaw.

  4. Injury of the mandibular nerve during difficult extractions of deeply positioned lower molars, eventually breaking the lower jawbone.

  • Breakage of an extracted tooth is quite common complication that requires finishing the extraction by surgical means. A surgical extraction starts by cutting the mucosa and the periosteum, and continues by forming so called mucoperiosteal flap. A cortical part covering the broken tooth’s root is removed by bone surgery instruments (chisel, hammer, milling cutter). The root is pulled up by extraction levers and after trimming the bone wound, edges of the mucosa are joined by a stitch.

Complications after an extraction.

  • Impaired healing of an extraction wound. Under physiological conditions, healing of an extraction wound is made by formation of a blood clot that fills an alveolus after a tooth has been pulled out. The coagulum changes into a granulating tissue that becomes ligamentous tissue in 3 to 4 weeks. Complete healing of a bone tissue takes around six months or more. This healing process may be hampered by absence of a blood clot at hemocoagulation disorders, or by washing off a coagulum during extensive mouth rinsing after an extraction, or by infection of a coagulum followed by its decay. This leads to the post-extraction syndrome , causing prolonged healing of an extraction wound. This syndrome has two forms:
  • Alveolitis sicca (dry socket) is caused by traumatization of tissues after a difficult extraction or by a tissue ischemia after the use of excessive amounts of an anesthetic. A sharp pain which shoots to temples, ears and cheeks, occurs the second or third day after an extraction. The alveolar socket is covered with a gray coat and its surroundings are red and painful.
  • Alveolitis purulenta (purulent alveolitis) is caused by infection and subsequent decay of a blood coagulum. It is characterized by a large general alteration, fevers, foetor ex ore and reaction of local lymph nodes. Therapy of an alveolitis tries to restore the physiological filling of the tooth’s bed by a blood clot after former wound excochleation. Rinsing the alveolus with solutions of a disinfectant (1%0 Rivanol) are used. For local therapy, drugs with analgesic effects (Pharodoran, Apernyl) or physical therapy (Solux lamp) are used. Currently, a biostimulating and analgesic effects of a laser have been used successfully. For general therapy, analgesic and antipyretic medications are administered. Antibiotics should be used only if there is a danger of spreading the alveolitis further (a possibility of osteomyelitis or jaws inflammation).

Bleeding after an extraction.

Bleeding from an extraction wound stops in 5-10 minutes under physiological conditions and the wound gets filled with a blood coagulum. Prolonged bleeding may be caused by local or general factors:

  • Local causes of bleeding can be numerous. It may be a granulous tissue inside en extraction wound, a root or its fragment after an unfinished extraction, foreign objects (pieces of metal fillings) in a wound, bruised mucous edges. Bleeding can also be provoked by irritation of the wound’s edges by tongue, excessive rinsing or sucking. More serious bleeding may occur in cases of angioma in the oral cavity or by damaging blood vessel branches by cutting, e.g. during incision of abscesses.
  • General causes of bleeding. Heavy bleeding may appear at patient with hypertension, respiratory tract diseases with a fever, when a permeability of blood vessel walls is increased due to infection. Diabetic angiopathies cause heavy bleeding at patients with diabetes. Menstruation tends to increase bleeding, so surgeries are not usually planned for this period. Bleeding disorders (coagulopathias such as hemophilia A, B, thrombopathia and purpuras of blood vessel types), anticoagulation therapy at patients after myocardial infarction, heart surgeries and thromboembolic diseases, belong to severe causes of post-extraction bleeding. As one can see from the above listed causes of post-extraction bleeding, a detailed anamnesis before a surgery itself is very important. In cases of general illnesses, a specialist’s opinion and recommended preparation of a patient are required. Bleeding disorders are an indication for a surgery in the inpatient care. In case an unexpected bleeding of unclear origin occurs after an extraction, a local wound dressing has to be made. It should start with a local anesthesia that enables for good overview of a bleeding wound and its painless revision. Remains of a granulous tissue, fragments of teeth and other foreign objects are removed from the alveolar socket by excochleation and bruised edges of a wound should be trimmed (the wound toilet). Sharp edges of the alveolus should be smoothened by a milling cutter providing a good cooling is ensured. Mucous margins are brought together by a stitch (“mattress stitch”). An absorbable hemo-styptic drug Traumacel in the powder form (Traumacel P) or dental suppositories have been used with good results. If bleeding does not stop upon this treatment, it is necessary to identify its cause and hospitalize a patient at a specialized department.

Category: Endodontics Notes



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