Tooth extraction is one of the invasive dental procedures that involve the removal of the tooth from its bony socket. Typically tooth extractions are performed for a wide range of dental conditions such as tooth decay, periodontal disease, traumatic fracture of the tooth, and tooth impactions.
Sometimes, even orthodontic interventions require the removal of teeth to allow proper alignment of the jaw’s remaining teeth. Usually, an oral surgeon decides to extract the tooth after careful examination and observation of the dental condition.
Although tooth extraction helps to treat a dental condition, it can have some complications that can affect the healing of the extraction site. Some of the post-extraction difficulties include bone disease, dry socket, bleeding, and infection. Today’s article will highlight the complications of tooth extractions. Furthermore, we will discuss some preventive tips that can tackle the difficulties.
What is the purpose of tooth extraction?
Typically, tooth extraction is a dental procedure performed by an oral surgeon to preserve or improve the oral health of the patient. It involves the removal of the tooth entirely from the jaw bine. Usually, tooth extractions are performed for the following reasons –
- Grossly decayed or damaged tooth – in such cases, the tooth can not be restored by any other dental treatment. Tooth extraction is the only option to prevent further infection spread in the mouth.
- Orthodontic intervention – often, malocclusions like crowding of the teeth and protrusion of the front teeth require removal of one or more teeth in the jaw to create space. This helps to align the remaining teeth with braces, which eventually fills the gap. (1)
- Impactions – third molars are most commonly removed from the jaw due to tooth impaction and to prevent the risk of pericoronitis.
- In patients undergoing radiation or chemotherapy – sometimes radiation and chemotherapy to the head and neck cause tooth decay. In such cases, the affected teeth are extracted from the jaw.
What are the complications associated with tooth extraction?
Generally, the complications of tooth extraction can be categorized into three types –
- Failure of anesthesia due to faulty technique or insufficient dosage
- Pain associated with a burning sensation during the administration of anesthesia
- Breakage of needle
- Soft tissue injury such as puncture wound or abrasion of the tissues – caused by slippage of a sharp instrument such as an elevator leading to lacerations. Additionally, bruises are made during the rubbing of bur shank against the soft tissue.
- Root fracture, dislodgment of the adjacent tooth or restoration and root displacement (2)
- Extraction of the wrong tooth
- Dislocation of the temporomandibular joint due to excessive application of the force and inadequate jaw support during extraction.
- Fracture of the alveolar process and maxillary tuberosity due to excessive pressure applied during tooth extraction.
- Dry socket – caused by dislodgement of the blood clot in the socket. The bony socket becomes red, tender, and swollen. This condition is excruciating and usually occurs after 2-3 days of tooth extraction.
Treatment of dry socket usually includes irrigation of the socket with warm saline and antiseptic solution. A zinc oxide eugenol dressing is placed in the socket. Analgesics and sedatives are prescribed to relieve the pain. (3)
- Trismus – it is usually caused due to damage to the temporomandibular joint. Additionally, patients who keep their mouth open for a long time may experience trismus. This condition usually recovers itself within 5-6 weeks. Physiotherapy and warm saline mouth rinse are best to treat trismus.
- Hemorrhage is a typical tooth extraction complication that occurs within 48 hours (reactionary hemorrhage) or after seven days (Secondary hemorrhage). Typically, it is caused by an increase in blood pressure or infection, respectively.
Treatment of hemorrhage depends on the general medical condition of the patient. The dentist cleans the extraction wound and applies digital pressure with gauze. The tannic acid powder is also used to arrest the bleeding. Once the bleeding is slowed down, gelatin or fibrin foam pack is placed into the socket for healing.
- Infections – these are usually caused when there is bone sequestrum. It is seen as granulation tissue. Usually, diseases are treated with hot water mouth rinse and removal of the granulation tissue. (4)
- Osteomyelitis – it is a bone condition caused y extraction of lower teeth under acute gingival inflammation. This condition leads to general weakness, pain, and pyrexia. Treatment involves debridement of the affected area and the use of analgesics and antibiotics.
- Edema – is a swelling caused secondary to soft tissue trauma during tooth extraction. Usually, edema is formed by extravasation of the fluid in the traumatized tissue.
Usually, treatment of edema includes cold compressions and therapeutic management with antibiotics.
What are the techniques to prevent complications of tooth extraction?
Let’s review the management techniques in the same order as the complications mentioned earlier –
Prevention of pre-extraction complications
- Usually, 2 – 4 ml of local anesthesia is sufficient to anesthetize the area of the extraction. Proper techniques must be followed for nerve block and infiltrations to ensure that the tooth and soft tissues are numb. The dentist must also check for signs of adequate numbness before proceeding with a tooth extraction.
- Pain and burning sensation during anesthesia can be managed by using topical anesthetic before using the needle. Use a sterile anesthetic solution and make sure the needle is sharp. Inject the solution slowly into the site.
- Needle breakage can be managed by using a needle with appropriate length and width suitable for specific nerve blocks. Avoid using short needles. Do not bend the needle at any point. Be cautious when inserting the needle into the soft tissue, especially in children. (5)
Prevention of complications during tooth extraction
- The surgeon must be mindful of the surrounding soft tissues. Care must be taken to use a gauze piece to place it on the soft tissue where the bur handpiece would be placed. Moreover, effective suction and appropriate support are necessary to prevent slippage of the instrument.
- Root displacement and dislodgment of adjacent teeth or even root fracture can be prevented by limiting the force applied to luxate the tooth of interest. Avoid excessive pressure application that may cause damage to the integrity of the adjacent tooth.
- The dentist must always double-check which tooth is to be removed before starting the procedure.
- The lower jaw must always be supported during the extraction procedure. Never force the patient to open the mouth wide.
- Reasonable force should be applied while luxating the tooth. At the same time, the dentist must apply intermittent pressure to allow the ligaments to break and loosen the tooth. The alveolar process must be supported at all times.
Take away message
Tooth extraction is one of the most extensive dental procedures performed to prevent the spread of a tooth infection. Additionally, it is committed to treating grossly decayed teeth that are also associated with periodontal problems.
As a beneficial tooth extraction procedure is, there are also some complications associated with this procedure. Some of the tooth extraction complications include post-extraction infection, bleeding, trismus, and pain. Some complications may occur before a during tooth extraction, such as soft tissue injury, injury to adjacent teeth, and surrounding bone.
The dentist should take every preventive measure to ensure proper tooth extraction. Moreover, the patient must follow post-extraction instructions to allow adequate healing of the extraction site.
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