Difficulties or complications may occur during tooth extraction. Here some of the problems are listed which may occur during the tooth extraction procedure. Some of these complications which occur during the tooth extraction procedure are common and others are quite rare.
To minimize risk of Tooth extraction complications, patient should discuss his medical history, past dental history with the dentist or the oral surgeon.
In some rare cases, it may become difficult to numb the tooth which can be due to infection and inflammation of the tooth, anatomical differences or apprehension of the patient. If the tooth is not anesthetized, then the tooth extraction is rescheduled with antibiotic coverage or the procedure is done under sedation or general anesthesia.
The fillings or crowns of the adjacent teeth may come out or the adjacent teeth may become loose or fracture during the tooth extraction procedure. It can occur due to injudicious use of elevators during the tooth extraction. The dental surgeon should be careful during the tooth extraction and this should not happen.
Oroantral fistula after extraction of an upper molar. The antral floor is often in close proximity to the roots of maxillary molars and premolars
The maxillary sinus may be accidentally opened during the tooth extraction and cause complication after tooth extraction. In some cases; the roots of the teeth (molars and premolars) may be displaced into it. The upper molars and the premolars or bicuspids have their roots close to the sinus. This complication is more common when the teeth project into the sinus than when there is considerable bone between the floor of the sinus and the root apices. In cases of apical infections, the chances of perforation (communication) are more as the bone between the root and the sinus may have been destroyed by the infection. Mouth sinus communication complication can occur during tooth extraction.
In most cases, the perforation is very small and may not even be noticed by the surgeon. The blood clot filling the tooth extraction wound will close such small communications and unless the sinus is infected, the area will heal spontaneously.
If a small opening is seen, then treatment is done by placing sutures across the socket to approximate the gingival tissue. Some absorbable materials may be used. Large openings can be closed with buccal flap. Post-operatively, patient should not blow nose for 1week, keep mouth open if sneezing is necessary, avoid rinsing vigorously, remain on relatively soft diet for several days.
If this communication is left untreated then it might result in a grave situation, like every time the patient drinks something, it will flow out of his nose. This can go on to cause more harm and result in a serious condition called sinusitis.
Root of the tooth may be displaced in the sinus and may cause tooth extraction complication of sinus. The roots have to be removed from the sinus.
X-ray showing root fragment in maxillary sinus
To remove the root, suction tip, iodoform gauze packed through the socket into the sinus or direct approach method can be used.
Root Displaced in Fascial (submandibular) Space during Tooth Extraction
The roots of lower molars may be pushed through a perforation in the back surface of mandible to the region of submandibular fossa and then fascial space. The root should be removed by oral surgeon in these cases and prophylactic antibiotic should be given post-operatively.
Right side submandibular space infection
Laceration of Gums and Mucosa Complication during Tooth Extraction
Gingival and mucosal lacerations occur mostly in difficult and complicated tooth extractions. It mostly occurs due to faulty technique used by the dentist to remove the tooth or due to wrong method of tooth extraction. Gum laceration if associated with destruction and loss of underlying bone can result in irregularity of the alveolar ridge and prolongs the healing process.
Injury to the Nerve (Inferior alveolar nerve) during Tooth Extraction
Injury to the inferior alveolar nerve may occur during the lower teeth extraction. Improper use of instruments may cause tearing or displacement of bony fragments that may impinge on the nerve. In this tooth extraction complication, paresthesia and sometimes anesthesia of half the lower lip and chin is present. There is loss of sensation and numbness present in the tongue, chin and lower lip in this tooth extraction complication. In most cases, the nerve regenerates itself in 6 weeks to 6 months. If the nerve doesn’t regenerate, then surgery is done for it.
1. Excessive bleeding may be encountered during tooth extraction procedure. Excessive, profuse bleeding can occur during the extraction procedure if there is accidental tearing or cutting of the large artery or vein. Laceration of inferior alveolar artery or vein during attempted root removal can cause profuse bleeding.
2. The bleeding is also profuse in region of inflammation where the tissues are excessively hyperemic.
3. Profuse bleeding can occur during the extraction if there is injudicious use of suction apparatus or when the wound is wiped excessively which causes continual removal of blood clots.
4. Patients with high blood pressure and those with bleeding disorders bleed profusely after the tooth removal. That’s why in cases of elevated blood pressure and bleeding disorders, tooth extraction procedure is not performed.
During the tooth extraction procedure, the tooth may fracture which further will complicate the procedure. More time and effort will be required to complete the tooth extraction and tooth sectioning may be required to remove the tooth.
Jaw Fracture Complication during Tooth Extraction
Jaw fracture may occur in patients with weak bone or patients with osteoporosis or if excessive force is applied to remove the tooth. If jaw fracture occurs during the tooth extraction, then jaw fixation is done and the tooth extraction is done after the jaw has healed.
Fracture of maxillary tuberosity during Tooth Extraction
Maxillary tuberosity fracture complication can occur during the tooth extraction procedure. The upper molars may be fused to the bone around the tooth and fracture of maxillary tuberosity may occur during the tooth removal. Fracture of maxillary tuberosity can be avoided by the dentist by expansion of socket with an elevator or small osteotome before attempted extraction of the tooth.
Subcutaneous emphysema (Air forced into connective tissue) during Tooth Extraction
Subcutaneous emphysema is a rare and an unusual complication which occurs during surgery in the mouth. It results from air being forced into the connective tissue of intramuscular or fascial spaces and it mostly occurs due to use of an air-driven dental hand piece or a compressed air spray bottle for irrigation. The swelling is rapid in this condition and may even result in mental disorientation of the patient due to extreme pain.
Incomplete Tooth Extraction
A small part of the tooth root may remain in the jaw bone after tooth extraction. It may increases the risk of infection in the socket. If the tooth tip is very small, then it may not be removed. It resorbs on its own in some time. If the tooth tip is very close to the nerve, then the dentist may not extract it as it is risky. They may be pushed into the sinus or local blood vessel network (pterygoid plexus) and may create tooth extraction complication.
Wrong Tooth Extracted during Tooth Extraction Procedure
It is possible that the dentist may remove the wrong tooth instead of tooth which needs to be extracted. The dental surgeon should be careful during the tooth extraction and this should not happen.
Lingual plate fracture during Tooth Extraction
It can occur in horizontally impacted lower wisdom teeth with low grade infection, in case of presence of large roots of tooth, in older patients who have sclerotic bone present, use of sudden force or injudicious use of osteotomes or chisels during tooth extraction. Socket needs to be tidied up in such case. Lingual nerve may also be damaged during the process. If lingual nerve is damaged in the process, it can cause numbness and burning sensation of the tongue.
Jaw dislocation during Tooth Extraction
Jaw dislocation during Tooth Extraction
Lower jaw dislocation complication may occur during the lower teeth extraction. In patients with pre-existing temporomandibular joint problem (TMJ), removal of wisdom tooth may exacerbate the condition. It can be prevented by telling the patient to bite on prop and making him rest for few minutes if the procedure is prolonged. If there is problem after tooth extraction, then it can be treated with heat. Muscle relaxants or bite raising appliances.
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