Oral and Maxillofacial Surgery Consulting Specialist

Complications of Dental Extractions Compromises of the Airway Oral Bleeding Orofacial Injuries Odontogenic Infections Osteonecrosis Orafacial Pain Perils of Treatment - Diseases of the Teeth /Mouth

Complications of Dental Extractions Bleeding Swelling Jaw Stiffness (Trismus) Pain / Dry Socket (Alveolar Osteitis) Infection Sensory Nerve Disturbance Oral antral communication (fistula) Temporomandibular Joint (TMJ) dysfunction Jaw fracture

~ Dental Caries ~ Periodontal Disease Dental infections are the most common infections known to man

Dental treatment is frequently performed on an urgent / emergency basis as a result of an active dental infection or injury producing pain and/or swelling

 Rate of post operative bleeding ( 7% to 10% 3 rd molars)  Usually associate with  difficult extraction  long surgical procedures  Usual bleeding sources  7 % arterial  72 % soft tissue

Bleeding – Complication of tooth extraction

Bleeding – Complication of tooth extraction Pressure placed directly over the bleeding site typically stops bleeding

Swelling after tooth extraction is not uncommon

Jaw Stiffness (Trismus) Complication of tooth extraction

Jaw pain following tooth extraction 1 st 24 hours usually associated with surgery 24 to 36 hours post op Constant dull throbbing spontaneous pain may be associated with DRY SOCKET

TREATMENT: 1.Gently irrigate (saline) 2.Place sedative dressing

Post Op Infections (0.06 – 4.3% for 3 rd molars) Many extractions are performed on and urgent basis due to pain from an infected tooth

Infections may spread to adjacent tissue spaces Sinus and orbital cavities Sinus and orbital cavities Inter muscular spaces Inter muscular spaces of the jaw of the jaw Floor of the mouth Floor of the mouth Parapharyngeal spaces Parapharyngeal spaces

Altered Nerve Function (0.02 – 7.1% for 3 rd molars) The most frequent nerve injury Lingual and Inferior Alveolar / Mental NervesMental nerve nerve Lingual Inferior Alveolar nerve nerve Lingual

Oral Antral Communication following tooth extraction (0.06% for 3 rd molars)

Temporomandibular Joint Pain / Dysfunction Myofascial Pain

Fracture of the jaw associated with dental extractions (< 0.01% for 3 rd Molars) Subject to Spontaneous Fracture

Complications of Dental Extractions Compromises of the Airway Oral Bleeding Orofacial Injuries Odontogenic Infections Osteonecrosis Orafacial Pain Perils of Treatment - Diseases of the Teeth /Mouth

Compromises of the Airway Aspiration Bleeding Infection Injuries

Aspiration Teeth & fragments Dental appliances Dental instruments Aspirated Tooth Ingested Tooth Barriers (rubber dam) frequently used to prevent swallowing / aspiration

Airway compromise Due to bleeding Post op chin / floor of mouth surgeryPost extraction in patient with Bleeding Diatheses

Airway compromise due to dental infection

Airwaycompromise due to Injury Flail Mandible Fracture Unopposed pull of supra hyoid muscles in an inferior & posterior direction

Airway compromise Injury with bleeding (Mandibular Fractures)

Complications of Dental Extractions Compromises of the Airway Oral Bleeding Orofacial Injuries Odontogenic Infections Osteonecrosis Orafacial Pain Perils of Treatment - Diseases of the Teeth /Mouth

Bleeding Gums Periodontal Disesae Hormonal Changes (pregnancy gingivitis) Anticoagulant Therapy Bleeding Diatheses

Midline tongue piercing relatively blood-free especially when good compression hemostasis is used (tongs)

Significant bleeding may be encountered with with piercing more laterally

Direct pressure whether applied manually or with sutures generally arrests bleeding

Complications of Dental Extractions Compromises of the Airway Oral Bleeding Orofacial Injuries Odontogenic Infections Osteonecrosis Orafacial Pain Perils of Treatment - Diseases of the Teeth /Mouth

Dentoalveolar Fractures Jaw Fractures (Maxilla / Mandible) Soft Tissue