Local complications involving teeth and jaws
The most common complication is fracture of the crown or root of the extracted tooth. This is caused by severe caries destruction, complex anatomical shapes (severely curved or divergent roots, hypercementosis), as well as technical errors by the physician (improper forceps grip, sharp rotational movements). The left-behind root fragment will inevitably cause inflammation and must be removed (immediately or delayed by 7–10 days).
Rough instrument handling can lead to trauma to the adjacent tooth if it is used as a fulcrum for the elevator. This may result in its fracture or luxation. In complete luxation, replantation is indicated; in partial luxation, splinting is indicated.
An extremely rare but severe complication is a mandibular fracture. It usually occurs due to excessive pressure during the extraction of a lower third molar against a background of bone thinning (due to cysts, osteomyelitis, or senile osteoporosis). The patient experiences pain and is unable to open the mouth or chew. Treatment requires reposition and fixation of the fragments. In addition, in elderly patients, wide opening of the mouth combined with pressure on the jaw can provoke a mandibular dislocation, which the physician must reduce immediately.
Soft tissue injury and tooth displacement
Careless technique frequently leads to injuries of the gingiva and oral mucosa.
- Gingival laceration occurs if the circular ligament of the tooth was not completely detached.
- Tissue crushing happens when applying forceps beaks "blindly".
- Injury to adjacent areas (cheek, palate, tongue) occurs when the elevator slips.
Prevention consists of mandatory control of the alveolar process with the surgeon's left hand. All torn tissues must be surgically debrided and sutured.
A specific problem during the extraction of lower wisdom teeth is pushing the root into soft tissues. The root is displaced beneath the mucosa on the lingual side. Attempts to retrieve it "blindly" only worsen the situation, pushing the fragment deeper into the sublingual region. In such cases, accurate radiography and sometimes hospitalization are required.
Maxillary sinus complications
During the extraction of maxillary molars and premolars, perforation of the floor of the maxillary sinus is possible. The reasons lie in anatomy (thin sinus wall), the presence of chronic periodontitis, or rough manipulation with a surgical curette.
Diagnosis of perforation:
- Blood with air bubbles is released from the socket.
- When exhaling through a pinched nose, air whistles out through the mouth (Valsalva maneuver / nose test).
- The surgical curette drops deep into the socket without resistance.
If there is no inflammation in the sinus, the socket is covered with a hemostatic sponge or iodoform gauze and fixed with a splint to preserve the blood clot. A gross error is tight tamponade of the entire socket, as it prevents clot formation and leads to chronic sinusitis. For a large defect, plastic closure with a trapezoidal flap is used.
Sometimes the root of a tooth can be pushed into the sinus itself. It is strictly prohibited to try to retrieve it through the socket! The patient must be referred to a hospital for endoscopic extraction or surgery through the anterior wall of the sinus.
Bleeding after tooth extraction
Hemorrhages are divided into primary (occurring immediately) and secondary. Secondary can be early (1–2 hours later due to the vasodilation phase after the effect of epinephrine in the anesthetic wears off) and late (several days later due to purulent dissolution of blood clots).
Among local causes, traumatic extractions and inflammatory processes predominate. Local arrest of hemorrhage includes suturing (for mucosal tears), compression of the bone edges with forceps, or tight packing of the socket with iodoform gauze for 5–6 days. Biological hemostatics such as gelatin and collagen sponges are also widely used.
General complications and aspiration
General systemic reactions include fainting and collapse, which occur against the background of severe stress, fear, or inadequate anesthesia. The risk of aspiration (inhalation) of a slipped tooth is singled out separately. This is a life-threatening condition causing asphyxia and requiring emergency tracheotomy. If the tooth was accidentally swallowed, it most often passes through the GI tract naturally, causing only temporary throat discomfort due to scratches.
Briefly: answers to topical questions
What general systemic complications can develop during a dental surgeon appointment?
The following general complications and life-threatening conditions can develop at the dental office:
- Fainting (syncope) — may be associated with psychoemotional stress and fear.
- Collapse — accompanied by profound hemodynamic and circulatory disorders.
- Shock — classifies as a general complication.
- Coma.
- Cardiac arrest — can be sudden or gradual.
- Myocardial infarction.
- Heart and respiratory failure.
- Hypertensive crisis.
- Epileptic status.
- Allergic reactions.
What local hemostatic agents and materials are used to stop socket bleeding?
For local arrest of bleeding from the tooth socket, the following are used:
- Iodoform gauze — used for socket packing.
- Hemostatic sponges — collagen, gelatin, as well as sponges with gentamicin.
- Thrombin.
- Fibrin film.
- Biological antiseptic tampon.
What instruments are used for the extraction of mandibular tooth roots?
Specialized surgical instruments are used to extract mandibular roots. Depending on the clinical situation, the following are used:
- Cowhorn forceps (beaked forceps) — curved on the edge, with converging thin and narrow beaks for extracting the roots of incisors, canines, and premolars.
- Bayonet forceps — universal bayonet forceps, which are used when necessary for the roots of mandibular incisors and canines.
- Angular elevator — the main instrument for extracting separated roots of mandibular molars and other mandibular roots.
- Fissure bur — used to separate the roots of molars when forceps cannot be applied.
To memorize the causes of maxillary sinus perforation, use the rule "APA": Anatomy (thin bone up to 1 mm), Pathology (chronic inflammation fuses the mucosa), Iatrogenesis (rough handling with forceps or curette).
Class and exam questions
Is it mandatory to remove a fractured root tip?
Yes, leaving a root fragment leads to the development of an inflammatory process. If it cannot be removed immediately, a revision surgery is scheduled in 7–10 days once the inflammation subsides.
Is it possible to retrieve a root pushed into the maxillary sinus through the socket?
Strictly forbidden. Attempts to retrieve the root through the socket increase the bone defect and worsen the prognosis. Extraction is performed in a hospital setting surgically or endoscopically.
Why is it not allowed to tightly pack the entire socket in case of sinus perforation?
Tight packing to the full depth prevents the formation and preservation of a blood clot. This leads to the formation of a permanent fistulous tract and the development of chronic sinusitis.
How to stop bleeding from the depth of the bone socket?
Tight packing with iodoform gauze placed from the bottom to the edges of the socket, or the introduction of biodegradable hemostatic sponges, is used. The gauze strip is removed strictly on the 5th–6th day.
What else to study on this topic
- Processes of normal osteogenesis and socket healing after tooth extraction
- Classification and pathogenesis of hemorrhagic diatheses affecting tooth extraction
- Methods of plastic closure of an oroantral communication
- Application of biological hemostatics and blood products in dentistry
- Surgeon's action algorithm in case of partial and complete luxation of an adjacent tooth
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Other topics in "Chapter 14. Tooth Extraction"
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