Complications of Exodontia

Postoperative pain: discomfort is normal. Analgesia (paracetamol or ibuprofen). Severe pain is unusual and may indicate other complication.

Postoperative swelling: mild swelling normal, esp. if difficult procedure / trauma. Significant swelling = postop infection / hematoma. Managment required like systemic antibiotics, drainage. Less likely is surgical ephysema.

Trismus: limited mouth opening is unusual and likely infectiv in origin.

Fracture of teeth: crown may fracture if large restoration present. If fractured subgingival then transalveolar approach necessary to remove root. If small root fragment retained (3mm) it may remain in situ. If a pical infection, inform patient, Atb.

Excessive bleeding: measure BP and pulse to establish if patient is in shock, this while patient bites firmly on gauge to encurage hemostasis. If in shock, must replace volume with plasma infusion (hospital). History gives you important info to realise reason (previous history, medications, liver disease, family history, previous complications, alcohol etc.)

- To achieve hemostasis: socket capillaries (pack with resprbable cellulose: surgicell), gingival capillaries (suture socketwith material that has adequate tension like silk, vicryl), large blood vessels: ligate vessel with suture

Dry socket (alveolar ostitis): a blood clot may unadequately form /break down. Predisposing factors: smoking, surgical trauma, vasoconstriction in anesthetic, oral contraceptives and history of radiotherapy. Exposed bone is painful and sensitive to touch. Management: reassure patient, irrigate socket with warm saline /chlorhexidine (remove debris), dress socket to protect it from painful stimuli. BIPP (bismuth iodeform parafin paste), lidocaine gel on ribbon gauge.

Postoperative infection: pus, local swelling, lymphadenopathy. Manage same way as dry socket and maybe Atb. Take xray to exclude retained root or sequestered bone. If material present, curettage.

Damage to soft tissue: when lower lip is anesthesized and extracting upper tooth, bein elevator to tongue!

Damage to nerves: paresthesia / anesthesia = damage in inferior alveolar canal during extraction of lower 8s!

Opening of maxillary sinus: oro-antral fistula during extraction of upper molars or damage to the lamina creating a oroantral communication with tooth.

Loss of tooth: displace into maxillary sinus, infratemporal fossa or tissue spaces about the jaw. Loss of tooth fragments to sinus or inferior alveolar canal etc. Aspiration can also happen.

Fracture of maxillary tuberosity

Fracture of jaw

Dislocation of mandible

Surgical empysema (air in soft tissues producing crackling on palpation).