10 Questions and Answers About complications of tooth extraction

1.  What are the major complications of tooth extraction?

Fracture of the root or alveolar plate            Infection

Displacement of a root tip                            Perforation of the maxillary sinus

Bleeding                                                      Paresthesia

Dry socket (localized osteitis)                      

Soft-tissue injury 

Fracture of the tuberosity

2.  What is the most common complication of tooth extraction? How can it be prevented?

The most common complication of tooth extraction is root fracture. The best method of prevention is to expose the tooth surgically and to remove bone before extraction.

3.  Which tooth root is most likely to be displaced into an unfavorable anatomic site during extraction?

The palatal root of the maxillary first molar is most likely to be displaced into the maxillary sinus during extraction.

4.  Describe the prevention and treatment of postoperative bleeding.

A thorough preoperative medical history helps to identify most patients at systemic risk for postoperative bleeding. On leaving the office, patients should receive both verbal and written instructions for postoperative wound care. Of particular relevance regarding bleeding is the avoidance of rinsing, spitting, and smoking during the first postoperative day. The patient should be specifically instructed to avoid aspirin. Patients should be instructed to bite on a gauze sponge for 30 minutes after the extraction.

A patient with postoperative bleeding should return to the office. The wound should be cleared of residual clot or debris, and the source of the bleeding identified. Local anesthesia should be administered, and existing sutures removed. The wound should be irrigated copiously with saline. Residual granulation tissue should be removed. A hemostatic agent, such as gelatin sponge, oxidized cellulose, or oxidized regenerated cellulose, may be placed into the extraction site. The wound margins should be reapproximated and carefully sutured.

5.  What is a dry socket?

Dry socket is a localized osteitis of the extraction site that typically develops between the third and fourth postoperative day. The term applies to the clinical appearance of the socket, which is devoid of a typical clot or granulating wound. Consequently, patients develop moderate-to-severe throbbing pain. The frequency of dry socket after routine tooth extractions is around 2%. However, the condition may occur in as many as 20% of cases after extraction of impacted mandibular third molars.

6.    How can dry socket be prevented?

Prevention of dry socket is somewhat controversial. It is generally agreed that careful technique to minimize trauma reduces the likelihood of this complication. In addition, preoperative rinsing with chlorhexidine gluconate 0.12% may be of benefit. Placement of antibiotic-impregnated gelfoam or injection of polylactic acid granules into the socket before suturing may be of value, although these interventions are far from being universally accepted.

7.    How is dry socket treated?

Curettage of the extraction site is contraindicated. The extraction site should be gently irrigated with warm saline. A medicated dressing is then placed into the socket. The medication used for this purpose has been the topic of much discussion. One alternative consists of eugenol, benzocaine, and balsam of Peru. Alternatively, a gauze dressing impregnated with equal amounts of zinc oxide, eugenol, tetracycline, and benzocaine may be used.

8.    What substances should never be placed into a healing socket? Petrolatum-based compounds and tetracycline powder.

9.    Describe pain control after extraction.

For most patients, adequate control of postoperative pain is obtained with nonsteroidal antiinflammatory drugs (NSAIDs). A large number of compounds are available. Data indicate that postoperative pain can be minimized if the first dose of NSAIDs is administered immediately after the procedure. No evidence indicates that preoperative administration of NSAIDs favorably alters the postoperative course. For patients unable to take NSAIDs because of allergies, ulcer disease, or other contraindications, various narcotic analgesics are available. Patients taking such medications must be cautioned about drowsiness and concurrent use of alcohol or other medication. In no instance is persistent postoperative pain (>2 days) to be expected, and patients should be instructed to call if they have prolonged discomfort, which may indicate infection or another complication.

10.    What percent of patients request pain medication after third-molar removal?

90%.