Joseph L. McQuirter, DDSOral 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

Bleeding following tooth extraction Rate of post operative bleeding ( 7% to

10% 3rd 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

extraction1st 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

Dry Socket

(1 – 30% for 3rd molars)

Post Op Infections(0.06 – 4.3% for 3rd 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• Inter muscular spaces of the jaw• Floor of the mouth• Parapharyngeal spaces

Altered Nerve Function (0.02 – 7.1% for 3rd molars)

The most frequent nerve injury Lingual and Inferior Alveolar /

Mental Nerves

Mental nerve

Lingual nerve

Inferior Alveolar nerve

Lingual nerve

Oral Antral Communicationfollowing tooth

extraction(0.06% for 3rd molars)

Temporomandibular Joint Pain / Dysfunction

Myofascial Pain

Fracture of the jaw associated with dental extractions (< 0.01% for 3rd 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 compromiseDue to bleeding

Post op chin / floor of mouth surgery

Post extraction in patient with Bleeding Diatheses

Airway compromise

due to dental infection

Airway comprom

isedue to

Injury Flail Mandible Fracture

Unopposed pull ofsupra hyoid muscles in an inferior & posterior

direction

Airway compromiseInjury 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

DentoalveolarFractures

Jaw Fractures(Maxilla / Mandible)

Soft Tissue

Orofacial

Injuries