SOME IMPORTANT COMPLICATIONS OF EXTRACTION

In some unusual cases, there may be:-

a. Failure to secure anaesthesia.
b. Fracture of crown, root, alveolar bone, adjacent tooth, maxillary tuberosity, mandible.
c. Dislocation of adjacent tooth, TMJ.
d. Displacement of root into soft tissues, maxillary antrum.
e. Excessive haemorrhage – during, after completion and post operatively.
f. Damage to soft tissues, adjacent nerves.
g. Post operative pain due to dry socket.
h. Post operative swelling – oedema, haematoma, infection.
i. Trismus – inability to open mouth fully.
j. Syncope.
k. Oro-antral communication.
l. Respiratory arrest, cardiac arrest.

EXCESSIVE HAEMORRHAGE

Treatment :--

a. Pressure packs.
b. Suturing.
c. Styptics—Thrombin, gelatin foam, ethamsylate, botropase, adrenaline, etc.
d. Bone wax.

DRY SOCKET

It is a condition characterized by loss of clot in socket, sever throbbing pain, bad odour, which is usually manifested after 48 hrs following the extraction.

Etiology

1. Unknown.
2. Excessive trauma during extraction.

It is more common in mandible than in maxilla and more so in posterior region than in anterior region.
It happens more in females than males. Old age is more prone for this condition. Smokers are affected more than non-smokers.

Features

a. Severe throbbing pain.
b. Bad breath.
c. Empty socket appearance.
d. Cervical lymphadenopathy.
e. Fever.

Management

A. Local.

Local dressing in the dry socket. Eg. ZnOE paste, BIPP, Metronidazole gel.

B. Systemic.

Usually symptomatic, giving antipyretics, analgesics, etc. A course of Metronidazole 400 mg TID is recommended.

Prevention

1. Minimum trauma during extraction.
2. Avoid smoking after extraction.
3. Chlorhexidine mouthrinse from 2 days prior to extraction.
4. Warm saline mouthrinse 24 hrs. after extraction.

SYNCOPE

It is sudden transient loss of consciousness secondary to cerebral ischaemia.

Predisposing factors :-

• Psychogenic

  a. Fright.
  b. Anxiety.
  c. Emotional Stress.
  d. Sudden pain.
  e. Sight of blood.
  f. Sight of surgical instruments.

• Non Psychogenic

  a. Upright / standing position.
  b. Hunger.
  c. Exhaustion.
  d. Poor physical condition.
  e. Hot humid climate.

Critical level of cerebral blood flow required to maintain unconsciousness is 30 ml/100gm of brain tissue/minute. When a patient is still maintained in upright position, ability of heart to pump blood to brain is impaired leading to loss of consciousness.

Clinical Manifestations

Early – Feeling of warmth, pale appearance, heavy perspiration, complaint of feeling bad or weak or giddy, nausea, rapid heart rate.

Late -- Pupillary dilatation, yawning, coldness in hands, hypotension, bradycardia, visual disturbances, dizziness.
All this eventually leads to unconsciousness.

Management

1. Place patient in supine position with feet elevated.
2. Establish patent airway with chin lifted and head tilted.
3. Check breathing.
4. Loosen clothings.
5. Monitor vital signs like blood pressure, heart rate, respiratory rate.
6. Spirit of ammonia – nose.
7. Spray cold wave.
8. Maintain verbal conversations.
9. If pulse < 30/minute, administer Atropine 0.4 mg IV. It increases heart rate.
10. Transient hypoglycemia—Administer 50 % dextrose in saline IV.