Tooth Extraction Complications: What Are The Risks?

Tooth Extraction Complications
Tooth Extraction Complications

Tooth extraction complications may occur like any surgical procedure. The complications include prolonged bleeding, swelling, infection, and dry socket. First, let me clarify how the tooth extraction is performed and how the healing process occurs. After the injection of local anesthetic, the dentist grasps the tooth with a dental forceps and gently moves it back and forth to loosen it. Then, he/she removes it from the bone (the socket). If the tooth is broken under the gumline or impacted, the dentist will perform a surgical extraction and may cut the tooth in half to facilitate its removal.

After the removal of the tooth from the socket, the blood fills the socket and a blood clot forms. This blood clot protects the bone and nerve endings and helps in the formation of new bone and soft tissue. The dentist will give you instructions following the extraction (aftercare instructions) to speed the healing process and prevent tooth extraction complications.

Tooth Extraction Complications

In most cases, tooth extraction is performed successfully. However, tooth extraction complications may occur during or after the procedure.

Tooth Extraction Complications: During The Procedure

Fracture of The Tooth

Tooth fracture during the extraction is one of the most common tooth extraction complications, especially if the tooth has a large restoration, root canal treatment, or extensive dental caries. However, this may not prevent the extraction from continuing. If the fracture occurs at the gumline, the dentist will perform a surgical extraction and may cut the tooth in half to facilitate its removal.

Maxillary Sinus Exposure

The maxillary sinus is located above upper molar teeth. During the extraction, a communication between the oral cavity and the maxillary sinus may occur. It is known as oroantral communication. The treatment of maxillary sinus exposure depends mainly on the size of the exposure and whether the sinus membrane is perforated or not.

Loss of a Tooth

A tooth or a part of a tooth may be displaced into the maxillary sinus. In this case, a procedure is known as “Caldwell-luc” may be needed to remove the tooth from the sinus.

Injury to The Adjacent Tooth

The application of force on the adjacent tooth by various instruments may cause the damage of the adjacent tooth, restorations, or crowns. Also, it may loosen the adjacent tooth.

Nerve Injury

It is a rare complication. Nerve injury can occur during the extraction of lower third molar (wisdom tooth), causing numbness and tingling sensation. The injury can be temporary or permanent, depending on the type of injury.

Fracture of The Jaw

This is a rare complication. This may be caused by the application of excessive force during the extraction or the bone that surrounds the tooth is fragile.

Dislocation of The Mandible

Dislocation may occur if the mandible is not supported during the removal of lower teeth.

Displacement of The Tooth into The Airway

During the procedure, the tooth may slip out the forceps. If the dentist can’t find the tooth, he/she will refer the patient to perform a chest x-ray in a hospital. If the patient swallowed the tooth, it won’t cause any harm. However, if the patient inhaled the tooth, an urgent operation must be performed to remove the tooth from the airway or the lung for the prevention of any complication such as lung abscess or pneumonia.

Osteonecrosis

It is characterized by the death of bone due to the damage of blood vessels. Possible causes of osteonecrosis after tooth removal (risk factors) include:

  • Excessive alcohol use.
  • Radiation therapy and chemotherapy.
  • Chronic corticosteroid use.
  • Cancer.
  • Autoimmune disease.

Tooth Extraction Complications: After The Procedure

Postoperative Pain

Discomfort after tooth removal is expected and can be relieved by painkillers and anti-inflammatory drugs. However, severe pain after tooth removal is unusual and may indicate that another complication has occurred. So, contact your dentist if you have pain for more than 2 days after tooth removal.

Swelling

Mild swelling may occur after simple extraction. It is common and normal. With difficult, surgical, or multiple extractions, you may notice a more significant swelling involving a large portion of your face. To prevent or minimize the swelling, apply ice packs to your face over the area where the surgery is performed, immediately after the procedure. Also, swelling may indicate postoperative infection and may require antibiotics.

Postoperative Bleeding

Follow aftercare instructions to stop the bleeding and speed the healing process. If you:

  • Have previous postoperative bleeding.
  • Take medications such as anticoagulant medications.
  • Take aspirin.
  • Have bleeding disorders (hemophilia).
  • Have a liver disease.

You should give this medical history to your dentist or oral surgeon to prevent tooth extraction complications.

Limited Mouth Opening

Limited mouth opening, also known as trismus or lockjaw, may be caused by:

  • The inflammation after the procedure
  • Postoperative infection.
  • Postoperative swelling.
  • Excessive stretching of the jaw during the procedure.
  • Surgical trauma.
  • Injury of the chewing muscle due to the needle (local anesthetic injection).

Dry Socket

It is one of the painful tooth extraction complications. In some cases, a blood clot may adequately form, dislodge, or dissolve before the healing, making the bone and nerve endings exposed. The exposed bone is extremely painful and sensitive to touch. The factors that increase the risk of dry socket include smoking, surgical trauma, and poor oral hygiene.

Postoperative Infection

In some cases, the socket may become infected, causing pus formation, swelling, and pain. In this case, the dentist may prescribe antibiotics.

How to Prevent Tooth Extraction Complications?

To prevent tooth extraction complications, you should:

  • Give your medical history and report all medications used to the dentist before the extraction.
  • Follow aftercare instructions provided by your dentist, immediately after the procedure.
    • Bite on the gauze bad for 30 minutes to stop the bleeding.
    • Don’t rinse your mouth or spit forcefully in the first 24 hours to prevent the dislodging of the blood clot.
    • Apply ice packs to your face immediately after the procedure to prevent the swelling.
    • Avoid smoking and alcohol because the can cause postoperative bleeding.
    • Take the prescribed medications and avoid aspirin.
  • Maintain a good oral hygiene by using a soft toothbrush and dental floss and avoid the extraction site.
  • Watch out for potential tooth extraction complications, keep your follow-up appointment, and contact your dentist immediately if you have:
    • Prolonged bleeding.
    • Persistent pain for more than 2 days.
    • Persistent swelling.
    • Bad smell or taste.
    • Limited mouth opening.
    • Numbness or tingling sensation.