Complication of Tooth Extraction and their Management - Presented by Dr. Trisha and group as a part of OMS Department weekly presentation in Dhaka Dental College

1. Complication of Tooth
Extraction and their
Management
DR.TRISHA_49DDCH_2017

2. Classification of
COMPLICATION
Pre - Extraction
During
Extraction
Post Extraction

3. Pre -
Extraction
Associated with
LA
Difficulty in
Achieving
Pain During Needle Breaking Others
Difficulty in Co-
operation
Difficulty of
Access
Trismus
Restricted
mouth opening
Crowded or
Misplaced Teeth

4.  During Extraction
1.ABNORMAL RESISTANCE
2.EXTRACTION OF WRONG TEETH
3.DISLOCATION OF
-ADJACENT TOOTH
-TEMPOROMANDIBULAR JOINT
4.FRACTURE OF
-CROWN OF TOOTH BEING EXTRACTED
-ROOTS OF TOOTH BEING EXTRACTED
-ALVEOLAR BONE
-MAXILLARY TUBEROSITY
-ADJACENT OR OPPOSITE TOOTH
-MANDIBLE
5.DISPLACEMENT OF A ROOT
-INTO THE SOFT TISSUE
-INTO THE MAXILLARY ANTRUM
-UNDER GENERAL ANESTHESIA IN THE DENTAL
CHAIR
6.EXCESSIVE HAEMORRHAGE
-DURING TOOTH REMOVAL
-ON COMPLETION OF TOOTH REMOVAL
-POSTOPERATIVELY
7.SOFT TISSUE INJURIES
8.BROKEN INSTRUMENT
9.ORO-ANTRAL COMMUNICATION
10.NERVE INJURY
11.EMERGENCIES

5.  Post Extraction
• DRY SOCKET
• TRISMUS
• POST EXTRACTION HAEMORRHAGE
• HEMATOMA
• EDEMA
• INFECTION
• ACUTE OSTEOMYELITIS
• ORO-ANTRAL FISTULA

6. PRE – EXTRACTION
COMPLICATIONS

7. 1. Associated with Local Anaesthesia
A. Failure to secure
anaesthesia:
Cause-
 Faulty Technique
 Insufficient Dosage

8. Prevention
Careful Diagnosis of Nerve Distribution

9. Appropriate Technique
FIG: VARIOUS TECHNIQUES OF LA

10. B. PAIN AND BURNING SENSATION DURING
ANAESTHESIA
PREVENTION –
1. USE SHARP NEEDLE
2. USE TOPICAL ANAESTHETIC
3. USE STERILE LA SOLUTION
4. INJECT LA SLOWLY
5. MAINTAIN TEMPERATURE
6. BUFFERED LA, AT A pH APPROXIMATELY 7.4 , HAVE BEEN
DEMONSTRATED TO BE MORE COMFORTABLE ON
ADMNISTRATION.

11. C. NEEDLE BREAKAGE –
1. DO NOT USE SHORT NEEDLES FOR INFERIOR
ALVEOLAR NERVE BLOCK IN ADULTS OR LARGER IN
CHILDREN
2. DO NOT USE 30 GAUZE NEEDLES FOR IA NERVE
BLOCK
3. DO NOT BEND NEEDLES WHEN INSERTING THEM
INTO SOFT TISSUES
4. DO NOT INSERT A NEEDLE INTO SOFT TISSUE TO ITS
HUB UNLESS IT IS ABSOLUTELY ESSENTIAL FOR THE
SUCCESS OF THE INJECTION.
4. OBSERVE EXTRA CAUTION WHEN INSERTING
NEEDLES IN YOUNGR CHILDREN OR EXTREMELY

12. • ENSURE ANAESTHESIA BY
PUSHING A BLUNT PROBE
FIRMLY INTO THE GINGIVAL
CREVICE ON THE BUCCAL AND
LINGUAL SURFACES OF THE
TOOTH.
• EXPLAIN THE PATIENT
THAT ALTHOUGH HE MAY FEEL
PRESSURE BUT HE SHOULD
NOT FEEL ANY SENSATION OF
SHARPNESS.
• BUT IF PAIN FELT THAT
INDIACATES A FURTHER
INJECTION IS REQUIRED

13. 2.DIFFICULTY IN
CO-OPERATION:
• DO NOT FORCE THE
PATIENT
• SOUGHT
ALTERNATIVE METHOD
• IF NECESSARY USE
SEDATIVE OR GA.

14. 3.DIFFICULTY OF ACCESS
A . TRISMUS -
EXTRINSIC – FACIAL SCARS AND INFLAMMATORY SWELLINGS
INTRINSIC – ABNORMALITIES IN THE TMJ
PREVENTION-
1. WAIT UNTIL THE CONDITION RESOLVES
2. IF THERE IS A RISK TO THE AIR WAY – DO NOT DELAY IN
REMOVING CAUSE AND INSTITUTING DRAINAGE.
3. THE ACUTE PHASE MAY BE TREATED WITH ANTIBIOTIC AND
DRAINAGE
4. DO NOT FORCE THE JAW TO OPEN WHEN TRISMUS THAT IS
CAUSED DUE TO INFECTION AS IT MAY BREAK DOWN THE
PYOGENIC MEMBRANE AND CAUSE SPREAD.

15. B. REDUCED
APERTURE OF MOUTH
CAUSE -
• MALFORMATION –
(MICROSTOMIA)
• SCARRING
• PREVENTION – SURGICAL
APPROACH THROUGH ANGLE OF
MOUTH
C. CROWDED OR
MISPLACED TEETH
CAUSES LOOSENING OF ADJECENT
TOOTH
PREVENTION – SURGICAL

16. DURING
EXTRACTION

17. ABNORMAL
RESISTANCE:
CAUSES:
1.ROOT ABNORMALITIES- TWISTED,
DIVERGENT, BULBOUS, HYPERCEMENTOSIS.
2. SCLEROSIS OF ALVEOLAR BONE-
- PERIODONTAL DISEASE
- GERIATRIC PATIENT
3. ISOLATED TOOTH IN OCCLUSION OWING
TO NARROWING OF THE PDL
4. UNERUPTED TOOTH IMPACTED AGAINST
THE ROOTS OF TOOTH TO BE EXTRACTED
eg; LOWER THIRD MOLARS AGAINST
SECOND MOLAR ROOTS
PREVENTION:
1. CAUSE SHOULD BE SOUGHT

18. EXTRACTION OF WRONG TEETH
-COMMON SOURCE OF LITIGATION AND INDEFENSIBLE
PRECAUTIONS -
1.CHECK IMMEDIATELY BEFORE EXTRACTION.
2. RE-CHECK RADIOGRAPH
3. LET THE PATIENT CONFIRM
IF OCCURS-
1.INFORM THE PATIENT
2.EXTRACT RIGHT TOOTH
3.MAKE DECISION IMMEDIATELY
-RE- IMPLANT
-ACCEPT THE SITUATION

19. DISLOCATION OF ADJACENT TOOTH/RESTORATION
CAUSES-
1. MISUSE OF FORCEP
- ACCIDENTALLY ENGAGE PART OF NEXT TOOTH
- WITHOUT SUFFICIENT CONTROL,IT MAY BANG AGAINST THE UPPER TEETH.
2. MISUSE OF ELEVATOR
- MISUSED AS CLASS -1 LEVER.
-EMPLOYING THE NEIGHBOURING TOOTH,NOT BONE,AS FULCRUM.
3.SOME UNAVOIDABLE CAUSE-
eg-LUXATION OF PERMANENT PREMOLARS WHILE EXTRACTING DECIDUOUS MOLAR DUE TO ROOT
FORMATION OR INFECTION.
PREVENTION
1.WATCHING FINGERS- TO SUPPORT THE ADJACENT TOOTH AND TO DETECT ANY FORCE
TRANSMITTED TO IT.
2. IN CASE OF MISPLACED/MILDLY IMPACTED TOOTH, SURGICAL METHOD SHOULD BE FOLLOWED.
3.DON'T PLACE ELEVATOR TO MESIAL SURFACE OF 1 ST PERMANENT MOLAR,BECAUSE SMALLER 2ND
PREMOLAR MAY BECOME DISLODGED.

20. DISLOCATION OF
TEMPOROMANDIBULAR
JOINT
ETIOLOGY-
1. EXCESSIVE APPLICATION OF FORCE
2. INADEQUATE JAW SUPPORT
3. IT COMMONLY OCCUR IN SOME PATIENTS WHO
HAVE POSITIVE HISTORY OF RECURRENT
DISLOCATION.
4.IT MAY BE CAUSED BY INJUDICIOUS USE OF GAGS.
5. IN LENGTHY PROCEDURES
PREVENTION -
1.LOWER JAW SHOULD BE SUPPORTED DURING
EXTRACTION.
2. DO NOT FORCE OPEN THE MOUTH

21. MANAGEMENT-
TAKE A RADIOGRAPH FIRST-
IT SHOULD BE REDUCED IMMEDIATELY THE
OPERATOR STANDS IN FRONT OF THE PATIENT AND
PLACES HIS THUMBS INTRAORALLY ON THE
EXTERNAL OBLIQUE RIDGES LATERAL TO ANY
MANDIBULAR MOLARS WHICH ARE PRESENT AND
HIS FINGERS EXTRAORALLY UNDER THE LOWER
BORDER OF MANDIBLE. DOWNWARD PRESSURE
WITH THE THUMBS AND UPWARD PRESSURE WITH
THE FINGERS REDUCE THE DISLOCATION.
2.IF TREATMENT IS DELAYED, MUSCLE SPASM MAY
MAKE REDUCTION IMPOSSIBLE, EXCEPT UNDER
GENERAL ANESTHESIA.
3.THE PATIENT SHOULD BE WARNED NOT TO OPEN
HIS MOUTH TOO WIDELY OR TO YAWN FOR A FEW
DAYS POSTOPERATIVELY.
4.AN EXTRAORAL SUPPORT TO THE JOINT SHOULD
BE APPLIED AND WORE UNTIL TENDERNESS IN THE
AFFECTED JOINT SUBSIDES.
**IF THE CONDYLE IS INTO MIDDLE CRANIAL FOSSA,
REFER TO AN ORAL SURGEON.

22. FRACTURE

23. FRACTURE OF THE CROWN OF THE TOOTH TO BE
EXTRACTED
CAUSE –
1. IF THE TOOTH IS WEAKENED BY CARIES OR A LARGE
RESTORATION
2. IMPROPER APPLICATION OF THE FORCEPS TO THE TOOTH,
THE BLADES BEING EITHER APPLIED TO THE CROWN
INSTEAD OF THE ROOT OR ROOT MASS, OR WITH THEIR
WRONG AXIS ACROSS THAT OF THE TOOTH
3. IF THE BLADES ARE TO BROAD AND GIVE ONLY “ONE-
POINT CONTACT” , THE TOOTH MAY COLLAPSE.
4. IF FORCEP HANDLES ARE NOT FIRMLY HELD TOGETHER
5. EXCESSIVE FORCE OR SHORT JERKY MOVEMENT

24. FRACTURE OF THE CROWN

25. PREVENTION -
1. WHEN CORONAL FRACTURE OCCURS THE METHOD USED TO REMOVE
THE RETAINED PORTION OF TOOTH WILL BE GOVERNED BY THE
AMOUNT OF TOOTH REMAINING AND THE CAUSE OF MISHAP.
2. SOMETIMES A FURTHER APPLICATION OF THE FORCEP OR ELEVATOR
WILL DELIVER THE TOOTH.
3. OTHERWISE TRANS-ALVEOLAR METHOD SHOULD BE USED.

26. ROOT-FRACTURE OF THE TOOTH TO BE EXTRACT
• A ROOT APEX MAY BE DEFINED AS A ROOT
FRAGMENT WHEN ITS LESS THEN 5mm IN ITS
GREATEST DIMENTION.
CAUSE -
• SAME FACTORS CAUSING CROWN FRACTURE
• IN DEVITALIZED TEETH AND PERIODONTAL DISEASE
AND IN AGED PATIENTS
• BRITTLE ROOT
• SCLEROSIS
• LOSS OF ELASTICITY OF ALVEOLAR BONE

27. CAUSTIONS:
• ALL FRAGMENT SHOULD BE REMOVED
• WHEN THEY ARE LIABLE TO BECOME
EXPOSED WHEN DENTURES ARE
WORN.
• BUT IN CERTAIN CIRCUMSTANCES IT
IS WISE TO LEAVE THEM SUCH AS
• WHEN IT REQUIRES REMOVAL OF
LARGE AMOUNT OF BONE SUCH AS
EXTRACTION OF APICAL ONE-THIRD
OF PALATAL ROOT OF A MAXILLARY
MOLAR INVOLVES REMOVAL OF A
LARGE AMOUNT OF ALVEOLAR BONE
AND MAY BE COMPLICATED BY
DISPLACEMENT OF FRAGMENT INTO

28. TREATMENT :
1. THE USE OF LUXETORS MAY FURTHER EXPAND THE
ALVEOLUS TO ALLOW ELEVATION OR SAFE
APPLICATION OF ROOT FORCEPS.
2. EXTRACTED PORTION CAN BE USED AS GUIDE FOR
RETAINED PORTION.
3. TRANS-ALVEOLAR APPROACH
4. IF TRANS-ALVEOLAR METHOD IS NOT POSSIBLE,
REMOVE ANY PULPAL TISSUE AND ZINC-OXIDE AND
CLOVE OIL DRESSING SHOULD BE INCORPORATED
OVER THE FRAGMENT , THEN SEND FOR
MANAGEMENT

29. ALVEOLAR PROCESS
• IT’S A COMMON
COMPLICATION
• FRACTURE OF LINGUAL
CORTICAL PLATE IS SPCIALLY
SIGNIFICANT BECAUSE THE
LINGUAL NERVE MAY ALSO
BE TRAUMATIZEDCAUSE
• ACCIDENTAL INCLUSION OF ALVEOLAR BONE WITHIN THE FORCEPS
BLADES OR TO THE CONFIGURATION OF ROOTS
• PATHOLOGICAL CHANGES TO BONE
• THE EXTRACTION OF CANINES IS FREQUENTLY COMPLICATED BY
FRACTURE OF LABIAL PLATE, SPECIALLY IF THE ALVIOLAR BONE HAS BEEN
WEAKENED BY EXTRACTION OF LATERAL INCISOR OR FIRST PRE-MOLAR
BEFORE CANINE.

30. PREVENSION
IF 2, 3, 4 ARE TO BE EXTRACTED AT ONE VISIT, THE
CANINE SHOULD BE REMOVED FIRST
TREATMENT
1. REMOVE ANY FRAGMENT WHICH HAS LOST HALF OF ITS
PERIOSTIAL ATTACHMENTS BY GRIPPING IT WTH
HAEMOSTATIC FORCEP AND DISSECTING OFF THE SOFT
TISSUES WITH PERIOSTIAL ELEVATOR, A MITCHELL
TRIMMER OR A CUMINE SCALER.
2. SMOOTHEN ALL SHARP EDGES
3. IRRIGATE WITH NORMAL SALINE
4. SUTURE

31. MAXILLARY TUBEROSITY
CAUSES -
• INVATION OF TUBEROSITY BY MAXILLARY ANTRUM IN CASE OF
POSTERIOR MAXILLARY TOOTH.
• PATHOLOGICAL GEMINATION BETWEEN AN ERUPTED MAXILLARY
SECOND MOLAR AND AN UNERUPTED MAXILLARY THIRD MOLAR.
• ANKYLOSIS OF MAXILLARY MOLAR
• DECREASE RESISTANCE OF THE BONE OF THE REGION, DUE TO SEMI-
IMPACTED OR IMPACTED THIRD MOLAR.
• INADEQUATE LUXATION
• FORCEFUL CARELESS MOVEMENT

32. EFFECT
• MAY LEAD TO ORO-ANTRAL COMMUNICATIONS
• CREATE PROBLEM FOR RETENSION OF FULL
DENTURE IN FUTURE.

33. TREATMENT
1. WHEN FRACTURE OCCURS THE FORCEPS SHOULD BE
DISCARDED AND A LARGE BUCCAL MUCO-PERIOSTEAL FLAP
RAISED.
2. THE FRACTURED TUBEROSITY AND THE TOOTH SHOULD
THEN BE FREED FROM THE PALATAL SOFT TISSUES BY
BLUNT DISSECTION AND LIFTED FROM THE WOUND.
3. THE SOFT TISSUE FLAPS ARE THEN APPOSED WITH MATTRES
SUTURE, WHICH EVERT THE EDGES AND ARE LEFT IN SITU
FOR ATLEAST 10 DAYS.
4. BROAD SPECTRUM ANTIBIOTIC AND NASAL DECONGESTENT
ARE PRESCRIBED IF THIS COMPLICATION OCCUR IN ONE MAXILLA, IT IS LIABLE
TO OCCUR ON ANOTHER SIDE DURING EXTRACTION, SO
CAREFUL DISSECTION SHOULD BE MADE WHILE TOOTH
EXTRACTION.

34. ADJACENT OR OPPOSING TEETH
CAUSE:
• CARIOUS TOOTH
• HEAVILY RESTORED
• OPPOSITE TOOTH LIES ALONG THE LINE OF WITHDRAWAL
• UNCONTROLLED FORCE
PREVENTION:
• IN CASE OF ABUTMENT, BRIDGE SHOULD BE DIVIDED WITH A
VULCARBO OR DIAMOND DISK BEFORE THE EXTRACTION
• LOOSE OR OVERHANGING FILLINGS SHOULD BE REMOVED &
TEMPORARY DRESSING SHOULD BE INSERTED BEFORE EXTRACTION
• DON’T USE AS A FULCRUM
• GAGS OR PROPS SHOULD BE AVOIDED IN SUCH TOOTH
• CAREFUL CONTROLLED TECHNIQUE SHOULD BE MAINTAINED
• IF IT IS DONE UNDER GENERAL ANAESTHESIA, PRECAUTIONS MUST BE
TAKEN.

35. FRACTURE OF MANDIBLE
RARE COMPLICATION MAINLY ASSOCIATED WITH IMPACTED THIRD MOLAR.
CAUSE
• EXCESSIVE FORCE WITH ELEVATOR
• INADEQUATE PATHWAY
• ANKYLOSED TOOTH
• WEAK MANDIBLE DUE TO
• IMPACTED TEETH
• SENILE OSTEOPOROSIS AND ATROPHY
• OSTEOMYELITIS
• FIBROUS DISPLASIA
• CYST, TUMOR
• HYPERPARATHYROIDISM

37. TREATMENT
• PERFORM RADIOGRAPHIC AND CLINICAL ASSESMENT FIRST
• IF THERE IS ANY OFFENDING TOOTH THAT MUST BE REMOVED
• AFTERWARDS, DEPENDING ON THE CASE STABILIZATION BY WAY OF
INTERMAXILLARY FIXATION OR REGID INTERNAL FIXATION OF THE
JAW SEGMENTS IS APPLIED FOR 4 TO 6 WEEKS.
• BROAD SPECTRUM ANTIBIOTIC
• IN DENTAL OFFICE – PROVIDE EXTRA ORAL SUPPORT AND REFER TO
ORAL SURGEON.

38.  DISPLACEMENT OF ROOT/IMPACTED
TOOTH
-INTO THE SOFT TISSUE
-MAXILLARY ANTRUM
-UNDER GENERAL ANESTHESIA DURING DENTAL
CHAIR

39.  INTO THE SOFT TISSUE
ETIOLOGY- IT IS USUALLY THE RESULT OF
INEFFECTUAL ATTEMPTS TO GRIP THE ROOT
WHEN VISUAL ACCESS IS INADEQUATE.
PREVENTION-
IT CAN BE AVOIDED IF THE OPERATOR ATTEMPTS
TO GRASP ROOTS ONLY UNDER DIRECT VISION.

40.  INTO THE
MAXILLARY
ANTRUM
A ROOT DISPLACED INTO THE
ANTRUM IS USUALLY THAT OF A
MAXILLARY PREMOLAR OR
MOLAR AND IS MOST OFTEN
THE PALATAL ROOT.
 ETIOLOGY -
THE PRESENCE OF LARGE

41.  PREVENTION-
1. NEVER APPLY FORCEPS TO A MAXILLARY CHEEK TOOTH OR ROOT UNLESS
SUFFICIENT OF IT'S LENGTH IS EXPOSED, BOTH PALATALLY AND
BUCCALLY,TO ALLOW THE BLADES TO BE APPLIED UNDER DIRECT VISION.
2. LEAVE THE APICAL ONE THIRD OF THE PALATAL ROOT OF A MAXILLARY
MOLAR IF IT IS RETAINED DURING FORCEPS EXTRACTION UNLESS THERE
IS POSITIVE INDICATION FOR REMOVING IT.

42. 3. NEVER ATTEMPT TO REMOVE A
FRACTURED MAXILLARY ROOT BY
PASSING THE INSTRUMENT UP THE
SOCKET. IF REMOVAL IS INDICATED,
RAISE THE MUCOPERIOSTEAL FLAP
AND REMOVE ENOUGH BONE TO
PERMIT AN ELEVATOR TO BE INSERTED
ABOVE THE BROKEN SURFACE OF THE
ROOT,SO THAT ALL THE FORCE
APPLIED TO THE ROOT TENDS TO
MOVE IT DOWNWARDS AND AWAY
FROM THE ANTRUM.

43.  DISPLACED OF ROOT INTO EITHER THE ANTRUM OR
SOFT TISSUE UNDER GENERAL ANESTHESIA IN
DENTAL CHAIR MANAGEMENT-
1. THE ANESTHESIA SHOULD BE STOPPED IMMEDIATELY AND THE
PATIENT'S HEAD BROUGHT FORWARD.
2. AFTER THE COUGH REFLEX HAS RETURNED THE MOUTH IS EXAMINED
AND PACK CAREFULLY REMOVED AMD INSPECTED. IF PROPER
SAFEGUARDS HAVE BEEN TAKEN THE ROOT IS FOUND IN THE PACK IN
MOST INSTANCES.
3. BUT IF THE ROOT CAN NOT BE LOCATED AFTER REMOVAL OF PACK,
RADIOGRAPHS SHOULD BE TAKEN OF BOTH SOCKET AND THE CHEST.
THE LATTER FILM IS TAKEN TO ENSURE THAT THE ROOT HAS NOT
PASSED IN TO THE BRONCHI.
4. IF THE ROOT IS REVEALED LYING IN THE BRONCHUS, THE PATIENT MUST
IMMEDIATELY REFERRED TO HOSPITAL, WHERE IT CAN REMOVED BY
BRONCHOSCOPY.

44. 5. IF THE ROOT IS NOT LOCATED THE PATIENT SHOULD BE GIVEN AN
APPOINTMENT FOR EXAMINATION IN 3 DAYS
6. HE SHOULD BE INSTRUCTED TO ATTEND HOSPITAL IMMEDIATELY IF HE
DEVELOPS EITHER A TEMPERATURE, COUGH OR CHEST PAIN.

45.  EXCESSIVE HEMORRHAGE
• DURING TOOTH REMOVAL
• ON COMPLETION OF THE EXTRACTION
• POSTOPERATIVELY
 ETIOLOGY-
1. ACCIDENTAL TEARING OR CUTTING OF LARGE ARTERY
OR VEIN.
2. LACERATION OF LARGE ARTERY OR VEIN DURING ROOT
REMOVAL.
3. IF INFLAMMATION IS PRESENT.
4. PATIENT WITH HIGH BLOOD PRESSURE AND BLEEDING
DISORDER.

46. MANAGEMENT -
1. MANUAL PRESSURE OR GAUZE PACK PLACED
OVER THE AREA CAN BE USED BY THE DENTIST TO
ARREST THE BLEEDING.
2. IF A LARGE VESSELS IS INVOLVED, THEN IT CAN BE
CLAMPED WITH HEMOSTAT AND IS TIED WITH
ABSORBABLE STICHES.
3. IF THE BLEEDING IS FROM BONE,THEN
ABSORBABLE HEMOSTAT GAUZE OR BONE WAX
OVER THE SITE OF BLEEDING CAN BE PLACED.
PRECAUTION-
1. PROPER HISTORY SHOULD BE TAKEN.
2. AVOID VIGOROUS RINSING OF THE MOUTH
3. WARM SALINE RINSES 3-4 TIMES/DAY, 24 HOURS
AFTER EXTRACTION SHOULD BE DONE WHICH
WILL FASTEN THE HEALING PROCESS OF

47.  SOFT TISSUE INJURY
 GUM INJURY
 LIP INJURY
 NERVE INJURY
 TONGUE AND FLOOR OF MOUTH INJURY

48.  GUM INJURY
• PREVENTED BY-
1. CAREFUL SELECTION OF FORCEP
AND GOOD TECHNIQUE.
2. GUM ADHERE TO A TOOTH
SHOULD BE CAREFULLY DISSECTED
FROM THE TOOTH EITHER A
SCALPEL OR SCISSORS BEFORE
ANY ATTEMPT.

49.  LIP INJURY
 LOWER LIP MAY BE CRUSHED BETWEEN THE HANDLES OF
THE FORCEPS.
 LIPS MAY BE BURNED IF INSTRUMENT ARE NOT ALLOWED
TO COOL BEFORE USE AFTER BEING STERILIZED.

50. PREVENTION-
1. USE OPERATOR'S LEFT HAND TO RETRACT THE LIP
PROPERLY.
2. ALLOW THE INSTRUMENTS TO COOL BEFORE
USING.
3. EXTRA CARE IS REQUIRED WHEN MAXILLARY TEETH
ARE BEING EXTRACTED UNDER GENERAL
ANESTHESIA.

51. *TREATMENT
1.WHEN THE INJURIES ARE SMALL AND
LOCALIZED THERE IS NO PARTICULAR
TREATMENT.
2.IN CERTAIN CASES HEALING IS FACILITATED IF
THE LESION IS COVERED WITH PETROLATUM
(VASELINE) OR WITH ANY OTHER APPROPRIATE
OINTMENT.
3. WHEN THE INJURIES ARE EXTENSIVE, AND
THERE IS ALSO HEMORRHAGIC, THE SURGICAL
PROCEDURE MUST BE POSTPONED.

52.  INJURY TO THE TONGUE AND FLOOR OF
THE MOUTH
 IT MAY HAPPEN DURING THE APPLICATION OF FORCEPS
AND THE USE OF ELEVATORS.WITHOUT PROPER CONTROL
INSTRUMENT MAY SLIP AND DRIVE INTO TONGUE/FLOOR
OF THE MOUTH.
 MOST COMMONLY THESE MISHAPS OCCUR UNDER
GENERAL ANESTHESIA.
 MANAGEMENT-
 TONGUE BLEEDING CAN BE CONTROLLED BY PULLING IT
FORWARD AND BY INSERTION OF SUTURES. A SURGICAL
SECOND OPINION SHOULD BE SOUGHT IN ALL SUCH

53. *NERVE INJURY
-THE MOST COMMON NERVE
INJURIES ARE-
INFERIOR ALVEOLAR
MENTAL AND
LINGUAL NERVE INJURY
ACCORDING TO SEDDONS
CLASSIFICATION THERE ARE
THREE TYPE OF NERVE
DAMAGE-
1. NEURAPRAXIA
2. AXONOTMESIS
3.NEUROTMESIS

54. *EITIOLOGY
1. NERVE BLOCK OF THE INFERIOR
ALVEOLAR NERVE AND MENTAL NERVE.
2. INCISION THAT EXTEND TO THE
REGION OF THE MENTAL FORAMEN
AND LINGUAL VESTIBULAR FOLD.
3. EXCESSIVE FLAP RETRACTION AND
COMPRESSION WITH RETRACTORS
DURING RETRACTION IN THE REGION
OF THIRD MOLAR.
4. WHEN BONE NEAR A NERVE IS
EXCESSIVELY HEATED.
5. IN THE CASE OF REMOVAL OF
IMPACTED TEETH, ROOTS AND ROOT
TIPS THAT ARE DEEP IN THE BONE AND
CLOSE TO MENTAL/ INFERIOR ALVEOLAR
NERVE.

55. * FEATURES-
THE PATIENT WITH A NERVE INJURY MAY EXPERIENCE A VARIETY OF
SENSATION SUCH AS-
1. NUMBNESS OF TONGUE (LINGUAL NERVE INJURY)
NUMBNESS OF LIP/CHIN AND GUM.( INFERIOR ALVEOLAR NERVE
INJURY)
2.TINGLING
3.BURNING
4. CRAWLING SENSATION
5.ELECTRIC SHOCK/ HYPERSENSITIVITY OF THE AFFECTED AREA.

56. * TREATMENT
1. NO PARTICULAR TREATMENT IS INDICATED FOR
NEURAPRAXIA OR AXONOTMESIS, UNLESS THERE IS A
ROOT TIP/OTHER FOREIGN BODY COMPRESSING THE
NERVE, IN WHICH CASE IT MUST BE REMOVED.
2. ANALGESIC CAN BE ADMINISTRATED IN PAINFUL
CONDITION.
3. MULTIVITAMIN SUPPLEMENT OF THE VITAMIN B
COMPLEX TO RESTORE SENSATION.
4. IN CASE OF NEUROTMESIS, IT MUST BE TREATED AS
SOON AS POSSIBLE, OFTEN A GRAFT MUST REPLACE
THE INJURED NERVE SEGMENT OR THE SEVERED
SEGMENTS MUST BE SUTURED.

57.  BROKEN INSTRUMENT
IN TISSUE
• ETIOLOGY-
1. EXCESSIVE FORCE DURING LUXATION OF
THE TOOTH.
2. REPEATED USE OF THE INSTRUMENT
ALTERING ITS METALLIC COMPOSITION.
• MANAGEMENT
AFTER PRECISE RADIOGRAPHIC
LOCALIZATION, THE BROKEN PIECES ARE
REMOVED SURGICALLY AT THE SAME TIME
EXTRACT THE TOOTH/ROOT

58. • OROANTRAL
COMMUNICATION
DEFINITION:
-IT IS AN ABNORMAL COMMUNICATION
BETWEEN THE MAXILLARY SINUS AND THE
ORAL CAVITY.
-IT IS A COMMON COMPLICATION WITH
EXTRACTION OF MAXILLARY POSTERIOR
TEETH.
• ETIOLOGY
1.DISPLACEMENT OF IMPACTED TOOTH/ROOT TIP INTO THE
MAXILLARY SINUS DURING REMOVAL ATTEMPT.
2. CLOSENESS OF THE ROOT TIPS TO THE FLOOR OF THE
MAXILLARY SINUS.

59.  CONFIRMATORY TEST
-CONFIRMED BY OBSERVING THE PASSAGE OF AIR OR
BUBBLING OF BLOOD FROM THE POST EXTRACTION
ALVEOLUS WHEN THE PATIENT TRIES TO EXHALE
(GENTLY) TROUGH THEIR NOSE WHILE THEIR
NOSTRILS ARE PINCED. (VALSALVA TEST).

60. MANAGEMENT
1. SMALL SIZED OROANTRAL COMMUNICATION WHICH IS
PERCEIVED IMMEDIATELY AFTER EXTRACTION,TREATMENT
CONSISTS OF SUTURING THE GINGIVA WITH A FIGURE OF EIGHT
SUTURE.
2. WHEN THE SOFT TISSUES DO NOT SUFFICIENT, A SMALL
PORTION OF THE ALVEOLAR BONE IS REMOVED WITH A BONE
RONGEUR SO THAT THE BUCCAL AND PALATAL MUCOSA CAN
BE RE-APPROXIMATE MORE EASILY, FACILITATING CLOSURE OF
THE ORO-ANTRAL COMMUNICATION.
3. NASAL DECONGESTANTS SHOULD BE PRESCRIBED.
4. THE PATIENT IS GIVEN APPROPRIATE INSTRUCTIONS ( AVOID
SNEEZING, BLOWING) AND IS SHOULD GO BACK FOR
EXAMINATION IN 15 DAYS.

61. EMERGENCIES

62. EMERGENCY:
1.SYNCOPE
2.ANAESTHETIC EMERGENCY
3.ACUTE HYPOGLYCAECAEMIA
4.ANAPHYLACTIC REACTION
5.RESPIRATORY ARREST
6.CARDIAC ARREST
7. STATUS ASTHMATICUS
8.HAEMORRHAGE
9.DRUG INTERACTION

63. SYNCOPE
FACTORS PREDISPOSING TO SYNCOPE:
1. ANXIETY
2. PAIN
3. INJECTIONS
4. FATIGUE
5. HUNGER
SIGNS & SYMPTOMS :
1.PREMONITORY DIZZINESS, WEAKNESS OR NAUSEA
2.PALE,COLD MOIST SKIN
3.INITIALLY SLOW & WEAK PULSE BECOMING FULL & BOUNDING
4.LOSS OF CONSCIOUSNESS

64.  MANAGEMENT OF A SYNCOPAL ATTACK:
1. LOOSEN ANY TIGHT CLOTHING ROUND THE NECK
2. LOWER THE HEAD
3. MUST BE GIVEN A SWEETENED DRINK WHEN CONSCIOUSNESS HAS
BEEN RECOVERED
4. IF NO RECOVERY WITHIN A FEW MINUTES, CONSIDER OTHER CAUSES
OF LOSS OF CONSCIOUSNESS.
 PREVENTION:
REGULAR FAINTERS ARE FREQUENTLY HELPED BY AN ANXIOLYTIC, SUCH
AS TEMAZEPUM 5 MG ORALLY,ON THE NIGHT BEFORE & AGAIN AN
HOUR BEFORE TREATMENT.

65. ANAESTHETIC EMERGENCY :
MANAGEMENT:
1.THE ANAESTHETIC MUST BE STOPPED IMMEDIATELY.
2.THE AIRWAY SHOULD BE CLEARED.
3. ALL PACKS,APPARATUS & DEBRIS BEING REMOVED FROM THE MOUTH.
4.THE MANDIBLE & TONGUE SHOULD BE PULLED FORWARDS,THE NECK EXTENDED,THE
HEAD EITHER HELD DOWNWARDS & FORWARDS IF THE PATIENT CAN NOT BE LIFTED
FROM THE CHAIR OR UPWARDS IF HE CAN BE LAID ON THE FLOOR.
5.OXYGEN SHOULD BE GIVEN IF THERE IS EXCESSIVE CONTRACTION OF THE ACCESSORY
MUSCLES OF RESPIRATION.
6.IF THE OBSTRUCTION TO RESPIRATION IS NOT RELIVED, EITHER LARYNGOTOMY OR
TRACHEOSTOMY MUST BE PERFORMED.

66. ACUTE HYPOGLYCAECAEMIA :
SIGNS & SYMPTOMS :
1. SIGNS ARE SIMILAR TO THOSE OF A SYNCOPAL ATTACK
2. UNCONSCIOUSNESS STEADILY DEEPENS
MANAGEMENT :
1. PATIENTS OFTEN AWARE OF WHAT IS HAPPENING AND ABLE TO WARN THE
DENTIST.
2. BEFORE CONSCIOUSNESS IS LOST, GIVE GLUCOSE TABLETS OR PWDER/SUGAR
AS A SWEETENED DRINK REPEATED IF SYMPTOMS NOT COMPLETELY RELIEVED.
3. IF CONSCIOUSNESS IS LOST,GIVE STERILE INTRAVENOUS GLUCOSE
4. IF STERILE GLUCOSE NOT AVAILABLE SHOULD BE GIVEN SUBCUTANEOUS
GLUCAGON 1 MG THEN MUST BE GIVEN SUGAR BY MOUTH DURING THE
RECOVERY PERIOD.
5. HYPOSTOP,A GEL CONTAINING GLUCOSE,MAY PROVIDE SUFFICIENT ABSORBED
THROUGH THE ORAL MUCOSA.

67. ANAPHYLACTIC REACTION :
SIGNS & SYMPTOMS :
1.INITIAL FACIAL FLUSHING, ITCHING, PARAESTHESIA OR COLD EXTREMITIES.
2.FACIAL OEDEMA OR URTICARIA
3.WHEEZING
4.LOSS OF CONSCIOUSNESS
5.PALLOR
6.COLD CLAMMY SKIN
7.RAPID WEAK OR IMPALPABLEB PULSE
8.DEEP FALL IN BLOOD PRESSURE.

68. MANAGEMENT :
1.LAY THE PATIENT FLAT.RAISE THE LEGS TO IMPROVE CEREBRAL
BLOOD FLOW
2.SHOULD BE GIVEN 0.5-1 ML OF 1-1000 EPINEPHRIN(ADRENALIN) BY
INTRAMUSCULAR INJECTION. REPEAT EVERY 15 MINUTES IF
NECESSARY. UNTILL THE PATIENT RESPONDS
3.SHOULD BE GIVEN 10-20 MG CHLORPHENIRAMINE INTRAVENOUSLY
SLOWLY
4.MUST BE GIVEN 200 MG OF HYDROCIRTISONE SODIUM SUCCINATE
INTRAVENOUSLY
5.SHOULD BE GIVEN OXYGEN & IF NECESSARY, ASSISTED

69. RESPIRATORY ARREST:
SIGNS & SYMPTOMS :
1. SKELETAL MUSCLES BECOME FLACCID
2. THE PUPILS ARE WIDELY DILATED

70. MANAGEMENT :
1.THE PATIENT SHOULD BE LAID FLAT ON THE
FLOOR
2.HIS AIRWAY SHOULD BE CLEARED
3.MANDIBLE SHOULD BE PULLED UPWARDS
AND FORWARDS TO EXTEND THE HEAD FULLY
4.THE PATIENT'S NOSTRILS SHOULD BE
COMPRESSED BETWEEN THE OPERATOR'S
POINT FINGER & THUMB & MOUTH TO
MOUTH RESUSCITATION SHOULD BE
PERFORMED SO THAT THE CHEST IS SEEN TO
RISE EVERY 3 0R 4 SECONDS

71. CARIAC ARREST:
SIGNS & SYMPTOMS:
1.SUDDEN LOSS OF CONSCIOUSNESS
2.ABSENCE OF ARTERIAL PULSE
3.ABSENCE OF BREATHING
4.PATIENT EXHIBIT A DEATHLY PALLOR & GREYNESS & HIS SKIN IS
COVERD WITH A COLD SWEAT

72. MANAGEMENT :
IN CASE OF ADULT:
• DENTAL SURGEON KNEELS AT ONE SIDE OF HIS TRUNK
AND PLACES THE HEEL OF HIS LEFT HAND ON THE
LOWER THIRD OF THE PATIENT’S STERNUM.
• THE OPERATOR THEN PLACES HIS RIGHT HAND ON
THE BACK OF THE HEEL OF HIS LEFT HAND & PRESSES
DOWNWARDS RHYTHMICALLY AT 1 SECONDS WITH
SUFFICIENT FORCE TO COMPRESS THE HEART
BETWEEN THE STERNUM & THE VERTEBRAL COLUMN.
** CONTINUE COMPRESSIONS & VENTILATIONS UNTIL
THR VICTIM SHOWS SIGNS OF LIFE
IN CASE OF CHILDREN:
IF THE PATIENT IS CHILD, THE HEART WILL OFTEN START
BEING AGAIN IF THE STERNUM IS TAPPED SHARPLY.

73. STATUS ASTHMATICUS
:
SIGNS & SYMPTOMS :
1.BREATHLESSNESS
2.INABILITY TO TALK
3.EXPIRATORY WHEEZING
4.RAPID PULSE
5.CYANOSIS

74. MANAGEMENT :
1. CALL AN AMBULANCE FOR TRANSFER TO
HOSPITAL
2. REASSURE THE PATIENT
3. PATIENT SHOULDN'T BE LAID FLAT
4. GIVE NORMALLY USE ANTI-ASTHMATIC
DRUG
5. GIVE HYDROCIRTISONE SODIUM SUCCINATE
200 mg INTRAVENOUSLY
6. GIVE OXYGEN
7. IF NO RESPONSE WITHIN 2-3 MINUTES,
IDEALLY GIVE SALBUTAMOL 250 MG BY
SLOW INTRAVENOUS INJECTION
8. IF I/V SALBUTAMOL NOT AVAILABLE AND
PATIENT CONTINUES TO DETERIORATE, GIVE
EPINEPHRIN AS FOR PROPHYLAXIS.

75. Post
Extraction

76.  Post Extraction
• DRY SOCKET
• TRISMUS
• HEMATOMA
• SPACE INFECTION
• EDEMA
• NERVE PARALYSIS
• POSTEXTRACTION GRANULOMA
• DISTURBAMCES IN POST-OPERATIVE
• WOUND HEALING
• ORO-ANTRAL FISTULA

77. Dry socket
IT IS THE MOST COMMON AND PAINFUL
IN THE HEALING OF EXTRACTION
WOUNDS.
Causes-
-EXCESSIVE FORCE
-LIMITED LOCAL BLOOD SUPPLY
- LOCAL ANAESTHETICS WITH
ADRENALIN
- ORAL CONTRACEPTIVE
- OSTEOSCLEROTIC DISEASE
- RADIOTHERAPY

78. **PATHOLOGY
* DESTRUCTION OF THE BLOOD CLOT EITHER BY
1.PROTEOLYTIC ENZYMES PRODUCED BY BACTERIA.
2.EXCESSIVE LOCAL FIBRINOLYTIC ACTIVITY.
-ANAEROBES ARE LIKELY TO PLAY A MAJOR ROLE.
-DESTRUCTION OF THE CLOT LEAVES AN OPEN SOCKET,
INFECTED FOOD AND OTHER DEBRIS ACCUMULATE.
-THE NECROTIC BONE LODGES BACTERIA WHICH
PROLIFERATE FREELY, LEUCOCYTES UNABLE TO REACH THEM
TROUGH THE AVASCULAR MATERIAL.
-DEAD BONE IS GRADUALLY SEPARATED BY OSTEOCLASTS.
-HEALING IS BY GRANULATION TISSUE FROM THE BASE
OF THE WALLS OF THE SOCKET.

79. Clinical features-
 MANDIBLE IS MOSTLY AFFECTED
 DEEP SEATED ,SEVERE, ACHING,THROBBING PAIN
 USUALLY PAIN STARTS AFTER FEW DAYS
 MUCOSA IS RED AND TENDER
 NO CLOT IN THE SOCKET
 SALIVA AND DECOMPOSING FOOD DEBRIS PRESENT IN
THE SOCKET
 WHITE DEAD BONE MAY BE SEEN
 PAIN CONTINUES FOR 1-2 WEEKS

80. TREATMENT-
 IRRIGATION WITH WARM SALINE OR ANTISEPTIC
SOLUTION
 SUITABLE DRESSING PACK IS PLACED IN THE
SOCKET -USUALLY ZNO AND EUGENOL
 ALVOGEL IS FREQUENTLY USED
 REPEAT IRRIGATION AND DRESSING FOR FEW
DAYS
 ANALGESIC
 SEDATIVE
 METRONIDAZOLE
 ORAL HYGIENE INSTRUCTIONS
 NEWER TECHNIQUE: TOPICAL HONEY

81. PREVENTION
1.MINIMAL TRAUMA
2. SQUEEZED THE SOCKET EDGE FIRMLY AFTER EXTRACTION
3.IN CASE OF DIS-IMPACTION OF 3RD MOLAR DRY SOCKET IS MORE
COMMON.
-MINIMAL STRIPPING OF THE PERIOSTEUM.
-MINIMAL DAMAGE TO THE BONE.
-USE PROPHYLACTIC ANTIBIOTIC.
4.IN PATIENT WHO HAVE HAD RADIOTHERAPY, EVERY POSSIBLE PRECAUTION
SHOULD BE TAKEN.
5.IN OSTEOSCLEROTIC DISEASE
-LITTLE DAMAGE TO BONE(SURGICAL EXTRACTION)
-PROPHYLACTIC ANTIBIOTIC.
6. STOP SMOKING FOR TWO DAYS POST EXTRACTION.

82. Trismus
AFTER EXTRACTION IT USUALLY OCCURS
DUE TO EDEMA AND SWELLING.
Causes-
 DAMAGE TO
TEMPOROMANDIBULAR JOINT
DUE TO EXCESSIVE DOWNWARD
PRESSURE.
 KEEPING PATIENT'S MOUTH WIDE
OPEN FOR A LONG TIME.
 DURING INFERIOR ALVEOLAR
NERVE BLOCK
 INJECTION TO MEDIAL
PTERYGOID MUSCLE
 INJURY TO SMALL VESSEL
CAUSING HAEMATOMA

83. TREATMENT -
 RECOVERS WITH TIME ,
USUALLY 6 WEEKS.
 WARM SALINE MOTH BATHS.
 PHYSIOTHERAPY

84. POST EXTRACTION HAEMORRHAGE
IT IS A COMMON COMPLICATION OF TOOTH EXTRACTION.
REACTIONARY HAEMORRHAGE-
OCCURS WITHIN 48 HRS AFTER EXTRACTION.
IT OCCURS DUE TO LOCAL RISE OF BLOOD PRESSURE.
COMMON IN PATIENTS TREATED UNDER LOCAL
ANAESTHETIA AS EFFECT OF VASOCONSTRICTOR WEARS
OFF.
SECONDARY HAEMORRHAGE - STARTS ABOUT 7 DAYS
AFTER EXTRACTION.
IT OCCURS DUE TO INFECTION WHICH DESTROYS BLOOD
CLOT OR MAY ULCERATE VESSEL WALL.

85. LOCAL CAUSE -
EXCESSIVE TRAUMA
DISLODGEMENT OF CLOT
SLIPPING OF LIGATURE
IMPROPER STITCH
REPEATED CHANGE OF COTTON PACK
SYSTEMIC CAUSE-
BLEEDING OR CLOTTING DISORDER
ANAEMIA
LEUKAEMIA
RENAL FAILURE
LIVER DISEASE
HYPERTENSION
DRUGS- ASPIRIN, WARFARIN, HEPARIN.
OTHER- IF PATIENT DOES NOT FOLLOW INSTRUCTIONS

86. Management -
-RAPID HISTORY TAKING
- ASSESMENT OF GENERAL HEALTH CONDITION
- EXAMINE THE BLEEDING SITE UNDER SUFFICIENT LIGHT
- CLEAN THE AREA WITH GAUZE
- DIGITAL PRESSURE
- ANOTHER DAMP GAUZE IS PLACED UPON SOCKET
- TANNIC ACID POWDER IS APPLIED OVER GAUZE
- INTERRUPTED HORIZONTAL MATTRESS SUTURE
- BITE UPON A GAUZE PACK FOR 5 MINUTES
- IF FAILS , GELATIN OR FIBRIN FOAM MAY BE TUCKED INTO THE
SOCKET AND REFERRED TO NEAREST HOSPITAL.

87. INFECTION
POST EXTRACTION INFECTION MAY TAKE ANOTHER FORM IN WHICH
EXUBERANT GRANULATION AND DISCHARGE OF PUS LOCALISED TO THE
SOCKET APPEAR A WEEK OR SO AFTER EXTRACTION.
Cause - FREQUENTLY BONE SEQUESTRA.
Clinical feature-
- RELATIVELY PAINLESS
- GRANULATION MAY CAUSE PACKING DIFFICULT
Treatment-
- HOT MOUTH BATHS
- IF NOT SUBSIDE RADIOGRAPH MAY BE NECESSARY TO CONFIRM THE
LOCAL NATURE OF INFECTION
- THE SOCKET IS OPENED ,SEQUESTRA AND GRANULATIONS ARE
REMOVED

88. ACUTE OSTEOMYELITIS
Predisposing factor - EXTRACTION OF LOWER MOLARS UNDER LOCAL
ANAESTHETIC IN PRESENCE OF ACUTE GINGIVAL INFLAMMATION
Clinical features-
-GENERAL WEAKNESS
- TOXICITY
- PYREXIA
- SEVERE PAIN
- EXTRAORAL SWELLING
- IMPAIRMENT OF LABIAL SENSATION SOME HOURS OR EVEN DAYS
AFTER EXTRACTION IS CHARACTERISTIC.
Treatment -
- DEBRIDEMENT OF THE AREA
- ANTIBIOTIC ACCORDING TO C/S
- ANALGESICS

89. HAEMATOMA
o OCCUR WHEN THE CORRECT MEASURE FOR CONTROL OF
BLEEDING ARE NOT TAKEN(LIGATION OF VESSELS, ETC.) OR
VESSEL INJURY OCCUR DURING ADMINISTRATION OF LA
o BLOOD ACCUMULATE INSIDE THE TISSUES, WITHOUT ANY
ESCAPE FROM THE CLOSED WOUNDS OR TIGHTLY SUTURED
FLAPS UNDER PRESSURE.

90. TREATMENT
 IF A HEMATOMA IS FORMED DURING THE FIRST FEW HOURS
AFTER THE SURGICAL PROCEDURE, THERAPEUTIC
MANAGEMENT CONSISTS OF PLACING COLD PACKS
EXTRAORALLY DURING THE FIRST 24 HOURS, AND THEN HEAT
THERAPY TO HELP IT TO SUBSIDE MORE RAPIDLY. SOME
PEOPLE RECOMMEND THE ADMINISTRATION OF ANTIBIOTICS
TO AVOID SUPPURATION OF HEMATOMA, AND ANALGESICS
FOR PAIN RELIEF.

91. SUBCUTANEOUS /SUBMUCOSAL
EMPHYSEMA
-IT IS A WELL ESTABLISHED COMPLICATION OF TRAUMA.
-RESULTS FROM AIR ENTERING TROUGH LOOSE CONNECTIVE TISSUE,
WHEN AN AIR ROTOR IS USED IN SURGICAL PROCEDURE FOR THE
REMOVAL OF BONE /SECTIONING THE IMPACTED TOOTH.
CLINICAL FEATURES
1.SWELLING PRESENT ON THAT REGION, SOMETIMES EXTENDING INTO
NECK AND FACIAL AREA.
2.ON CLINICAL EXAMINATION, CRACKING SOUND PRESENT DURING
PALPATION.
TREATMENT
1.NO SPECIFIC TREATMENT.IT USUALLY SUBSIDES SPONTANEOUSLY AFTER
2-4 DAYS.

92. EDEMA
• OCCUR SECONDARY TO SOFT TISSUE
TRAUMA.
• IT IS THE RESULT OF EXTRAVASATION OF
FLUID BY THE TRAUMATISED TISSUES
BECAUSE OF DESTRUCTION AND
OBSTRUCTION OF LYMPH VESSELS,
RESULTING IN THE CESSATION OF THE
DRAINAGE OF LYMPH,WHICH
ACCUMULATES IN THE TISSUES.
• SWELLING REACHES A MAXIMUM WITHIN
48-72 HOURS AFTER THE SURGICAL
PROCEDURE AND BEGINS TO SUBSIDE ON
THE THIRD OR FOURTH DAY
POSTOPERATIVELY.
• DEPENDING ON THE AMOUNT OF TISSUE

93. TREATMENT
• A SMALL SIZED EDEMA DOES NOT REQUIRED
ANY THERAPEUTIC MANAGEMENT. FOR
PREVENTIVE REASONS, COLD PACKS SHOULD BE
APPLIED LOCALLY IMMEDIATELY AFTER SURGERY.
• SEVER EDEMAS MUST BE TREATED CAREFULLY,
BECAUSE IF EDEMAS PRESENT FOR A
PROLONGED PERIOD MAY LEAD TO FIBROSIS,
AND IF EXTEND TO FACIAL AND PHARYNGEAL
SPACES MAY LEAD TO ASPHYXIA. TREATMENT
HERE INCLUDE THE INTRAVENOUS
ADMINISTRATION OF 250-500 MG
HYDROCORTISONE AND BROAD SPECTRUM
ANTIBIOTICS.

94. OROANTRAL FISTULA IS AN
EPITHELIALIZED,PATHOLOGICAL, UNNATURAL
COMMUNICATION BETWEEN ORAL CAVITY AND
MAXILLARY SINUS.
Clinical features-
*In fresh communication -
-ESCAPE OF FLUID
-EPISTAXIS
-ESCAPE OF AIR FROM MOUTH TO NOSE ON
SUCKING,INHALING, SMOKING
- ALTERATION OF VOCAL RESONANCE
- EXCRUCIATING PAI

95. *In established
communication -
- MILD PAIN
- PERSISTENT,PURULENT
FOUL UNILATERAL
DISCHARGE
- POST NASAL DRIP
- POPPING OUT OF
ANTRAL POLYP
- SYSTEMIC TOXEMIC
CONDITION

96. Management -
Preoperative:
-WELL FITTED ACRYLIC BASE PLATE
- INFECTED ANTRUM WASHED WITH WARM NORMAL SALINE
- DECONGESTANT NASAL DROP
- SYSTEMIC ANTIBIOTIC THERAPY
Operative:
- BUCCAL FLAP ADVANCEMENT OPERATION
- MODIFIED REHRMAN'S BUCCAL ADVANCEMENT FLAP
- PALATAL PEDICLE FLAP
- ROTATIONAL ADVANCEMENT FLAP OPERATION
- COMBINATION OF BUCCAL AND PALATAL FLAP
- CALDWELL LUC OPERATION WITH INTRA NASAL ANTROSTOMY

97. Post operative:
- INSTRUCTIONS TO PATIENT
• AVOID SNEEZING
• AVOID NOSE BLOWING
• AVOID EXPLORE THE
WOUND WITH TONGUE
• AVOID DELIBERATELY
SUCKING AIR OR FLUID
- MEDICATIONS
- REMOVAL OF SUTURE ON
7TH OR 10TH POST OPERATIVE
DAY
- FOLLOW UP

98. GENERAL PREVENTIVE MEASURES TO AVOID
COMPLICATION OF TOOTH EXTRACTION :
1. CAREFUL MEDICAL HISTORY SHOULD BE TAKEN
2. PROPER TECHNIQUE SHOULD BE FOLLOWED
3. A DENTIST SHOULD ALWAYS CARRY AN EMERGENCY KIT
4. AFTER EXTRACTION ALWAYS GIVE PROPER INSTRUCTION
TO THE PATIENT
5. DO NOT HURRY!