Complications in Oral Surgery

Dry Socket
Failed extraction
Post operative haemorrhage
Oro antral communication fistula
Root in Maxillary Sinus/Antrum

Dry Sockets/Alveolar Osteitis

Definition:

  • A post dental extraction inflammation of the alveolar bone.

Predisposing factors:

  • Traumatic difficult extraction
  • Mandibular molars
  • Smoker
  • Diabetes
  • Reduced local blood supply (post radiotherapy)

Signs and symptoms:

  • Persistent severe throbbing pain.
  • Usually in posterior mandible.
  • Develops two or more days following dental extraction a change in nature of pain.
  • Often foul taste and halitosis
  • Empty socket may see exposed bone

Management

  • Confirm no root, sequestrum, infection
  • Clean socket debris
  • Dressing resorbable or non resorbable
  • Analgesia

(back to top)

Management of Failed Extraction

Sucess in atraumatically removing a tooth is often determined by good preparation and adequate assessment. Appropriate radiographs are essential. Determine whether the tooth or patient present any difficulties, determine if referral is required before attempting extraction. Allow adequate time to undertake the extraction.

  • Set yourself a sensible time limit, for example 30 minutes. this will vary and is as much based on patient tolerance as anything.
  • If abandoning the extraction consider extirpating the pulp and placing a temporary dressing.
  • Suture any wounds if necessary
  • Inform the patient of the reasons why you cannot continue and explain what the likely outcome is, i.e. a surgical extraction on a follow up appointment, referral for extraction etc...
  • Provide analgesia and if necessary antibiotics

(back to top)

Post Operative Haemorrhage

  • Clean area, examine, rinse , good suction
  • Pressure (disposables) allow time (upto 20 minutes per swab)
  • Confirm medical history re drugs coagulopathies
  • Suture horizontal mattress purse string
  • Haemostatic agent (Kaltostat, Surgicel or similar)
  • Reinforce postoperative instructions
  • If all fails refer by phoning hospital and speaking to on call SHO.

(back to top)

Oral antral communication/fistula

Definitions:

  • Communication: A pathological communication between oral cavity and maxillary antrum.
  • Fistula: An epithelial lined pathological communication between oral cavity and maxillary antrum.

Acute Signs and symptoms

  • Clinical evidence of communication
  • Blood bubbbling in socket

Chronic Signs and symptoms

  • Nasal regurgitation
  • Episodic sinusitis
  • Foul taste
  • Antral polyp herniates intraorally
  • Demonstration of communication


Acute Oral antral communication


Oral Antral Communication after 3 weeks

Management of Acute Oral antral communication

  • Confirm presence of communication
  • Clean socket & examine note size of communication
  • Are any roots present? if suspected radiograph for roots
  • Inform patient and remain calm
  • Can you close (a skill and time issue)
  • Medication: analgesia, antibiotics
  • Explanation and post op instructions
  • Refer
  • Notes record incident and management


Antral polyp in OAF


Chronic OAF

Surgical techniques for closure of OAF/communication

Buccal advancement may well be within the competency of a dentist with a special interest in oral surgery and can be readily achieved in primary care under local anesthesia. It is a useful technique in the acute phase

• Buccal advancement flap
• Palatal rotation flap
• Distant flaps tongue, buccal fat pad
• Use of graft material

(back to top)

Root in Antrum/Maxillary Sinus

Management

  • Recognise it
  • Can you retrieve it
  • Do you refer patient
  • Inform patient
  • ? Close communication
  • ? Prophylaxis re infection

Root in antral floor



Root in Antrum Lateral facial and Occipito mental views


 

All Site content is copyright Taunton and Somerset NHS trust. Legal info. Website problems email web@tauntonmaxfax.net