Oral and Maxillofacial Surgery
Consulting Specialist
Perils of Treatment - Diseases of the Teeth /Mouth
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Complications of Dental Extractions
Compromises of the Airway
Oral Bleeding
Orofacial Injuries
Odontogenic Infections
Osteonecrosis
Orafacial Pain
Complications of Dental Extractions
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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
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Rate of post operative bleeding ( 7% to 10% 3rd molars)
Usually associate with
 difficult extraction
 long surgical procedures
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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 extraction
1st 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
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 3
rd
molars)
The most frequent nerve injury
Lingual and Inferior Alveolar / Mental Nerves
Lingual
nerve
Lingual
nerve
Inferior
Alveolar
nerve
Mental
nerve
Oral Antral Communication
following 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
Perils of Treatment - Diseases of the Teeth /Mouth
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Complications of Dental Extractions
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Compromises of the Airway
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Oral Bleeding
Orofacial Injuries
Odontogenic Infections
Osteonecrosis
Orafacial Pain
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Compromises of the Airway
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Aspiration
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Bleeding
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Infection
Injuries
Barriers (rubber
dam) frequently
used to prevent
swallowing /
aspiration
Aspiration
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Teeth & fragments
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Dental appliances
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Dental instruments
Ingested
Tooth
Aspirated
Tooth
Airway compromise
Due to bleeding
Post op chin / floor of mouth surgery
Post extraction in patient with
Bleeding Diatheses
Airway compromise
due to
dental infection
Airway
compromise
due to Injury
Unopposed pull of
supra hyoid muscles in an
inferior & posterior direction
Flail Mandible Fracture
Airway compromise
Injury with bleeding
(Mandibular Fractures)
Perils of Treatment - Diseases of the Teeth /Mouth
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Complications of Dental Extractions
Compromises of the Airway
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Oral Bleeding
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Orofacial Injuries
Odontogenic Infections
Osteonecrosis
Orafacial Pain
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Bleeding Gums
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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
Perils of Treatment - Diseases of the Teeth /Mouth
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Complications of Dental Extractions
Compromises of the Airway
Oral Bleeding
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Orofacial Injuries
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Odontogenic Infections
Osteonecrosis
Orafacial Pain
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Soft Tissue
Dentoalveolar
Fractures
Jaw Fractures
(Maxilla / Mandible)