post operative complication of teeth extraction

1. Infection: The dentists may opt to prescribe antibiotics pre- and/or post-operatively if they determine the patient to be at risk.
2. Prolonged bleeding:  Small amounts of blood mixed in the saliva after extractions are normal, even up to 72 hours after extraction. Usually, however, bleeding will almost completely stop within eight hours of the surgery, with only minuscule amounts of blood mixed with saliva coming from the wound. A gauze compress will significantly reduce bleeding over a period of a few hours.if still bleeding persists septics can be used
3. Swelling:  this is the most common complication after tooth extraction.ice packs work very well for swelling after extractions
4. Sinus exposure and oral-antral communication: This can occur when extracting upper molars (and in some patients, upper premolars). The maxillary sinus sits right above the roots of maxillary molars and premolars. There is a bony floor of the sinus dividing the tooth socket from the sinus itself. This bone can range from thick to thin from tooth to tooth from patient to patient. In some cases it is absent and the root is in fact in the sinus. At other times, this bone may be removed with the tooth, or may be perforated during surgical extractions. The doctor typically mentions this risk to patients, based on evaluation of radiographs showing the relationship of the tooth to the sinus. It is important to note that the sinus cavity is lined with a membrane called the Sniderian membrane, which may or may not be perforated. If this membrane is exposed after an extraction, but remains intact, a "sinus exposed" has occurred. If the membrane is perforated, however, it is a "sinus communication". These two conditions are treated differently. In the event of a sinus communication, the dentist may decide to let it heal on its own or may need to surgically obtain primary closure—depending on the size of the exposure as well as the likelihood of the patient to heal. In both cases, a resorbable material called "gelfoam" is typically placed in the extraction site to promote clotting and serve as a framework for granulation tissue to accumulate. Patients are typically provided with prescriptions for antibiotics that cover sinus bacterial flora, decongestants, as well as careful instructions to follow during the healing period.
5. Nerve injury: This is primarily an issue with extraction of third molars, but can occur with the extraction of any tooth  where the  nerve is  close to the surgical site. Two nerves are typically of concern, and are found in duplicate (one left and one right): 1. the inferior alveolar nerve, which enters the mandible at the mandibular foramen and exits the mandible at the sides of the chin from the mental foramen. This nerve supplies sensation to the lower teeth on the right or left half of the dental arch, as well as sense of touch to the right or left half of the chin and lower lip. 2. The lingual nerve (one right and one left), which branches off the mandibular branches of the trigeminal nerve and courses just inside the jaw bone, entering the tongue and supplying sense of touch and taste to the right and left half of the anterior 2/3 of the tongue as well as the lingual gingiva (i.e. the gums on the inside surface of the dental arch). Such injuries can occur while lifting teeth (typically the inferior alveolar), but are most commonly caused by inadvertent damage with a surgical drill. Such injuries are rare and are usually temporary, but depending on the type of injury (i.e. Seddon classification: neuropraxia, axonotmesis, & neurotmesis), can be prolonged or even permanent.
6. Displacement of tooth or part of tooth into the maxillary sinus (upper teeth only). In such cases, almost always the tooth or tooth fragment must be retrieved. In some cases, the sinus cavity can be irrigated with saline (antral lavage) and the tooth fragment may be brought back to the site of the opening through which it entered the sinus, and may be retrievable. At other times, a window must be made into the sinus in the Canine fossa--a procedure referred to as "Caldwell luc".
7. Dry socket (Alveolar osteitis) is a painful phenomenon that most commonly occurs a few days following the removal of mandibular (lower) wisdom teeth. It is commonly believed that it occurs because the blood clot within the healing tooth extraction site is disrupted. More likely,alveolar osteitis is a phenomenon of painful inflammation within the empty tooth socket because of the relatively poor blood supply to this area of the mandible (which explains why dry socket is usually not experienced in other parts of the jaws). Inflamed alveolar bone, unprotected and exposed to the oral environment after tooth extraction, can become packed with food and debris. A dry socket typically causes a sharp and sudden increase in pain commencing 2–5 days following the extraction of a mandibular molar, most commonly the third molar. This is often extremely unpleasant for the patient; the only symptom of dry socket is pain, which often radiates up and down the head and neck. A dry socket is not an infection, and is not directly associated with swelling because it occurs entirely within bone — it is a phenomenon of inflammation within the bony lining of an empty tooth socket. Because dry socket is not an infection, the use of antibiotics has no effect on its rate of occurrence. The risk factor for alveolar osteitis can dramatically increase with smoking after an extraction.
8. Bone fragments Particularly when extraction of molars is involved, it is not uncommon for the bones which formerly supported the tooth to shift and in some cases to erupt through the gums, presenting protruding sharp edges which can irritate the tongue and cause discomfort. This is distinguished from a similar phenomenon where broken fragments of bone or tooth left over from the extraction can also protrude through the gums. In the latter case, the fragments will usually work their way out on their own. In the former case, the protrusions can either be snipped off by the dentist, or eventually the exposed bone will erode away on its own.
9. Loss of a tooth: If an extracted tooth slips out of the forceps, it may be swallowed or inhaled. The patient may be aware of swallowing it, or they may cough, which suggests inhalation of the tooth. The patient must be referred to for a chest Xray in hospital if a tooth cannot be found. If it has been swallowed, no action is necessary as it usually passes through the alimentary canal without doing any harm. But if it has been inhaled, an urgent operation is necessary to recover it from the airway or lung before it causes serious complications such as pneumonia or a lung abcess.
10. Precipitation of systemic problems

DRY SOCKET

Dry socket it is also called alveolitis sicca dolorosa, alveolagia or postoperative osteitis.It is basically focal osteomyelitis in which blood clot has disintegrated or is lost.Dry socket is a temporary dental condition that sometimes occurs after extraction of a permanent tooth. The term alveolar refers to the alveolus, which is actually the part of the jawbone which surrounds the teeth, and osteitis means simply "bone inflammation".Dry socket occurs when the blood clot at the site of the tooth extraction is dislodged, exposing underlying bone and nerves and causing increasing pain. Dry socket is the most common complication following tooth extractions. When it occurs, dry socket usually strikes one to three days after a tooth extraction. The most common hallmark of dry socket is significant pain.

DRY SOCKET

Complications of Dry Socket

Complications as well as problems that dry socket may cause or be associated with consist of:

1. pain
2. Postponed healing after tooth extraction
3. Infection
4. grayish slough
5. foul odor
6. Unpleasant taste in your mouth

Causes of Dry Socket

Usually, a blood clot forms at the site of a tooth extraction. This blood clot serves as a protective coating over the underlying bone and nerve endings in the empty tooth socket. The clot provides the foundation for the growth of new tissue and bone. In some cases,either the clot doesn't form properly or is physically dislodged before complete healing. With the clot is dislodged, bone and nerves in the socket are exposed to air, fluids and food. This can cause intense pain, not only in the socket but also along the nerves radiating to the ear and eye on the same side of the face. The precise cause of dry socket is still not known. Some causes, including:

• Bacterial contamination of the socket
• Difficult or traumatic tooth extraction surgery
• Roots or bone fragments remaining in the wound after surgery

Dry socket occurs in about 3 to 5 percent of all tooth extractions. It's much more common after extraction of wisdom teeth and impacted wisdom teeth.

Signs & Symptoms of Dry Socket

1. Severe pain within a few days after  tooth extraction
2. Partial or total loss of the blood clot at the tooth extraction site, which may be noticed as an empty looking  socket.
3. Visible bone in the socket
4. Pain that radiates from the socket to  ear or eye on the same side of  face
5. Bad breath or a foul odour coming from  mouth
6. Unpleasant taste in mouth
7. Swollen lymph nodes around  jaw or neck

Diagnosis of Dry Socket

Severe pain following a tooth extraction is often enough for your dentist to suspect dry socket  dentists checks to see if any blood clot in the tooth socket and whether their is  exposed bone. You may also need to have X-rays taken of your mouth and teeth to rule out other conditions.

Treatments of Dry Socket

• Medicated dressings. This is the main way to treat dry socket. The socket is packed with medicated dressings.The active ingredients in these sedative dressings usually include substances like soluble aspirin, zinc oxide, eugenol, and oil of cloves. It is usually necessary to have this done for two or three consecutive days, although occasionally it can take longer.  The severity of your pain and other symptoms determines how often you need to return for dressing changes or other treatment.
• Flushing out the socket.  the socket is flushed out with betadine  to remove any food particles or other debris that has collected in the socket and that contributes to pain or infection.
• Pain medication. mostly analgesics are prescribed for pain control.
• Self-care. You may be instructed how to flush your socket at home to promote healing and eliminate debris.you are instructed to do  warm salt water rinses  into the socket for atleast 5-6 times in a day. You may need to continue to do this daily for three or four weeks.
• Once treatment is started, you may begin to feel some relief in just a few hours. Pain and other symptoms should continue to improve over the next few days. Complete healing typically goes smoothly and generally takes about 10 to 14 days.

Prevention of Dry Socket

What your dentist  may do

Your dentist or oral surgeon may discuss with you the following medications that may help prevent dry socket:

• Antibacterial mouthwashes or gels immediately before and after surgery
• Oral antibiotics, particularly for people with compromised immune systems
• Antiseptic solutions applied to the wound
• Medicated dressings applied after surgery
• Experiment by placing sulfanilamide
• Oxidase cellulose-inserted for haemostatic purpose, produces retardation of healing similar to that of combined sulfonamide.
• Sulfathiazole in 60% glycerine base reduces the frequency of occurance of dry socket.
• ureomycin-causes significant reduction in decomposition of blood clot. these is decreased incidence of postoperative pain & swelling after 1 week.
• Tetracycline hydrochloride- if tablet is placed in extraction socket, it helps in reduction of dry socket to 0.78 %.
• Trypsin-digest necrotic tissue & debris & restrains bacterial growth.

What you can do before surgery

You can take the following steps to help prevent dry socket:

• Seek a dentist or oral surgeon with experience in tooth extractions.
• If you take oral contraceptives, schedule your extraction, if possible, during days 23 to 28 of your menstrual cycle, when estrogen levels are lower.
• Stop smoking and the use of other tobacco products at least 24 hours before tooth extraction surgery. Consider talking to your doctor or dentist about a program to help you quit permanently.
• Talk to your dentist about any prescription or over-the-counter medications or supplements you're taking, as they may interfere with blood clotting.

What you can do after surgery

• You'll receive instructions about what to expect during the healing process after a tooth extraction and how to care for the wound. These instructions will likely address the following issues that can help prevent dry socket:
• Activity.For at least a week, avoid rigorous exercise and sports that might result in dislodging the blood clot in the socket.
• Beverages. Drink lots of water after the surgery. Don't drink alcoholic, caffeinated, carbonated or hot beverages in the first 24 hours. Don't drink with a straw for at least a week because the sucking action may dislodge the blood clot in the socket.
• Food. Eat only soft foods, such as yogurt or applesauce, for the first 24 hours. Start eating semisoft foods when you can tolerate them. Avoid hard, chewy, hot or spicy foods that might get stuck in the socket or irritate the wound.
• Cleaning your mouth. Don't brush your teeth, rinse your mouth, spit or use a mouthwash during the first 24 hours after the surgery. After that time, gently rinse your mouth with warm salt water every two hours while awake and after meals for a week after your surgery. After the first 24 hours, resume brushing your teeth, being particularly gentle near the surgical wound.
• Tobacco use. If you smoke, don't do so for at least 24 hours after surgery. If you chew tobacco, don't use it for at least a week. Any use of tobacco products after oral surgery can delay healing and increase the risk of complications.