What are the Risk and Potential Complications?
There are many potential complications with having a tooth out, but the ‘vast’ majority of dental extractions are simple and uneventful.
Thousands, if not millions of teeth are probably extracted on any given day across the world and most of these will be without any issues. You should however be aware of the more common problems and your dentist should inform you of anything they believe may increase the likelihood of a complication.
It is important that the dentist takes a history of not only medical conditions you suffer from that could complicate things, but assess the tooth and root, both clinically in the mouth and by an X-ray in order to approach the extraction in the most suitable way. This will help in predicting potential issues that may arise.
A word on medical history.
The medication that you take or conditions that you have, may increase the likelihood of complications. Thus it is very important for the dentist to know your current and previous medical history. You may have conditions that need specialised care, additional precautions involving antibiotics or be taking medication that requires adjustment in collaboration with your doctor.
An extraction may be best avoided in some circumstances where delayed healing and infection is likely- such as previous radiotherapy to the head and neck region or leukaemia. All efforts should be placed on treatments to save your tooth or teeth. There are far too many conditions for me to cover here, but suffice to say, that it is really important that your dentist has an up to date medical history for you.
We can divide our risks into those that occur during the procedure and those that occur afterwards. Some of these are exceedingly rare and I have just included them for completion. Having examined you fully, the dentist will draw your attention to anything in this list they feel is particularly relevant to your situation.
Risks during the procedure:
- Fractured tooth
Sometimes, if part of the tooth fractures below the gum, the extraction cannot be completed or needs a different approach such as a surgical extraction. It depends on the amount of tooth, if it is infected and the risk of doing further damage by attempting to retrieve it, that determines the best course of action. Occasionally, it is sensible for the dentist to stop the procedure and refer you off to an oral surgeon to have it completed.
- Fractured socket
When expanding the socket to remove the tooth it is not unusual for a bit of the socket to fracture. If small, this can just be removed and if the bone is sharp underneath, the dentist will smooth this off, to promote healing using a wonderfully named instrument called the ‘bone rongers’. I have to laugh- we don’t make it easy for you to like us do we… would it have hurt to call them something that sounds less like it’s out of a horror film!
- Damage to your gum, tongue, cheek, or lip
This may occur because of from the pressures of instruments being applied to your tooth. Sometimes because of the anaesthetic you aren’t able to tell till afterwards when the effects have worn off.
- Damage to other teeth
The tooth next door may be damaged or its filling dislodged – the more heavily restored the tooth, the more at risk they become.
Upper 1st and 2nd molars can sometimes have very large roots that extend into you antrum (air sinus). On removal this can cause a communication between the sinus and your mouth which may result in a blocked and runny nose on one side.
- Fractured tuberosity
Your tuberosity is an area of bone behind your last upper molar. On occasions, this may fracture and if large, will need to be splinted back in place and the tooth removed by a surgical approach after the bone has healed- usually about a month later. If this was to happen, your dentist may decide to carry out the procedure, or refer the case on to an oral surgeon.
- Nerve damage
Two nerves are principally at risk from stretching or bruising during the removal of lower wisdom teeth or any surgical tooth extraction in that area. The lingual nerve supplies the sense of taste and touch to the front 2/3 of the tongue on that side. The ID nerve supplies sensation to all the teeth, the lower lip and the chin on the same side. The proximity of the nerves to the root, how deeply impacted the tooth is and the type of procedure carried out, are all factors in determining the risk. A simple fully erupted tooth is unlikely to have any involvement – particularly if a clear gap exists between the nerve canal and the roots of the wisdom tooth. A deep impaction requiring extensive bone removal in the region of the nerve carries a much higher risk. A fractured root tip of a lower premolar may put the mental nerve at risk, if a surgical extraction to remove it is needed in this area.
- Fractured jaw
Very thin resorbed jaws in the elderly, particularly women with osteoporosis, are at risk from this serious complication. If a single tooth spans the whole width of the jaw, this would be cause for concern and would need referral to an oral surgeon. This is incredibly rare.
Risks after the procedure:
- Excessive Bleeding
If you have ever had a tooth taken out, you will know that the dentist will leave you biting down on a gauze for a good few minutes in order to stop the bleeding and get a good clot to form. Sometimes bleeding will continue, this may be because:
(i) You are taking medication to thin the blood- this should be assessed before hand. If you are taking any anti-coagulants such as warfarin, herpain, aspirin etc. these sometimes need adjusting in consultation with your doctor (DO NOT just stop taking your medication).
(ii) The gum is bleeding.
(iii) The bone is bleeding. Bone has a rich supply of blood vessels running through it so yes… it can bleed!
(iv) There is infection or inflammation present such as periodontal disease.
Dentists have an array of ways to stop bleeding if simple pressure alone is not doing the trick. Most often this will include:
(i) Placing a simple stitch to pull the gum tight against the socket walls, enough to stop the bleeding.
(ii) Placing a restorable haemostatic (blood stopping) pack such as oxidized cellulose, gelatin or fibrin foam, collagen granules etc. These are materials that are tucked into the socket to help clotting.
(iii) A combination of the above.
It is not uncommon for bleeding to start again a few hours after the extraction. This is due to the adrenalin in the anaesthetic (which causes your blood vessels to constrict) wearing off, so your blood vessels open back up and bleeding begins. This is generally controlled by appropriate
If you are worried contact your dentist and if bleeding continues for a number of days without any cause that you are aware of (such as medication), it may be sensible to see a doctor and have them run some tests.
This isisparticularly likely in patients who have a lowered immune system such as those with diabetes, HIV, cancer or renal transplant medication to name just a few. It is also more common in smokers and people who don’t look after their socket appropriately.
- Pain and soreness
This is to be expected and will depend on the type of extraction and difficulty in removing the tooth.
- Bruising and swelling
Is often associated with surgical extractions in which considerable bone was removed. It will generally resolve over two weeks.
- Delayed healing
This may be caused by infection, failure of the blood clot to form, poor aftercare or hygiene.
- Difficulty opening (trismus)or TMJD
A mild soreness of your jaw muscles and the joint is much more common than TMJD- which occurs most often when teeth are removed under general anaesthetic and you already have some symptoms of the problem.
As your socket heals, the bone is no longer required to hold the tooth that was removed and so it will shrink down (resorb) this can mean the gum shrinks down around the neighbouring teeth, exposing some of their root surface, which may lead to sensitivity. This is more likely to occur if a surgical extraction is needed that involves considerable bone removal.
- Osteo-Necrosis of the Jaw (ONJ) or Osteomyelitis .
These are very rare but more serious non-healing conditions, that can occur in patients with certain medical conditions and taking particular medication. Your dentist will discuss this with you if they believe you to be at risk.
- Infective endocarditis.
Certain heart conditions can slow the blood flow around the valves of your heart, making it easier for the bacteria to settle there. The mouth contains as we know millions and millions of bacteria and during any procedure that causes bleeding such as an extraction or deep cleaning in periodontal treatment they can get into your blood stream. Generally this isn’t a problem, but if your medical history places you at risk of this condition precautions must be taken.In most case, this is simply a good dose of antibiotics, an hour before the procedure, but if you are very high risk, it may be necessary to look after you in a hospital setting.
If you truly thought of all the ways you could get hurt in any standard day, crossing the road, driving, cooking etc it would get rather overwhelming and the chances are you would never leave the house, have any kind of interesting life and rather wrap yourself up a big cotton wool blanket-
So when reading these risks understand that is what they are… risks. They could potentially happen and you need to be aware of them but if after a discussion with your dentist, it is decided a tooth extraction is the best treatment, then the potential complications just come with the territory.