Injuries and complications following wisdom teeth extractions

Tooth extraction is a radical, necessary operation to remove irrecoverable teeth from the socket.

Wisdom molar extraction is an operation that is required when the tooth in question is no longer of prosthetic importance, suffers carious lesions or any other type of destructive lesion that is difficult to treat, blocks the development of neighboring dental units or damages their health, or suffers repeated infections that do not improve after conservative treatment.

Removal of impacted wisdom molars, also called odontotomy, is a difficult operation because it requires bone sacrifice. Drilling of the cortical bone will be done with rotary drills.

Even if the patient experiences an unpleasant sensation at the time of drilling, the pain is absent, thanks to the anesthesia carried out beforehand.

However, no matter how careful the operator is when performing wisdom molar extractions, due to the complexity and morphological diversity, there is a risk of intraoperative accidents and postoperative complications.

The distal location of the molars produces difficult access and the order of eruption, which ends with the wisdom molars, often produces crowding or even submucosal or intraosseous remnants.

Accidents during extraction of wisdom molars:

Fracture

The crown or roots of the wisdom molars may suffer fractures, thus making the whole extraction process more difficult.

Fracture can occur through improper choice of instrumentation, errors in technique, difficult access to the extraction site, or the improper position of the tooth.

Fracture of the cortical bone – the location deep in the bone of the impacted wisdom molar involves drilling through the cortical bone to release the crown. This may result in fracture of the bone plate with exposure of vascular and nerve elements.

The oral bone plate is more fragile than the buccal bone plate, so the lingual nerve, located near the buccal floor, may be injured.

Fracture of the mandible

Sometimes, the deep bony impacted molar is a stabilizing factor for the mandible. Sometimes, when it occupies a considerable volume of the mandibular bone mass, by extraction, the bone can become brittle and even fracture.

Dislocation of the mandible

If the patient keeps the mouth open for a long-time during extraction, the temporomandibular joint may become dislocated.

Complications of wisdom molar extraction occur shortly after the operation is completed, usually within hours or days. These are related to:

Pain and inflammation

These are normal reactions that occur after wisdom teeth extraction, especially if the operation was difficult. The patient should be given painkillers and cold-water compresses until the pain is relieved.

Remaining socket infection

This can occur when the place previously occupied by the tooth has been contaminated with bacteria.

This infection is called alveolitis and, depending on its form, dry or wet, it presents pain of varying intensity.

The patient should see the dentist again to have the socket disinfected.

Trismus

It is the impossibility of opening the mouth within its physiological limits.

Trismus may occur due to post-operative inflammation. On the other hand, keeping the mouth open for a longer period of time causes the muscular system to suffer, the fibers become inflamed and the amplitude of the closing and closing movements is reduced.