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Post Extraction Complications - An Institution Based Retrospective Study

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Madhulaxmi Marimuthu, SohaibShahzan. Post Extraction Complications - An Institution Based Retrospective Study. Int J Dentistry Oral Sci. 2021;08(03):1911-1914.
1911
OPEN ACCESS https://scidoc.org/IJDOS.php
Post Extraction Complications - An Institution Based Retrospective Study
Research Article
Madhulaxmi1*, SohaibShahzan2
1 Professor, Department of Oral Surgery, Saveetha Dental College, Saveetha Institute of Medical and Technical Sciences (SIMATS), Saveetha Univer-
sity, Chennai 600077, India.
2 Research assistant Dental Research Cell Saveetha dental college, Saveetha Institute of medical and Technical Sciences (SIMATS), Saveetha University,
Chennai 600077, India.
International Journal of Dentistry and Oral Science (IJDOS)
ISSN: 2377-8075
*Corresponding Author:
Madhulaxmi Marimuthu,
Professor, Department of Oral Surgery, Saveetha Dental College, Saveetha Institute of Medical and Technical Sciences (SIMATS), Saveetha University, Chennai 600077, India.
Tel: +91 7373814000
Email Id: madhulaxmi@saveetha.com
Received: February 25, 2021
Accepted: March 04, 2021
Published: March 08, 2021
Citation: Madhulaxmi Marimuthu, SohaibShahzan. Post Extraction Complications - An Institution Based Retrospective Study. Int J Dentistry Oral Sci. 2021;08(03):1911-1914.
Copyright: Madhulaxmi Marimuthu©2021. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted
use, distribution and reproduction in any medium, provided the original author and source are credited.
Introduction
Tooth extraction is one among the common procedures under-
taken in dental clinics [27]. Post extraction complications gen-
erally don't occur, however there are times when the dentist is
faced with post extraction complications [20]. Complications are
unforeseen events that tend to extend from a specic operative
procedure under normal circumstances [33].
Though they are rare, their occurrences results in a protracted
phase of treatment, which is cumbersome to the patient and also
to the clinician [19]. Thus it becomes imperative that the clini-
cian is aware and recognises the entire spectrum of complications
and their implications [30]. Complications are often wide, starting
from common ones like alveolitis and root fracture to uncommon
ones like displacement of a root fragment with in the sinus and
oro-antralstula [14]. Disturbed healing can also complicate or
even jeopardize dental implant placement and other procedures
[17]. Alveolar osteitis (AO) is the most common and most widely
discussed in the literature and is sometimes confused with other
less common complications [5]. Pain is a natural bodily response
to noxious stimuli [13]. In post-extraction wound healing, pain is
a key factor alerting patients to seek professional care out of con-
cern for disturbed healing [26]. Normal uncomplicated alveolus
healing has also been reported to cause moderate to severe pain
[13]. The aim of this study was to analyze the incidence of post
extraction complication among patients visiting Saveetha Dental
College in a period of 1 year.
Abstract
Tooth extraction is one of the most common procedures under taken in dental clinic. As with any surgical procedure, even
a simple tooth extraction can result in complications. Post extraction complications can be annoying to the patient there by
causing mild morbidity and have an impact in their quality of life. Complications are wide starting from common ones like
alveolitis and root fracture, dry socket, infraction, halitosis, pain, trismus and uncommon ones like displacement of root frag-
ments with in sinus and oral antral stula. The aim of this study was to evaluate post extraction complications among patients
visiting saveetha dental college. This is a retrospective study. We reviewed patient records and analysed the data of 86000
patients between June 2019 and March 2020. From a pooled sample size of 23000 extractions done during this period, data of
patients reporting for post extraction complications were segregated and analysed. The statistical analysis was done using SPSS
Version 20 by IBM. The results were analysed using chi-square test. In this study we observed that among a sample of 23000
simple extractions, only 42 patients had reported back with post extraction complications (0.18%). These complications were
more in males than females. When compared between maxillary and mandibular arch the mandible had more incidence with
54.16%. The most common complication was dry socket (58.34%). Pain as a complication was more in males than in females.
With in the limits of study, the incidence of post extraction complication is more in males than females. Higher incidence of
complication was seen in mandibular arch (54.16%) than in maxillary arch (45.84%).
Keywords: Teeth; Extraction; Complications; Pain; Dry Socket.
Madhulaxmi Marimuthu, SohaibShahzan. Post Extraction Complications - An Institution Based Retrospective Study. Int J Dentistry Oral Sci. 2021;08(03):1911-1914.
1912
OPEN ACCESS https://scidoc.org/IJDOS.php
Materials and Methods
This is a retrospective study done among patients who visited
Saveetha Dental college and Hospitals during the period June
2019 to March 2020. From a pooled sample size of 23000 ex-
tractions done during this period, data of patients reporting for
post extraction complications were segregated and analysed. The
approval for this university setting study was obtained from the
Institution Ethics Board.
Inclusion criteria: Patients over 18 years, medically t and
healthy with no comorbidities, patients who reported with pain/
swelling/open extraction wound/difculty in mouth opening and
any other complaints after simple dental extraction.
Exclusion criteria: Patients less than 18 years, medically com-
promised patients and patients who underwent trans alveolar ex-
tractions.
We reviewed patient records and analysed the data of 86000 pa-
tients between June 2019 and March 2020. The parameters stud-
ied and tabulated included age, gender, teeth extracted and type
of complications. The data was reviewed by 2 reviewers.
Statistical Analysis:
After further verication by an external reviewer, it was imported
to the SPSS Version 20 by IBM for statistical analysis. Percentages,
mean, standard deviation, frequency of parameter were employed
in the analysis. Chi-square test was used to detect the signicance
between age, gender, site and various complications.
Results and Discussion
Post extraction complications were more in age group above 40
years. Bony spicules, pain management and dry socket were seen
more in this age group. The most common complication in both
age group was dry socket. There were 2 cases of trismus reported
in age group below 40 years and 1 case in age group above 40
years (Graph 1).
Most complications were in mandibular arch than in maxillary
arch (Graph 2). This can be attributed to the anatomical blood
supply to maxilla vs the mandible. It can also be due to more
extractions done in mandibular arch than the maxillary arch.
Though this observation can be of clinical signicance, there was
no statistically signicant difference in complications occurring in
maxillary vs the mandibular.
Prevalence of complications were more in males than in females.
Two cases of trismus were reported in males and one case in fe-
males. 3 cases of bony spicules were reported in males and 2 cases
in females. Same number of cases of dry socket were reported in
males and females (Graph 3).
Surgery and complications go hand in hand. Dental extraction is
a minor surgical procedure which can lead to complications[24].
Although careful attention to surgical details, including proper
patient preparation, asepsis and meticulous management of hard
and soft tissue, controlled force when applying surgical instru-
ments, hemostatis and adequate post operative instruction may
help to reduce the rate of complications, though it has not been
found to eliminate it [1].
The factors that contribute to such complications are numerous
and include the patients compliance and general medical and oral
health, difculty of extraction, surgeons operative experience, etc.
[34]. Other factors found to affect the complication rate include
age and gender of patient [25].
The study sample included were patients mostly treated by den-
Graph 1. Bar chart depicting the post extraction complications in different age groups.
Graph 2. Bar chart depicting the distribution of post extraction complications in maxillary and mandibular arch.
Madhulaxmi Marimuthu, SohaibShahzan. Post Extraction Complications - An Institution Based Retrospective Study. Int J Dentistry Oral Sci. 2021;08(03):1911-1914.
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OPEN ACCESS https://scidoc.org/IJDOS.php
tal graduate students. As the study was done in a university set-
ting, materials used for extraction, technique and post operative
medications were standardised. The study shows higher incidence
of dry socket (58.34%), pain management(25%), bony spic-
ules(10.41), trismus(6.25%).
Dry socket was the most common complication [3]. Similar re-
sults were observed in a study by Adeyemo et al [3]. In a histo-
logical study, Amler reported AO results from disturbances in the
progression of healing from blood clot to granulation tissue [7].
Failure or interference in the mechanism of the granulation tissue
development to replace the clots results in disintegration of the
blood clot by putrefaction rather than by orderly resorption, giv-
ing rise to the well-known symptoms of dry socket [7].
Post operative pain management was more in males than in fe-
males.This may be due to various habits like smoking, alcohol,
tobacco which are more common in males than in females [20].
And, also pain tolerance is generally said to be more in females
than in males [1]. And, there are many studies which show that
men more often complained of post operative pain than women
[15]. Proper analgesic protocol can be taken to reduce pain [32].
Regardless of pain severity, one should seek to optimize “around-
the-clock” dosages of these agents and then, if necessary, add an
opioid to the regimen as needed for breakthrough pain [10].
The percentage of bony spicules was found to be 10.41%. After
tooth extraction, bone spicules should be removed, because they
may result in an obstruction in placing a prosthetic restorative ap-
pliance [16]. Alveoloplasty can be done to remove bony spicules,
prior to prosthetic rehabilitation [18].
Incidence of trismus was found to be 6.25%. The factors contrib-
uting to trismus are: Low-grade infection post administration of
local anesthetic agents [9]. Multiple needle penetrations correlate
with a greater incidence of post injection trismus. This complica-
tion is especially noted when injections were given using barbed
needle. The most commonly involved muscle is medial pterygoid
during inferior alveolar nerve (IAN) block [9]. It has been hy-
pothesised that trauma to this muscle, can cause microbleeding,
hematoma formation and trismus. Elevation of ap beyond the
external oblique ridge can also result in postoperative edema and
there by pain and difculty while opening the mouth [29].
At times, the patient hurts his/her own tongue or cheek under the
effect of anesthesia resulting in reex trismus [9]. Physiotherapy
treatments may be required to establish normal function (exer-
cises will include neck stretching, chin tuck, massaging of masti-
catory muscles, and other jaw stretching) [6]. Mandibular opening
devices might be considered in some cases, but most likely pro-
vided by a physiotherapist or dental specialist [6].
Complications were more in age group above 40 the older adults
than in age group below 40 the younger adults [4]. The possible
reasons might be due to decreased healing potential and dense
bone [31]. Increase in neurosensory problems in patients above
24 years was reported in a study [11]. Post extraction complica-
tions were more prevalent in males than in females. As mentioned
earlier this may be due to various habits in males. However there
are studies which show that complications are more in females
than in males [8].
A higher incidence of complication was seen in extraction carried
out in mandible (54.16%) as compared to maxilla (45.84%) [35].
This may be due to anatomical factors including dense cortical
bone and comparatively lesser vascularity in mandible as com-
pared to maxilla which has a good blood supply [35].
Conclusion
With in the limits of study, overall percentage of post extraction
complications are signicantly very minimal (0.18%). Among
those reported, post extraction complications are more in older
males and affecting the mandibular arch (54.16%). From this
study, it can be inferred that proper surgical technique and proto-
cols; post extraction instructions; patient compliance and motiva-
tion with good analgesics prescribed postoperatively, complica-
tions can be avoided to a great extent in simple extractions.
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Full-text available
  • Sep 2017
Introduction: Ranula is mucous extravasation cyst that occurs in the floor of the mouth. There are various methods of management of paediatric oral ranula each of which has their own advantage and disadvantage. Aim: The aim of this paper was to systematically review the available literature on the management of paediatric oral ranula. Materials and methods: A total of 64 articles were retrieved by electronic search. Based on the preset inclusion and exclusion criteria, a total of 21 articles were retrieved for full text analysis. The following characteristics were assessed from the retrieved articles: author, year of publication, study design, sample size, intervention, adverse effects and follow up period. Results: The included studies consisted of the following study design: Seven articles were prospective clinical study, four articles were retrospective review, five articles were case series and five articles were case report. The mode of care varied from surgical excision to drug administration and lasers. Conclusion: The data obtained from the review, display a lack of high quality study, with proper sample size and adequate follow up period. Further, randomized clinical trials are required to help the clinicians devise a best treatment approach for the management of paediatric oral ranula.
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Analgesic Efficacy of Paracetamol Vs Ketorolac after Dental Extractions
Article
  • Jan 2018
Objective: To evaluate the analgesic efficacy of paracetamol(500mg) and ketorolac(10mg) after dental extractions. Methods: A prospective study was conducted during the academic year September-November 2017, randomly among 20 dental patients who visited the outpatient Department of Oral and Maxillofacial Surgery, Saveetha Dental College, Saveetha University, Chennai, for single tooth extraction. 20 patients were randomized into two treatment groups (each with 10 patients), group A received Paracetamol 500 mg orally and group B received Ketorolac 10 mg orally immediately after dental extraction procedure. Pain intensity levels of patients were measured using the visual Analog scale (VAS) at different time intervals and compared between the two groups. Data collected were analyzed with Statistical Package for Social Sciences for Windows, Version 16.0 (SPSS Inc., Chicago, IL, USA) and results obtained. Results: Patients who received Ketorolac had lower pain intensity compared with patients who received Paracetamol. The duration of analgesia was longer in the Ketorolac group when compared with the Paracetamol group. There was a statistically significant difference in pain scores between ketorolac and paracetamol groups at p<0.05. Conclusion: Ketorolac 10 mg is more effective than Paracetamol 500mg as an analgesic after dental extractions.
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Evaluation of Three-Dimensional Changes in Pharyngeal Airway Following Isolated Lefort One Osteotomy for the Correction of Vertical Maxillary Excess: A Prospective Study
Article
  • May 2018
Background Orthognathic surgery involves movement of jaws in all three planes, and this being a part of airway complex, displacement of jaws can influence the dimension of airway at all levels. Lefort one osteotomy surgery with superior repositioning is a common procedure done for patients with vertical maxillary excess Purpose The purpose of this study was to evaluate the three-dimensional volumetric changes in airway after lefort one impaction surgery using three-dimensional cone beam computed tomography (3D-CBCT) in patients with vertical maxillary excess (VME). Methods A prospective analysis of 15 patients who underwent isolated lefort one impaction surgery was done with pre-operative (T0) and 3-months (T1) post-operative 3D-CBCT scans. Airway was divided into three segments, nasopharyngeal, velopharyngeal and oropharyngeal. Volumetric analysis of all these segments was done before and after surgery. Paired ‘t test’ was used to assess the mean difference in airway volume and area between T0 and T1. One-way ANOVA was used to check the mean percentage difference in airway volume and area among the three segments. Results The mean percentage of nasopharyngeal volume difference was − 0.6299 ± 0.9146%, velopharyngeal volume difference was − 0.5205 ± 1.107%, oropharyngeal volume difference was − 1.492 ± 2.745%. Though volume and area of pharyngeal airway were decreased after maxillary impaction surgery in all three segments of airway studied, they were not statistically significant. Conclusion Among the three segments of airway studied, oropharyngeal airway volume has shown the highest post-surgical reduction though statistically insignificant. ESS scores were within normal limits. Hence, we are of the opinion that there is lack of evidence to conclude that the patients undergoing lefort one superior repositioning for the treatment of VME might develop significant narrowing of PAS that may predispose the patient to breathing disorders.
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The emerging role of botulinum toxin in the treatment of orofacial disorders: Literature update
Article
  • Sep 2017
Botulinum toxin (BTX) is a lethal neurotoxin produced by Gram-positive anaerobic bacterium called Clostridium botulinum. It is the first toxin used fortherapeutic purposes since 1989. BTX treatment is relatively safe and efficacious, less invasive, conservative, and the effects are faster and reversible.The purpose of this article is to review the literature regarding the applications of BTX in the treatment of various orofacial disorders, their mechanismof action, contraindications, and complications. From the recently published literature, it is clear that the role of BTX as a therapeutic agent for severalconditions is expanding. With the training of BTX-A injection techniques and adequate knowledge about treatment protocols, general dentists cansafely administer BTX injections. The ability to use Botox as an adjuvant and primary mode of the treatment for various maxillofacial disorders offersexciting treatment options for dentists and patients in the future.
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Knowledge, awareness, and practices regarding biomedical waste management among undergraduate dental students
Article
  • Aug 2017
Objective: The objective of this study was to assess the knowledge, awareness, and practices of dental students regarding biomedical waste (BMW)management.Methods: A self-administered structured questionnaire consisting of 16 questions on knowledge, awareness, and practices about BMW managementwas distributed among 100 students randomly belonging to 3rd year, final year and intern students of Saveetha Dental College, Saveetha University,Chennai. The data extracted were tabulated, statistically analyzed using SPSS version 20.0 and results obtained. The data were analyzed using ANOVAtest (all the results are calculated at 1% level of significance) and Post-hoc test.Results: Overall, 67% respondents were aware of the existing BMW management policy systems in India. 62% of students were aware about thecorrect color coding management system for hospital waste management that prevails in India. 86% of students knew about the dental wastecategories of materials used in dentistry. There was a statistically significant difference of knowledge levels among the 3rd year, final year students andthe interns. 100% practice discarding sharps in the puncture-proof containers. Only 27% of the respondents discarded the extracted tooth in a properway. Only 51% of them have attended previous training programs on dental waste management. There was also a statistically significant difference ofBMW disposal practices among the three groups.Conclusion: The majority of dental students in our study have good level of knowledge and awareness regarding BMW management in dental clinics.However, their practice toward BMW disposal was poor. Hence, the knowledge acquired must be put into practice. Intern students have the highestlevel of knowledge and practices toward dental waste disposal when compared to final year and 3rd year students. Hence, these findings imply thatproper training, continuing education programs, and short-term courses about BMW management, and infection control procedures are requiredto motivate the dental students and dental auxiliaries. The importance of training regarding BMW management must be emphasized as the lack ofproper and complete knowledge about BMW management impacts practices of appropriate waste disposal.
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Relationship between dental anxiety and pain experience during dental extractions
Article
  • Mar 2017
Objective: To assess the effects of anxiety on pain experienced during dental extractions. Methods: A prospective study was conducted during the academic year July-September 2016, randomly among 60 dental patients who visited the outpatient Department of Oral and Maxillofacial Surgery, Saveetha Dental College, Saveetha University, Chennai, for single tooth extraction. Anxiety was measured using the Hamilton anxiety rating scale. The pain was measured using the pain visual analog scale (VAS) for the level of pain perceived during extraction. Data collected were analyzed with Statistical Package for Social Sciences for Windows, Version 16.0 (SPSS Inc., Chicago, IL, USA) and results obtained. Results: From regression analysis, R²=0.605 which meant that the independent variable (anxiety) explained 60.50% of the variability of the dependent variable (pain) with significant t-value. There was a statistically significant correlation between VAS and total anxiety score (p<0.05). This strongly suggests that an increase in pain level is associated with an increase in anxiety level. Conclusion: Pre-operative dental anxiety is a major predictor of pain experienced by patients during dental extractions. Hence, it is an important to reduce anxiety before treatment to reduce pain during the treatment. Pharmacologic modalities like sedation can be used for reducing anxiety and pain related to the treatment in indicated patients.
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