Complications during tooth extraction. Various injuries after extraction. How long does it take for gums to heal after wisdom tooth removal?

This should not be taken lightly, because after such a procedure there are complications, just like after any other intervention.

They can be caused by the behavior of patients, or they can arise for reasons beyond their control. Let's consider the main reasons for complications during and after tooth extraction, as well as characteristic features and methods of treatment.

Tooth extraction is serious

Any tooth extraction cannot be considered harmless dental procedure. Moreover, modern medicine With the introduction of tooth-saving technologies, he considers this a last resort measure. After all, the loss of even one tooth is a big problem for a person.

Tooth extraction is carried out only by medical indications when it is impossible to prevent the development of the disease in other ways. This procedure is not performed during pregnancy.

A separate problem is the removal of the third molar: due to the peculiarities of its position, such a procedure is the most common cause development of complications.

Light extraction of teeth is carried out using dental forceps. The doctor makes special movements to help remove the tooth from the socket.

Complex extraction is a situation where a tooth cannot be removed using forceps alone. The doctor first creates access to the tooth root by cutting the periosteum. If the tooth is located obliquely or horizontally, then removal occurs in parts using special tools.

The method of tooth extraction depends on each case. Only a specialist can determine the tactics of such an operation. This is a very serious procedure, which in some cases can cause complications.

What causes unpleasant consequences?

Unpleasant consequences and excruciating pain after tooth extraction are associated with a number of reasons. Although the current level of development dentistry reduces the likelihood of complications to a minimum.

Thus, the most common cause of bleeding is blood clotting pathologies. Even the reception acetylsalicylic acid poses a serious risk of bleeding.

The same can be said for patients suffering arterial hypertension. When the pressure stabilizes in such patients, the risk of bleeding remains.

Bleeding wounds can also occur as a result of the following reasons:

• features of the pathological process;
• features of the location of the teeth;
• careless removal;
• failure to follow doctor's recommendations.

Inflammation after tooth extraction - alveolitis or osteomyelitis is provoked due to the following factors:

• the existence of multiple foci of inflammation with frequent relapses;
• traumatic removal (this creates conditions for penetration pathogenic microflora in fabric);
• absence blood clot in the tissue formed after removal;
• pathological changes in the body due to stress, as well as acute diseases;
• Availability endocrine diseases in the stage of exacerbation or decompensation;
• exhaustion.

Perforation maxillary sinus occurs for the following reasons:

• anatomical features of the structure of the tooth and the location of its roots;
• the presence of chronic foci of inflammation;
• careless actions of the doctor;
• if during the procedure the patient suffered from inflammation of the maxillary sinus.

These are the most common causes of complications after tooth extraction.

How do the risks exist?

After tooth extraction, the patient may have the following complications:

• bleeding;
• temperature increase;
• paresthesia;
• change in the position of adjacent teeth;
• trauma or incomplete tooth extraction;

Alveolitis is a painful inflammation of the tooth socket

Alveolitis is an inflammation of the socket after tooth extraction. In some cases, the hole may look completely normal, and the diagnosis of “alveolitis” is made by a doctor only after a thorough examination. However, in most cases, the hole swells and an unpleasant odor appears from it.

Upon visual inspection, the hole is empty, there is a yellowish coating, as well as food debris. In some cases, purulent contents are found in it. The adjacent gum is swollen, bright red, painful to the touch. IN severe cases exposed bone tissue is revealed.

In case of violation, pain is observed of different nature– acute or mild. They are often accompanied by a headache.

When the blood clot suppurates, it is noticeable. In this case, symptoms of general intoxication of the body are often observed - weakness, bad feeling, elevated temperature body, fatigue.

At acute course During the process, swelling of the cheek or gums is added to these symptoms. Typically, the patient feels severe pain.

Alveolitis is treated exclusively by a dentist. Self-medication is useless in terms of effectiveness.

The doctor removes the blood clot under anesthesia. The hole is washed antiseptic solutions. At home, you may need to wash the hole yourself.

Blood from a tooth - drip, drip, drip...

It often appears if a large vessel is damaged during tooth extraction. It also appears after a few hours after surgery or even at night.

However, you should not expect the bleeding to stop on its own. At home, you can make a tight gauze swab and place it over the hole.

Cold must be applied to the cheek in the projection of the socket. If you can’t visit a doctor, this will help hemostatic sponge, which you can buy at the pharmacy. The condition is alleviated by taking Dicinone.

If these measures are not successful, you must immediately contact a dental clinic or call an ambulance.

In order to, you need:

• do not take hot water treatments;
• do not make sudden facial movements;
• do not smoke or drink alcohol;
• do not engage in physical labor.

Temperature increase

After tooth extraction, natural healing of the hole occurs, and it is possible slight increase body temperature. However, in some cases there is a risk of swelling, redness, and pain.

They indicate that microorganisms have entered the hole and an inflammatory process is developing.

In this case, you cannot delay contacting a doctor, nor should you self-medicate. In a clinical setting, the patient is provided qualified assistance aimed at relieving inflammation.

Hematoma formation

A hematoma usually forms in the gum tissue. It develops as a result of capillary fragility or hypertension.

The appearance of a hematoma is indicated by enlarged gums, redness, and increased temperature.

Hematoma is treated by a dentist.

Paresthesia - decreased sensitivity

When nerves are damaged, sensitivity decreases. A person loses touch, pain, temperature and taste sensitivity. Often the sensations are similar to those observed after the administration of an anesthetic.

Most often, paresthesia goes away within a few days. However full recovery Sensitivity may last for several months. Persistent paresthesia is said to exist if it lasts more than six months.

In case of prolonged paresthesia, the patient is prescribed combined medical supplies. Injections of Dibazol, Galantamine or aloe extract are indicated.

Flux formation

After tooth extraction, an infection occurs in the jaw. This is a purulent focus formed in the gum tissue.

Among the signs of this complication, one should note severe pain radiating to the eyes or temples, swelling of the cheeks, redness and swelling of the mucous membrane, and increased body temperature.

It consists of opening it and washing the cavity with antiseptics. The doctor also prescribes antibiotics.

Injuries and tooth displacements

After tooth extraction, the following injuries are possible:

1. Damage to adjacent teeth. They may be fragmented, broken or weakened.
2. Incomplete removal occurs when a tooth is removed in parts.
3. Jaw fracture occurs in patients with weakened jaw bones. Most often this happens after.
4. Removal of part of the alveolar ridge occurs most often due to unprofessional and careless actions of the doctor. This problem can be solved with plastic surgery.

Complications during the procedure

Numerous complications often occur during tooth extraction. They are divided into general and local:

1. To general complications include collapse, shock, fainting, attack hypertensive crisis etc. In this case, assistance to the patient is provided immediately.
2. Most common local complication is a fracture of a tooth or tooth root. Most often this happens when high degree its destruction. The patient feels severe pain.

Treatment for a fracture depends on the severity of each individual case.

If the forceps are selected incorrectly, a fracture, dislocation or removal of an adjacent tooth may result. This often happens during rough operations.

Jaw dislocation occurs when the mouth is opened too wide. Treatment for a dislocation involves its reduction.

If the doctor works carelessly, damage to the soft tissues of the mouth may occur. Treatment for such injuries depends on the extent of the injury.

Other problems

Complications also include:

• rudiment damage permanent teeth in children;
• swallowing a tooth;
• aspiration of the tooth with subsequent development of asphyxia;
• perforation of the maxillary sinus;
• sudden bleeding.

So, tooth extraction cannot be harmless and simple intervention. It's always major surgery, which has some contraindications.

As a rule, the attentive approach of the doctor and the use of modern dental equipment minimizes the occurrence of various types of complications.

At timely treatment possible complications, recovery occurs, and jaw functions are restored.

Complications after tooth extraction are quite common. What are they? What to do when the first symptoms appear, how to treat? Let's try to figure it out.

Alveolitis after tooth extraction

On the spot extracted tooth arises open wound. In order to prevent infection from getting into it, a blood clot must form. If this does not happen, the hole may become inflamed.

What you should pay attention to if you suspect alveolitis:

1. Painful sensations. They may appear immediately after removal or after 1–2 days.
2. Swelling of the gums.
3. Absent from the wound.
4. The edges of the wound are inflamed.
5. In the socket of the extracted tooth there are food remains that smell unpleasant.
6. The patient has heat bodies.
7. Complaints about .
8. Sometimes they increase The lymph nodes in the throat area.

Causes of alveolitis

alveolitis after tooth extraction

Why does this complication develop? Main reasons:

1. Weakness of the body due to bad work immune system.
2. Previous history of illnesses caused by viral infections.
3. Stress, exhaustion of the body due to heavy physical exertion.
4. Injuries during removal (part of the facial bone was removed).
5. Ingress of tooth particles into the wound.
6. The wound was incorrectly or insufficiently treated with an antiseptic.
7. Poor blood clotting.
8. Failure to follow the doctor's instructions, due to which the blood clot does not form on the wound or is removed by the patient (for example, during rinsing too vigorously or introducing foreign objects into the wound).

Treatment

The main rule is not to self-medicate. Only a specialist can deliver correct diagnosis and prescribe appropriate treatment, which occurs only in a hospital setting.

First of all, to stop inflammatory process, prescribe medications:

1. Antibiotics that destroy the infection.
2. to disinfect the wound. Such a remedy can be a solution of ordinary soda.
3. Medicines that relieve pain.
4. If it is necessary to remove pus or dental fragments from the wound surgically, use local anesthesia (this is for everyone known drugs– novocaine or ).

During the treatment period, it is necessary to maintain oral hygiene, as well as follow all the doctor’s instructions. On early stages It is possible to get rid of alveolitis; advanced disease entails loss of performance, and in especially severe cases, death.

Socket bleeding

This complication is characterized by bleeding directly from the wound at the site of the extracted tooth. Occurs immediately or after some time (after several hours or days).

Causes

The main causes of alveolar bleeding are:

1. Traumatic damage to the gums, the septum connecting the roots of adjacent teeth, blood vessels tongue or palate.
2. Diseases of the patient that can provoke bleeding (blood diseases, hypertension, sepsis).
3. Damage to the wound due to violation of its integrity.
4. Stops working local anesthesia, which leads to vasodilation. The result is bleeding from a fresh wound.

Treatment

Treatment for alveolar bleeding involves stopping it.

First, the location and nature of the damage are determined, and then one or another method is used to stop blood loss:

1. If the integrity of the gum is damaged, sutures are placed on it.
2. If there is bleeding from the hole itself ( vessel damaged its walls), apply ice to make the vessels narrow, find the damaged vessel and squeeze it to stop the bleeding. After this, a tampon soaked in a hemostatic agent is lowered into the wound. After a few hours, the tampon is removed.
3. Drugs that promote general blood clotting are used only in as a last resort– when it is not possible to stop the bleeding using the above methods.

Paresthesia

Local anesthesia is used for tooth extraction. It has an analgesic effect, but partial loss of sensitivity occurs and the face goes numb. This process lasts several hours, and soon everything returns to normal. But it happens that the numbness does not go away after removal. This complication is called paresthesia.

Causes

Paresthesia is most often a temporary phenomenon. It disappears after a few days, sometimes weeks.

Reasons that can cause prolonged numbness in the lower part of the face may be:

1. Incorrect anesthesia.
2. Allergic reaction to an anesthetic drug.
3. Damage to nerve endings.

All this is a consequence of a doctor’s mistake or negligence.

Treatment

In most cases, paresthesia goes away on its own. But if this does not happen after 2-3 weeks, you should seek advice from an experienced dentist.

Treatment can take place in the following ways:

1. Taking B vitamins.
2. Injections of dibazole or aloe extract.
3. Physiotherapy (electrophoresis, ultra-high frequency therapy)

If this does not help, surgery may be scheduled to repair the facial nerve.

Changing the position of adjacent teeth

A hole forms in the jaw where the tooth was removed. This leads to the fact that the neighboring teeth gradually tilt, as if trying to cover the defect.

The same thing happens with the tooth that is located parallel to the opposite jaw. This phenomenon negatively affects the chewing process and leads to the formation of an incorrect bite.

To avoid such troubles, it is necessary to place a prosthesis or implant in place of the extracted tooth as soon as possible.

Possible injuries

It happens that during the removal process not everything goes smoothly.

All sorts of traumatic cases occur due to the negligence of the doctor or the restlessness of the patient:

1. Fracture of the tooth being removed and pulling it out in parts.
2. Neighboring teeth break or become loose.
3. Sometimes part of the root cannot be pulled out and the doctor leaves it in the jaw. In this case, there is a risk of inflammation.
4. Fracture of the jaw bone. It most often occurs in elderly patients when the jaw bone is weakened due to age or a previous illness.
5. If a tooth is removed incorrectly, the doctor may pull out part of the alveolar ridge along with it. At the same time, you can’t do without plastic surgery.

Complications in children

What complications can there be in children? They also have milk teeth, the roots of which sit loosely in the jaw bone. Often parents remove them at home (either on their own or entrust this procedure to amateur doctors).

But this is unacceptable:

1. Firstly, such an operation often occurs in unsanitary conditions without use antiseptics. Therefore, there is a high risk of infection in the wound.
2. Secondly, at least some kind of anesthesia is rarely used; the child may experience painful shock.
3. Thirdly, carelessness can lead to damage to the permanent rudiment.

Dear parents! Don't experiment on your children's health!

To prevent terrible consequences, it is necessary to take tooth extraction responsibly and seriously. Use the services of only experienced professionals.

Let such a procedure in dental clinic will cost more than an underground doctor who does not have the appropriate education and necessary experience. Don't take risks. If any complications occur, do not self-medicate.

Seek help from professionals. Value yourself, your health and your life.

Since childhood, most of the population has been unimaginably afraid of visiting the dentist. As they get older, many naturally stop being nervous, understanding the need for preventive examinations and boldly go to the next appointment. One of the most common actions performed by doctors every day is tooth extraction. Like most other surgical procedures, this operation can have its challenges, which can affect the recovery process by reducing the ability of the injured area to heal.

Complications after this usually come down to several problems. First of all, this is secondary bleeding. In most cases, such consequences appear after the removal of wisdom teeth, since such an operation is the most difficult among other similar actions. The risk category includes patients who have hypertension or diseases associated with a decrease in the ability of blood to clot. Among other things, complications afterward may be closely related to any individual characteristics of the patient. Bleeding does not necessarily occur immediately after surgery. It is quite possible that blood appears after a short period of time. In this case, it is recommended not to delay and contact the dentist who performed the operation, or call an ambulance.

Complications after tooth extraction are sometimes expressed in the form of swelling. You should know that not only the gums at the extraction sites are affected, but also the cheeks. Typically, this reaction is a consequence of the destruction of the soft tissue around the unwanted tooth. However, an allergy to the drug that was used as anesthesia is also possible. If such complications after tooth extraction do not go away on their own, then you should contact your dentist again, who will prescribe an antibiotic to relieve swelling and prevent the inflammatory process from developing.

One of the most unpleasant complications can be fever after tooth extraction. In principle, if it has risen slightly in the first couple of days after the removal procedure, then there is no cause for special concern, just as in the case of swelling. In a person in in good condition a slight change in temperature, especially in the late afternoon, is considered normal, and even more so after undergoing stress (meaning tooth extraction surgery). In cases where it lasts more than four days, it is better to consult a doctor. The same applies to a strong increase in temperature.

Another rather unpleasant complication is dry socket. It is called this because for some reason there is no small amount of dried blood at the site of the extracted tooth. As a result, various microorganisms, including harmful ones, can easily enter the wound. Most often, such difficulties arise in patients who smoke or those who do not follow the specialist’s recommendations for treating the wound on their own. It often happens that the doctor himself can remove the clot if he does not perform any actions carefully. This usually becomes obvious after a few days when painful sensations, and very different: from aching to acute. This indicates the beginning of the inflammatory process, which, moreover, is accompanied by the appearance unpleasant odor. As a rule, when dealing with such complaints, the doctor prescribes compresses with certain medications applied to the wound.

Quite rarely, but it still happens that when pulling out an unnecessary tooth, a dental surgeon damages the jaw nerve. With this outcome, you may become numb Bottom part faces and tongue. The sensations are similar to the effects of anesthesia. The duration of such a complication can be calculated in several weeks, but it does not pose a particular threat and goes away on its own.

The most important thing is that if you have any doubts or complaints, do not wait for the problem to “resolve itself,” but seek advice from a specialist dentist (preferably the one who performed the tooth extraction operation) and strictly adhere to the recommendations he prescribed.

Complications after tooth extraction are not uncommon, because extraction is a complete surgical intervention, in which damage to adjacent tissue occurs. With these phenomena, the body's reaction is always unambiguous and characteristic: swelling, pain, bleeding. All these reactions are physiological and do not require separate treatment. All symptoms should go away within 2–3 days. But if the process is delayed, new symptoms are added in the form of a rise in temperature, signs of intoxication, the appearance of pus, bad breath, we're talking about about complications, and you need to see a doctor urgently.

Factors causing complications

The main reason for complications is that not all removals can be considered simple procedures: it is often necessary, in the presence of inflammation, to make an incision on the gum for drainage, to remove obstacles in the form bone tissue, apply stitches. All this creates difficulties, because the oral cavity is still a small surgical field, and manipulation here is difficult. Tooth extraction - always last resort, which is carried out only when it is not possible to save the tooth.

Complications can be caused by:

• presence of caries;
• lack of proper oral hygiene;
• colds at the time of surgery;
• oral infections;
• blood and vascular diseases, coagulation disorders;
• bad habits of the patient;
• taking certain medications.

Complications can appear not only due to the patient’s fault, but also due to the dentist himself, if the extraction was carried out too traumatically, in a hurry, poor lighting, and low qualifications of the doctor.

Removing molars and, in particular, wisdom teeth is by no means a simple procedure, since they have powerful roots. Often, after the removal of this tooth and other large molars, strong pain in the gums, numbness of the lips and tongue appears. This is called paresthesia and indicates that the adjacent nerve is affected. Other common complication when manipulating a wisdom tooth - alveolitis.

Removing a molar tooth is also difficult because when the process of inflammation is advanced, purulent cysts can often form on the roots. Extraction of the 7th and 8th molars may result in a fracture due to increased pressure on the jaw during tooth extraction. Moreover, these injuries are most often not diagnosed on time. The reason primarily lies in the effect of anesthesia. If a fracture or dislocation is nevertheless detected, the doctor must fix the jaw and prescribe anti-inflammatory therapy.

Tumor after tooth extraction

Most often, the appearance of swelling after removal is associated with damage to the gums. If swelling occurs immediately after surgery and in the first 2 days after it, and it is small and does not increase, then this is not a pathology and is perceived as physiological process. In such cases, you need to:

• apply to cheek for a few minutes plastic bottle with ice, wrapped in a towel;
• make baths with saline solution, antiseptics, herbal decoctions (preferably sage).

Otherwise, we are talking about the beginning of a wound infection and you need to consult a doctor. You can only rinse on day 3.

Causes of infection:

• failure to comply with asepsis;
• infection caused by the patient himself;
• insufficient sterilization of instruments.

Patients should absolutely not touch the wound with their hands, hard objects, or disturb it. Infection will be indicated by severe, ongoing pain, bleeding, and fever. You need to apply a cotton swab soaked in 3% hydrogen peroxide to the wound for 30 minutes and immediately go to the doctor.

When a tooth is removed, adjacent tissues are always damaged, which can swell and give a temperature of 37.2–37.9ºC. This will be normal within 2-3 days. At such times, the doctor may prescribe antibiotics proactively to prevent more complex complications. Further fever is most often a sign of a complication such as stomatitis. Antibacterial treatment, rinsing, washing oral cavity and doctor's supervision.

Bleeding after removal

During tooth extraction, blood vessels are necessarily damaged and, as a result, the wound begins to bleed. This is a consequence of any operation. But the blood clotting time does not exceed 10 minutes, during which time the blood should stop. If bleeding appears after 2 days at the site of the extracted tooth, this is late secondary bleeding. With it, purulent softening of blood clots in the wound occurs - there are general and local reasons. Local:

1. traumatic tooth extraction with broken bone fragment;
2. damage to the dental artery;
3. interradicular septum.

Common causes: blood clotting is impaired, there are other pathologies of the blood and blood vessels, hypertonic disease. Help: apply a pressure tampon soaked in hemostatic agent and urgently consult a doctor.

Selected complications

Alveolitis is an inflammation of the tooth socket after its removal: often when removing a tooth, the dentist is forced to cut the gum, and the socket is damaged. This always causes inflammation. Alveolitis leads among complications - 40% of cases. It occurs more often during operations on lower jaw, and when removing eights - in every 5 patients. The alveolitis wound usually heals within 2 weeks. The presence of inflammation after 2-3 days is indicated by an increase in regional lymph nodes, a rise in temperature, swelling in the cheek area, pain in and around the wound, and a putrid odor appears from the mouth.

In addition, there is no blood clot in the wound; in its place there is a gray coating, the gums are inflamed and red, and malaise is noted. The pain radiates to the ear, cephalgia is noted, it becomes difficult to speak and chew. Alveolitis can develop due to a dry socket, improper removal, infection, a tooth fragment getting into the wound, colds at the time of removal, or decreased immunity. Inflammation can spread to the periodontium.

Dry socket - after tooth extraction, a blood clot forms in the socket within a few minutes; it protects the wound from the penetration of microbes and injury. It cannot be removed; because of it, rinsing is not allowed on the first day. After 1–1.5 weeks, the clot disappears on its own after the wound heals and new epithelial cells grow. If zealous patients violate the doctor’s instructions on the first day, the hole becomes empty after the clot is washed out, and the path to infection is open. This is called a dry socket. Smoking on the first day and neglecting the diet will also contribute to this. Local antibacterial and antiseptic treatment. When you return, the doctor scrapes and cleans the hole under novocaine, then treats it with an antiseptic, prescribes baths, analgesics and antibiotics. If there is no treatment, osteomyelitis may develop.

Problems after removal can also result in perforation of the bottom of the maxillary cave. Provoking moments: the close proximity of the teeth and the bottom of the sinus is already individual feature when the bottom thickness is less than 1 cm. Sometimes the root itself can enter maxillary sinus, dental diseases in the form of cysts and periodontitis. The main symptom of perforation is the appearance of air bubbles in the blood, a nasal voice and blood in the nose. When probing the hole, the doctor can make sure that it has no bottom, or X-ray. If the perforation is not immediately diagnosed, then after 4–5 days its symptoms subside, but signs appear chronic sinusitis, because A fistula occurs at the site of perforation.

Then there is pain in the sinuses, eyes and temples, constant nasal congestion, and from it there are purulent discharge. On the side of the injury, the cheek is swollen. Treatment is usually surgical with closure of the defect (the damaged bone is connected with a plastic plate). And the sinus is opened, cleaned, treated with an antiseptic and antibiotics, the fistula is excised, and antibiotics are prescribed. An iodine tampon is inserted into the socket for a week before full formation new granulations at the site of the defect.

Damage to the gums

Complications during removal can manifest themselves as damage to the gums: due to the doctor’s haste, insufficient lighting, or disturbances in anesthesia. Dislocation of the lower jaw occurs when the mouth is opened too wide, or when a hammer or chisel is used. Local complications can also result in a fracture of the lower jaw - this is only due to the fault of the doctor.

Paresthesia (neuropathy of the inferior alveolar nerve) appears after the anesthetic wears off. The lip, tongue, and sometimes part of the face go numb. Most often, such consequences after tooth extraction go away on their own without treatment.

IN difficult cases Treatment is carried out in a hospital: physiotherapy and vitamin therapy, injections of Dibazol, Galantamine, Aloe are used.

Incomplete tooth extraction is also an iatrogenic complication due to the doctor’s negligence and inexperience. The doctor should always examine the extracted tooth and check the integrity of its roots to see if there is any chipping.

The question is that an unscrupulous doctor can remain silent about the problem, and then the patient’s pain will not stop and a complication will develop. When a problem is detected good doctor will perform a repeat, but minor operation: a small incision in the gum, closer to the fragment, and removing it through this incision. This must be done, otherwise osteomyelitis will develop.

The consequences of tooth extraction can be general. These include a change in the position of the nearest teeth: neighboring teeth move into the empty space, then the bite is disturbed, crowding of the teeth may develop, and the chewing load increases. To avoid this, it is best to undergo implantation, use dentures, or install bridge, and the sooner the better.

Injuries after tooth extraction

When a dentist works roughly, a tooth, root, or crown may break, or a piece of the alveolus may break off; this happens when the bone is weak, the patient makes unnecessary movements, or the doctor is insufficiently experienced. Neighboring teeth can also break due to their lack of stability as a support.

Loss of consciousness during surgery

Another common complication after tooth extraction is loss of consciousness or fainting, which can occur before or after tooth extraction as a result of the patient’s strong emotional stress. No one is immune from such temporary disturbances of consciousness, just the reasons are different: someone is overly emotional, someone has a fear of pain and a rude dentist, someone is afraid of the sight of blood. This, of course, is not life-threatening, but it will definitely frighten the patients sitting in the waiting room. It is necessary to lay the patient horizontally and provide him with access fresh air; loosen the collar and let the ammonia smell.

Complications after tooth extraction are more likely to develop if the patient consults a doctor late, so there is no need to delay the visit. You cannot wait for the pain to intensify when the inflammation can reach the gums and damage it. It loosens and swells: removing a tooth from such a gum cannot but cause bleeding. If a cyst with pus has formed on the root, this also leads to inflammation: then a complication from the removed bag of pus can result in the development of alveolitis and osteomyelitis. If a woman is menstruating, then, if possible, postpone tooth extraction until the end of menstruation (blood clotting decreases). It is better to go to the doctor in the first half of the day so that possible complications After tooth extraction, decide on the spot. If not general anesthesia, then it is better to eat before extraction, because... satiety leads to faster blood clotting. If a person has CVD and is taking anticoagulants, then they should be stopped one day before surgery and for 48 hours after it.

Removal of the gauze pad is possible after half an hour. If blood clotting is poor, the tampon can be kept in place for 40–60 minutes. To avoid complications after removal, rinsing the mouth is strictly prohibited in the first 2 days. Only baths are applicable: put a saline or other antiseptic solution into your mouth, then tilt your head towards the wound, hold the solution for 5-6 minutes without rinsing, and carefully release it. The procedure is repeated up to 3 times a day. The use of baths is especially indicated in the presence of purulent processes in the mouth. This is inflammation of the dental pulp, gingivitis, cyst.

When a tooth is removed, complications often occur when the blood clot is handled incorrectly: it has already been mentioned that it cannot be touched or removed. Even if food gets on the surface of the clot, you should not try to pick it out with a toothpick; you can touch and damage the clot, this is especially important in the first day. In general, 1 day after tooth extraction should be strictly observed. following rules: You cannot blow your nose, spit, or brush your teeth. You can't smoke, because... When you inhale smoke, negative pressure occurs in the mouth, and the clot can be pulled out of the hole. The maximum that can be held is to hold saline solution near the hole and carefully release it.

For the first 2–3 hours after removal, you should not eat or drink water. It is forbidden to drink alcohol, eat spicy, hard, hot foods: the flow of blood to the socket increases, and the pain and swelling intensify.

On day 2, baths should be done every time after meals. Brushing your teeth with a soft brush is allowed only from day 2, being careful not to touch the socket. For the next 3 days, food should only be soft; you should not eat sweets, drink alcohol, or drink hot drinks or food. Chew only on the healthy side. You are allowed to rinse your mouth only on the 3rd day, you can use soda-saline solution, Furacilin, Miramistin, Chlorhexidine, chamomile. To relieve pain in the first 2 days, you can take NSAIDs: Indomethacin, Ketanov, Naproxen, etc. You can also slightly reduce the pain by applying a bottle of cold water wrapped in a towel. Ice from the freezer is not allowed! The pain will decrease every day; in the absence of complications, it should not increase when eating. Sunbathing on the beach, hot procedures in the form of baths, baths, saunas, and physical overload are excluded. If these rules are followed, complications can be completely avoided.

Complications after tooth (root) extraction can be caused by the following reasons:

1. iatrogenic reasons, that is, related to violations of the surgical technique;

2. the presence of concomitant diseases in the patient;

How are complications of tooth extraction surgery divided?

There are local and general complications

Based on the time of occurrence, they are divided into: complications that arise during the removal operation; and complications arising after tooth (root) removal surgery.

Local complications during tooth extraction include:

Fractures and dislocation of teeth (roots) at different levels;

Acute perforation of the bottom of the maxillary sinus and pushing of the root into the maxillary sinus;

Rupture of the soft tissues of the alveolar process;

Dislocation or fracture of the lower jaw;

Detachment of the tubercle of the upper jaw;

Entry of a tooth (root) into the upper Airways and gastrointestinal tract;

Local complications after tooth extraction include:

Early and late socket bleeding, bleeding from soft tissues surrounding the socket of an extracted tooth (root);

Alveolitis;

Maxillary sinus fistula or odontogenic sinusitis with a fistula in the area of ​​the socket of an extracted tooth (root);

Traumatic neuritis and neuralgia;

Osteomyelitis of the socket of an extracted tooth;

Osteomyelitis of the jaw;

Exostoses (“sharp edges”) in the area of ​​the removed socket

What dental injuries occur during tooth extraction? How to eliminate the complication?

Fracture of the crown or root of the tooth being removed is the most common of all. local complications. In some cases, it is associated with significant damage to the tooth by the carious process, with anatomical features the structure of the root and surrounding bone tissue (long, thin or strongly curved roots with thick interradicular septa and stubborn walls of the socket, uneven thickening or significant divergence of the roots). Often this complication occurs due to a violation of the surgical technique: incorrect choice of forceps, their application, sudden movements during tooth dislocation, tooth displacement towards the thick wall of the alveolus, rough and incorrect use of the elevator, etc.

In the event of a tooth root fracture, it is necessary to continue the intervention and remove it, possibly using complex removal techniques. Leaving a broken part of the root, as a rule, leads to the development of an inflammatory process in the surrounding tissues

Fracture and dislocation of an adjacent tooth can occur if this tooth is affected by caries or is not sufficiently stable and is used as a support while working with an elevator. In case of incomplete dislocation, the tooth should be strengthened with a splint; in case of complete dislocation, replantation should be performed.

The application of the cheeks of forceps to the edges of the socket or hypercementosis is often accompanied by the breaking off of a small section of bone, this leads to longer healing of the socket, the appearance of socket pain and alveolitis. As a result of the pathological process in the periodontium, it is replaced by bone tissue and the tooth root is tightly welded to the alveolar wall. During the removal of such a tooth, sections of the alveolar process of different sizes are broken off. Most often they are removed together with the tooth to which they are soldered. If the broken piece of bone is not removed from the socket along with the tooth, then it is separated from the soft tissue with a smoothing tool or a rasp and removed. The resulting sharp edges of the bone are smoothed. The broken section of the bone does not heal, it is removed, the wound is sutured or packed with gauze soaked in iodoform liquid.

Under what conditions does the lower jaw dislocate during extraction?

Dislocation of the lower jaw can occur when the mouth is opened wide and pressure is applied to the jaw with forceps or an elevator during the removal of the lower small and large molars in the presence of habitual dislocation in a patient or in elderly people. Usually, anterior unilateral dislocation occurs, less often - bilateral dislocation. Clinical picture its quite typical: the patient cannot close his mouth, there is sharp pain associated with overstretched muscles and ligaments, drooling due to the inability to swallow saliva

Under what conditions does a tooth or root push through? soft fabrics? Pushing the tooth root into the soft tissue sometimes occurs during the removal of the third lower molar. This is facilitated by resorption of the thin inner wall of the alveoli as a result of a pathological process or breaking it off during surgery. During rough work with the elevator, when the alveolar process is not fixed with the fingers of the left hand, the dislocated root is displaced under the mucous membrane of the alveolar process to the lingual side in the tissue of the sublingual, less often - the submandibular region.

If the root is located under the mucous membrane of the alveolar process and can be felt with a finger, then it is removed after dissecting the tissue above it. When the removed root cannot be detected, an X-ray of the lower jaw is taken in frontal and lateral projections, from which the location of the root in the soft tissues is determined. The root, displaced in the tissue of the posterior part of the sublingual or submandibular region, is removed in a hospital setting.

In what cases does the gum mucosa rupture?

Damage to the gum mucosa and soft tissues of the oral cavity occurs as a result of violation of the surgical technique and rough work of the doctor. If the circular ligament is not completely separated from the neck of the tooth, the gum connected to it may tear in the form of a ribbon during removal of the tooth from the socket. Sometimes, when the circular ligament is poorly detached, forceps are applied not to the root, but to the mucous membrane, causing crushing and rupture.

In order to prevent this complication, the doctor must carefully and completely exfoliate the gum; if the forceps are not firmly fixed, grasp the alveolar process in the area of ​​the tooth being removed with the fingers of his left hand and protect the surrounding tissue from accidental damage. Injury to the soft tissues of the oral cavity leads to bleeding. It is stopped by suturing the damaged mucous membrane. The crushed areas of the gums are cut off, the torn ones are brought together with sutures.

What causes alveolar bone fracture?

The application of the cheeks of forceps to the edges of the socket or hypercementosis is often accompanied by the breaking off of a small section of bone, this leads to longer healing of the socket, the appearance of socket pain and alveolitis. As a result of the pathological process in the periodontium, it is replaced by bone tissue and the tooth root is tightly welded to the alveolar wall. During the removal of such a tooth, sections of the alveolar process of different sizes are broken off. Most often they are removed together with the tooth to which they are soldered. If the broken piece of bone is not removed from the socket along with the tooth, then it is separated from the soft tissue with a smoothing tool or a rasp and removed. The resulting sharp edges of the bone are smoothed. The broken section of the bone does not heal, it is removed, the wound is sutured or packed with gauze soaked in iodoform liquid

Fixing the lower jaw with the left hand during surgery eliminates the possibility of this complication. If the temporomandibular joint is dislocated, it is adjusted using the appropriate technique.

Fracture of the lower jaw. This complication is very rare and occurs, according to the literature, in 0.3% of all cases of mandibular fractures. A fracture of the lower jaw most often occurs as a result of excessive force when removing the third, less often the second, large molars with an elevator or chisel. The development of this complication is facilitated by thinning or resorption of the bone as a result of a previous pathological process (radicular or follicular cyst, ameloblastoma, chronic osteomyelitis, etc.). In older people, due to atrophy of the jaw bone tissue, its strength decreases.

With fractures in the postoperative period, pain in the jaw, difficult and painful opening of the mouth, inability to chew food, changes in bite, and pathological mobility occur. Treatment of a patient with a fracture of the lower jaw consists of repositioning the fragments and fixing them with dental splints or by extrafocal or intrafocal osteosynthesis.

How to prevent perforation of the maxillary sinus?

Perforation of the bottom of the maxillary sinus can occur during the removal of large upper, and less commonly, small molars. This is facilitated by the anatomical features of the relationship between the roots of these teeth and the bottom of the maxillary sinus. With the pneumatic type of sinus structure, the apices of the roots of large and small molars are separated from its bottom by a thin bone bridge. In the area of ​​the first and second large molars, its thickness is 0.2-1 mm. Sometimes the tops of the roots of these teeth protrude into the sinus and protrude above its bottom and are covered only by mucous membrane. As a result of chronic periodontitis, the bone separating the roots of the teeth from the maxillary sinus is resorbed, and the tissue of the pathological focus is soldered to its mucous membrane. When such a tooth is removed, the mucous membrane of the sinus is torn, and a connection is formed with the oral cavity through the socket of the extracted tooth. Perforation of the bottom of the maxillary sinus can also occur due to the fault of the doctor. This happens with traumatic tooth extraction.

In case of perforation of the maxillary sinus, blood with air bubbles is released from the socket of the extracted tooth. During exhalation through the nose, pinched with the fingers (nasal test), the air whistles out of the hole. In some cases, bleeding appears from the corresponding half of the nose. In the presence of purulent process in the sinus, pus is released from the tooth socket. Or while puffing out the cheeks, when rinsing the mouth, or eating food through the perforation, the fistula liquid contents enter the maxillary sinus and pour out through the nose (oronasal test).

When opening the maxillary sinus and there is no inflammatory process in it, it is necessary to achieve the formation of a blood clot in the socket, to protect it from mechanical damage and infection, the hole in the lower third is covered with iodoform turunda. The tampon lasts 5-7 days. To hold it, you can make a mouth guard from quickly hardening plastic or apply a figure-of-eight ligature bandage to two adjacent teeth. Also used removable denture sick. Tamponade of the entire hole when perforating the bottom of the maxillary sinus is a gross mistake, since the tampon prevents the formation of a blood clot and therefore contributes to the formation of a permanent passage into the sinus and the development of sinusitis.

The most effective is to close the perforation hole with mucoperiosteal flaps from the cheek and palate. After infiltration anesthesia, preferably without vasoconstrictors, a trapezoidal flap is cut out in the area of ​​the alveolar process with a transition to the mucous and submucosal mucosa of the cheeks, 2–3 mm wider than the perforation. The edges of the socket are diethelialized using a drill or scalpel and mobilized, separated from the underlying tissues. The hole is filled with a clot; seoinduction drugs, such as “Kallapan”, “Kallapol”, or drugs that stimulate epithelization - amnion, placenta - can be placed in it. The flap is pulled to the palatal edge of the socket and hermetically sutured. The principle of collecting a flap from the sky is similar. In order for the healing period to pass safely, the patient is treated under the guise of antibacterial therapy. It is imperative to adhere to a safe regimen, which consists of using a gentle diet, preventing an increase in pressure in the maxillary sinus caused by blowing the nose, puffing out the cheeks, and maintaining oral hygiene.

What happens when perforation of the mandibular canal occurs?

In addition to perforation of the maxillary sinus due to the presence of a pathological process leading to bone resorption, perforation of the mandibular canal is possible. When the root is dislocated by an elevator from the deep parts of the socket, the nerve can be injured, as a result of which its function is partially or completely disrupted: pain in the jaw, numbness of the lower lip and chin, decreased or loss of gum sensitivity, decreased electrical excitability of the dental pulp on the affected side.

Usually, if the correct tactics are followed, the phenomena gradually disappear after a few weeks. For the hundredth injury, we prescribe non-steroidal anti-inflammatory drugs, which also have a pronounced analgesic effect, “Nise” 0.1 g 2 times a day. To prevent the spread of inflammation, you can prescribe drugs that stabilize cell membranes - this is the local administration of glucocorticoid hormones by electrophoresis, drugs from the group of mast cell stabilizers - Erius, Zeritec. It is possible to prescribe decongestant therapy for 3 days for the first time. With pronounced pain symptom analgesics and pulsed current physiotherapy are prescribed. To accelerate the recovery of nerve function, a course of injections of vitamin B\s\up 10(　 (1 ml of a 6% solution every other day, 10 injections) is prescribed). Electrophoresis is performed with a 2% solution of novocaine (5-6 procedures for 20 minutes) or a 2% solution of novocaine with 6% solution of vitamin B\s\up 10((5-10 procedures for 20 minutes). Good results are achieved by oral administration for 2-3 weeks. Vitamin B\s\up 10(　 (0.005 g 2 times a day) and vitamin C (0.1 g 3 times a day), as well as up to 10 injections of dibazole (2 ml of 0.5% solution every other day), galantamine (1 ml of 1% solution per day), aloe extract (1 ml daily ), vitamin B\s\up 9((1 ml of 0.02% solution every other day).

How to stop socket bleeding?

Tooth extraction, like any other operation, is accompanied by bleeding. After a few minutes, the blood in the hole coagulates and the bleeding stops. However, in some cases it does not stop on its own, it continues long time(primary bleeding). Sometimes the bleeding stops in usual terms, but after some time it appears again (secondary bleeding). Prolonged bleeding can be caused by both local and common reasons.

In most cases, bleeding occurs due to traumatic removal, crushing of soft tissues, or fracture of the interalveolar septum. Socket bleeding is associated with damage to the neurovascular bundle from the vessels of the socket wall and gums. When an acute inflammatory process has developed in the surrounding tissues, the vessels are dilated and do not collapse, which also leads to bleeding. In some patients, under the influence of adrenaline used together with the anesthetic, early secondary bleeding occurs after approximately 1 to 2 hours.

Common causes of prolonged bleeding after tooth extraction occur in diseases characterized by a violation of the blood coagulation process or disorders of the vascular system. These include hemorrhagic diathesis: hemophilia, thrombocytopenic purpura, hemorrhagic vasculitis, hemorrhagic angiomatosis, C - vitamin deficiency, acute leukemia, infectious hepatitis, septic endocarditis, scarlet fever, etc.

The blood clotting process is disrupted in patients receiving anticoagulants. direct action, suppressing the function of prothrombin formation by the liver (neodicoumarin, phenylin, sincusar), as well as in case of overdose of the direct anticoagulant - heparin. A tendency to bleeding is observed in people suffering from hypertension.

As a result of prolonged bleeding caused by local or general causes and associated blood loss, the patient’s general condition worsens, weakness, dizziness, pale skin, and acrocyanosis appear. The pulse quickens and blood pressure may drop. The socket of the extracted tooth is covered with a huge clot from under which blood flows.

The first step to stopping bleeding is to determine its type and location after anesthesia and inspection of the hole. We remove the clot. We pack the hole with iodoform turunda, laying it in a zigzag manner and pressing tightly on each turn. You can sew the turunda to the edges of the hole, or put a few balls on top and ask them to bite them tightly and hold them for 20 - 30 minutes. Monitoring to stop bleeding is mandatory.

It will be more effective to suture the hole by filling it with a foreign protein - catgut, which swells when exposed to a humid environment, “Kallapan”, “Kallapol”, and suturing it using the same catgut as a suture material. Locally, if the bleeding is capillary and lacunar, you can use Carbazochrome, Tachocomb, a gelatin or collagen hemostatic sponge, a warm solution of calcium chloride, fibrinolysis inhibitors - aminocaproic acid, activators of thrombin formation - potrombin, Etamsylate (Dicinone). Orally you can prescribe: Etamzilat 25-500 mg 3 – 4 times a day; vitamin C 1.0 g per day; vitamin K 0.015 g 2 times a day, epsilon-aminocaproic acid 05 - 30 g per day for 3 - 6 doses. For hypertensive patients, the use of antihypertensive drugs is indicated for increased blood pressure.

When determining the concomitant pathology of the hematological profile, it is necessary to hospitalize the patient in a hospital, in the hematology department

for the purpose of blood transfusion, transfusion of antihemophilic blood clotting factors, cryoprecipitate.

Prevention of bleeding. Before tooth extraction, it is necessary to find out whether the patient has had prolonged bleeding after accidental tissue damage. If there is a tendency to bleeding, before surgery, a general blood test is performed, the number of platelets, blood clotting time and duration of bleeding are determined, and a detailed coagulogram is drawn up. If hemostasis indicators deviate from the physiological norm, measures are taken aimed at increasing the functional activity of the blood coagulation system (administration of a solution of calcium chloride, aminocaproic and ascorbic acid, Vikasol, rutin and other drugs), consult the patient with a hematologist or therapist.

Tooth extraction for patients with hemorrhagic diathesis is carried out in a hospital setting. They are prepared for surgery together with a hematologist. Under the control of a coagulogram, agents are prescribed that normalize hemostasis parameters. For hemophilia, antihemophilic plasma, cryoprecipitate or antihemophilic globulin, freshly citrated blood are infused; for thrombopenia - platelet suspension, whole blood, vitamins K and C. A plastic protective plate is made. Tooth extraction in such patients is sought to be performed with minimal trauma to the bone and surrounding soft tissues.

What is alveolitis?

Alveolitis is an inflammation of the walls of the socket that develops after a traumatic operation or when the body’s defenses are reduced due to primary or secondary immunodeficiencies.

In the initial stage of alveolitis, a constant aching pain appears, which intensifies while eating. The tooth socket may be partially filled with a disintegrating clot or there may not be any in it. The hole contains food debris, saliva, and its walls are exposed. The gum mucosa is hyperemic and swollen. The transitional fold can be smoothed out, palpation is sharply painful.

With further development, the pain becomes constant, radiating to the ear, temple, and the corresponding half of the head. The patient's general condition worsens, malaise and low-grade body temperature appear. Eating is difficult due to pain. The tooth socket contains the remains of a disintegrated blood clot; her walls are covered gray coating with an unpleasant putrid odor. The mucous membrane around the hole is hyperemic, swollen, and painful on palpation. The submandibular lymph nodes are enlarged and painful. Sometimes there is slight swelling of the soft tissues of the face. Alveolitis, in turn, can cause a number of complications: periostitis and osteomyelitis of the jaw, abscess, phlegmon, lymphadenitis.

In the postoperative period, general therapy aimed at increasing blood clotting is continued (transfusion of blood, antihemophilic plasma, cryoprecipitate, aminocaproic and ascorbic acids, administration of calcium chloride, hemophobin rutin, vikasol). Hemostatic drugs are left in the hole until it is completely healed. Such patients should not have several teeth removed at the same time.

During treatment, after local anesthesia has been performed, the wound is treated. Using a syringe with a blunt needle, a stream of warm antiseptic solution (hydrogen peroxide, furatsilin, chlorhexidine, ethacridine lactate, potassium permanganate) is used to wash out particles of a disintegrated blood clot, food, and saliva from the tooth socket. Then, using a sharp surgical spoon, carefully (so as not to injure the walls of the socket and not cause bleeding), the socket is inspected: the remains of a decomposed blood clot, granulation tissue, bone fragments, and teeth are removed from it. After this, the hole is again treated with an antiseptic solution, dried with a gauze swab, powdered with anesthetic powder and covered loosely with a bandage of narrow strip gauze soaked in iodoform. As a bandage on the hole, the preparations “Alvostaz”, “Alvozhil” are used, complex ointments consisting of an antibacterial drug, an anesthetic, glucocorticoid hormones, heparin, and drugs that stimulate epithelialization. Anti-inflammatory drugs with a good analgesic effect, “Nise”, 0.1 g 2 times a day, and antibacterial therapy with desensitizing therapy are prescribed internally. At home, in order to ensure the effectiveness of local treatment, we recommend irrigating the hole with Ingalipt aerosol 6-7 times.

To cleanse the tooth socket from necrotic decay, proteolytic enzymes are used - crystalline chymotrypsin is poured into the socket for 15-20 minutes before treatment, then an antiseptic treatment is carried out and a complex ointment is applied.

Carry out one of the types physical treatment: fluctuarization, UHF, microwave therapy, local ultraviolet irradiation, helium-neon laser rays, Milta laser. They recommend 4 times a day oral baths with a warm (40-42° C) solution of potassium permanganate (1:3000) or 1-2% sodium bicarbonate solution, herbal decoctions with an anti-inflammatory effect - chamomile, sage. Local exposure to the inflammatory focus (treating the hole with antiseptics and changing the bandage) is carried out daily or every other day until the pain completely stops. After 5-7 days, the walls of the socket are covered with young granulation tissue, but inflammatory phenomena in the gum mucosa still persist. After 2 weeks, the gum acquires a normal color, swelling disappears, the socket is filled with granulation tissue, and its epithelization begins. In the future, the healing process of the hole proceeds in the same way as in the absence of complications. When a purulent-necrotic inflammatory process develops in the walls of the socket, then, despite active treatment alveolitis, pain and inflammation do not stop. This indicates the development of a more severe complication - limited osteomyelitis of the tooth socket.

How is limited socket osteomyelitis clinically manifested?

Limited osteomyelitis of the tooth socket. An acute throbbing pain appears in the socket of the extracted tooth, and pain occurs in the neighboring teeth. Weakness and severe headache appear. Body temperature is 37.6-37.8 ° C and higher, sometimes there is chills. The patient does not sleep and cannot work.

There is no blood clot in the hole, its bottom and walls are covered with a dirty gray mass with a fetid odor. The mucous membrane surrounding the tooth socket turns red, swells, the periosteum infiltrates and thickens. Palpation of the alveolar process from the vestibular and oral sides in the area of ​​the socket and in neighboring areas is sharply painful. When percussing adjacent teeth, pain occurs. The perimandibular soft tissues are swollen, the submandibular lymph nodes are enlarged, dense, and painful. With osteomyelitis of the socket of one of the lower large molars, due to the spread of the inflammatory process to the area of ​​the masseter or medial pterygoid muscle, mouth opening is often limited. The symptoms of acute inflammation last 6-8 days, sometimes 10 days, then they decrease, the process passes into the subacute and then into the chronic stage. The pain becomes dull and weak. The general condition improves, body temperature normalizes.