Third molar surgery and associated complications
Section snippets
Mild bleeding, surgical edema, trismus, and postoperative pain
Complications such as pain, swelling, and trismus are anticipated after the removal of third molars. Although transitory, these conditions can be a source of anxiety for the patient. Much of this anxiety can be alleviated if there is a preoperative discussion of the expected perioperative course.
Mild bleeding can be managed effectively with local measures. Most bleeding can be managed by applying gauze packing over the extraction site with direct focused pressure. Persistent intraoperative
Alveolar osteitis
Alveolar osteitis is one of the most common complications associated with third molar surgery [5], [6]. It is characterized by a severe throbbing pain that usually begins 3 to 5 days postoperatively [5]. By this time, most of the pain and swelling associated with surgical trauma should disappear, and residual radiating pain to the ear is a common complaint in patients with alveolar osteitis. The causes of this painful condition, commonly known as “dry socket,” are not completely known but are
Fractures
Although they occur infrequently (0.00049%) during the extraction of third molars, fractures of the mandible (Fig. 1) are of serious consequence, particularly if associated with nerve injury [31]. Fractures usually occur when excessive force is used to extract a tooth, although even small forces can cause fractures for deeply impacted teeth. Because of extremely small numbers, specific risk factors are difficult to identify. Some studies have shown older age as a risk factor [32]. Fracture also
Nerve injuries after third molar removal
Among the most serious and often discussed postoperative complications that arise from third molar surgery is trigeminal nerve injury, specifically, involvement of either the inferior alveolar or lingual nerve. These nerves can be damaged as the result of direct or indirect forces. Direct injuries include those that result from anesthetic injections, crush injuries, injuries sustained during the extraction process or soft tissue management, and damage caused by the use of instruments. Indirect
Summary
Recent literature and long-term experience have improved the understanding of the origin and treatment of complications related to third molar surgery. The armamentarium available to the clinician in preventing and managing these problems continues to evolve. As the body of literature related to third molar surgery and its complications expands, more techniques and predisposing factors will be elucidated. Until such a time when there is a concrete and unambiguous literature regarding such
References (68)
- et al.
Determination of the anti-inflammatory effects of methylprednisolone on the sequelae of third molar surgery
J Oral Maxillofac Surg
(1999) - et al.
Evaluation of dexamethasone for reduction of postsurgical sequelae of third molar removal
J Oral Maxillofac Surg
(1992) Alveolar osteitis after surgical removal of impacted mandibular third molars: identification of the patient at risk
Oral Surg Oral Med Oral Pathol
(1992)- et al.
A clinical investigation into the incidence of dry socket
Br J Oral Maxillofac Surg
(1984) - et al.
Risks and benefits of removal of impacted third molars: a critical review of the literature
Int J Oral Maxillofac Surg
(1992) On the genesis of “dry socket”
J Oral Maxillofac Surg
(1983)- et al.
Effect of oral contraceptive cycle on dry socket (localized alveolar osteitis)
J Am Dent Assoc
(1980) - et al.
Complications following removal of impacted third molars: the role of the experience of the surgeon
J Oral Maxillofac Surg
(1986) - et al.
The effect of tetracycline on the incidence of postextraction alveolar osteitis
J Oral Maxillofac Surg
(1987) Alveolar osteitis prevention by immediate placement of medicated packing
Oral Surg Oral Med Oral Pathol Oral Radiol Endod
(2000)