Tooth extraction is a familiar procedure for many people. Numerous patients with periodontal disease opt for extraction to relieve chronic tooth pain. While this effectively eliminates dental pain, it's crucial to prevent post-extraction complications that could cause secondary oral damage. Below we outline common complications associated with tooth extraction.Post-Extraction Bleeding
Under normal circumstances, bleeding should cease after applying pressure to the extraction site for half an hour. Persistent bleeding after spitting out the sterilized gauze roll, or bleeding that resumes on the second day post-extraction, constitutes post-extraction bleeding. Bleeding that occurs immediately after extraction is termed primary bleeding, while bleeding on the second day due to other causes is classified as secondary bleeding.
Causes of bleeding include systemic and local factors.Systemic causes include various blood disorders, hypertension, and liver/biliary diseases. Local causes encompass gingival lacerations, alveolar bone fractures, presence of granulation tissue or foreign bodies in the socket, dislodged blood clots, or secondary infections.
Prevention and Management: Conduct a thorough preoperative medical history review. For patients with systemic conditions, consult relevant specialists and refer for specialized care when necessary. Perform extractions meticulously to minimize trauma.The extraction site must be meticulously managed, and patients and their families should be thoroughly instructed on post-extraction precautions. For patients with significant trauma or bleeding tendencies, they may leave only after examining the site and confirming no abnormalities following 30 minutes of gauze packing over the extraction socket.
If post-extraction bleeding occurs, initiate a local examination first. Typically, a blood clot protruding above the socket is visible, with blood seeping beneath it.Management involves: first removing the clots protruding above the socket, identifying the bleeding site, rinsing with saline, applying topical hemostatic agents, and reapplying pressure. If foreign bodies are present in the socket, thoroughly curette the socket under local anesthesia. Allow fresh blood to fill the socket before reapplying pressure.For significant bleeding, pack the socket with gelatin sponge or chloroform gauze, then approximate and suture the wound edges. Following local management, patients with systemic factors require laboratory testing and symptomatic treatment, such as fresh blood transfusion or coagulation factor administration.
2. Extraction Site Infection
While extraction site infections are uncommon after routine tooth removal, they frequently occur following complex extractions or impacted tooth removal. Extraction site infections are categorized into three types: acute infection, dry socket, and chronic infection.
1. Acute Infection
Associated with significant local trauma during extraction, pre-existing local infection foci, or patient conditions like diabetes.Symptoms typically appear on the second day post-extraction, including localized or facial pain, swelling, and limited mouth opening. In cases involving impacted teeth, flap surgery with bone removal, or significant trauma, pronounced facial swelling and pain may occur within 12–24 hours post-extraction. However, these symptoms gradually subside within 3–5 days and are not classified as acute infection.
Prevention and Treatment: Maintain strict aseptic technique during extraction to minimize surgical trauma. Avoid vigorous scraping of the extraction site in cases with local infection to prevent spreading the infection. Diabetic patients should undergo extraction only when their condition is well-controlled. Administer antibiotics pre- and postoperatively.
2. Dry Socket
Dry socket represents another form of acute wound infection following tooth extraction, most commonly occurring in posterior mandibular teeth—particularly after removal of impacted mandibular third molars. Under normal circumstances, even after flap-and-bone-removal extractions, wound pain typically subsides within 2–3 days.If severe pain develops 2–3 days post-extraction, radiating to the ear-temporal region, submandibular area, or vertex, and unresponsive to standard analgesics, dry socket is suspected. Clinical examination reveals an empty socket or a necrotic, grayish-white blood clot.Necrotic material covering the socket wall emits a foul odor. Probing directly reveals the bone surface with sharp pain. There is no significant swelling in the maxillofacial region, and mouth opening is not markedly restricted. Submandibular lymph node enlargement and tenderness may be present. Histopathology shows superficial osteitis of the alveolar socket wall or mild localized osteomyelitis.
Prevention and Treatment: Dry socket is associated with surgical trauma and bacterial infection. Therefore, strict adherence to aseptic technique during surgery is essential to minimize trauma. Once dry socket occurs, the treatment principle involves thorough debridement and isolation of the alveolar socket from external irritants to promote granulation tissue growth.
Treatment involves irrigating the socket with 3% hydrogen peroxide solution under local anesthesia, followed by repeated swabbing with cotton balls to remove necrotic debris until the socket is clean and odor-free.The socket is then repeatedly irrigated with hydrogen peroxide solution and saline, followed by placement of an iodoform gauze pack. To prevent dislodgement of the pack, the gingiva may be sutured in place with a single stitch. The typical healing process takes 1–2 weeks. The iodoform pack can be removed after 8–10 days, by which time a layer of granulation tissue has formed over the socket walls, allowing for gradual healing.
3. Chronic Infection
Primarily caused by local factors such as residual root fragments, granulation tissue, calculus, or foreign bodies like tooth or bone fragments left in the socket. Clinically, the extraction site fails to heal, leaving a persistent small wound with surrounding gingival tissue exhibiting redness, swelling, and occasional pus discharge or granulation tissue proliferation. Typically, there is no significant pain.
Prevention and Treatment: Thoroughly clean the alveolar socket after extraction, especially for teeth with chronic apical periodontitis. Failure to completely remove the apical inflammatory lesion may cause post-extraction bleeding or lead to chronic inflammation that persists without healing.During extraction of multi-rooted teeth, prevent residual root fragments. If chronic infection occurs, take an X-ray to assess alveolar socket pathology, presence of retained foreign bodies, and healing status. Under local anesthesia, re-perform socket curettage. Allow blood to fill the socket, then apply pressure with disinfected gauze rolls to stop bleeding. Administer oral antibiotics.