Tooth extraction: Would You Be Able To Recognize Infection And Other Complications?

‘Your tooth needs to be extracted’. These could be quite possibly some of the most terrifying words for a patient to hear as they sit on the dental chair. Visions of blood, pain and swelling flood the mind and every instrument starts to seem like a weapon of torture. Thankfully, the procedure itself is nothing like how people imagine it to be. In fact, Dentistry has undergone a huge shift in treatment planning from a time when extraction used to be the first choice of treatment to it being that absolute last alternative.

Surprisingly though, a lot of misconceptions and unfounded fears are associated with complications of extraction. Most of these complications are rather minor and take care of themselves; however there are a few rare occasions when serious complication can be encountered as well.

Pain During The Procedure

This is usually the first thing that a patient inquires about when informed that he or she will have to undergo an extraction. Here is the short answer. There should be absolutely no pain whatsoever. Dentists will avoid saying such a thing to their patients because they do not want to set extremely high expectations (it is always better to promise less and deliver more), while at the same time pain is subjective in nature and varies widely from person to person. What one person may find unbearably painful will be mildly unpleasant to another.

The sensation of pressure however is still felt by the patient. In case of a difficult extraction, where a large amount of force is applied during the extraction, this pressure is perceived as pain by an apprehensive patient. The presence of an active infection or an abscess can also make the local anesthesia less effective than in normal condition, however this is something that can be easily managed by changing the alkalinity of the anesthetic solution.

Pain After The Procedure

It is important to understand that once a tooth has been extracted, the socket healing takes a minimum of seven days. Of these seven days, the first couple of days are the ones when some amount of pain can be experienced. There are a number of reasons why this pain might occur. Some amount of pain is associated with the process of inflammation that accompanies normal wound healing. This is not very severe and is easily managed by over the counter pain medication. Another cause is muscular pain.

Our jaw muscles are notorious for being extremely weak as compared to most other species and can take several days to recover. Some amount of pain while talking, chewing and swallowing and even drinking water can persist for a couple of days after the extraction procedure.

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There is another condition called as a Dry Socket, which is extremely painful and occurs after traumatic extractions. This condition occurs when a clot is not allowed to stabilize over the healing site leading to necrosis of the bone. Avoiding spitting is one simple way to reduce the chance of dislodging the clot. Another is to keep the post operative pack for the prescribed time. 

Complications Of Extraction: Infection, Swelling And Nerve Injury

Infection

This is something that can really cause trouble to the patient and needs to be treated aggressively by the attending doctor. Thanks to strict sterilization protocols followed by most clinics around the world, the incidence of infection following extraction has come down dramatically, however it is still quite common. Such situations where infections are transmitted to patients because of unclean instruments or reusing of disposable equipment is much more common in economically backward nations. You as patient can take care of certain things to minimize the chance of this infection occurring. Make sure your doctor is wearing fresh gloves and removing all equipment from sealed packets in front of you.

The occurrence of post extraction infections is more common in medically compromised patients like those suffering from Diabetes, immune-compromised individuals and patients who may not have the mental faculties necessary to understand and follow post operative instructions.

Swelling

Swelling of the face following an extraction can be seen in both infected and non infected cases. It can be a part of normal healing or an indicator of underlying infection. It actually depends upon the specific immune response of the patient and so can be difficult to predict with absolute surety whether a patient will develop swelling or not. Of course, some situations like surgical extractions, traumatic extractions, immune-compromised individuals and presence of a pre-existing widespread infection are more likely to result in swellings than others.

Nerve Injury

This is one of the more serious complications following extractions. It can happen during the removal of a lower tooth which is embedded deep in the bone or due to the uncommon anatomic placement of the mandibular nerve. Luckily, with the advent of 3D imaging techniques, doctors have a better idea of what to expect before they actually start the surgery, however incidents sometimes do occur due to human error.

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The symptoms to watch out for include a loss in sensation on the side of extraction, a drooping of the lip, difficulty in talking, chewing or swallowing. The severity of this injury can vary according to injury however in most cases no additional treatment needs to be done. The nerve function returns to normal over the period of a few months. In some rare cases the injury is permanent and does not return back to normal.

Conclusion

Overall, the risk for complications with a well planned extraction procedure carried out under standard working conditions is extremely low, however it is better to be aware of some of the things that a patient can encounter.