1. Oral and Maxillofacial Surgery Consulting Specialist

2. Complications of Dental Extractions Compromises of the Airway Oral Bleeding Orofacial Injuries Odontogenic Infections Osteonecrosis Orafacial Pain Perils of Treatment - Diseases of the Teeth /Mouth

3. Complications of Dental Extractions Bleeding Swelling Jaw Stiffness (Trismus) Pain / Dry Socket (Alveolar Osteitis) Infection Sensory Nerve Disturbance Oral antral communication (fistula) Temporomandibular Joint (TMJ) dysfunction Jaw fracture

4. ~ Dental Caries ~ Periodontal Disease Dental infections are the most common infections known to man

5. Dental treatment is frequently performed on an urgent / emergency basis as a result of an active dental infection or injury producing pain and/or swelling

7.  Rate of post operative bleeding ( 7% to 10% 3 rd molars)  Usually associate with  difficult extraction  long surgical procedures  Usual bleeding sources  7 % arterial  72 % soft tissue

8. Bleeding – Complication of tooth extraction

9. Bleeding – Complication of tooth extraction Pressure placed directly over the bleeding site typically stops bleeding

10. Swelling after tooth extraction is not uncommon

11. Jaw Stiffness (Trismus) Complication of tooth extraction

12. Jaw pain following tooth extraction 1 st 24 hours usually associated with surgery 24 to 36 hours post op Constant dull throbbing spontaneous pain may be associated with DRY SOCKET

13. TREATMENT: 1.Gently irrigate (saline) 2.Place sedative dressing

14. Post Op Infections (0.06 – 4.3% for 3 rd molars) Many extractions are performed on and urgent basis due to pain from an infected tooth

15. Infections may spread to adjacent tissue spaces Sinus and orbital cavities Sinus and orbital cavities Inter muscular spaces Inter muscular spaces of the jaw of the jaw Floor of the mouth Floor of the mouth Parapharyngeal spaces Parapharyngeal spaces

16. Altered Nerve Function (0.02 – 7.1% for 3 rd molars) The most frequent nerve injury Lingual and Inferior Alveolar / Mental NervesMental nerve nerve Lingual Inferior Alveolar nerve nerve Lingual

17. Oral Antral Communication following tooth extraction (0.06% for 3 rd molars)

18. Temporomandibular Joint Pain / Dysfunction Myofascial Pain

19. Fracture of the jaw associated with dental extractions (< 0.01% for 3 rd Molars) Subject to Spontaneous Fracture

20. Complications of Dental Extractions Compromises of the Airway Oral Bleeding Orofacial Injuries Odontogenic Infections Osteonecrosis Orafacial Pain Perils of Treatment - Diseases of the Teeth /Mouth

21. Compromises of the Airway Aspiration Bleeding Infection Injuries

22. Aspiration Teeth & fragments Dental appliances Dental instruments Aspirated Tooth Ingested Tooth Barriers (rubber dam) frequently used to prevent swallowing / aspiration

23. Airway compromise Due to bleeding Post op chin / floor of mouth surgeryPost extraction in patient with Bleeding Diatheses

24. Airway compromise due to dental infection

25. Airwaycompromise due to Injury Flail Mandible Fracture Unopposed pull of supra hyoid muscles in an inferior & posterior direction

26. Airway compromise Injury with bleeding (Mandibular Fractures)

27. Complications of Dental Extractions Compromises of the Airway Oral Bleeding Orofacial Injuries Odontogenic Infections Osteonecrosis Orafacial Pain Perils of Treatment - Diseases of the Teeth /Mouth

28. Bleeding Gums Periodontal Disesae Hormonal Changes (pregnancy gingivitis) Anticoagulant Therapy Bleeding Diatheses

29. Midline tongue piercing relatively blood-free especially when good compression hemostasis is used (tongs)

30. Significant bleeding may be encountered with with piercing more laterally

31. Direct pressure whether applied manually or with sutures generally arrests bleeding

32. Complications of Dental Extractions Compromises of the Airway Oral Bleeding Orofacial Injuries Odontogenic Infections Osteonecrosis Orafacial Pain Perils of Treatment - Diseases of the Teeth /Mouth

33. Dentoalveolar Fractures Jaw Fractures (Maxilla / Mandible) Soft Tissue