June 1, 2013
by Dr. Simon Weinberg
The traditional classification of exodontia as minor surgery is often unwarranted considering the potential for the development of serious and unusual intra and post-surgical complications.
Indeed, few situations in dentistry generate as much fear and anxiety as those precipitated by the sudden and unexpected emergence of a serious complication associated with the performance of a seemingly routine and innocuous oral surgical procedure. As it applies to surgery, the term Minor implies an uncomplicated procedure that is devoid of the precise technical complexities and risks associated with more complicated procedures and whose post operative course, given the anticipated sequelae, is typically uneventful.
While there are a number of predictive factors that may signal the potential development of exodontia-related complications, some factors that have been implicated include errors in judgment, the use of excessive force, instrument abuse and poor visualization. However, some complications are unpredictable, bizarre, extraordinary and limited only by our imaginations. In this regard, this issue of Oral Health features an article entitled “Complications During and After Surgical Removal of Third Molars”. The authors identify unusual post exodontias complications including the death of a 71-year-old man resulting from asphyxiation caused by a post-extraction hematoma. The hematoma reportedly involved the submandibular, lingual and buccal spaces leading to severe narrowing of the oropharynx. Although the removal of third molars presents its own unique set of anatomical difficulties, nevertheless, the removal of a single, erupted tooth may result in the emergence of a serious intra or post-surgical complication.
Considering the potential for the development of serious, unusual intra and post surgical exodontia complications, some other post-operative complications identified included orbital abscess, brain abscess, epidural abscess, emphysema, subdural empyema, life threatening hemorrhage and pneumothorax.
Clearly, no seemingly straightforward exodontic procedure can be taken lightly. Certainly the simple surgical procedure of tooth removal merits the same degree of diligence, meticulous care and surgical skill devoted to more complex and onerous surgical procedures. Truly, a simple surgical procedure such as the removal of a single erupted tooth can be a daunting experience unless meticulous attention is paid to the fundamental surgical principles governing exodontia and these include avoidance of the use of excessive force, proper use of instrumentation and avoidance of instrument abuse and proper visualization.
Obviously, the prevailing attitude toward tooth removal should be dominated by diligence and caution. Complacency and over-confidence should be avoided as they may lead to errors in judgment and technical problems. Undoubtedly, vigilance in the time of potential adversity is always the prudent course.
Although complications may not be preventable, they are capable of being significantly reduced by strict adherence to these sound surgical principles.
With regard to proper visualization there is an appropriate surgical adage; “in order to do well what you see, you must see well what you do.” OH
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