Tooth removal (or extraction) - surgical procedure, so some complications cannot be excluded. The trick is to distinguish natural complications from pathological ones. If the latter appear, you should immediately consult a doctor.
General complications arise during tooth extraction itself; they affect the entire body as a whole. This is a reaction to stress and pain. Sometimes patients faint. Painful shock is possible.
If the removal process is very long and is accompanied by serious blood loss, acute cardiovascular failure may occur.
Local complications arise after tooth extraction. This is what we will talk about in detail.
A completely natural thing. Still, they did it to you surgery, the process of restoration and regeneration began. So discomfort and dull aching pain in the area of the wound are normal, they will go away on their own in a few days. The gums often hurt after tooth extraction. IN as a last resort The use of mild painkillers is recommended.
Very often, after tooth extraction, swelling occurs. It can be in the form of a slight swelling of the gums or cheeks and even a small gumboil. Applying ice or a heating pad helps a lot cold water, this should be done as soon as possible after a visit to the dentist, before the swelling has yet developed significantly.
If it doesn’t get better in a couple of days, and the swelling only increases, you may have an inflammation. In this case, see a doctor.
Bleeding after tooth extraction always happens. For some time after the operation, blood oozes from the wound. But gradually the healing process begins, and then the bleeding stops. To speed up this process, you can apply a gauze swab to the sore spot and press it lightly. And if blood flows and flows for many hours, of course, you need to see a doctor.
Natural phenomenon. The temperature rises slightly for a few days. Up to about 37 degrees. This usually happens in the late afternoon. If this bothers you greatly, you can easily take something antipyretic.
However, if the temperature is very high and does not subside, the dentist is waiting for you. It is possible that you have started to develop an infection. Possible complications after wisdom tooth removal are exactly the same as those listed above. All the tips and tricks are great too.
If any of the symptoms bother you greatly and do not want to go away, go to the doctor. Still, it’s always nice to know that everything is fine with your teeth and gums. Moreover, it may indeed turn out that you have some serious complication that will require additional treatment.
Persistent aching pain in the gums and deterioration in general health occur if:
The cause of the pain can also be judged by its location - in the throat, cheek or socket.
The pain persists for 7-10 days, because with this type of surgical intervention the gums are injured more and deeper. If the pain in the socket intensifies on the second or third day after extraction and the following is observed:
– perhaps we are talking about alveolitis, inflammation of the infected jaw socket, and it’s time to consult a dentist.
Sore throat most often occurs after extraction of lateral chewing and wisdom teeth. Its cause may be such a serious pathology as a hematoma. Signs of a hematoma will be:
A swollen cheek is another matter - if swelling was present on it before extraction, then facial asymmetry will be observed for another 2-3 days after the procedure. This does not pose a direct threat to health.
Throbbing pain in the jaw is usually the result of damage to bone tissue and the development of a localized (limited) inflammatory process in them, osteomyelitis.
Pain in an adjacent tooth can be a symptom of dislocation during complex extraction, and therefore is a direct indication for repeated radiography.
If toothache If you find yourself on a weekend or holiday, and there is not a single 24-hour dental office nearby, they will help you:
These are “first aid” methods that will temporarily relieve pain, but in no case will they replace dental therapy in a clinic.
Aching pain in the gums on the first day after the procedure, dentists consider it a natural, physiological reaction of the body to surgery. The appearance should alert you to:
Such symptoms indicate the development of complications, and the right decision will consult a dentist who:
Procedures will help remove pain syndrome, and you'll feel significantly better immediately after leaving the dentist's office.
Especially for you, we have collected on our website the best dental clinics, where they will always help you.
3.5. LOCAL COMPLICATIONS ARISING AFTER TOOTH EXTRACTION
♦ Bleeding
The effusion of blood from the socket after tooth extraction is a normal physiological reaction and should be considered as a favorable outcome of the operation. The spilled blood serves as a substrate for the formation blood clot, filling the hole, which performs both hemostatic and plastic functions (it is a matrix for tissue covering the wound defect).
Patients with bleeding after tooth extraction range from 0.25 to 5% (L.Z. Polonsky, 1965; M.P. Barchukov, L.M. Seletsky, 1969; Yu.I. Bernadsky, 1976; Yu.M. Rumyantsev , 1977; A.M. Sokolov, 1979; V.I. Serdyukov et al., 1984; Every year in Kyiv, bleeding after tooth extraction develops in 1145-1830 patients, i.e. they occur in 3.2% of all patients who sought this help (S.I. Lysenko, 1991).
Zilber A.P. (1984) indicates that tooth extraction is accompanied by bleeding of insignificant intensity and slight blood loss, because During the operation, vessels of small diameter (up to 100 microns) are damaged and, accordingly, low blood pressure (about 20-30 mm Hg).
There are three degrees of intensity of alveolar bleeding (Pavlov B.L., Shashkin V.V., 1987):
First degree - bleeding continues for more than 20 minutes, the blood stains the saliva and soaks the gauze swabs.
Second degree - bleeding lasts more than 40 minutes, saliva mixes abundantly with blood.
Third degree - bleeding continues for one hour or more; there is free blood in the oral cavity.
Bleeding that appears immediately after tooth extraction is called primary. If it appears some time after the operation (several hours or even days) - secondary bleeding.
In the oral cavity there are idiopathic and iatrogenic bleeding (Beldukevich M.A., 1978; Cheraskin E., 1979). Idiopathic- occur spontaneously with ulceration of tumors, hemorrhagic diseases and some forms of periodontopathies. Iatrogenic - appear after surgical interventions.
Tatarintsev K.I. (1958) notes that in 69.5% of cases, primary bleeding develops after tooth extraction. According to Gensen P.S. (1974) they occur in 75% of cases.
Socket bleeding is most often caused by local, less often - common reasons. According to the observations of Tatarintsev K.I. (1958), primary bleeding in 77.4% of cases occurs due to local causes, and in 22.6% - general causes. Secondary bleeding is also often associated with local factors.
Local reasons alveolar bleeding is as follows: damage (rupture, crushing) of soft tissue and bone vessels during a traumatic operation; fracture of part of the alveoli or interradicular septum; presence of intraosseous vascular tumor or vascular osteodysplasia; in acute inflammatory process (since there is inflammatory hyperemia in the inflammatory focus); cessation of the action of vasoconstrictors (initially, adrenaline causes vasoconstriction, and after 1-2 hours they dilate); purulent melting (destruction) of a blood clot and thrombi in vessels during alveolitis, when fibrinolytic activity in the socket increases significantly.
Common reasons post-extraction bleeding: diseases that are accompanied by a violation of the blood coagulation process (hemophilia, angiohemophilia - von Willebrandt disease, pseudohemophilia - hypofibrinogenemia, hypoprothrombinemia, hypoproconvertinemia, etc.) or damage to the vascular wall (hemorrhagic vasculitis, hemorrhagic angiomatosis - Rendu-Osler disease, C-vitaminosis - scurvy, systemic lupus erythematosus, some infectious diseases - eruptive and typhoid fever, scarlet fever, etc.); fibrinolytic bleeding caused by an increase in its fibrinolytic activity (shock); functional and quantitative deficiency of platelets (platelets live 7-12 days), which is observed in thrombocytopenia, leukemia, Werlhof's disease, sepsis - DIC syndrome, etc.; liver diseases (liver cirrhosis, infectious hepatitis); hormonal hemorrhages (hypermenorrhea, metrorrhagia, etc.); when using anticoagulants of indirect (neodicoumarin, syncumar, phenylin) or direct (heparin) action; when using certain medications before surgery - aspirin, paracetamol, nitroglycerin, quinidine, etc.
Research has proven that during menstruation, blood clotting increases, and does not decrease, as is commonly believed. Therefore, bleeding that occurs after tooth extraction during menstruation is most often associated with local causes.
In an adult, the amount of blood is equal to 4.5-6 liters, i.e. 6-8% or 1/16 of body weight.
SI. Lysenko (1991) suggests dividing post-extraction bleeding into three degrees:
I degree - minor bleeding - blood loss intensity up to 15 ml/hour;
II degree - moderate bleeding- intensity of blood loss from 15 to 30 ml/hour;
III degree - intense bleeding - blood loss rate exceeds 30 ml/hour.
With bleeding intensity of up to 15 ml/hour lasting even 24 hours, blood loss would be up to 360 ml, which does not exceed the volume of a one-time blood donation by donors. In case of bleeding with a blood loss rate of more than 30 ml/hour, negative autonomic reactions are possible, because blood loss during the day exceeds 600 ml (SI. Lysenko, 1991).
As a result of prolonged bleeding, the patient’s general condition worsens, weakness, dizziness and pallor appear. skin. Blood pressure decreases and pulse increases. The socket, adjacent teeth and alveolar process are covered with a shapeless blood clot, from under which blood is released.
Mechanism of hemostasis Kuznik B.I., Skipetrov V.P. (1974), Frick U., Frick G. (1984) associate the interaction of three important elements: the vascular wall, platelets and coagulation factors.
After damage to a vessel, its lumen decreases due to a decrease in blood pressure and a reflex contraction of the muscular lining of the vessel. The state of contraction of the damaged vessel is maintained by biologically active substances that are released when cells are damaged. Subsequently (within 2-4 minutes), a white (platelet) blood clot is formed, followed by the inclusion of other coagulation factors (factors V, VII - XI, etc.).
Subsequently, proliferation of fibroblasts and endothelial cells is observed. Granulation tissue is formed, which replaces the fibrin clot in the socket. The dissolution of the fibrin clot is regulated and occurs under the influence of the fibrinolytic activity of proliferating tissue, where the vascular endothelium is a source of plasminogen (Kuznik B.I., Skipetrov V.P., 1974; Andreenko G.V., 1979; Klyachkina L.M. et al. , 1980). Epithelization occurs along the surface of the connective tissue in the form of marginal regeneration. Epithelization is completed by days 14-16 (Verlotsky A.E., 1960). Subsequently, the fibrous connective tissue is transformed into osteoid tissue with its gradual replacement by mature bone tissue.
Hemostasiological examination of patients consists of conducting the following tests: duration of bleeding, prothrombin time, fibrinogen concentration, blood clot retraction, number of platelets in the blood, etc. The intensity of blood loss must be determined by the content of hemoglobin and red blood cells in the blood, as well as the hematocrit number.
♦ Local methods of hemostasis
A surgical instrument is used to remove the blood clot from the socket and dry it and the surrounding areas of the alveolar process. The doctor examines the wound and determines the cause of the bleeding. If the vessels of the mucous membrane are damaged, after anesthesia, coagulation, ligation of the vessel or suturing of tissue can be performed. Stopping post-extraction bleeding is completed by mobilizing the edges of the wound and suturing it. Used for tissue coagulation physical factors or chemicals (potassium permanganate crystals). Necrosis occurs at the site of coagulation, and after rejection of necrotic tissue, repeated bleeding may occur.
If a bone vessel is damaged, it is compressed with forceps or another surgical instrument. After stopping the bleeding, the postoperative wound should be sutured.
Bleeding from the depths of the wound is stopped by tamponade of the hole with gauze turundas with various medications. The most common method of hemostasis is wound tamponade with iodoform gauze. Tamponade begins from the bottom of the hole, tightly pressing and folding the turunda, the hole is gradually filled to the brim. Turunda is removed from the wound no earlier than 5-6 days after its application, i.e. after the start of granulation of the walls of the hole. Removal of iodoform turunda in the early stages may lead to repeated bleeding.
For tamponade of the hole during post-extraction bleeding, you can use gauze impregnated with thrombin, epsilonaminocaproic acid, hemophobin, amifer, as well as a hemostatic sponge or gauze, fibrin sponge (film, cotton wool, foam), fibrin glue, biological antiseptic tampon (BAT), gelatin or collagen sponge and other means. To locally stop bleeding, a hemostatic sponge is used, manufactured at the Kiev Institute of Hematology and Blood Transfusion, which is obtained from human plasma and contains thrombin, calcium chloride, aminocaproic acid.
Let us give a brief description of some hemostatic drugs.
Hemophobin- a clear or slightly cloudy liquid of brown or yellow-brown color with a specific odor. Contains a solution of pectin (3%) with the addition of calcium chloride (1%) and aromatic substances. Available in bottles. It is used both topically and orally, 2-3 teaspoons 1-3 times a day.
Aminocaproic acid- a substance that inhibits fibrinolysis is a kinin inhibitor. Excreted in urine after 4 hours. It is used topically, intravenously and orally. With a moderate increase in fibrinolytic activity, take 2-3 grams 3-5 times a day (daily dose - 10-15 grams) for 6-8 days. A 5% solution of the drug up to 100 ml is administered intravenously. If necessary, repeated infusions should be repeated after 4 hours.
Ambien(Pamba) is an antifibrinolytic agent. Its chemical structure and mechanism of action are similar to aminocaproic acid and are more active. It is used topically, intravenously and orally. The drug is administered intravenously in a stream of 5-10 ml of a 1% solution (50-100 mg) at intervals of at least 4 hours.
Hemostatic sponge with Amben - contains human donor blood plasma, Amben and calcium chloride. A porous hygroscopic substance is white with a yellow tint.
Thrombin- the activity of the drug is expressed in activity units (EA). Thrombin solution is used only locally. A sterile gauze swab or hemostatic sponge is impregnated with thrombin solution and applied to the bleeding area of the socket. A hemostatic sponge soaked in thrombin can be left in the socket because it subsequently resolves.
Hemostatic collagen sponge- prepared from collagen mass with the addition of furatsilin and boric acid. It is a dry porous mass yellow, soft consistency, absorbs liquid well. Left in the hole, it completely dissolves.
Gelatin sponge- dry porous mass of white color. Contains furatsilin. It completely dissolves in the hole.
Fibrinogen- natural component blood. It is used both locally and intravenously. The drug is dissolved ex tempore in water for injection, heated to a temperature of +25 to +35 C; the amount of water is indicated on the bottle label. The solution must be used no later than 1 hour after its preparation. The intravenous dose of the drug ranges from 0.8 to 8.0 g or more. Daily dose- 2-4 grams.
Isogenic fibrin film- is fibrin obtained from fibrinogen in human blood plasma and impregnated aqueous solution glycerin. The film left in the hole completely dissolves.
Isogenic fibrin sponge- porous fibrin obtained from human blood plasma. Dry porous mass of white or cream color. The sponge in the wound gradually dissolves.
Antiseptic sponge with kanamycin- contains gelatin with the addition of kanamycin sulfate, furatsilin, calcium chloride. In case of inflammatory processes in the socket, the sponge is changed daily. The sponge left in the hole is completely absorbed.
Zhelplastan- consists of dried cattle blood plasma, kanamycin monosulfate and edible gelatin. Available in powder form, which is applied to gauze turunda.
Hemostatic agents of plant origin- these are nettle leaves, viburnum bark, yarrow grass, pepper or kidneyweed grass, arnica flowers.
To stop the purulent process in the socket when tamponing with hemostatic material S.I. Lysenko (1991) suggests using a device whose action is to ensure the evacuation of exudate from the source of inflammation.
According to S.I. Lysenko (1991) for minor bleeding, the introduction of the hemocoagulant substance kaprofer into the wound provides complete hemostasis in 68.6% of patients; for moderate bleeding, this tamponade provides hemostasis in 72.7% of patients; and for intense bleeding, suturing of the hole is indicated in 73.3% of cases .
♦ General methods of hemostasis
Along with local stoppage of bleeding, medications that increase blood clotting are used. They are usually prescribed after receiving an analysis that determines the state of the blood coagulation and anticoagulation systems (coagulogram). The normal values for these indicators are given in Chapter 1, “Examination of the maxillofacial patient,” of this manual.
Before receiving the results of these tests, 10 ml of a 10% solution of calcium chloride (calcium gluconate) or 5-10 ml of a 1% solution of Ambien (Pamba) can be administered intravenously. A 12.5% solution of ethamsylate (dicinone) should be used intramuscularly or intravenously, 2-4 ml per first injection, and then every 4-6 hours, 2 ml (or 2 tablets). Simultaneously with these drugs, it is necessary to prescribe intravenous administration 2-4 ml of 5% ascorbic acid solution.
At hypoprothrombinemia drugs from the vitamin K group are prescribed: phytomenadione is used orally 30 minutes after meals, 0.01-0.02 g 3-4 times a day (up to 6 times a day) or vikasol 0.015 g 2-3 times a day for 3-4 days (for intramuscular injection of 1 ml of 1% vikasol solution).
If the fibrinolytic activity of the blood is increased, aminocaproic acid or Ambien should be used (see the description of the drugs earlier).
With increased vascular permeability, the patient is given rutin 0.02-0.05 g 2-3 times a day or ascorutin (contains rutin and ascorbic acid 0.05 g and 0.2 g glucose).
In patients with hypertension, it is necessary to prescribe antihypertensive drugs (clonidine, raunatin, octadin, guanfacine, etc.).
General treatment of patients with post-extraction bleeding should be carried out in a hospital setting.
♦ Prevention
Before tooth extraction, it is necessary to carefully collect anamnesis in order to identify patients with prolonged bleeding after tissue damage or previous operations. If there are any doubts about the patient’s normal blood clotting, a general blood test should be done (to find out the number of platelets), determine the blood clotting time (duration of bleeding) and find out the coagulogram parameters. If these indicators deviate from the norm, you should consult a therapist or hematologist. If patients have common concomitant diseases that may lead to the development of post-extraction bleeding, then surgical treatment must be carried out after special antihemorrhagic preparation. In some cases, postoperative antihemorrhagic measures should be used.
Tooth extraction should be carried out with minimal trauma to bone and soft tissue. In case of traumatic extraction, it is necessary to perform thorough hemostasis followed by suturing the postoperative wound. Measures should be taken to prevent the development of alveolitis, since late bleeding may develop with this disease.
Providing emergency surgical care patients with hemorrhagic diathesis should be carried out only in a hospital setting with pre- and postoperative antihemorrhagic preparation.
♦ Features of treatment of patients with hemophilia
Hemophilia is a group of common hemorrhagic diathesis caused by hereditary deficiency of the coagulation component factor VIII or factor IX. The prevalence of the disease is 6-12 patients per 100 thousand population. Thanks to advances in hematology, the life expectancy of patients has increased from an average of 20 years to 50 years.
Depending on the level of concentration in the patient’s blood of factor VIII or factor IX, four forms of the disease are distinguished:
Severe form- characterized by the early manifestation of bleeding, severe hemorrhagic syndrome with frequent post-traumatic spontaneous hemorrhages in the joints. Bleeding may occur periodically during internal organs. The level of factors VIII and IX in the blood of patients is from 0 to 3%.
Moderate- first manifests itself in preschool age as a moderately severe hemorrhagic syndrome with frequent hemorrhages in the joints, muscles, renal bleeding and other complications. The level of factors VIII and IX in the blood of patients is from 3.1 to 5%.
Light form- characterized by more rare and less intense bleeding, usually occurring in school age after injury or surgery. In most cases, patients do not have hemorrhagic syndrome. The level of factors VIII and IX in the blood of patients is from 5.1 to 10%.
Hidden (latent) form long time may be asymptomatic and detected only in connection with injury or surgery. The level of factors VIII and IX in the blood of patients is from 10.1 to 25%.
The course of hemophilia is significantly aggravated by the presence of circulating antibodies (inhibitors) of factors VIII and IX, which make patients resistant to antihemophilic drugs, and therefore increase the risk of surgical interventions.
After establishing the type of hemophilia and its severity, depending on the circulating factor VIII and IX, pathogenetic therapy is carried out. The introduction of purified and standardized drugs (VIII and IX factors) into clinical practice has opened up new opportunities for surgical interventions in patients with hemophilia. Sukhovy M.V. (1993) developed a set of treatment measures that make it possible to carry out surgical interventions in patients with hemophilia “A” and “B”. The main link is the timely and adequate administration of blood clotting factor VIII (hemophilia “A”) or IX (hemophilia “B”) drugs obtained from donor blood. Its main advantage over previously used preserved blood and plasma is its higher concentration and activity in a smaller volume, which allows you to quickly compensate for the deficiency of factor VIII or IX, without overloading the cardiovascular system.
A parallelism has been clearly established between the amount of factor VIII or IX administered to the patient and the level of its activity in the patient’s circulating blood. This makes it possible to calculate the amount of drug required to increase the concentration of factor VIII or IX to the level required for the patient. With timely administration of cryoprecipitate or other concentrated factor VIII preparations in an appropriate dose, bleeding, as a rule, can be stopped (Sukhoviy M.V., 1993).
Specific hemostatic therapy is compiled individually, depending on the patient’s body weight, the severity of hemophilia, the method of treatment and the type of surgical intervention. Cryoprecipitate is administered intravenously as a bolus at the rate of 40-80 units per 1 kg of patient body weight. The individual dose of cryoprecipitate is calculated using the formula:
X = (Y + M)/100
X - required quantity cryoprecipitate in doses;
U- required level of factor VIII in%;
M- patient’s body weight in kg;
100 - content of antihemophilic globulin (AGG) activity in one dose.
Cryoprecipitate is administered every 8-12 hours, according to its half-life, in order to maintain the concentration of factor VIII or IX at the level of 40-50% required for the thrombus formation process (Sukhoviy M.V., 1993).
Depending on the clinical course of postoperative complications, the dose of cryoprecipitate may be increased. The effectiveness of antihemophilic therapy is assessed by the dynamics of blood plasma factor VIII or IX, which is determined by the thromboplastin formation method throughout the entire treatment period. The determining factor for good hemostasis and a smooth course of the postoperative period is the degree of replenishment of factor VIII or IX for the entire period of treatment.
Depending on the duration of alveolar bleeding, the concentration of the deficient factor decreases significantly, which is due to the loss of a significant part of it due to blood loss.
This circumstance requires additional administration of the drug in the early period of treatment, in accordance with its actual deficiency (50-60 IU per 1 kg of patient body weight). Particular attention should be paid to replenishing blood loss with blood components - erythromass, albumin.
In subsequent days, the dose of cryoprecipitate is maintained at the level of 20-30%, which corresponds to a dose of 30-40 units per 1 kg of patient body weight.
When executing infusion therapy Sukhovy M.V. (1993) recommends, along with specific means of hemostasis, nonspecific therapy: the introduction of fibrinolysis inhibitors (contrical, gordox), as well as immunocorrectors that prevent the formation of antibodies to factors VIII and IX (hydrocortisone and prednisolone). When transforming hemophilia into an inhibitory form, the use of therapeutic plasmapheresis is most effective.
Thus, adequate antihemophilic transfusion therapy is the leading link in surgical interventions in patients with hemophilia. Without observing all its principles and individualization for each patient, all attempts at surgical interventions are doomed to failure.
♦ Alveolitis
The term "alveolitis" was proposed by A.I. Verlotsky and A.M. Pimenova. Its synonyms are: post-extraction alveoloneuritis (A.I. Evdokimov), socket postoperative pain (G.A. Vasiliev), socket osteomyelitis (F.A. Zverzhkovsky), etc.
Alveolitis is a widespread disease, which, according to various authors, accounts for 24-35% of the number of cases of all complications occurring in patients after tooth extraction (V.E. Zhabin, 1975; Yu.I. Vernadsky et al., 1983; GA Zhitkova, 1984; Krajnik, 1981; Wolf, Schneider, 1984).
Alveolitis can occur in two forms: the first one is in the form osteomyelitis of the alveolar process, in which, by the end of the 2-3rd week of the disease, as a result of sequestration of the walls of the tooth socket, the need for surgical intervention arises; the second - in the form "dry socket" which lasts for 1 week and does not require surgical treatment.
According to our research, in 24.2% of patients this pathological process develops upper jaw and in 75.8% - on the lower one (A.A. Timofeev, 1983). In the upper jaw, alveolitis is observed more often after the removal of 7 teeth (in 30.2% of patients), 6 teeth (in 24.1%), 5 teeth (in 16.4%), and 4 teeth (in 22 .6%), and on the lower jaw - after removal of 8 (in 33.2%), 7 (in 22.1%), 6 (in 27.4%) and 5 teeth ( in 12.5%).
Acute alveolitis occurs mainly in children (65.4%) during the development of permanent occlusion in the sockets of removed first permanent molars (69.2%) of the mandible (G.K. Sidorchuk, 1974). Thus, this complication is more often observed in older children.
Bertrand (1981) studied the nature of complications that arise in patients after removal of 8 upper teeth. However, the development of alveolitis was not observed in them. The difference in the frequency of localization of alveolites on the upper and lower jaws is explained by the peculiarities of their anatomical structure (Yu.I. Vernadsky, 1984; Pavek, Rezny, 1974).
Alveolitis is more common in women (57.1%) than in men (42.9%). It is believed that in women, the appearance of alveolitis is influenced by the increase in the level of female sex hormones noted during menstruation. Hormones influence fibrinolysis of a blood clot. In the absence of regular menstruation in girls under 16 years of age, the number of complications after tooth extraction is much less.
This disease is characterized by seasonality. We registered the largest number of cases of alveolitis in March and April (15.2 and 16.8%, respectively), then in December (12.0%), January (9.3%) and February (8.9%). According to M.E. Otsa and A.A. Erimäe (1983), the highest frequency of occurrence of this pathological process noted in December. In autumn, alveolitis is observed less frequently.
Quite often, alveolitis develops as a result of a traumatic tooth extraction operation, especially if the patient does not comply with the rules of oral hygiene. It is believed that when the amount of bacterial microflora in the oral cavity decreases, the number of alveolites (especially when lower teeth are removed) decreases.
Alveolitis is more often observed during prolonged tooth or root extraction operations, as well as with significant injury to the bone and mucous membrane, which are subsequently subject to infection. If, after removing the tooth root, the edges of the socket remain sharp and exposed, then this contributes to the appearance of post-traumatic neuritis in the postoperative period and the development of alveolitis against its background.
For normal healing of a post-extraction wound, it is necessary to have a blood clot in the socket. To prevent the formation of dry sockets, you need to eliminate the causes that may prevent the formation of a blood clot. The cause of the development of alveolitis may be excessive infiltration of tissues with an anesthetic substance that promotes the formation large number"dry sockets"
There are indications in the literature of the existence of factors that can prevent the formation or contribute to the destruction of an already formed blood clot. Yes, use vasoconstrictor drugs, introduced together with local anesthetics, leads to prolonged vasospasm and prevents the formation of a blood clot in the tooth socket. Violation of the blood coagulation process (hemophilia, pseudohemophilia, Henoch-Schönlein disease, the use of anticoagulants in patients with myocardial infarction, hormonal hemorrhages), tamponade of the hole with gauze strips, non-compliance by the patient with the doctor’s recommendations (rinsing the mouth after surgery, smoking, drinking alcohol) can also occur cause disruption of blood clot formation. The destruction of a blood clot can occur due to the fibrinolytic effect of saliva.
Complications after tooth extraction are quite common. What are they? What to do when the first symptoms appear, how to treat? Let's try to figure it out.
On the spot extracted tooth arises open wound. In order to prevent infection from getting into it, a blood clot must form. If this does not happen, the hole may become inflamed.
What you should pay attention to if you suspect alveolitis:
alveolitis after tooth extraction Why does this complication develop? Main reasons:
The main rule is not to self-medicate. Only a specialist can deliver correct diagnosis and prescribe appropriate treatment, which occurs only in a hospital setting.
First of all, to stop the inflammatory process, medications are prescribed:
During the treatment period, it is necessary to maintain oral hygiene, as well as follow all the doctor’s instructions. On early stages It is possible to get rid of alveolitis; advanced disease entails loss of performance, and in especially severe cases, death.
This complication is characterized by bleeding directly from the wound at the site of the extracted tooth. Occurs immediately or after some time (after several hours or days).
The main causes of alveolar bleeding are:
Treatment for alveolar bleeding involves stopping it.
First, the location and nature of the damage are determined, and then one or another method is used to stop blood loss:
Local anesthesia is used for tooth extraction. It has an analgesic effect, but partial loss of sensitivity occurs and the face goes numb. This process lasts several hours, and soon everything returns to normal. But it happens that the numbness does not go away after removal. This complication is called paresthesia.
Paresthesia is most often a temporary phenomenon. It disappears after a few days, sometimes weeks.
Reasons that can cause prolonged numbness in the lower part of the face may include:
All this is a consequence of a doctor’s mistake or negligence.
In most cases, paresthesia goes away on its own. But if this does not happen after 2-3 weeks, you should seek advice from an experienced dentist.
Treatment can take place in the following ways:
If this does not help, surgery may be scheduled to repair the facial nerve.
A hole forms in the jaw where the tooth was removed. This leads to the fact that the neighboring teeth gradually tilt, as if trying to cover the defect.
The same thing happens with the tooth that is located parallel to the opposite jaw. This phenomenon negatively affects the chewing process and leads to the formation of an incorrect bite.
To avoid such troubles, it is necessary to place a prosthesis or implant in place of the extracted tooth as soon as possible.
It happens that during the removal process not everything goes smoothly.
All sorts of traumatic cases occur due to the negligence of the doctor or the restlessness of the patient:
What complications can there be in children? They also have milk teeth, the roots of which sit loosely in the jaw bone. Often parents remove them at home (either on their own or entrust this procedure to amateur doctors).
But this is unacceptable:
Dear parents! Don't experiment on your children's health!
To prevent terrible consequences, it is necessary to take tooth extraction responsibly and seriously. Use the services of only experienced professionals.
Let such a procedure in dental clinic will cost more than an underground doctor who does not have the appropriate education and necessary experience. Don't take risks. If any complications occur, do not self-medicate.
Seek help from professionals. Value yourself, your health and your life.
Complications after tooth extraction can occur in any person, since this procedure involves surgery. Often they are caused by erroneous actions of a specialist. Sometimes the patient himself is to blame for the negative outcome of the operation. But before you start worrying, you need to understand the seriousness possible consequences. In addition, it is worth distinguishing between two concepts - “consequences”, which are the norm after any operation, as well as “complications”, which require prompt contact with a specialist. About the latest and we'll talk further.
Important! Complications can arise both during the operation - they are called early, and in the first days of tissue healing. They are usually called delayed or late complications.
Below we will discuss what is considered normal after tooth extraction.
The first couple of days after surgery, your temperature may rise. If the thermometer shows a little over 37, and in the evening the readings rise to 38 degrees, this means an active process of tissue restoration is underway. If a very high temperature lasts more than three days, you should visit a dentist. Most likely, an infection has entered the wound, which requires a prompt resolution of the issue.
The patient may feel pain at the site of tooth extraction. The tissues hurt because when the root is extracted, they are injured. Minor pain is again a normal reaction of the body. The discomfort will soon go away on its own. But if the pain only intensifies, does not go away within 2-3 days, and is not relieved by painkillers, you should immediately consult a doctor.
Swelling often develops after the procedure. A slightly swollen gum or cheek is not a reason to panic. Just apply cold on the side of your cheek (but do not overcool - it is better to wrap ice or meat from the freezer in a towel). Increasing swelling that does not decrease after 3 days is a sign of inflammation, so it is better to go to the doctor.
A fairly common occurrence is bleeding. The socket may begin to bleed immediately after removal or several hours later. This usually occurs as a result of damage to small vessels of the soft tissues of the tooth. The patient himself can damage the wound if he violates the doctor’s recommendations for rehabilitation. Normally, the bleeding should stop within half an hour. Light bleeding over a couple of hours is not a problem. To speed up the healing process, simply apply something cold to the sore cheek. It is imperative to hold the tampon that the doctor placed on the gum. If the bleeding is severe and for a long time does not stop, again you should consult a doctor.
Important! Some vascular diseases and hematopoietic system(hemophilia, acute leukemia, scarlet fever, infectious hepatitis, etc.), medications and high blood pressure prevent blood clotting. In patients with such pathologies, bleeding may continue longer. It is also recommended to take appropriate medications in order to normalize this process.
It is also a completely normal process, especially when removing complex teeth. For example, impacted, i.e. those who are inside bone tissue. Or have many branched roots. A hematoma often appears on the cheek on the side of the operation.
This section lists problems that require prompt medical attention.
But this is no longer a normal consequence, but a complication. If a blood clot has not formed in the socket, if it has been damaged or dissolved, the patient will face the problem of a dry socket. It is accompanied by slight pain and extreme unpleasant smell from the mouth. The clot is necessary for tissue rehabilitation to take place quickly and efficiently. Its damage leads to inflammation of the socket, which requires consulting a doctor and drug therapy.
A numb tongue or paresthesia develops if nerve endings are damaged during complex extraction (tooth extraction). In addition, “goosebumps” are sometimes felt on the lips, cheeks, and chin. In cases where the unpleasant feeling does not go away for a long time, the doctor prescribes medicinal injections and vitamins B and C. Physiotherapeutic procedures are prescribed.
This is the most common and serious complication that can develop during the extraction of any teeth.
With alveolitis, as a result of disruption of the healing processes, inflammation of the tissues of the tooth socket occurs. Possible reason– ignoring postoperative recommendations dentist Or bacteria that have penetrated an open wound and triggered the development of the inflammatory process. The patient experiences severe pain in the area of the missing tooth, difficulty swallowing, and swelling of the gums is possible. If these symptoms intensify after three days, you should immediately consult a dentist. He will prescribe physical therapy and select certain medicines, will clean the hole from inflamed tissue.
Important! Rinsing during the healing period of the hole is contraindicated - they can damage the blood clot and thereby provoke the development of alveolitis. The broth should be cooled to room temperature, then taken into the mouth and held for about three minutes.
Osteomyelitis is purulent-inflammatory processes in bone tissue that develop due to infection. The course of the disease is characterized by bursting pain at the site of infection, general weakness, sweating, and fever. A slight swelling is noticeable in the affected area, the skin is hot and changes color. Over time, the swelling grows and in its place a purulent fistula. The patient is treated strictly in a hospital. After tooth extraction, osteomyelitis does not occur often - as a rule, inflammation spreads to the entire upper or lower jaw, if the patient does not treat alveolitis.
Remember these manifestations: they all indicate that you need to immediately consult a doctor - often this is an indicator that the healing process of the hole is not going well.
There is no categorical prohibition on removal for pregnant women. However, during this period, women are prohibited from taking most medications, including antibiotics. A high load during surgery can affect your well-being. expectant mother and a child. Therefore, if possible, it is better to refuse this procedure. But it is also worth remembering that a diseased tooth, affected, for example, is a breeding ground for infection, which can cause much more damage than such a surgical intervention.
What local complications can occur in pregnant women? As a rule, simple extraction of incisors and molars ends successfully. But with difficult removal, there is a high risk of bleeding, a sharp increase in temperature, and acute pain, general deterioration of the pregnant woman’s condition and development inflammatory processes. In some cases, you will need to take antibiotics. It is also worth remembering that a woman in the “position” is quite sensitive emotionally, so even a simple procedure for removing teeth can provoke a miscarriage. early stages or premature birth in the 3rd trimester.
U small child or children younger age complications usually do not occur. But if the dentist was not careful, the roots could break baby tooth. Removing debris remaining in the hole can cause severe inflammation. You also need to make sure that the child does not touch the wound.
If after 2-3 days the pain has not subsided, radiates to the ear, neck, the temperature has not returned to normal, the swelling has not gone away, or bad breath appears, you should rush to the dentist. The doctor will determine the cause of the problem and, if necessary, treat complications:
Avoid severe consequences After surgery, following preventive recommendations will help:
To reduce the risk of serious complications, you just need to carefully monitor your well-being, and if any alarming symptoms contact a specialist. And if you had to deal with tooth extraction, then it’s time to think about restoring your smile, the most the best option however, today it remains .
Video on the topic
From this article you will learn:
The article was written by a dental surgeon with more than 19 years of experience.
According to statistics, after the removal of a wisdom tooth, inflammation of the socket of the extracted tooth occurs in 25-30% of cases. For example, after the removal of any other groups of teeth, inflammation occurs only in 3-5% of cases. This is due: firstly, to the higher complexity of removing wisdom teeth, and secondly, to the fact that they are surrounded by a large amount of soft tissue.
The last circumstance is very important, because the presence of moving soft tissues in the area of the extracted tooth socket often leads to the loss of the clot - its loss or even destruction. If the hole of the extracted tooth turns out to be without a clot, inflammation will inevitably develop in it.
Gums after wisdom tooth removal (normal) –
When wisdom teeth are removed, stitches are almost always required. This is necessary because these teeth are located deep in the soft tissues and in this place the mucous membrane is very mobile. The absence of sutures in this situation can lead to prolapse of the clot and inflammation. But if the patient long length There is enough space for the jaw and wisdom tooth - the hole will look traditional (Fig. 3).
It must be said that the severity negative symptoms after wisdom tooth removal directly depends on the degree of traumatic removal. In turn, the incidence of trauma depends not only on the simple or complex position of the tooth in the jaw, but, first of all, on the qualifications of the dental surgeon.
For example, surgeons often spend 1-2 hours trying to remove a patient’s wisdom tooth with just forceps and an elevator - instead of immediately making an incision in the gum, drilling out some bone around the tooth and/or sawing the tooth crown into several parts (after that, removing each root by separately), and spending only 15-20 minutes on it.
Another main cause of complications after complex wisdom tooth removal is the use of a drill by the surgeon, the surgical tip of which is not water-cooled. As a result, there is thermal burn bones, accompanied by sweat severe pain and the development of suppuration in the socket of the extracted tooth.
Important : Thus, the main causes of inflammation and other complications are the mistakes and negligence of the dental surgeon during the removal process. However, a lot also depends on the doctor’s prescriptions. Correct prescriptions dramatically reduce the risk of developing inflammation of the socket.
What to do after wisdom tooth removal will depend on the complexity of the removal. If the removal was simple (that is, it was not accompanied by an incision in the gum and sawing out the bone), then after removal it will be sufficient. If the removal was difficult or was carried out against the background purulent inflammation, then the following must be added to these recommendations...
Firstly, Amoxiclav. The dosage for adults should contain 500 mg amoxicillin and 125 mg clavulanic acid. At this dosage, the drug is taken only 2 times a day. However, if you previously experienced diarrhea after taking antibiotics, then it is better to purchase another drug - Unidox-solutab. soluble tablets(taken 100 mg 2 times a day, 5 or 6 days).
Very often, doctors also prescribe a drug from the Soviet past - ( adult dosage– 2 capsules 3 times a day, for a total of 5-6 days). It is inexpensive, effective, but kills the entire intestinal microflora, causing you to suffer from dysbacteriosis later.
When a wisdom tooth has been removed, what to do after removal will directly depend on the symptoms that you experience. It must be said that according to statistics, complications after wisdom tooth removal occur in almost every 4th patient. Most often, patients encounter the following symptoms, indicating the development of complications -
Having a wisdom tooth pulled out, how long will it hurt is the most common question patients ask. How much your gums hurt after wisdom tooth removal directly depends on the degree of traumatic removal. Normally, pain after wisdom tooth removal should not be very strong and, once it occurs, it should gradually only decrease. After easy removal pain usually goes away completely in 1-2 days, and after a difficult one, normally in no more than 3-5 days.
If you have a wisdom tooth pulled out and the pain immediately after removal is very strong and practically does not decrease in the first days, this indicates that the removal was excessively traumatic and possible development inflammation of the socket of an extracted tooth (). Here you need to urgently go to the dentist for a second examination. At worst case scenario Development of events of pain can be observed up to 3-4 weeks.
Symptoms of inflammation of the wisdom tooth socket
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upon examination you can see that the hole is empty or it is full food leftovers and necrotic disintegration of the blood clot. Sometimes patients feel sharp/moving bone fragments with their tongue. There is always pain, there is always an unpleasant smell from the hole. The mucous membrane is swollen and red. Such symptoms are characteristic of a mild form.
However, in some cases, inflammation of the socket occurs with abundant formation of pus, swelling of the cheek, difficulty opening the mouth and painful swallowing. And it must also be said that if you experience pain when cold or hot water, then this clearly indicates the presence of an exposed area of bone. In any case, only a dentist can help you.
Below you can see what inflammation of the sockets of removed wisdom teeth looks like in the video. Please note that in video 2, when you press on the gums in the area of both removed wisdom teeth, thick pus comes out of the patient’s sockets.
Reasons for the development of alveolitis
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If the patient rinses his mouth vigorously in the first days after extraction, this can lead to a blood clot falling out of the socket of the extracted tooth. This leads to inflammation in 100% of cases, because... the hole is immediately filled with food debris and microbes from the oral cavity. But in most cases, alveolitis still develops due to the fault of the doctor -
Important : alveolitis is the most common complication after wisdom tooth removal. If the described symptoms occur, you should immediately run to the doctor and treat alveolitis. From experience I can say that when a doctor sutures a hole even after a simple removal, the number of cases of alveolitis development is almost zero. In addition, studies have shown that suturing the socket reduces the severity of pain after removal by 30-50%. Therefore, before removal, you should definitely ask the doctor to sew up your hole, even if you have to pay extra for it (about 500 rubles for 2 stitches).
If you have a wisdom tooth removed and your cheek is swollen the next day, then in some cases this is normal. Normally, after simple removal, swelling rarely develops, and most often it occurs in people with an abundance of subcutaneous fat on the face. Such swelling most often becomes noticeable only in the morning of the next day.
Normally, after a complex removal, swelling gradually develops immediately and gradually increases, becoming maximum the next morning. Usually the swelling is stable over the next 1-2 days, after which it begins to slowly decrease. If, against the background of swelling, there is no increasing temperature or pain, but on the contrary, all symptoms slowly decrease, then everything is OK.
When to sound the alarm
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if the swelling continues to increase over the next 1-2 days after removal, pain and temperature may also increase, pain when swallowing increases, and the mouth opens less and less - all these are unfavorable symptoms indicating suppuration. If you have at least one of the symptoms listed, you need to urgently run to the dentist.
Important : To ensure that swelling after wisdom tooth removal does not appear or is minimal, it is advisable to take antihistamines (Suprastin is best) for the first 2-3 days before going to bed - once a day before bed. Antihistamines They have not only an antiallergic effect, but also an anti-edematous effect.
When to sound the alarm: if the temperature does not subside the entire next day after extraction, and even more so continues to increase, then this indicates suppuration of the hole of the extracted tooth. All you need to do is run to the dentist.
A hematoma appears due to the fact that a vessel in the soft tissues has been injured. There is no point in blaming the doctor for this, because... When administering anesthesia, the doctor does not see where the vessels pass in your soft tissues. The needle can injure such a vessel and after a few days the skin may appear blue. Gradually it will pass.
However, the formation of a hematoma may require additional measures. A hematoma often festeres after wisdom tooth removal. In this case, already on this day or the next day after removal, the patient experiences swelling of the cheek, a feeling of fullness, pain, and a slight fever. Here you need to urgently consult a doctor, because... when the hematoma suppurates, an incision is required to release the pus.
If you have a wisdom tooth removed: what to do after removal, what to rinse with, how quickly the hole will heal and when it will be possible to treat your teeth... We answer all questions separately.
It is best to rinse your mouth after wisdom tooth removal. This drug is sold in every pharmacy and costs only about 30 rubles per 100 ml bottle. Please note that you can only rinse your mouth gently, because... Strong rinsing can cause a blood clot to fall out of the socket of the extracted tooth. The latter will lead to the development of inflammation.
How long it takes for the gums to heal after wisdom tooth removal depends on the complexity of the removal. Typically, you must wait 1 week to begin treatment after wisdom tooth removal. But after a complex removal, the gums may take longer to heal (up to 10-14 days), which will depend on the degree of traumatic removal. If inflammation occurs in the hole, healing may take 20-30 days. We hope that our article on the topic: Wisdom tooth removal, how much it hurts, turned out to be useful to you!
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