COMPLICATIONS OF EXODONTIA

K.Samhita-42
 local
Complications
due to L.A &
block techniques
systemic
Complications of Intra-operative
exodontia complications
Early post-
operative
Post-operative
complications
Late post-
operative

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 Complications due to L.A and
block techniques
SYSTEMIC COMPLICATIONS LOCAL COMPLICATIONS
• Overdose • Needle breakage
• Prolonged anesthesia/
• Allergy paresthesia
• Idiosyncracy • Facial nerve paralysis
• Trismus
• Hematoma
• Pain and burning on
injection
• Infection
• Edema
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 LOCAL COMPLICATIONS

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 Needle Breakage

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 CAUSES
• Hubbing the needle
• Intentional bending of needle by
doctor
• Sudden unexpected movement by
the patient while needle is still
embedded in tissue
• Forceful contact with bone

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 Management
• Immediate referral to specialist
• Locate retained fragment

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 Prevention

• Do not use short needles for IANB

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 Paresthesia
CAUSES:
• Trauma
• L.A is contaminated by alcohol or
sterilizing solution
• Hemorrhage
• Local anesthetic solution itself
PREVENTION:
• Strict adherence to injection protocol

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 MANAGEMENT

• Examine patient in person

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 FACIAL NERVE PARALYSIS

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 CAUSES
• Introduction of local anesthetic
into the capsule of the parotid
gland, which is located at the
posterior border of the mandibular
ramus.

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 • PREVENTION:
• Adhering to protocol with IANB
and Vazirani-Akinoski nerve blocks
• MANAGEMENT:
• Contact lenses should be removed
until muscular activity returns

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 TRISMUS

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 CAUSES
• Trauma to muscles or blood vessels
in the infratemporal fossa
• Contamination of L.A with alcohol or
sterilizing solutions
• Hemorrhage
• Low grade infection after injection
• Multiple needle penetrations
• Excessive volumes of local anesthetic
solution deposited

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 PREVENTION
(Not always preventable)
• Use sharp, sterile, disposable needle
• Use aseptic technique. Contaminated
needles should be changed
immediately.
• Practice atraumatic insertion and
injection technique
• Avoid repeat injections and multiple
insertions into same area
• Use minimum effective volumes of
local anesthetic.
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 MANAGEMENT
• Heat therapy, warm saline rinses,
analgesics, muscle relaxants
(Diazepam or Meprobamate)
• Physiotherapy

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 HEMATOMA
• CAUSES:
• Arterial or venous puncture after a
posterior superior alveolar or
inferior alveolar nerve block

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 PREVENTION
• Knowledge of the normal anatomy
• Modify injection technique as
dictated by the patients anatomy
• Use short needle for the PSA nerve
block

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 MANAGEMENT
• IMMEDIATE: direct pressure should
be applied to the site of bleeding (
not less than 2 mins)
• IANB: pressure is applied to the
medial aspect of mandibular ramus.
• PSA: digital pressure is applies to soft
tissues in mucobuccal fold as far
distally as can be tolerated by
patient.
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 • Ice may be applied immediately.
• With or without treatment, A
hematoma will be present for 7 to
14 days.
• Do not apply heat to the area for
atleast 4 to 6 hours after the
incident
• Patient should apply warm moist
heat to the affected area for 20
mins every hour.

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 PAIN ON INJECTION
• CAUSES:
• Careless injection technique and
callous attitude
• A needle can become dull from
multiple injections
• Rapid deposition of L.A
• Needles with barbs

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 PREVENTION
• Proper technique of injection
• Use sharp needles
• Use topical anesthetic properly
before injection
• Use sterile local anesthetic solution
• Inject local anesthetic slowly
• Make certain that the temperature of
the solution is correct

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 BURNING ON INJECTION
• CAUSES:
• pH of the solution
• Rapid injection of L.A
• Contamination of L.A

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 PREVENTION
• Buffering of L.A to pH of
approximately 7.4
• Slowing the speed of injection

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 INFECTION
• CAUSES:
• Contamination of needle
• PREVENTION:
• Use sterile disposable needles
• Avoid contamination of needle
• Proper care for and handle dental
catridges of local anesthetic
• Properly prepare the tissues before
penetration

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 EDEMA
• Edema , or swelling of the tissues, is
usually a symptom and rarely an
entity itself.
• Trauma, infection, allergy,
hemorrhage, and other factors can
produce edema.
• Each cause of edema should be
considerded under its own
classification in regard to prevention
and treatment.
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 SYSTEMIC COMPLICATIONS

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 TOXICITY
• CAUSES:
• Too large a dose of local anesthetic
drug
• Usually rapid absorption of the drug
of intravascular injection
• Usually slow biotransformation
• Slow elimination or redistribution

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 PREVENTION
• The patient should be adequately evaluated
before given a regional anesthetic
• The anesthetic drug must be selected with
care
• The least possible volume should be used
• The weakest concentration compatible with
successful anesthesia or analgesia should be
used
• The solution should be deposited slowly
• Aspiration must be done before injecting
• A vasoconstrictor should be used with local
anesthetics if not contra indicated.
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 IDIOSYNCRACY
• An abnormal reaction to a normal
reaction to a normal dose of drug.
• Extremely variable and
unpredictable
• May resemble toxic/ allergic
reaction but differ in etiology
• Unusual or bizarre symptoms

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 HYPERSENSITIVITY (allergy)
• Manifested by skin rash, urticaria,
edema and its full blown state by
anahylaxis
• If allergic to methyl paraben, cardiac
lidocaine used
• If allergic to L.A, 10%
diphenhydramine hydrochloride.

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 ANAPHYLAXIS
• Urticaria, abdominal cramping,
vomiting, diarrhea and
incontinence.
• Respiratory distress
• Hypotension
• Cardiovascular collapse
• unconsciousness

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 TREATMENT
• Epinephrine (0.3 – 0.5 mg) I.V
• An anti-histamine

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 PERI-OPERATIVE
COMPLICATIONS

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 • FRACTURE:
• Alveolar bone
• Maxillary tuberosity
• Adjacent or opposing tooth
• Mandible
• DISLOCATION OF:
• Adjacent tooth
• Temporomandibular joint
• DISPLACEMENT OF ROOT:
• Into soft tissue
• Into maxillary antrum
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 POST-OPERATIVE
COMPLICATIONS

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EARLY LATE
• Excessive bleeding • Traumatic arthritis of
• Oedema TMJ
• Pain due to damage • Acute osteomyelitis
to hard and soft of mandible
tissues • Sweeling due to
infection
• Dry socket
• Trismus
• Fracture of bone

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 CONCLUSION
Practitioners must realize that no drug
or technique of administration even in
healthy patient is without risk. Serious
and even fatal complications have and
will occur in dental offices
• Dentists must take all precautions
necessary to prevent their occurrence
and prepare themselves to properly
manage those untoward events that
prove unavoidable
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 REFERENCES
• Stanley F. Malamed 6th edition
• Monheim’s Local anesthesia and
pain control in dental practice 7th
edition
• Daniel M. Laskin

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