the dentist but also dangerous to the patient to find out about warfarin (or other blood thinner) use only after surgery has begun. 2. What should Dr. Wagoner do to control the hemorrhage at this time? Most likely, the hemorrhage is mainly from capillaries, since Dr. Wagoner has not yet removed bone. Therefore, the bleeding should decrease within a relatively short time. He should keep finger pressure with moistened gauze over the area (or have an assistant do it) for several minutes. He should check regularly and remove the pressure only when the bleeding has stopped or has been reduced to a mild ooze. If the flap is large enough, it should be secured with sutures. 3. What type of follow-up care should be planned? In consultation with Clarence’s physician, a safe INR (international normalized ratio) should be agreed upon for his extraction and a new appointment scheduled. The INR should be measured within 24 hours of the extraction. In the meantime, an antibiotic should be given to reduce infection. If necessary, pain can be controlled with ibuprofen/ acetaminophen or a prescription pain medication.
During the extraction, the crown of tooth #31 breaks off at the gumline and Dr. Wagoner determines the need to reflect a tissue flap to remove bone so he can better access the roots. As he reflects the flap, the area begins to bleed profusely, limiting Dr. Wagoner’s visibility. When the bleeding fails to subside after several seconds, Dr. Wagoner places pressure over the flap with gauze for two minutes. When the pressure is relieved, bleeding continues at nearly the same rate as before. Dr. Wagoner replaces the pressure and asks Clarence whether he is taking any blood-thinning medications. Clarence replies that he is on warfarin (Coumadin) following a minor stroke several years ago. Although not listed with his other medications, Dr. Wagoner recognizes that this is the cause of Clarence’s abnormal bleeding and decides he should stop the surgery. Points to Consider 1. How could this unexpected complication have been avoided? It should not be assumed that a medical history filled out by a patient is complete. Patients may leave out information due to embarrassment or simple forgetfulness. In the case of an extraction on a medically compromised patient, it is important to ask additional questions that may prevent unexpected negative results. It is not only embarrassing to Conclusion Pain, edema, trismus, infection, ecchymosis, hemorrhage, nausea, dislocation of the condyles, and dry socket are the most common complications arising after oral surgery. The dental practitioner must be able to identify these complications. The practitioner must also take the appropriate precautions to minimize the risks and, if necessary, manage the complications associated with oral surgery. References Abraham, M. A., Azari, A., Westcott, J., & Stavropoulos, F. (2016). Dry socket (alveolar osteitis, fibrinolytic osteitis). In L. Ganti (Ed.), Atlas of emergency medicine procedures (pp. 373-374). Springer. Ahmadi, H., Ebrahimi, A., & Ahmadi, F. (2021). Antibiotic therapy in dentistry. International Journal of Dentistry, 6667624. doi: 10.1155/2021/6667624 Aiyaka, P., & Techakehakij, W. (2019). The prevalence of cross-reactivity of cephalosporin in penicillin-allergic patients: A cross-sectional study in Thailand. Hong Kong Journal of Emergency Medicine, 26 (3), 151-155. Ali, T., Keenan, J. Mason, J., Hseih, J. T. & Batstone, M. (2022). Prospective study examining the use of thrombin-gelatin matrix (Floseal) to prevent post dental extraction haeomorrhage in patients with inherited bleeding disorders. International Journal of Oral and Maxillofacial Surgery, 51 (3), 426-430. Bailey, E. (2018). Prevention and management of post-operative pain in oral surgery. Primary Dental Journal, 7 (3), 57-63. Banawas, S. S. (2018). Clostridium difficile infections: A global overview of drug sensitivity and resistance mechanisms. Biomed Research International . doi: 10.1155/2018/8414257. Bird, D. 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Many postoperative dentoalveolar complications can be reduced or eliminated with proper patient consultation, education, and counseling on what to expect. This communication helps eliminate patient complaints and unnecessary postsurgical callbacks to the office (Sun et al., 2015).
Nehme, W., Fares, Y., & Abou-Abbas, L. (2021). Piezo-surgery technique and intramuscular dexamethasone injections to reduce postoperative pain after impacted mandibular third molar surgery: A randomized clinical trial. BMC Oral Health, 21 (1), 393. doi: 10.1186/s12903-021-10759-x Oral Cancer Foundation. (2016). Understanding: Complications of treatment. Trismus . http://www. oralcancerfoundation.org/complications/trismus.php Passarelli, P. C., DeAngelis, P., Pasquantonio, G., Manicone, P. M., Verdugo, F., & D’Addona, A. (2018). Management of single uncomplicated dental extractions and postoperative bleeding evaluation in patients with factor V deficiency: a local antihemorrhagic approach, Journal of Oral and Maxillofacial Surgery, 76 (11), 2280-2283. doi: 10.1016/j.joms.2018.06.022 Picard, M., Robitaille, G., Karam, F., Daigle, J. M., Bedard, F., Biron, E., Tardif, M. R., Lacombe-Barrios, J., & Begin, P. (2019). Cross- reactivity to cephalosporins and carbapenems in penicillin-allergic patients: Two systematic reviews and meta-analyses. The Journal of Allergy and Clinical Immunology: In Practice, 7 (8), 2722-2738e.5. Rohe, C., & Schlam, M. (2022). Alveolar osteitis. In StatPearls . StatPearls Publishing. https://pubmed.ncbi.nlm. nih.gov/35881742/ Santiago-Rosado, L. M., & Lewison, C. S. (2021). Trismus. In StatPearls . StatPearls Publishing. https://www.ncbi. nlm.nih.gov/books/NBK493203/ Shaban, B., Azimi, H. R., Naderi, H., Janani, A., Zarrabi, M. J., & Nejat. A. H. (2014). Effect of 0.2% chlorhexidine gel on frequency of dry socket following mandibular third molar surgery: A double-blind clinical trial. Journal of Dental Materials and Techniques, 3 (4), 175-179. Shenoy ES, Macy E, Rowe T, Blumenthal KG. Evaluation and Management of Penicillin Allergy: A Review. JAMA. 2019;321(2):188–199. doi:10.1001/jama.2018.19283 Shoohanizad, E., & Parvin, M. (2020). Comparison of the effects of dexamethasone administration on postoperative sequelae before and after “third molar” extraction surgeries.Endocrine, Metabolic & Immune Disorders Drug Targets , 20 (3), 356-364. doi: 10.2174/1871530319666190722120405 Simmons, K. B., Haddad, L.B., Nanda, K., & Curtis, K. M. (2017). Drug interactions between non-rifamycin antibiotics and hormonal contraception: A systematic review. The American Journal of Obstetrics and Gynecology, 218 (1), 88-97.e14. doi: 10.1016.j.ajog.2017.07.003 Sreesha, S., Ummar, M., Sooraj, S., Aslam, S., Roshni, A., & Jabir, K. (2020). Postoperative pain, edema and trismus following third molar surgery: A comparative study between submucosal and intravenous dexamethasone. Journal of Family Medicine and Primary Care, 9 (5), 2454-2459. doi: 10.4103/jfmpc. jfmpc_188_20 Sun, B. C., Chi, D. L., Schwarz, E., Milgrom, P., Yagapen, A., Malveau, S., … Lowe, R. A. (2015). Emergency department visits for nontraumatic dental problems: A mixed-methods study. American Journal of Public Health, 105 (5), 947-955. U.S. Department of Justice, Drug Enforcement Administration, Office of Diversion Control. (n.d.a). List of controlled substances . http://www.deadiversion.usdoj.gov/schedules U.S. Department of Justice, Drug Enforcement Administration, Office of Diversion Control. (n.d.b). Practitioner’s manual: Section V. Valid prescription requirements . http://www.deadiversion.usdoj.gov/pubs/ manuals/pract/section5.htm Wu, G., Wu, G., & Wu, H. (2015). A costly lesson: Fatal respiratory depression induced by clindamycin during postoperative patient- controlled analgesia. Pain Physician, 18 (3), E429-E431. Wynn, R. L., Meiller, T. F., & Crossley, H. (2016). Drug information handbook for dentistry (22nd ed., p. 349). Wolters Kluwer Clinical Drug Information, Inc. Yaedu, R. Y. F., de Almeida Barbosa Mello, M., da Silveira, J. S. Z., & Valente, A. C. B. (2018). Edema management in oral and maxillofacial surgery . https://www.intechopen.com/online-first/edema-management- in-oral-and-maxillofacial-surgery Li YH, Chang WC, Chiang TE, Lin CS, Chen YW. Mouth-opening device as a treatment modality in trismus patients with head and neck cancer and oral submucous fibrosis: a prospective study. Clin Oral Investig. 2019 Jan;23(1):469-476. doi: 10.1007/s00784-018-2456-4. Epub 2018 Apr 26. PMID: 29696422.
COMMON COMPLICATIONS ASSOCIATED WITH ORAL SURGERY Final Examination Questions Select the best answer for each question complete your test online at EliteLearning.com/Book
85. Which is a common postoperative complication associated with oral surgery? a. Tooth erosion b. Dislocation of the condyles
86. The most common complications in wisdom tooth extraction are: a. Pain after surgery and dry socket. b. Trismus and dislocation of the condyles. c. Infection and nausea. d. Ecchymosis, hemorrhage, and edema.
c. Gastrointestinal upset d. Pulmonary embolism
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