If you’ve worked in our fast track area, you’re familiar with the variety of dental issues our patients come in with on a daily basis. Here, we discuss post-extraction complications — namely pain, dry socket, and bleeding.
POSTEXTRACTION PAIN
Pain and edema is common after extraction of third molars (wisdom teeth)
Peaks within the first 24-48 hours after extraction
Treatment: ice packs, elevation of HOB to 30 degrees, and NSAIDs
NSAIDS preferred over oral narcotics for pain
Progressively worsening trismus is worrisome for a post-op infection
POSTEXTRACTION ALVEOLAR OSTEITIS (DRY SOCKET)
Total or partial displacement of the clot from the socket, resulting in alveolar bone exposure
Can progress to osteomyelitis of the exposed bone
Commonly occurs on the second or third postoperative day
Associated with severe pain
Incidence: 1-5% of all extractions, but up to 30% in impacted wisdom tooth extraction
Risk factors: smoking, pre-existing periodontal disease, traumatic extraction, prior episodes
Treatment: Pain control with expectant management, gentle irrigation with warm saline or chlorhexidine 0.12% oral rinse to remove debris
Intrasocket placement of medications is controversial
Give antibiotics for suspected infections
POSTEXTRACTION BLEEDING
Soak a 2x2 gauze pad in TXA, apply to socket and ask patient to bite down (not chew!)
If this doesn’t work, can apply Surgicel into the socket to serve as a clot-forming matrix
Can use loose sutures to hold in place, or to loosely close gingiva over the socket
CAVEAT: Tight sutures may cause necrosis of the gingival flap
If this doesn’t work, may inject lidocaine with epi or use silver nitrate cautery
Still no luck? —> Consult w/ OMFS
Sources: Tintinalli’s Emergency Medicine, 9th Edition pp 1582-1583