Extraction Complications - Oops, I did it again!

With the proper training, equipment and instruments, tooth extractions can often be successful, and the removal of a chronic source of inflammation is good for the patient. Complications will happen on a fairly regular basis, so this lecture includes discussion on challenges with extractions that may lead to complications, and how to deal with those issues.
While sometimes out of our control, time can place a large burden on the veterinarian. We are often limited by the available hours in our schedule, and when unexpected pathology is found, this can lead to the need for hurrying/rushing and loss of concentration, a bad combination that can lead to complications. Schedule planning can help to avoid ‘overbooking’ advanced procedures in the same day, and having the option to stage a procedure can be valuable.
Having the right equipment and instruments and keeping them` maintained and sharpened is so important. Without the optimal tools, extractions will be frustrating and can often lead to problems. Less than ideal sectioning of the tooth will also cause difficulties. Inadequate access to an extraction site may tempt us to use more force than finesse, and that can result in fracturing the tooth. Removing those root tips is typically warranted, but excess force can cause their displacement into the nasal cavity or mandibular canal, requiring options for retrieval
Not identifying, or not being cautious at extraction sites with compromised bone can lead to jaw fractures that must be managed further. Damage can occur to soft tissues if they are not protected, leading to lingual/sublingual tears, salivary duct injury, emphysema in underlying tissues and even air emboli.
Post extraction complications sometimes occurs due to patient self-trauma, so adequate analgesia and protection may be needed. Gingival flap dehiscence may occur if there was too much tension on the flap during closure. Even with good flap technique and adequate tension release, oronasal fistulation may recur, and gingival flaps and mandibular canine sites may have problems. Particularly in cats, sites in the region of an extracted tooth may experience trauma from the tooth directly opposite it. Pyogenic granulomas may occur at the site of mandibular first molar extraction due to maxillary premolar contact trauma, and lip entrapment may occur when maxillary canine teeth are extracted.