Unsuccessful tooth extraction. What are the possible complications after tooth extraction? Limited osteomyelitis of the tooth socket

Tooth extraction should not be taken lightly, because after such a procedure there are complications, as after any other intervention.

They can be caused by the behavior of patients, or they can arise for reasons beyond their control. Consider the main causes of complications during and after tooth extraction, as well as the characteristic signs and methods of treatment.

Tooth extraction is serious

Any extraction of teeth cannot be considered a harmless dental procedure. Furthermore, modern medicine with the introduction of tooth-saving technologies, considers such a measure to be extreme. After all, the loss of even one tooth is a big problem for a person.

Extraction of teeth is only medical indications when it is impossible to prevent the development of the disease in other ways. This procedure is not performed during pregnancy.

Light extraction of teeth is carried out using dental forceps. The doctor makes special movements to help extract the tooth from the hole.

Difficult extraction is a situation where the tooth cannot be removed with forceps alone. The doctor first creates access to the root of the tooth by dissecting the periosteum. If the tooth is located obliquely or horizontally, then the extraction occurs in parts using special tools.

The method of tooth extraction depends on each case. Only a specialist can determine the tactics of such an operation. This is a very serious procedure, which in some cases can lead to complications.

What provokes unpleasant consequences?

Unpleasant consequences and excruciating pain after tooth extraction are associated with a number of reasons. Although the current level of development dentistry reduces the likelihood of complications to a minimum.

So, the most common cause of bleeding is the pathology of blood clotting. Even taking acetylsalicylic acid gives a serious risk of bleeding.

The same can be said for patients suffering from arterial hypertension. With stabilization of pressure in such patients, the risk of bleeding remains.

Bleeding wounds can also occur as a result of such reasons:

features of the pathological process;
features of the location of the teeth;
careless removal;
non-compliance with the recommendations of the doctor.

Inflammation after tooth extraction - alveolitis or osteomyelitis is provoked due to the following factors:

Existence multiple foci inflammation with frequent relapses;
traumatic removal (in this case, conditions arise for the penetration pathogenic microflora in tissue)
the absence of a blood clot in the tissue formed after removal;
pathological changes in the body due to stress, as well as past acute diseases;
the presence of endocrine diseases in the stage of exacerbation or decompensation;
exhaustion.

Perforation of the maxillary sinus occurs for the following reasons:

anatomical features of the structure of the tooth and the location of its roots;
the presence of chronic foci of inflammation;
inaccurate actions of the doctor;
if during the procedure the patient suffered from inflammation of the maxillary sinus.

These are the most common causes of complications after a tooth has been pulled out.

How are the risks?

After tooth extraction, the patient may experience the following complications:

alveolitis;
bleeding;
temperature rise;
paresthesia;
repositioning neighboring teeth;
injury or incomplete removal tooth
flux and suppuration of the gums.

Alveolitis - painful inflammation of the socket of the tooth

Alveolitis is inflammation of the socket after tooth extraction. In some cases, the hole may look quite normal, and the diagnosis of alveolitis is made by the doctor only after a thorough examination. However, in most cases, the hole swells up, bad smell.

Upon visual inspection, the hole is empty, it has a yellowish coating, as well as food debris. In some cases, purulent contents are found in it. The adjacent gum is swollen, bright red, painful to the touch. AT severe cases exposed bone is found.

In case of violation, pain is observed different nature- acute or mild. They are often accompanied headache.

With suppuration of a blood clot, an unpleasant odor is noticeable. At the same time, symptoms of general intoxication of the body are often observed - weakness, bad feeling, fever body fatigue.

At acute course process, swelling of the cheeks or gums is added to these symptoms. As a rule, the patient feels acute pain.

The doctor removes the blood clot under anesthesia. The well is washed with antiseptic solutions. home may be required self-washing wells.

Blood from the tooth - drip, drip, drip ....

Bleeding often occurs if a large vessel is damaged during the extraction of a tooth. It also appears after a few hours. after surgery or even at night.

In this case, you should not expect that the blood will stop on its own. At home, you can make tight gauze swab and apply it over the hole.

Cold should be applied to the cheek in the projection of the hole. If it is not possible to visit a doctor, then a hemostatic sponge will help, which you can buy at a pharmacy. Facilitates the condition of taking Dicinon.

do not take hot water procedures;
do not make sudden facial movements;
do not smoke or drink alcohol;
do not engage in physical labor.

Temperature rise

After tooth extraction, natural healing holes, while it is possible slight increase body temperature. However, in some cases there is a risk of swelling, redness, pain.

They say that microorganisms have got into the well and an inflammatory process develops.

In this case, it is impossible to delay contacting a doctor, as well as self-medicate. In the clinic, the patient is provided with qualified assistance aimed at relieving inflammation.

Hematoma formation

A hematoma usually forms in the gum tissue. It develops as a result of capillary fragility or hypertension.

The appearance of a hematoma is indicated by an increase in the gums, redness, fever.

Treatment of a hematoma is carried out at the dentist.

Paresthesia - decreased sensation

When the nerves are damaged, there is a decrease in sensitivity. A person loses touch, pain, temperature and taste sensitivity. Often the sensations are similar to those observed after the introduction of an anesthetic.

Most often, paresthesia resolves after a few days. However full recovery sensitivity can be delayed for several months. Persistent paresthesia is said to last more than six months.

In case of prolonged paresthesia, the patient is prescribed combined medications. Injections of Dibazol, Galantamine or aloe extract are shown.

Flux formation

After tooth extraction, when an infection occurs, a flux occurs in the jaw. This is a purulent focus formed in the tissues of the gums.

Among the signs of this complication, it should be noted severe pain radiating to the eyes or temples, swelling of the cheeks, redness and swelling of the mucous membrane, and fever.

Flux treatment consists in opening it and washing the cavity with antiseptics. The doctor also prescribes antibiotics.

Injury and displacement of teeth

After tooth extraction, the following injuries are possible:

Damage to adjacent teeth. They may be fractured, broken, or weakened.
Incomplete removal occurs when a tooth is removed piecemeal.
jaw fracture occurs in patients with weakened jaw bones. Most often this happens after the removal of a wisdom tooth.
occurs most often due to unprofessional and careless actions of the doctor. This problem is solved with the help of plastic.

Complications during the procedure

Often, during the extraction of teeth, numerous complications occur. They are divided into general and local:

To common complications include collapse, shock, fainting, an attack of a hypertensive crisis, etc. Assistance to the patient in this case is provided immediately.
Most frequent local complication is a fracture of a tooth or tooth root. Most often this happens with a high degree of its destruction. The patient feels severe pain.

Treatment of a fracture depends on the severity of each individual case.

With the wrong selection of forceps, there may be a fracture, dislocation or removal of an adjacent tooth. Often this happens with a rough operation.

Dislocation of the jaw occurs when the mouth is opened too wide. The treatment for a dislocation is to reposition it.

Other issues

Complications also include:

primordia damage permanent teeth in children;
swallowing a tooth;
aspiration of the tooth with the subsequent development of asphyxia;
perforation of the maxillary sinus;
sudden bleeding.

So, tooth extraction cannot be a harmless and simple intervention. This is always a serious operation, which has some contraindications.

As a rule, the attentive approach of the doctor and the use of modern dental equipment minimizes the appearance of various kinds complications.

With timely treatment of possible complications, recovery occurs, and jaw functions are restored.

Possible complications after tooth extraction

Tooth extraction is a full-fledged operation, after which certain unpleasant consequences may arise, caused both by the behavior of the patient himself and by factors beyond his control. Complications can also arise during the operation, since the extraction of some teeth can be very difficult: due to the large size of the root or strong bone tissue, incisions have to be made, which, after a successful operation, are sutured. In any case, there is no need to worry, since unprotected tissues in the postoperative period are under the maximum influence of microbes, as a result of which inflammation may occur.

Alveolitis

Very often, after the extraction of teeth, there is such a complication as alveolitis. This problem occurs when a blood clot necessary for healing has not formed at the site of the extracted tooth. In this case, the hole becomes defenseless against external influences, as a result of which an inflammatory process often develops in it. .

The key symptom of this complication is pain after tooth extraction (varying degrees strength). Pain may occur after 2-3 days. At the same time, the mucous membrane of the gums swells, the edges of the hole become inflamed, there is no blood clot in the hole of the tooth, and perhaps the hole is filled with food debris. The patient may have a fever, sometimes there is pain when swallowing. At the same time, the hole itself is covered with a dirty-gray coating that emits an unpleasant odor. Simultaneously with these symptoms, the patient often feels general malaise, swollen lymph nodes, slight swelling, fever, pain in the area of the extracted tooth.

The main causes of alveolitis

Alveolitis is a disease that is not associated with the introduction of infection into the hole of the tooth due to the work of a non-sterile instrument. The disease develops with the participation of those microbes that are normally found in the oral cavity of each person.

So, teeth are usually removed due to the fact that in the area of \u200b\u200btheir roots such chronic foci of inflammation are localized that cannot be eliminated by conservative methods.

Therefore, the hole of the extracted tooth is primarily infected, and the concentration of microorganisms in it is quite high. If a person is healthy, and all immune systems are functioning normally, then the microflora is suppressed and the hole heals without complications. In the event that there are any local or general failures in the mechanisms of the body's reactivity, the likelihood of developing inflammatory complications in the hole increases significantly.

Thus, the following local and general causes can contribute to the development of alveolitis:

long-term existence of chronic inflammatory foci with frequent exacerbations, as well as exacerbation of a chronic inflammatory process;
traumatic removal, when conditions arise for the destruction of the created barrier and the penetration of microflora deep into the tissues;
the absence of a blood clot in the hole of the extracted tooth (the clot did not form, or the patient did not follow the doctor's instructions and the clot was removed - this usually happens when the patient is inattentive to the doctor's recommendations and diligently rinses out the tooth hole);
general changes in the body due to stress, recent colds (infectious or viral) diseases, the presence of chronic diseases (mainly endocrine), especially in the stage of decompensation, general physical exhaustion, etc.

Treatment consists in relieving inflammation with local and general remedies. Sometimes it is sufficient to simply thoroughly rinse the well with antiseptic solutions, and then treat it with a special aseptic ointment or paste. Then, with the help of antibiotics and vitamins, general anti-inflammatory therapy is carried out. But sometimes the treatment is delayed up to 1.5 - 2 weeks. In some cases, with this complication, physiotherapy or laser therapy may be prescribed.

Alveolar bleeding

One of the most common complications after tooth extraction is alveolar bleeding, which can occur immediately after surgery, within the next hour, day, and sometimes more than a day after tooth extraction.

The main causes of bleeding

Early alveolar bleeding can be caused by the use of adrenaline: when it stops its action, a short vasodilation occurs, which causes bleeding.
Late hole bleeding can occur due to a violation of the doctor's recommendations in the postoperative period - mainly as a result of external disturbance of the hole of the extracted tooth.
Local causes of alveolar bleeding include various physical injuries in the area of the hole of the extracted tooth: damage to the gums, breakage of part of the alveoli or interradicular septum, development of inflammation in the area of the extracted tooth, damage to blood vessels in the palate and under the tongue.
The reasons general The appearance of alveolar bleeding is most often associated with various comorbidities patient (leukemia, scarlet fever, jaundice, sepsis, hypertension, etc.).

Treatment of this complication after tooth extraction

The effectiveness of stopping hole bleeding depends on how correctly the causes and source of bleeding were identified.

If a blood is coming from the soft tissues of the gums, then sutures are applied to the edges of the wound.
If blood comes from a vessel in the wall of the tooth hole, then first cold is applied locally in the form of an ice pack, then the bleeding vessel is tightly squeezed and a swab soaked in a special hemostatic agent is placed in the hole, which is removed no earlier than 5 days later.
In the event that local measures do not help, dentists turn to general hemostatic agents that increase blood clotting.

paresthesia

Much less often, after tooth extraction, a complication such as paresthesia can occur, which is caused by nerve damage during the tooth extraction process. The main symptom of paresthesia is numbness in the tongue, chin, cheeks, and lips. Paresthesia, as a rule, is a temporary phenomenon, disappearing in a period of 1-2 days to several weeks.

Treatment of paresthesia is carried out through therapy with vitamins of groups B and C, as well as injections of dibazol and galantamine.

Changing the position of adjacent teeth after tooth extraction

After the extraction of teeth, defects can often form in the jaw, and adjacent teeth begin to tilt towards the formed defect, and the antagonist tooth from the opposite jaw begins to move towards the defect, which leads to a violation of the chewing process. At the same time, the masticatory load sharply increases, the usual state of the jaws is disturbed and bite deformity develops, which can greatly affect the general condition of the teeth. In this case, it is recommended to replace the extracted tooth with an artificial one using bridges, implants, removable partial dentures.

All kinds of injuries that occurred in the process of tooth extraction

Often when removing the second premolar and molars upper jaw arises perforation of the floor of the maxillary sinus, the consequence of which is the communication of the oral cavity and the nasal cavity through the sinus.

The reasons are as follows:

(subject to the correct careful actions of the doctor)

anatomical features: the roots of the above teeth are close to the bottom of the sinus, and in some cases there is no bone septum at all;
the presence of a chronic inflammatory focus at the top of the tooth, which destroys the already thinned bone plate.

If, after the removal of the premolars or molars of the upper jaw, a message nevertheless occurs, the doctor must, on the same visit, use one of the known methods to eliminate it.

One contraindication:

The presence of a purulent inflammatory process in the sinus (acute purulent maxillary sinusitis). If the message is not diagnosed and eliminated in time, then the patient feels the ingress of liquid and liquid food into the nose. In this case, you should consult a doctor as soon as possible. If the appeal to the doctor is postponed, then a chronic inflammatory process will inevitably develop in the sinus, which will require more serious and technically complex treatment.

Potential complications during a tooth extraction procedure include:

Damage to adjacent teeth. Adjacent teeth or dentures (eg, crowns, bridges, implants) adjacent to the extracted tooth may sometimes be damaged during the procedure. Neighboring teeth can become broken, chipped or loosened during the extraction of a tooth or teeth, sometimes requiring more dentist time.
Tooth fracture. The tooth may break during the extraction process, making the procedure more difficult and requiring more time and effort to complete the extraction. You may have to extract the tooth in parts. By the way, the process of extracting a tooth in parts can cause complications after tooth extraction.
Incomplete tooth extraction. A small part of the tooth root can be left in the jawbone. Although this can increase the risk of infection, sometimes the dentist will choose not to try to extract it because the removal can be too dangerous, for example if it is very close to a nerve.
Jaw fracture. Patients with weak jawbone structure (such as older women with osteoporosis) may be at risk of jaw fracture. Even if the actual tooth extraction procedure is performed smoothly without any problems, there are cases of complications during the recovery period. Most often, a jaw fracture mandible), happens during the removal of "wisdom teeth" and on the upper jaw - separation of the tubercle of the upper jaw.
Removal of part of the alveolar ridge- occurs when the tooth is removed incorrectly, when the tongs are placed directly on the bone surrounding the tooth and the tooth is removed along with it. In this case, there is an extensive bone defect and cosmetic (especially in the anterior-frontal area). Decide this problem is possible only with the help of plasty with the use of artificial bone tissue and special protective membranes.
Removal of milk tooth and germ permanent tooth – Occurs due to inattention or insufficient professionalism of the doctor. When a milk tooth is removed (very often there are no tooth roots, since they dissolve before the change of teeth), the doctor begins to look for them in the tooth socket and perceives the germ of the permanent tooth as the roots of the milk tooth.

Remember the main thing: you should trust your doctor and actively participate in the treatment yourself, i.e. unquestioningly and carefully follow all the recommendations. And if you suspect in terms of the development of complications - do not delay and do not hesitate to consult a doctor again.

What are the local complications after tooth extraction?

Tooth extraction is a complete operation, after which complications can develop. They can occur both through the fault of the doctor and the patient, and depend on various dental diseases and other factors. About what local complications may occur after tooth extraction, how they manifest themselves, and you will learn about methods for their elimination below.

What is alveolitis?

Alveolitis(it is also called post-extraction alveolitis) is an inflammatory process that sometimes develops after tooth extraction. Inflammation affects not only the hole, it also extends to the tissues surrounding it.

Alveolitis in most cases is a complication after unsuccessful extraction, accounting for 25-40% of all types of complications. Most often, inflammation develops after the removal of the lower teeth, and in the case of eights, it occurs in 20% of cases.

Important: Normally, the healing of the hole is painless and only bothers the patient for the first few days after the operation. Immediately after the extraction of the tooth, the hole fills with blood, and after a couple of minutes a blood clot forms in it. It reliably protects the wound from infection, various mechanical damage acting as a barrier.

Alveolitis requires professional treatment.

After a week and a half, when the wound is covered with new epithelium, the clot disappears. If the blood clot does not form or is insolvent, and also due to the influence of many other adverse factors an infection enters the wound, resulting in alveolitis.

Why does alveolitis occur?

The disease will make itself felt in a couple of days after the extraction of the tooth. The main reasons for the development of alveolitis:

Active rinsing of the mouth on the day of surgery.
If the patient does not follow the recommendations of the doctor after tooth extraction.
Smoking.
Insufficient processing of the hole after the operation, as a result of which fragments of the tooth and pathological tissue may remain in it.
Poor hygiene oral cavity.
Neglect of diet after surgery (eating hot, cold, spicy food, drinks).
The operation took place with complications.
Weakened immunity.
Errors and unprofessionalism of the doctor in the process of tooth extraction (violation of the rules of antiseptics, for example).
Systemic chronic diseases of the body.

How does the disease manifest itself?

How to understand that you have started alveolitis? Already two or three after the operation, the following symptoms may occur:

there is no blood clot in the wound,
gums reddened and inflamed,
pus began to stand out from the wound,
a gray coating appeared on the surface of the hole,
increase in body temperature,
there was a bad smell from the mouth,
severe pain in the hole and around it,
enlarged and painful cervical lymph nodes,
worsened general state(weakness, malaise).

Running stage The disease is characterized by the following features:

the pain increases and can radiate to the temple, ear, often a headache,
the subfertile temperature is maintained (37 - 37.5, such temperature indicators are a sign of an inflammatory process),
the jaw hurts so much that it becomes difficult to chew and talk,
the mucosa around the hole is inflamed and very sore,
the cheek may swell from the side of the extracted tooth.

Alveolitis - serious illness that requires professional treatment. In the absence of treatment, the disease can develop into more serious problem(osteomyelitis, for example).

After the operation, the cheek may become numb.

How to treat a complication?

Alveolitis is quite easy to diagnose by external signs, as well as by the results of a patient survey. If you have signs of alveolitis, immediately go to the dentist, self-treatment is inappropriate here. How is the treatment going? Therapy for alveolitis of the hole is as follows:

local anesthesia is administered
the well is cleaned of the remnants of a blood clot,
the doctor scrapes out the granulation hole, purulent discharge, the remains of the tooth (this procedure is called curettage),
then the wound is treated with an antiseptic,
a tampon impregnated with a special drug is applied to the well.

After such procedures, the patient is prescribed painkillers, a diet, as well as oral baths using an antiseptic solution. If the curettage was carried out qualitatively, and the patient responsibly followed all the recommendations of the dentist, the alveolitis is successfully cured in a few days.

If the patient went to the dentist for advanced stage alveolitis, the treatment is as follows:

after antiseptic treatment and curettage, a tampon impregnated with an antibiotic and drugs is placed in the well, which normalizes the microflora of the oral cavity, and also stops the inflammatory process,
such blockades are carried out several times,
if tissue necrosis has begun, proteolytic enzymes are used, which make it possible to clean the hole from dead tissue, as well as relieve inflammation,
if the inflammatory process has penetrated inside, the doctor blocks the nerve along its entire length with lidocaine or novocaine. If the pain and signs of inflammation do not disappear, after 48 hours the blockade is repeated,
physiotherapy is used: microwaves, laser, ultraviolet radiation,
the patient is prescribed vitamin complexes, analgesics, sulfonamides,
if there is a risk of spreading the inflammatory process to nearby tissues, the patient is prescribed a course of antibacterial drugs inside.

Perforation of the bottom of the maxillary sinus

Most often, perforation of the maxillary sinus occurs at the site of its bottom, this is facilitated by a number of factors:

the roots of the teeth are located very close to the bottom of the sinus: in some people, the thickness of the bone layer between the roots and the bottom of the sinus is less than 1 cm, and sometimes only 1 mm,
it happens that the root is located in the very maxillary sinus only a thin mucous membrane separates them,
the bone layer quickly becomes thinner in various dental diseases (cyst, periodontitis).

The main symptoms of perforation

Perforation of the bottom of the maxillary sinus, which occurred during the extraction of a tooth, is manifested by the following symptoms:

in the blood that is released from the hole, air bubbles appear, the number of which increases if you exhale sharply through the nose,
bloody discharge from the side of the perforation appears from the nose,
the timbre of the voice changes, “nasal” appears.

Diagnosis and treatment

Diagnosis is usually not difficult and is carried out by questioning the patient. If there is any doubt and you need to make sure the diagnosis is correct, the following studies can be carried out:

Hole probing makes it possible to make sure that there is no bone bottom in the wound. The instrument passes freely and unhindered through soft tissues.
radiograph areas of the maxillary sinuses: the picture will show blackouts that have arisen as a result of accumulation of blood in the sinuses.
CT scan.
General blood analysis.

Tactics for the treatment of perforation depends on what changes have occurred in the maxillary sinus after injury to its bottom. If the complication was detected immediately and inflammation did not develop in the sinus, the main task of the dentist is to keep the blood clot in the hole and prevent infection from entering the wound.

A swab is placed at the bottom of the hole, which is soaked in iodine solution. It is left there for a week until full granulations are formed. In addition, the defect can be closed with a special plastic plate that separates the oral and sinus cavities and promotes faster healing.

Also, the patient is prescribed a course of antibacterial drugs, vasoconstrictor drops and anti-inflammatory drugs to prevent the development of the inflammatory process.

If the perforation was not detected immediately, then after a few weeks acute symptoms subside, and at the site of the lesion is formed fistula. This process is accompanied by symptoms of chronic sinusitis:

dull pain in the sinus area, which radiates to the temple, eye,
from the side of the perforation, the nose is constantly stuffed up,
pus comes out of the nose
on the side of the perforation, the cheek may swell.

Perforation at such an advanced stage is difficult to treat. The only way out is surgery, during which the sinus is opened, all pathological contents are removed from its cavity, treated with an antiseptic, the fistula is excised, and the procedure is completed with plastic closure of the defect.

After the operation, the patient is prescribed a course of antibiotics, as well as anti-inflammatory and antihistamine drugs.

After tooth extraction, various injuries sometimes occur.

Bleeding

After tooth extraction, bleeding may open, which is external and hidden. And if the external one can be noticed and stopped immediately after the operation in the dentist's office, then latent bleeding provokes quite large blood loss.

Latent bleeding makes itself felt by the appearance of hematomas on the cheek, gums, mucous membrane respiratory tract. In especially advanced cases, the hematoma spreads to the neck and chest.

Bleeding is stopped as follows:

the wound is opened wide in order to determine the cause of the hemorrhage,
the damaged vessel is tied up or cauterized,
depending on the amount of blood released, the hole is either sutured or drained,
hematomas resolve on their own over time.

Various injuries after extraction

Since tooth extraction is a full-fledged operation that requires certain knowledge and skills, various injuries occur during the course:

Tooth fracture

Most often in dental practice there is a fracture (for more information on what to do if a tooth breaks off, read here) of the root or crown. This complication may occur under the influence of the following factors:

anatomical features of the tooth,
pathological changes in its structure as a result of various diseases,
restless behavior of the patient during the operation,
insufficient qualification of the doctor.

Dislocation or fracture of adjacent teeth

This happens if the doctor uses an insufficiently stable tooth as a support.

break off alveolar process

Most often occurs when the upper teeth are removed. The complication may arise from anatomical features structure of the jaw, various diseases, and also be the result of an excessive effort of the doctor used by the dentist at the time of tooth extraction.

gum damage

Various soft tissue injuries occur if the dentist removes the tooth in a hurry, with poor lighting, as well as with improper anesthesia.

Pushing the root into soft tissues

Most often occurs when removing the upper and lower molars. The reasons for pushing the root can be:

the doctor exerted excessive force,
fracture of the alveolar wall
the edge of the alveolus has resolved as a result of the inflammatory process,
the dentist poorly fixed the alveolar process at the time of tooth extraction.

Pushing the root into the sinus of the upper jaw

This happens if the root is separated from the sinus by a thin mucous membrane and the doctor makes an inaccurate movement of the instrument at the time of tooth extraction. You can determine the complication by questioning the patient, as well as the results of x-rays.

Dislocation of the lower jaw

A dislocation can occur if the patient opens his mouth too wide during the operation, the doctor uses a hammer and chisel, and there are additional loads on the lower jaw.

This complication is very rare and is the reason for the rough work of the dentist.

paresthesia

paresthesia(neuropathy of the lower alveolar nerve) - a complication after tooth extraction, if the nerve of the mandibular canal is damaged during the operation. The patient may not notice the symptoms of paresthesia until a few hours after the extraction, since only after this period of time the anesthesia ceases to work.

A person feels that his tongue, lip, sometimes cheek or even half of his face are numb. There are cases when, as a result of damage to the nerve, it becomes difficult to open the mouth (this condition is called lockjaw).

The numbness usually resolves on its own and does not require treatment. But if part of the face remains numb, special therapy is performed. Paresthesia is treated exclusively in a dental clinic or in a hospital setting, using the following methods:

physiotherapy procedures ,
injections of vitamin B, B2, C, aloe extract, galantamine, or dibazol.

Changing the position of neighboring teeth

After a tooth is removed, its neighbors begin to gradually move into the vacant space. As a result, the dentition shifts, crowding of the teeth may develop, and chewing load increases. Various bite anomalies develop, which negatively affects the general condition of the teeth and oral cavity.

To prevent such consequences, it is necessary to carry out implantation, install a bridge or use removable dentures.

Tooth extraction, like any other operation, is accompanied by bleeding. After a few minutes, the blood in the hole coagulates, the bleeding stops. However, in some cases, it does not stop on its own, it continues long time(primary bleeding). Sometimes the bleeding stops at the usual time, but reappears after a while (secondary bleeding). Prolonged bleeding is most often caused by local reasons, less common.

local reasons. In most cases, primary bleeding occurs from the vessels of soft tissues and bone due to a traumatic operation with rupture or crushing of the gums and oral mucosa, breaking off part of the alveolus, interradicular or interalveolar septum. Bleeding from the depth of the socket is usually associated with damage to the relatively large dental branch of the inferior alveolar artery. Abundant bleeding may be accompanied by tooth extraction with an acute inflammatory process that has developed in the surrounding tissues, since the vessels in them are dilated and do not collapse. In some patients, after tooth extraction, under the influence of the action of adrenaline, used together with an anesthetic for pain relief, early secondary bleeding occurs. Initially, adrenaline causes contraction of the walls of the arterioles in the wound, but after 1-2 hours, the second phase of its action begins - vasodilation, as a result of which bleeding may occur. Late secondary bleeding from the socket occurs a few days after tooth extraction. It is due to the development of an inflammatory process in the wound and purulent fusion of organizing blood clots in the vessels damaged during the operation.

Common Causes. Prolonged bleeding after tooth extraction occurs in diseases characterized by a violation of the blood coagulation process or damage to the vascular system. These include hemorrhagic diathesis: hemophilia, thrombocytopenic purpura (Werlhof's disease), hemorrhagic vasculitis, hemorrhagic angiomatosis (Ren-du-Osler's disease), angiohemophilia (Willebrand's disease), C-avitaminosis; diseases associated with hemorrhagic symptoms (acute leukemia, infectious hepatitis, septic endocarditis, typhus and typhoid fever, scarlet fever, etc.).

The process of blood clotting is impaired in patients receiving anticoagulants not direct action that suppress the function of prothrombin formation by the liver (neodicoumarin, phenylin, syncumar), as well as with an overdose of a direct-acting anticoagulant - heparin. Bleeding tendencies are observed in patients suffering from hypertension. As a result of prolonged bleeding caused by local or general causes, and the associated blood loss, the patient's general condition worsens, weakness, dizziness, pallor of the skin, and acrocyanosis appear. The pulse quickens, blood pressure may decrease. The hole of the extracted tooth, the alveolar process and adjacent teeth are covered with a blood clot, from which blood flows.

Local ways to stop bleeding. A blood clot is removed with tweezers and a surgical spoon, the hole and the surrounding areas of the alveolar process are dried with gauze swabs. After examining the wound, determine the cause of bleeding, its nature and localization.

Bleeding from the damaged mucous membrane is most often arterial, the blood flows out in a pulsating stream. Such bleeding is stopped by suturing the wound and bringing its edges closer together, ligating the vessel or stitching the tissues. When suturing a torn gum, sometimes it is necessary to mobilize the edges of the wound, peel off the mucous membrane from the bone along with the periosteum. Bleeding out small vessels can be stopped by electrocoagulation of the bleeding area of tissue.

Bleeding from the walls of the hole, interradicular or interalveolar septum is stopped by squeezing the bleeding area of the bone with bayonet or crampon forceps. To insert the cheeks of the forceps into the hole of the extracted tooth, in some cases, the gum must be peeled off.

To stop bleeding from the depth of the well, it is tamponade by various means. The simplest and most accessible method is tight tamponade with iodoform turunda. After removing the blood clot, the well is irrigated with a solution of hydrogen peroxide and dried with gauze swabs. Then they take an iodoform turunda 0.5-0.75 cm wide and begin to plug the hole from its bottom. Pressing firmly and folding the turunda, gradually fill the hole to the brim (Fig. 6.24). If bleeding occurs after the removal of a multi-rooted tooth, the hole of each root is plugged separately.

To bring the edges of the wound closer together and hold the turunda in the hole on top of it, 0.5-0.75 cm away from the edge of the gum, sutures are applied. A folded gauze pad or several tampons are placed on top of the hole and the patient is asked to clench their teeth. After 20-30 minutes, the gauze pad or tampons are removed and, in the absence of bleeding, the patient is released. If bleeding continues, the well is again carefully plugged. Turunda is removed from the hole only on the 5-6th day, when its walls begin to granulate. Premature removal of the gurunda can lead to re-bleeding.

In addition to iodoform turunda, the well can be tamponed with a biological swab, Oxycelodex hemostatic gauze, as well as gauze impregnated with a solution of thrombin, hemophobin, epsilon-aminocaproic acid or the drug caprofer. A good hemostatic effect is provided by the introduction into the well of absorbable biological hemostatic preparations prepared from human blood (hemostatic sponge, fibrin film), animal blood and tissue (hemostatic collagen sponge, Krovostan gelatin sponge, antiseptic sponge with gentamicin or kanamycin, hemostatic sponge with amben). With late secondary bleeding, a disintegrated blood clot is removed from the well, irrigated with an antiseptic solution, dried and filled with some kind of hemostatic preparation. In these cases, it is preferable to use an antiseptic sponge with kanamycin or gentamicin, which has hemostatic and antimicrobial properties.

General ways to stop bleeding. Along with stopping the bleeding local ways used drugs that increase blood clotting. They are prescribed after determining the state of the blood coagulation and anticonvulsant systems (detailed coagulogram). In emergency cases, before obtaining a coagulogram, 10 ml of a 10% solution of calcium chloride or 10 ml of a 10% solution of calcium gluconag, or 10 ml of a 1% solution of amben are injected intravenously. Simultaneously with these drugs, 2-4 ml of a 5% solution of ascorbic acid is administered intravenously. In the future, general hemostatic therapy is carried out purposefully, based on the indicators of the coagulogram. With bleeding associated with a low content of prothrombin as a result of a violation of its synthesis by the liver (hepatitis, cirrhosis), an analogue of vitamin K, vikasol, is prescribed. 1 ml of a 1% solution of this drug is administered intramuscularly 1-2 times a day, orally - 0.015 g 2 times a day. With an increased level of fibrinolytic activity of the blood, epsilon-aminocaproic acid is prescribed orally, 2-3 g 3-5 times a day or intravenously, 100 ml of a 5% solution. With increased permeability vascular wall and bleeding caused by an overdose of anticoagulants, it is advisable to prescribe rutin (contains vitamin P) inside 0.02-0.05 g 2-3 times a day. Dicynone is distinguished by its rapid hemostatic action. After intravenous administration of 2 ml of a 12.5% solution of the drug, the hemostatic effect occurs in 5-15 minutes. In the next 2-3 days, it is administered 2 ml intramuscularly or given orally 0.5 g every 4-6 hours. Patients suffering from hypertension, simultaneously with stopping bleeding local funds carry out antihypertensive therapy. After lowering blood pressure, bleeding stops quickly. With profuse and prolonged bleeding that does not stop, despite the general and local hemostatic medical measures indicated urgent hospitalization. Carefully examined in the hospital postoperative wound and depending on the source of bleeding, it is stopped by the previously described local means. In accordance with the indicators of the coagulogram, general hemostatic therapy is carried out. A pronounced hemostatic effect is exerted by direct blood transfusion or transfusion of freshly citrated blood.

Prevention of bleeding. Before removing a tooth, it is necessary to find out if the patient had prolonged bleeding after accidental tissue damage and previous operations. With a tendency to bleeding before surgery, do general analysis blood, determine the number of platelets, the time of blood clotting and the duration of bleeding, make up a detailed coagulogram. If the hemostasis parameters deviate from physiological norm carry out activities to improve functional activity blood coagulation system (introduction of a solution of calcium chloride, aminocaproic and ascorbic acid, vikasol, rutin and other drugs), consult the patient with a hematologist or therapist. Patients with hemorrhagic diathesis are removed in a hospital setting. Their preparation for surgery is carried out together with a hematologist. Under the control of the coagulogram, drugs are prescribed that normalize hemostasis. With hemophilia, antihemophilic plasma, cryoprecipitate or antihemophilic globulin, freshly citrated blood are infused; for clumping - platelet suspension, whole blood, vitamins K and C. A plastic protective plate is made.

Tooth extraction in such patients tends to be performed with the least trauma to the bone and surrounding soft tissues. After tooth extraction, the well is tamponed with a hemostatic sponge, antiseptic hemostatic sponge or dry plasma, and a protective plate is applied. It is not recommended to stitch the edges of the gums to hold hemostatic preparations in the hole, since mucosal punctures are an additional source of bleeding. Continue in the postoperative period general therapy aimed at increasing blood clotting (transfusion of blood, antihemophilic plasma, cryoprecipitate, aminocaproic and ascorbic acids, administration of calcium chloride, hemophobin, rutin, vikasol). Hemostatic drugs in the well are left until it is completely healed. Such patients should not remove several teeth at the same time. Emergency surgical dental care for patients with hemorrhagic diathesis is provided only in a hospital setting. Preoperative preparation provides for the full scope of general hemostatic measures. After the operation, the bleeding is stopped by general and local means.

Lunar postoperative pain

After the extraction of the tooth and the termination of the action of the anesthetic in the wound, there is a slight pain, the severity of which depends on the nature of the injury. Pain usually passes quickly. However, sometimes 1-3 days after the operation, a sharp pain appears in the area of the hole of the extracted tooth. Patients do not sleep at night, take analgesics, but the pain does not stop. Such acute pain is most often the result of a violation of the normal healing process of the tooth socket and the development of inflammation in it - alveolitis, less often - limited osteomyelitis of the tooth socket. In addition, the pain may be due to the remaining sharp edges of the hole or a bare, not covered by soft tissues area of \u200b\u200bthe bone of the alveolus.

Alveolitis- inflammation of the walls of the hole - often develops after a traumatic operation, which reduces the protective properties of tissues. Its occurrence is facilitated by pushing into the hole during the operation of dental deposits or contents carious cavity tooth the presence of pathological tissue remaining in it, fragments of bone and tooth; prolonged bleeding from the wound; the absence of a blood clot in the hole or its mechanical destruction; violation of the postoperative regimen for patients and bad care behind the mouth. The cause of alveolitis can be an infection in the hole when the tooth is removed due to acute and exacerbated chronic periodontitis or complicated periodontitis. A predisposing factor is a decrease in the overall immunological reactivity of the patient's body in old age and under the influence of general diseases. In alveolitis, the inflammatory process first involves the inner compact plate of the alveolus, then the deeper layers of the bone. Sometimes the inflammatory process of the alveoli acquires a purulent-necrotic character, there is a limited osteomyelitis of the tooth socket.

clinical picture. AT initial stage alveolitis appears intermittent It's a dull pain in the hole, which increases during eating. The general condition of the patient is not disturbed, the body temperature is normal. The tooth socket is only partially filled with a loose, decaying blood clot. In some cases, the clot in it is completely absent. In the hole there are food remnants, saliva, its walls are exposed. The mucous membrane of the edge of the gums is red, touching it in this place is painful. At further development inflammatory process, the pain intensifies, becomes constant, radiates to the ear, temple, the corresponding half of the head. The general condition of the patient worsens, malaise appears, subfebrile temperature body. Eating is difficult due to pain. The tooth socket contains the remains of a disintegrated blood clot, its walls are covered with a gray coating with an unpleasant putrefactive odor. The mucous membrane around the hole is hyperemic, edematous, painful on palpation. Submandibular The lymph nodes enlarged, painful. Sometimes there is a slight swelling of the soft tissues of the face. In turn, alveolitis can cause a number of complications: periostitis and osteomyelitis of the jaw, abscess, phlegmon, lymphadenitis.

Treatment. After completed local anesthesia or blockade of the anesthetic with lincomycin proceed to the treatment of the wound. Using a syringe with a blunt needle, a stream of warm antiseptic solution ( hydrogen peroxide, furacilin, chlorhexidine, ethacridine lactate, potassium permanganate) wash out particles of a decayed blood clot, food, saliva from the tooth socket. Then, with a sharp surgical spoon, carefully (so as not to injure the walls of the hole and cause bleeding), the remnants of the decomposed blood clot are removed from it, granulation tissue, fragments of bone, tooth. After that, the well is again treated with an antiseptic solution, dried with a gauze swab, powdered with anesthesin powder and covered with a bandage from a narrow strip of gauze soaked in iodoform liquid, or an antiseptic and analgesic bandage "Alvogyl" is injected. A biological antiseptic swab is used as a bandage on the hole, hemostatic sponge with gentamicin or kanamycin, pastes with antibiotics. The bandage protects the hole from mechanical, chemical and biological stimuli, acting simultaneously antimicrobially, with severe tissue edema, a blockade is performed with homeopathic remedy"Traumeel" and make an external bandage with the gel of this drug. Bandages with Karavaev's balm, "Rescuer" balm are also effective, as is the imposition of these preparations on the mucous membrane around the alveoli - the area of \u200b\u200bthe motionless and mobile gums.

In the initial stage of alveolitis after such treatment, the pain in the hole does not resume. The inflammatory process stops after 2-3 days. With developed alveolitis and severe pain after antiseptic and mechanical treatment of the hole, a strip of gauze impregnated with drugs that have (antibacterial and anesthetic properties: camphor-phenol liquid, 10% alcohol solution of propolis, "Alvogyl") is introduced into it. An effective remedy effects on microflora and inflammatory response is the introduction of a tetracycline-prednisolone cone into the well. Repeat the blockade of the anesthetic with lincomycin or the introduction of a solution of "Traumeel" according to the type of infiltration anesthesia.

Proteolytic enzymes are used to cleanse the tooth socket from necrotic decay. A strip of gauze, abundantly moistened with a solution of crystalline trypsin or chymotrypsin, is placed in the well. Acting on denatured proteins and breaking down dead tissue, they cleanse wound surface attenuate the inflammatory response.

As a means of pathogenetic therapy, lidocaine, novocaine or trimecaine blockade is used. 5-10 ml of 0.5% anesthetic solution is injected into the soft tissues surrounding the inflamed tooth hole. In some cases, the corresponding nerve is blocked throughout its entire length. If pain and inflammation persist, the blockade is repeated after 48 hours. Use one of the types physical treatment: fluctuorization, microwave therapy, local ultraviolet irradiation, helium-neon infrared laser beams. Recommend 4-6 times a day baths for the oral cavity with a warm (40-42 0 C) solution of potassium permanganate (1:3000) or 1-2% sodium bicarbonate solution. Inside prescribe sulfa drugs, analgesics, vitamins. With the further development of the disease and if there is a threat of the spread of the inflammatory process to the surrounding tissues, antibiotic therapy is carried out. Local impact on the inflammatory focus (treatment of the hole with antiseptics, blockade and dressing change) is carried out daily or every other day until the pain stops completely. After 5-7 days, the walls of the hole are covered with young granulation tissue, but inflammation in the mucous membrane of the gums still persists. After 2 weeks, the gum acquires a normal color, the edema disappears, the hole is filled with granulation tissue, and its epithelialization begins. In the future, the healing process of the hole proceeds in the same way as in the absence of complications. When a purulent-necrotic inflammatory process develops in the walls of the hole, then, despite the active treatment of alveolitis, pain and inflammation do not stop. This indicates the development of a more severe complication - limited osteomyelitis of the tooth socket.

Limited osteomyelitis of the tooth socket. In the hole of the extracted tooth, there is an acute throbbing pain, in the neighboring teeth - pain. There is weakness, severe headache. Body temperature 37.6-37.8 ° C and above, sometimes there is chills. The patient does not sleep, cannot work. There is no blood clot in the hole, its bottom and walls are covered with a dirty gray mass with a fetid odor. The mucous membrane surrounding the hole of the tooth turns red, swells, the periosteum infiltrates, thickens. Palpation of the alveolar process from the vestibular and oral sides in the region of the socket and in neighboring areas is sharply painful. Percussion of adjacent teeth causes pain. The perimaxillary soft tissues are edematous, the submandibular lymph nodes are enlarged, dense, painful. With osteomyelitis of the socket of one of the lower large molars, due to the spread of the inflammatory process to the area of \u200b\u200bthe chewing or medial pterygoid muscle, mouth opening is often limited. The phenomena of acute inflammation last 6-8 days, sometimes 10 days, then they decrease, the process passes into the subacute and then into the chronic stage. The pain becomes dull, weak. The general condition is improving. Body temperature normalizes. Edema and hyperemia of the mucous membrane become less pronounced; decreases, then pain on palpation of the alveolar process disappears, as well as swelling of facial tissues and manifestations of submandibular lymphadenitis. After 12-15 days, the tooth socket is filled with loose, sometimes bulging pathological granulation tissue from it, which, when pressed, releases pus. On the radiograph, the contours of the inner compact plate of the alveolus are indistinct, blurred, osteoporosis of the bone and its destruction at the alveolar margin are pronounced. In some cases, after 20-25 days from the start acute period, it is possible to detect small sequesters.

Treatment. In the acute stage of the disease, therapy begins with a revision of the hole. After conduction and infiltration anesthesia, a decomposed blood clot, pathological tissue and foreign bodies are removed from the hole. Then it is treated from a syringe with a weak antiseptic solution or biologically active drug: staphylococcal and streptococcal bacteriophage, proteolytic enzymes, lysozyme. After that, the wound is closed with an antibacterial viscous drug "Alvogyl", and the whole complex of local therapy is carried out similarly to the treatment of alveolitis. subside inflammatory phenomena and pain reduction is facilitated by the blockade of the anesthetic with lincomycin, the homeopathic preparation "Traumeel" according to the type of infiltration anesthesia, as well as the dissection of the infiltrated area of the mucous membrane and periosteum. An incision 1.5-2 cm long is made along the transitional fold and from the inside of the alveolar process, at the level of the tooth socket, to the bone. Inside, antibiotics, sulfanilamide and antihistamine drugs, analgesics, ascorbic acid are prescribed, blockades, physiotherapy continue. To increase the specific immunological reactivity, it is advisable to prescribe phagocytosis stimulants - psntoxyl, methyluracil, milaif, magnolia vine.

After the cessation of acute inflammatory phenomena, treatment with multivitamins and stimulants is continued. nonspecific resistance body: methyluracil 0.5 g or pentoxyl 0.2 g 3-4 times a day, sodium nucleinate 0.2 g 3 times a day, Milife 0.2 g. laser therapy the focus of inflammation. After 20-25 days, sometimes later from the onset of an acute inflammatory process with non-healing of the wound and the detection of sequesters on the x-ray, the formed pathological granulation tissue and small sequesters are removed from the hole with a surgical spoon, the bottom and walls of the hole are carefully scraped. The wound is treated with an antiseptic solution, dried and loosely plugged with a strip of gauze soaked in iodoform liquid. Dressings (treatment of the well with an antiseptic solution and change of iodoform gauze in it) are performed every 2-3 days until young granulation tissue is formed on the walls and bottom of the well.

Neuropathy of the lower alveolar nerve occurs due to damage to it in the mandibular canal during the removal of large molars. The apical section of the roots of these teeth is located in close proximity to the mandibular canal. In some cases, as a result of chronic periodontitis, the bone between the apical part of the root and the wall of the mandibular canal resolves. During dislocation of the root by the elevator from the deep parts of the hole, the nerve can be injured, as a result of which its function is partially or completely impaired: pain in the jaw appears, numbness lower lip and chin, decrease or loss of sensitivity of the gums, decrease in the electrical excitability of the pulp of the teeth on the affected side. Usually, all these phenomena gradually disappear after a few weeks. With a pronounced pain symptom, analgesics, physiotherapy with pulsed currents, and ultraviolet irradiation are prescribed. To speed up the restoration of nerve function, a course of vitamin B injections is indicated (1 ml of a 6% solution every other day, 10 injections). Electrophoresis is carried out with 2% lidocaine solution (5-6 procedures for 20 minutes) or 2% anesthetic solution with 6% vitamin B solution (5-10 procedures for 20 minutes). Nice results gives oral administration for 2-3 weeks of vitamin B2 (0.005 g 2 times a day) and vitamin C (0.1 g 3 times a day), as well as up to 10 injections of dibazol (2 ml of a 0.5% solution every other day), galantamine (1 ml of a 1% solution per day), aloe extract (1 ml daily), vitamin B: (1 ml of a 0.02% solution every other day).

Sharp edges of the alveoli. Alveolar pain can be caused by protruding sharp edges of the hole, injuring the mucous membrane located above them. The sharp edges of the alveoli are most often formed after a traumatic operation, as well as after the removal of several adjacent teeth or a single tooth (due to bone atrophy in neighboring areas). Pain appears 1-2 days after tooth extraction, when the edges of the gums above the hole begin to converge. Bone protrusions injure the mucous membrane of the gums located above them, irritating the gums located in it. nerve endings. The pain intensifies during chewing and when touching the gums. It is possible to distinguish this pain from pain in alveolitis by the absence of inflammation in the area of the hole and the presence of an organizing blood clot in it. When feeling the hole with a finger, a protruding sharp edge of the bone is determined, a sharp pain occurs.

To eliminate pain, an alveolectomy is performed, during which the sharp edges of the hole are removed (Fig. 6.25). Under conduction and infiltration anesthesia, an arcuate or trapezoid incision is made in the gums and a mucoperiosteal flap is peeled from the bone with a raspator. The protruding edges of the hole are removed with bone cutters. Irregularities of the bone are smoothed with a cutter with cooling. The wound is treated with an antiseptic solution. With an uneven edge of the bone, plasty with biomaterials is possible, which are tightly laid on the surface of the alveolar ridge and between the protrusions of the bone. The exfoliated gum is placed in its original place and reinforced with knotted catgut sutures.

Exposure of the alveoli. As a result of gum injury during tooth extraction, a defect in the mucous membrane of the alveolar process may form. A bare area of the bone that is not covered by soft tissues appears, causing pain during thermal and mechanical irritation. The exposed area of the bone must be removed with bone cutters or cut down with a bur. The wound should be closed with a mucoperiosteal flap or gauze soaked in iodoform mixture.

A person, due to certain circumstances, depending and not depending on him, is faced with the problem of dental treatment. The dentist is not always able to cure the tooth, sometimes you have to resort to its removal.

It is worth noting that if the tooth can still be restored, then it is not recommended to resort to removal, it would be more correct to seal it.

Removal of a tooth- This is a full-fledged operation, during which incisions and the introduction of surgical instruments into the area of the affected tooth occur, they lead to irritation and inflammation of the gums and tooth socket. Dental operations are performed with the help of local anesthesia.

An anesthetic injection is injected into the gum, directly into the area around the affected tooth. In place of the extracted tooth, a wound remains, which bleeds at first.

Removal of a tooth

Naturally, after the operation, unpleasant consequences and complications can be observed, which, as a rule, are of a short duration and disappear within a few days.

The consequences of the operation disappear quickly if the patient follows all the recommendations of the doctor.

The following postoperative symptoms are observed, which are considered normal:

aching pain in the part of the oral cavity where the surgical intervention took place;
secretion of ichor within a few hours;
slight increase in body temperature;
the residual effect of anesthesia causes temporary numbness of the cheek;
in rare cases, it is painful to swallow after tooth extraction. It's not worth worrying too much. This unpleasant symptom goes away on its own within a few hours after the anesthesia wears off.

If bleeding is observed, or the pain becomes very severe, you should consult a doctor.

Postoperative complications

In some cases, complications are observed that are not the norm. This may be due to the fault of the doctor, who did not completely remove the tooth root or treated the postoperative wound in an inappropriate way.

In some cases, the fault of the patient is observed, who neglected hygiene standards and the prescription of the attending physician. It is worth noting that complications after the extraction of a tooth with a cyst, appear more often than with a standard extraction, since the resulting wound is larger in size and the risk of infection getting into it is much higher.

The most serious complications include:

Abscess. If the patient did not follow the doctor's instructions after the operation, suppuration is observed in the area where the surgical intervention took place. This leads to serious complications, such as an abscess or osteomyelitis of the jaw.
Alveolitis. The consequences in the period after tooth extraction include the manifestation of alveolitis, which is a serious dental disease and requires appropriate treatment.

Above are the complications after tooth extraction, the photo of which clearly demonstrates the seriousness of their manifestation.

Alveolitis

Alveolitis- This is a disease that manifests itself in the case of infection of the wound, which is a natural consequence after the extraction of a tooth. During surgical intervention a small incision is made on the gum and the tooth socket is injured. This naturally leads to the process of inflammation. As a rule, the wound is completely tightened after two weeks.

If infection occurs, the healing process will be delayed for a long time. In order to prevent the occurrence of alveolitis, it is recommended to properly observe hygiene rules oral cavity.

Causes of alveolitis

Alveolitis is observed only in rare cases and is not characterized as an independent disease.

Causes of manifestation include:

surgical intervention that was performed during the extraction of a tooth;
decrease in immunity in the postoperative period;
insufficient compliance with hygiene rules;
improperly performed operation;
when tartar gets inside the formed wound;
Smoking is recognized as a factor contributing to the spread of infection.

Treatment has the right to prescribe only a doctor. Mouthwash is not characterized effective method in the treatment of alveolitis. The disease is accompanied by an infection, which can only be overcome by antibiotics and analgesics.

Symptoms of alveolitis

Aching pain and fever symptoms of alveolitis

The symptoms of alveolitis cannot be confused with anything. Blood thickens in the hole of the extracted tooth, aching pain appears in this place, which only becomes stronger and spreads to the nearby areas of the gums.

The wound may become covered with pus, Against this background, a repulsive odor from the mouth appears. Further, there is an increase in body temperature to a mark of 39 degrees. High fever is a consequence of the spread of infection, which is usually accompanied by chills.

In the event that the listed symptoms are observed, it is recommended to consult a dentist, since none of them is characterized as a natural consequence after tooth extraction.

Oral hygiene

In order to protect yourself from complications after tooth extraction, as well as to prevent inflammation of the dental nerves and destruction of enamel, it is recommended to observe the following hygiene rules:

After two days after the operation, it is recommended to rinse the mouth. This is done using antiseptics purchased at a pharmacy or a light chamomile tincture that can be prepared at home. For cooking, you will need dried leaves and chamomile flowers. One spoon of the dry component is mixed with a glass of warm water, insisted for a quarter of an hour and filtered. Next, the tincture is ready for use. For visible result, rinsing is done twice a day.
Recommended do not drink at all or drink small amounts of carbonated water. It contributes to the destruction of enamel;
First days after surgery teeth are recommended to be brushed soft brush, in order not to scratch the wound in the tooth hole.

Extraction of teeth - this is a last resort. If possible, doctors recommend filling or prosthetics. However, if this is not possible for medical reasons, then after the wound has healed from removal, it is considered necessary to install an implant.

There are complications during the operation and after the operation of tooth extraction, general and local.

For common complications include: fainting, collapse, shock.

Fainting- short-term loss of consciousness as a result of impaired cerebral circulation, leading to anemia of the brain.

Etiology: fear of surgery, type of instrumentation and the entire environment of the dental office, lack of sleep, hunger, intoxication, infectious diseases, pain during tooth extraction.

Clinic: sudden blanching of the face, general weakness, dizziness, tinnitus, darkening of the eyes, nausea, then loss of consciousness, the patient is covered with cold sticky sweat, the pupils dilate and roll up, the pulse becomes accelerated and weak. After a few seconds (minutes), the patient comes to his senses.

Treatment: aims to eliminate anemia of the brain and ensure normal blood circulation in it. It is necessary to stop the operation, sharply tilt the patient's head forward so that the head is below the knees or lean back the back of the chair and give the patient a horizontal position, open the window, unfasten everything that can restrict breathing, put a cotton ball with ammonia and s / c is administered 1-2 ml of 10% caffeine solution, 10-20% camphor oil solution., 1 ml of 10% solution of cardiazole, cordiamine, 1 ml of lobelin. After removing the patient from fainting, you can continue the operation of tooth extraction.

Prevention: elimination of all the above causes.

Collapse- develops as a result of acute cardiovascular insufficiency.

Etiology - prolonged and traumatic removal, accompanied by large blood loss and pain. Predisposing factors are the same as with fainting: overwork, hypothermia, intoxication, infectious diseases, exhaustion, psycho-emotional overstrain.

Clinic: skin bluish and pale, dry, consciousness is preserved, dizziness, nausea, retching, tinnitus, blurred vision. The vascular tone decreases, blood pressure drops, the pulse is filiform and sharply accelerated. Breathing is shallow and rapid. In the future, loss of consciousness may occur and go into a coma.

Treatment: elimination of blood loss and pain factor, increase in blood pressure, vascular tone by transfusion of blood, plasma, blood-substituting fluids, 40% glucose solution, saline, heating pads to the legs, s / c - cardiac agents (camphor, caffeine, cordiamine , ephedrine).

Prevention - careful attitude to periodontal tissues, effective anesthesia and elimination of predisposing factors.

Shock- a sharp, acute depression of the central nervous system (central nervous system).

Etiology: psycho-emotional overstrain, fear, large blood loss, and most importantly, the pain factor.

Clinic - there are 2 phases: erectile and torpid.

In the erectile phase, the patient is aroused. In the torpid phase - the phase of CNS depression, inhibition. Consciousness is preserved, according to N.I. Pirogov, the patient resembles a “living corpse” - he looks at one point, is indifferent and indifferent to everything around him, his face turns pale, acquires a grayish-ashy hue. The eyes are sunken and motionless, the pupils are dilated, the mucous membrane of the eyelids, the oral cavity is sharply pale. A / D drops, pulse weak content and stress, body temperature drops.

Treatment: administer cardiac, promedol, morphine, overlay the patient with heating pads, inject 50 ml of 40% glucose solution intravenously, transfuse blood, blood substitute fluids, Ringer's solution, immediately send to the hospital by ambulance.

Local complications during tooth extraction surgery are more common than common.

Fractures of the crown or root of the tooth.

Etiology: incorrect choice a tool for removing a crown or root of a tooth, an incorrect technique for extracting a tooth or root, a carious defect of the tooth, the presence of anatomical prerequisites for a fracture (strongly curved and thin roots in the presence of powerful and sclerosed partitions), teeth treated with resorcinol-formalin liquid.

Treatment: The tooth or root must be removed by any known means.

Fracture of the antagonist tooth.

Etiology - rapid extraction of the extracted tooth and the direction of the forceps up or down, insufficient closing of the forceps cheeks and slipping of the forceps during tooth extraction.

Treatment: depending on the trauma of the tooth, the antagonist tooth is filled, an inlay is placed, covered with a crown, and root residues are removed.

Dislocation or removal of an adjacent tooth.

Etiology: this complication occurs when the doctor, using an elevator, leans on an adjacent tooth. The removal of an adjacent healthy tooth also occurs as a result of slipping of the cheeks of the teeth from the causative tooth to the adjacent one, as a result of hypercementosis. Such a complication occurs if the width of the cheeks is wider than the tooth being removed itself.

Treatment: carry out trepanation of teeth and replantation.

Fracture of the alveolar process.

Etiology: forceps are advanced deeply and with significant use of force, either partial or complete fracture of the alveolar process occurs.

Clinic: there is bleeding and mobility of the alveolar process along with the teeth.

With a partial fracture, the fragment is removed, sharp edges are smoothed and sutures are applied. With a complete fracture, a smooth splint is applied, i.e. splinted.

Fracture of the tubercle of the upper jaw.

Etiology: with deep advancement of the forceps or elevator, with excessively rough and vigorous removal of the wisdom tooth.

Clinic: with a rupture of the mucous membrane of the maxillary sinus, with damage to the vascular anastomoses in the region of the tubercle, significant bleeding, pain, and mobility of the alveolar process along with the last two molars occur.

Treatment: they stop the bleeding with a tight tamponade and it stops after 15-30 minutes, then the tubercle of the upper jaw with a wisdom tooth or with the last two molars is removed and sutures are applied, anti-inflammatory therapy.

Fracture of the body of the mandible is a rare complication, but it does occur.

Etiology: rough, traumatic removal of a wisdom tooth, less often a second molar. Predisposing factors - the presence of a pathological process in the area of the angle of the lower jaw (inflammatory process, benign or malignant neoplasms, odontogenic cysts, atrophy of bone tissue in the elderly).

Clinic: mobility of fragments of the jaw, bleeding, pain, malocclusion.

Treatment: splinting.

Dislocation of the lower jaw.

It occurs more often in the elderly.

Etiology: excessive opening of the mouth, when lowering the lower jaw down during tooth extraction, in cases of prolonged gouging or sawing of the roots of the teeth.

Clinic: it happens only anterior and unilateral or bilateral, in patients the mouth is half open, saliva is determined from the mouth, the lower jaw is motionless.

Treatment: reduction of the lower jaw according to Hippocrates and immobilization of the lower jaw with a sling bandage.

Prevention: fixation of the chin of the lower jaw during tooth extraction.

Opening or perforation of the maxillary sinus.

Etiology:

Insignificant distance between the bottom of the maxillary sinus and the roots of the teeth or the absence of bone tissue, the roots of the teeth are in contact with the mucous membrane;

Pathological process in the area of the root apex;

Pathological process in the maxillary sinus;

Incorrect technical performance of the tooth extraction operation with an elevator, deep application of forceps;

Traumatic, rough removal of the tops of the roots.

Clinic. Patients have bleeding from the hole of the tooth, corresponding to half of the nose, along with air bubbles. With inflammation of the maxillary sinus, purulent discharge from the hole and perforation is noted.

To diagnose perforation of the bottom of the maxillary sinus, the patient is asked to inflate his cheeks, first holding his nose with two fingers, while air passes from the oral cavity through the alveolus, the perforation into the nasal cavity and cheeks subside, the symptom of puffed up cheeks is called. The perforation is also detected when probing the alveoli with either an eye probe or an injection needle - a message from the alveolus to the maxillary sinus is detected.

loose plugging of the hole, not reaching the bottom of the maxillary sinus and strengthened in the form of a wire frame or for adjacent teeth or sutured to the mucous membrane, fixed with a fast-hardening plastic cap;

radical treatment - a mucoperiosteal flap is formed and sutures are applied, if possible, without the formation of a flap, sutures are applied to the edges of the gums;

with purulent discharge from the hole and perforation from the maxillary sinus, with its acute inflammation, anti-inflammatory treatment is prescribed, antiseptic washing holes, further leading a hole under the iodoform turunda;

with chronic inflammation of the maxillary sinus, the patient is sent to the hospital for radical maxillary sinusectomy.

Pushing the root into the maxillary sinus.

Etiology - rough, traumatic removal of the root tips with elevators or deep advancement of bayonet forceps with narrow cheeks.

Clinic - there is bleeding, pain, when the maxillary sinus is infected, swelling increases, infiltration of soft tissues, and the temperature rises. Diagnosis - X-ray examination.

Treatment - patients are referred to a hospital, in the absence of inflammation in maxillary sinus- conduct an audit of the sinus and remove the root, the wound is sutured. In acute inflammation of the maxillary sinus - anti-inflammatory therapy, to stop the inflammatory process - surgery on the maxillary sinus with root removal, in chronic inflammation - radical maxillary sinusectomy.

Pushing teeth and roots into soft tissues.

Etiology - a sharp careless movement in the process of removing the lower wisdom teeth with an elevator or when gouging them.

Diagnosis - noticing the absence of a tooth or root, it is necessary to conduct an x-ray of the lower jaw in two directions.

Treatment depends on local conditions and the qualifications of the doctor, if possible, then continue the removal of the tooth or root from the soft tissues or refer to the hospital.

Damage to the surrounding soft tissues of the jaw.

Etiology - the gums are not exfoliated with a trowel, when working with a direct elevator - injury to the tongue, sublingual region.

Treatment. If the doctor noticed that during the removal the mucous membrane of the gums stretches, then the mucous membrane is cut off with a scalpel, and if there is a tissue rupture, then sutures are applied, as well as when the tongue and sublingual region are injured.

Swallowing an extracted tooth or root.

This complication often occurs asymptomatically and they come out naturally.

Ingestion of a tooth or root into the respiratory tract.

Asphyxia sets in. It is necessary to ensure an urgent consultation with an ENT doctor and transportation (if necessary) of the patient to a hospital in order to do a tracheobronchoscopy and remove the indicated foreign body, in case of asphyxia - the imposition of a tracheostomy.

Sudden profuse bleeding from a wound.

Etiology - during removal, an opening (accidental) of a vascular neoplasm.

Clinic - after tooth extraction, significant bleeding suddenly opens under pressure.

Treatment - urgently press the wound with a finger, then carry out a tight tamponade with iodoform turunda and send it to the hospital.

Common complications after tooth extraction surgery.

These include rare complications:

myocardial infarction;

hemorrhage in the brain;

subcutaneous emphysema in the cheeks, neck, chest;

hysterical fits;

thrombosis of the cavernous sinuses.

Treatment is carried out by specialist doctors in stationary conditions.

Local complications after tooth extraction.

Hole bleeding distinguish between primary and secondary, early and late.

Etiology: general and local etiological factors.

Common ones include: hypertension, hemorrhagic diathesis, blood disease (Werlhof's disease, hemophilia); menstruation in women.

For local reasons include: ruptures and crushing of soft tissues, breaking off part of the alveolus or interradicular septum, the presence of granulation tissue or granuloma in the hole (up to 70-90%), infection of the hole and the collapse of a blood clot.

Treatment - with common causes patients should be in stationary conditions and under the supervision of dentists and hematologists, or a general therapist and conduct general anti-hemorrhagic therapy.

Local ways to stop bleeding.

Most of the bleeding from the holes after the extraction of teeth can be stopped - by tamponade of the hole with iodoform turunda. Blood clots are removed from the hole, the bleeding hole is dried with 3% hydrogen peroxide and tight tamponade is carried out for 3-4 days, cold.

In the presence of granulation tissue or granulomas in the well, curettage is performed, put a ball with a hemostatic sponge, fibrin film on the well.

When bleeding from the damaged gums, tongue, sublingual region, the wound is sutured.

When bleeding from the bone septum (interdental or interradicular), the bleeding area is compressed by squeezing the bone with bayonet-shaped forceps.

Bleeding from the hole can be stopped by filling it with catgut, with bleeding from soft tissues, it can be cauterized with potassium permanganate crystals, trichloroacetic iron.

A radical way to stop bleeding, as well as with ineffective treatment by the above methods, is suturing the hole.

Extraction of teeth in patients with hemophilia should be carried out only in stationary conditions - in the hematology department under the supervision of a dental surgeon or in the dental department - under the supervision of a hematologist. They are not recommended to suture the hole, but to carry out tamponade with hemostatic drugs of local hemostatic action and prescribe blood transfusions, aminocaproic acid, vikasol to patients.

Alveolitis- acute inflammation of the hole, accompanied by alveolar pain.

Etiology - rough, traumatic extraction of a tooth or roots, pushing dental deposits into the hole, leaving granulation tissue or granuloma, tooth fragments or bone tissue in the hole, prolonged bleeding from the hole, the absence of a blood clot in the hole, violation of postoperative care by patients and poor cavity care mouth; infection in the hole, when the tooth is removed due to acute or exacerbated chronic periodontitis with a decrease in the reactivity of the body.

Clinic. Patients complain 2-4 days after tooth extraction on initially aching pains of a non-permanent nature, with its intensification when eating. The temperature is either normal or subfebrile (37.1-37.3 0 C), the general condition is not disturbed.

On external examination, no changes. On palpation in the submandibular, submental areas, slightly enlarged and painful lymph nodes are determined. Mouth opening is somewhat limited if mandibular molars are the cause. The mucous membrane around the hole is slightly hyperemic and edematous, the hole is filled with a partially disintegrating blood clot or is completely absent. The hole is filled with food debris, saliva, the bone tissue of the hole is exposed. On palpation of the gums, pain is noted.

After some time, patients are disturbed by acute persistent pains that have a tearing, pulsating character, radiate to the ear, temple, eyes, depriving the patient of sleep and appetite. The general condition worsens, general weakness, malaise, the temperature rises to 37.5-38.0 0 С.

On external examination, there is swelling of the soft tissues at the level of the extracted tooth; on palpation, the regional lymph nodes are enlarged and painful. In the presence of alveolitis in the region of the lower molars, patients have a restriction of mouth opening, painful swallowing.

Bad breath from the mouth, which is associated with the putrefaction of the blood clot in the hole. Hole walls are bare, covered with dirty gray decay; the mucous membrane around the hole is hyperemic, edematous, painful on palpation.

Treatment of alveolitis consists of the following points:

under conduction anesthesia, an antiseptic treatment of the hole of the extracted tooth is performed (hydrogen peroxide, furacillin, ethacridine-lactate, potassium permanganate);

a curettage spoon is used to carefully remove the disintegrated clot, fragments of bone tissue, and a tooth;

the well is again antiseptically treated, after which it is introduced loosely into the well:

a) iodoform turunda;

b) a strip with an emulsion of streptocide on glycerin and anesthesin;

c) turunda with chloral hydrate (6.0), camphor (3.0) and novocaine (1:5);

d) turunda with proteolytic enzymes (trypsin, chymotrypsin);

e) turunda with 1% solution of amorphous ribonuclease;

f) biomycin powder with anesthesin;

g) novocaine, penicillin - novocaine blockades are carried out along the transitional fold;

h) "alveostasis" (sponge).

After the removal of a tooth or root, it is necessary to carry out the toilet of the hole. In order to remove granulation or infected dead tissue detached from the root of the periradicular granuloma and bone fragments, the well should be washed with warm saline. Aspirate the wash liquid from the well with a pipette and isolate the well. Remove one (or several at the discretion of the doctor) sponge from the jar with tweezers and carefully place it in the hole. A dry swab can be applied over the alvostasis sponge. For difficult-to-heal holes, sutures may be placed over the sponge, since the sponge has the ability to completely dissolve.

Treatment of patients can also be carried out in an open way, without introducing turundas into the well with antiseptics, after gentle curettage, patients are prescribed intensive rinsing of the well with soda solution (1 tsp per glass of warm water) or a solution consisting of 3% hydrogen peroxide solution with furacillin, after pain relief, rinsing with furacillin, oak bark, a weak solution of potassium permanganate, sage, chamomile is prescribed.

Patients with alveolitis are prescribed anti-inflammatory therapy,

analgesics and physiotherapy: UHF, solux, fluctuation, microwave therapy, ultraviolet radiation, laser therapy.

Sharp edges of the alveolus or neuritis of the alveolar nerves.

Etiology: traumatic, rough tooth extraction, removal of several teeth.

Treatment is an alveolotomy operation, the sharp edges of the hole are removed.

QUALITY CONTROL,

MARKETING SUPPORT AND MANAGEMENT SUPPORT IN DENTAL PRACTICE

Importance of quality management in dental practice. Organization of the Quality Management System.

The state of health of the population, the organization of medical care, are one of the main indicators of the culture of society, the criteria for its economic development.

An important condition for raising the cultural level of the development of society is the strengthening of the requirements for the quality of medical care provided to the population, including in the field of dental practice. In this regard, the very definition of the concept of quality is significant. It can be defined as a result that meets and exceeds requirements.

Former Organization Director peer review health insurance, Missouri, Thomas K. Zinck defines the essence of the concept of quality as follows: “Do the right thing, in the right way, for the right reason, in right time, for the right price, with the right result.”

It should be recognized as appropriate to take into account at a clinical appointment and bring to the attention of patients the established warranty periods and service periods for the types of work carried out in the provision of therapeutic and orthopedic dental care. There are guidelines for dentists covering issues related to warranty obligations for clinical dental procedures.

The service life of certain types of orthopedic structures can be extended, provided that innovative technologies are used in clinical and laboratory practice.

In view of the use of the latest achievements of science, the improvement of the material and technical base, it becomes possible to manufacture fundamentally new modern orthopedic structures. In this regard, some types of prostheses can reasonably be considered outdated, physiological for patients to an incomplete degree. Therefore, the use of such structures for the purpose of orthopedic treatment of dentition defects through their manufacture and fixation (overlay) should be considered irrational.

According to sociologist, MA Cornelia Khan and head of one of the leading dental clinics in Europe, Dr. medical sciences, Friedhelm Burger (Germany) in the field of health care is the degree of compliance of the achieved treatment goal with what can be achieved in reality.

In the healthcare system, quality is measured in terms of:

structural quality;

procedural quality;

Efficient quality.

If we subdivide the value of quality into degrees, then we can determine its four steps:

"Poor quality", determined in cases where the services provided do not meet the requirements and desires of patients who seek help from a particular dental clinic.

Main quality, is determined in accordance with the requirements of patients and the services provided to them.

Achievement quality, is determined by justifying the requirements and desires of patients.

The quality of delight, is determined in cases where the services provided exceed the expectations of patients.

At the present level of development of society and medicine, in particular, the problem of quality management is outlined and becomes important.

The very concept of "quality management" comes originally from the industrial sector and then was transferred to the service sector.

Ensuring quality management implies the development and organization of new areas in the field of providing medical care to the population.

Quality management is defined as the sum of all the efforts of medical practice to improve the desired quality.

It should be noted that such an organizational form as quality management contributes to the economic survival of a dental medical institution.

There is a model of the European Organization for Quality Management (EFQM). This model is focused on meeting the needs of the client, the needs of the staff, and a positive perception of civic responsibility. Proper organization of processes and resources, as well as adequate staff orientation contribute to the achievement of outstanding clinical and economic performance.

In addition, one of the most interesting areas that correspond to the quality management organization is the Total Quality Management (TQM) model, which covers the entire enterprise, practice, organization. This model is based on an idea that follows the Japanese philosophy of quality, focusing on patients and continuous quality improvement in all areas. At the same time, each employee of a medical institution is required to focus on quality, initiative and responsibility for their activities.

Reasons why a quality management system should be developed and implemented in dental practice:

There are a number of aspects, in addition to medical duty and legal obligations, according to which it is necessary to introduce a Quality Management system into the practice of dentistry.

When using the quality management system in dental practice, an increase in the degree of patient satisfaction is achieved, confidence in the clinic and medical staff is aroused, which in turn contributes to the long-term existence of a dental medical institution.

Patients, health care institutions and insurance companies expect the dentist to maintain the quality of the ongoing consultative and treatment-diagnostic process. The Quality Management System contributes to this.

The Quality Management System is the basis for optimizing the organizational process in a dental facility, reduces the number of errors and costs, which in turn creates an improvement in patient provision.

The Quality Management System contributes to the reduction of economic risk and potential claims for damages.

The Quality Management System can be a factor of rational competition.

To organize a quality management system in the dental

practice, it is necessary to determine the structure and organization of work. The tasks, the solution of which is necessary for the organization of the Quality Management System, are: taking care of the constant professional development of dentists and medical staff of a dental institution, studying and using innovative technologies with the involvement of the latest equipment and consumables. Undoubtedly, one of the main points in the organization of the system is the development and implementation of preventive measures in order to prevent errors and quality problems. Attention should also be paid to the appropriate training of clinic administrators, in view of the fact that the correct construction of their communication with patients ultimately affects the quality of the ongoing consultative and treatment-diagnostic process.

What activities should be carried out by the head of the dental structure to organize a quality management system?

After understanding the purpose and objectives of the organization of the Quality Management system in a dental institution, the following should be carried out:

It is necessary to make a decision on the introduction of a quality management system and develop a calendar plan of activities.

It is necessary to search for information on the subject of Quality Management.

The practice of responsible persons in a certified institution is an undoubted advantage.

It is necessary to organize a quality circle in a dental institution, with the regulation of the timing of meetings.

It is necessary to hold regular meetings, highlighting the benefits of the activities carried out and their suitability for the intended purpose.

It is necessary to appoint an employee responsible for this type of activity, that is, for Quality Management.

It is necessary to specify in writing a quality policy that does not arouse objections from staff and patients.

The competences and areas of activity of the personnel should be defined, with the preparation of instructions and a graphical representation in the scheme of the structure of the organization.

Collection, analysis and distribution of all available forms.

Drawing up your own Quality Management handbook, in which it is necessary to document and describe the Quality Management system.

Keeping patients informed.

Carrying out inspection and evaluation of the quality of services provided by the dental institution.

An important aspect is bringing to the consciousness of the clinic staff the expediency of organizing a quality management system. In addition, it is necessary to ensure the interest of the staff in the rational operation of this system, with appropriate seminars on the rules of its work and organization.

One of the components of any rational model of Quality Management is to help colleagues in the team in clinical practice. Using the right management guidelines, the head of the dental institution ensures the motivation of the staff, which implies long-term cooperation in the team. To ensure this, the leader needs to clearly define the leadership style.

Summarizing the main nuances of leadership, three main styles, according to German scientists, can be distinguished.

The collaborative style called "Coaching" is considered by many dental leaders to be the most successful. This style provides for the coordination with the staff of the intended goals and the gradation of measures of responsibility, depending on the individual qualities and competence of the employees.

The third style is completely opposite to the second - the style of non-intervention. There is no leadership as such. Employees of the team are left to themselves, disoriented, have no connection with the leader, do not have the opportunity to collegially discuss the goal and tasks with him.

In order to develop motivation among the staff of a dental institution at any level, it is necessary to create conditions under which each employee will feel like a partner doing a common thing.

The implementation of the Quality Management System in practical dentistry should be primarily dealt with by the structures responsible for the organization of dental care and its management support.

Marketing and management in dental practice.

To increase the profitability of municipal and private dental institutions, it is necessary to improve the quality of the treatment provided, which leads to a reduction in the terms of the treatment itself, and, thereby, a decrease in the number of visits to the dentist by the patient, which provides a certain economic effect.

In the conditions of a market economy and insurance medicine, the requirements of patients for the quality of treatment of dental diseases, including the quality of measures related to the replacement of defects in the dentition, have sharply increased.

Necessary for improving the qualification level of dentists is the appropriate specialized training on thematic cycles.

It should be noted the rationality of conducting specialized cycles for dentists of related areas: dentists-therapists, dental surgeons, orthopedic dentists, pediatric dentists. Due to the fact that diseases of the dental profile quite often affect several dental disciplines at the same time, such an approach to improving the qualification level of specialists should be considered appropriate.

The ability of a dentist to competently understand various clinical situations allows you to raise the rating of a dental institution. The possibility of self-assessment of the clinical situation, diagnosis and treatment of diseases that are concomitant for a dentist of a certain discipline create significant prerequisites for increasing the economic effect of the activities of a particular unit of a medical institution of a dental profile.

The professional development of management in dentistry is of great importance in the current economic situation.

In this regard, a separate link should be allocated in the structure of dental institutions that provides management support for the functioning of the organization. This type of activity should include ensuring the professional development of dentists, their participation in scientific and practical conferences, seminars and exhibitions at various levels, communication with scientific and educational organizations in order to acquire the latest technologies and developments, facilitating the implementation of innovative technologies in clinical practice. practice, studying the results of statistical analysis of dental morbidity in the region and studying the trend towards changes in its indicators, cooperation with manufacturers of dental equipment and materials, as well as with dealers for their implementation.

Undoubtedly, a positive and significant activity is the creation of Training Centers on the basis of dental clinics.

Management support is determined by cooperation with the management departments of scientific and educational institutions, specialized medical institutions, manufacturers of dental equipment and materials, as well as companies selling them, organizers of conferences and exhibitions.

It can be argued that the development of management in the conditions of the medical dental unit contributes to the achievement of a higher quality of dental care provided to the population, creates conditions for increasing the professional growth of dentists, and increases the profitability and competitiveness of clinical dental institutions.

To ensure the effective operation of the management department of a dental institution, it is necessary to create a sufficient information base containing the results of research, including statistical data, reflecting the various characteristics of diseases of the dental profile in the region.

In addition to the quality of the treatment and prevention process, the quality of disease prevention is undoubtedly of great importance in protecting public health.

At present, the prevention of dental diseases is impossible without planning, managing the development of health, and strict quality control of the measures taken. The result of the introduction of the prevention system depends on a number of organizational factors, a rationally constructed management mechanism in the institution.

Features of the innervation of the upper and lower jaw

The maxilla and mandible are innervated, respectively, from the superior and inferior alveolar nerves, which are branches of the trigeminal nerve (the main sensory nerve of the head and face) and form the superior and inferior alveolar plexuses.

The superior and inferior alveolar nerves innervate the following anatomical structures:

gums;
periodontium - a complex of tissues surrounding the tooth root;
teeth: dental nerves, together with vessels, enter the pulp through an opening in the root apex.

Together with the tooth, the dentist removes the nerve in it. But there are nerve endings located in the gums and periodontium. Their irritation is due to the occurrence of pain after the extraction of the tooth.

How long does pain last after tooth extraction?

Typically, pain persists for 4 to 7 days.

Factors on which it depends:

complexity of the intervention: the location of the tooth (incisors, canines, small or large molars), the condition of the tooth and its surrounding bone tissue, the size of the tooth root;

compliance with the recommendations of the dentist after removal: if they are fulfilled, then it is possible to completely avoid pain;

doctor's experience how carefully the doctor removes teeth;

equipment of the dental clinic: the more modern instruments used to remove a tooth, the less pain will bother;

patient features: some people feel pain more acutely, others - not so much.

What if the pain persists for a long time?

The best solution is to return to the dentist for an examination and consultation. Pain relievers can be used as a temporary measure.

What does the hole look like after tooth extraction?

After the extraction of the tooth, a small wound remains.

Stages of healing of the hole after tooth extraction:

1 day	A blood clot forms in the lens. It is very important for the normal healing process. In no case should it be torn off and picked out.
3rd day	First signs of healing. A thin layer of epithelium begins to form on the wound.
3 - 4 days	At the site of the wound, granulations are formed - connective tissue which is involved in the healing process.
7 - 8 days	The clot is already almost completely replaced by granulations. Only a small part of it remains inside the hole. Outside, the wound is actively covered with epithelium. Inside, new bone tissue begins to form.
14 - 18 days	The wound in the place of the extracted tooth is completely overgrown with epithelium. The clot inside is completely replaced by granulations, bone tissue begins to grow in them.
30 days	New bone tissue fills almost the entire hole.
2 – 3 months	The entire hole is filled with bone tissue.
4 months	The bone tissue inside the hole acquires the same structure as the upper or lower jaw. The height of the margins of the socket and alveoli decreases by about 1/3 of the height of the tooth root. The alveolar ridge becomes thinner.

The wound at the site of the extracted tooth goes through all the described stages only if prosthetics are not carried out.

What should be done after tooth extraction?

Usually, after the extraction of a tooth, the dentist gives the patient recommendations. With their exact observance, you can either avoid toothache altogether, or significantly reduce its intensity and duration.

Avoid physical activity. Rest should be as passive as possible. At least during the first two days after tooth extraction.
Do not eat during the first 2-3 hours after the manipulation. Food injures a fresh wound and leads to pain, which can then be maintained for a long time.
For several days, you can not chew food on the side where the tooth was removed.
Avoid smoking and taking for several days alcoholic beverages. Cigarette smoke and ethyl alcohol irritate the mucous membrane of the gums, provoke the development and intensification of pain.
You can not touch the hole with your tongue, touch it with toothpicks and any other objects. There is a blood clot in the hole, which is very important for healing. If food particles get into the hole during chewing, then you should not try to remove them: you can remove the clot with them. It is better to rinse your mouth after eating.
Mouth rinses after tooth extraction are helpful. But do not start them from the first day.
If the pain gets worse, you can take painkillers. But before that, it is highly advisable to consult a doctor.

How to rinse your mouth after tooth extraction?

Mouth rinses can be started from the second day after tooth extraction. In this case, solutions prescribed by the dentist are used.

A drug	Description	Application
Chlorhexidine	Antiseptic. It is used to prevent infection of the hole after tooth extraction. It is sold in pharmacies in the form of a ready-made 0.05% aqueous solution for rinsing the mouth, which has a bitter aftertaste.	Rinse your mouth several times a day. During rinsing, keep the solution in the mouth for at least 1 minute.
Miramistin	Antiseptic solution. In terms of its ability to destroy pathogens, it is inferior to a solution of chlorhexidine, but is active against herpes viruses. Produced in bottles, which are attached to the spray nozzle.	Rinse your mouth with Miramistin solution 2-3 times a day. While rinsing, keep the solution in the mouth for 1 to 3 minutes.
Soda-salt baths	Rinsing the mouth with a strong solution of salt and table soda. As a rule, it is recommended by dentists in cases where there is an inflammatory process in the gum when an incision was made in order to release pus.
Herbal infusions	Sold in finished form in pharmacies. It is preferable to use infusions of chamomile, calendula, eucalyptus. They have a weak antiseptic effect (much weaker than that of Chlorhexidine or Miramistin)	Rinse your mouth 2-3 times a day. While rinsing, keep the solution in the mouth for 1 to 3 minutes.
Furacilin solution	Furacilin is an antimicrobial agent that is effective against many types of pathogens. Available in two forms: Ready solution for mouthwash in vials. Tablets. To prepare a rinse solution, dissolve two Furacilin tablets in a glass of water (200 ml).	Rinse your mouth 2-3 times a day. While rinsing, keep the solution in the mouth for 1 to 3 minutes.

How to rinse your mouth after tooth extraction?

On the first day after tooth extraction, mouth rinses are not performed. The blood clot that is in the hole is still very weak and can be easily removed. But it is extremely important for normal healing.

Rinse your mouth starting from 2 days, as prescribed by the dentist. In this case, intensive rinsing is unacceptable, as it can lead to the removal of a blood clot. Baths are carried out: the patient collects a small amount of liquid in his mouth and keeps it near the hole for 1 to 3 minutes. The liquid is then spit out.

How to eat right after tooth extraction?

In the first 2 hours after tooth extraction, you must refrain from eating. Do not use on the first day hot food, as it will irritate the wound and lead to increased pain.

take only soft food
avoid sweet and very hot
do not drink drinks through a straw
give up alcohol
do not use toothpicks: replace them with mouth rinses (baths) after each meal

How long can a hole bleed after a tooth extraction?

Bleeding after tooth extraction can continue for several hours. If during this time an admixture of ichor appears in the saliva, this is normal.

Measures that can be taken if severe bleeding occurs a few hours after tooth extraction:

Bite the gauze swab on the hole and hold it for a while. The blood must stop.

Apply cold to the place where the extracted tooth is located.

If this does not help, and severe bleeding persists, an urgent visit to the dentist is necessary.

Cheek swelling after tooth extraction

The reasons.

Tooth extraction is considered a microsurgical intervention in dentistry. For the tissues of the oral cavity, this is a trauma. After complex removals (irregular shape of the roots of the teeth, lack of a crown, removal of a wisdom tooth), edema almost always develops. Usually it is not very pronounced and does not last long (depending on the complexity of the intervention).

If the edema is severe enough and persists for a long time, then, most likely, its cause is an inflammatory process.

Possible causes of the inflammatory process that causes cheek swelling after tooth extraction:

errors in the doctor's compliance with the rules of asepsis and antisepsis during tooth extraction
violation of the recommendations of the dentist by the patient
insufficient sanitation (cleansing from pathogens) by the dentist of the wound after tooth extraction
allergic reactions to drugs that were used during the manipulation;
decrease in the immune defenses of the patient's body

What to do?

If, after tooth extraction, a slight swelling occurs on the face, its resorption can be accelerated by the following measures:

in the first few hours - applying cold to the cheek
followed by the application of dry heat.

Signs indicating that the patient needs urgent dental care:

swelling is very pronounced
swelling does not go away for a long time
there is severe pain that lasts for a long time
body temperature rises to 39 - 40⁰C
the general well-being of the patient is disturbed: there is a headache, increased fatigue, drowsiness, lethargy
over time, these symptoms not only do not decrease, but also increase even more

In this case, you should immediately consult a dentist. Most likely, the doctor will prescribe antibiotics after the examination. Additional tests may be required: complete blood count, bacteriological examination swabs from the oral cavity, etc.

Increased body temperature after tooth extraction

The reasons.

Normally, body temperature can rise within 38⁰C for no longer than 1 day. Otherwise, we can talk about the development of the inflammatory process. Its causes and main symptoms are similar to those described above when considering swelling of the cheek.

What to do?

With an increase in body temperature within 38⁰C on the first day, it is enough to simply follow the recommendations given by the dentist. With an increase in temperature and its long-term preservation, it is necessary to visit a dentist or call a doctor at home.

Complications after tooth extraction.

Dry hole.

dry hole- most frequent complication after tooth extraction. It is she who is the main cause of the development of a more formidable complication - alveolitis.

Causes of dry socket:

after tooth extraction, a blood clot did not form in the hole

a clot formed but was then removed due to eating hard food on the first day after removal, rinsing too hard, trying to remove food that got into the socket with toothpicks and other hard objects.

Dry socket treatment

If you suspect that you have this complication you need to visit the dentist as soon as possible. As a rule, the doctor applies compresses to the tooth with medicinal substances and gives the patient further advice. The main goals of dry socket treatment are to speed up the healing process and prevent the development of alveolitis.

Alveolitis.

Alveolitis- inflammation of the dental alveoli of the recess in which the root of the tooth was located.
Causes of alveolitis:

Violation by the patient of the recommendations of the dentist after tooth extraction, the rules of oral hygiene.

Damage and removal of a blood clot located in the hole. Most often this happens during attempts to get stuck food particles, with intensive rinsing.

Insufficient processing of the hole, violation by the dentist of the rules of asepsis and antisepsis during tooth extraction.

Decreased immunity in the patient.

Symptoms of alveolitis:

A few days after tooth extraction, the pain increases with new force and does not pass.

An increase in body temperature over 38⁰C.

The appearance of a characteristic bad breath.

Touching the gums is accompanied by severe pain.

Deterioration of the patient's well-being: headache, fatigue, drowsiness.

Alveolitis treatment

If you experience the symptoms described above, you should immediately visit the dentist.

Activities that take place in the dentist's office:

Anesthesia (an injection into the gum of a solution of lidocaine or novocaine).
Removal of an infected blood clot, thorough cleaning of the hole.
If necessary - curettage wells - its curettage, removal of all foreign bodies, granulations.
Treatment inner surface wells with antiseptic solutions.
A swab soaked in medicine is placed on the well.

In the future, it is necessary to rinse your mouth daily with antiseptic solutions, strictly adhere to all doctor's recommendations. If necessary, the dentist prescribes antibacterial drugs.

Used antibiotics

Name of the drug	Description	Mode of application
Josamycin (Valprofen))	A fairly strong antibacterial drug, which rarely, unlike others, develops resistance from microorganisms. Effectively destroys most pathogens inflammatory diseases oral cavity. Available in the form of tablets of 500 mg.	Adults and adolescents over 14 years of age take the drug at a dosage of 1 to 2 g per day (usually initially prescribed 1 tablet of 500 mg 1 time per day). The tablet is swallowed whole, washed down with a small amount of water.
hexalysis	Combined drug which contains the following components: Biclotymol- antiseptic, effective against a large number of pathogens, has an anti-inflammatory effect. Lysozyme- an enzyme with antimicrobial activity. Enoxolone- a drug with antiviral, antimicrobial and anti-inflammatory action. hexalysis available in tablets, each containing 5 g of each active substance.	Adults are prescribed 1 tablet every 2 hours. Maximum daily dose- 8 tablets.
Hexaspray	Almost an analogue of Hexalise. The active substance is Biclotymol. The drug is available in cans in the form of a spray for spraying in the oral cavity.	Inhalation is carried out 3 times a day, 2 injections.
Gramicidin (Grammidin)	Grammidin is powerful antibiotic that destroys most of the pathogens present in the oral cavity. Produced in the form of lozenges, each of which contains 1.5 mg of the active substance (which corresponds to 500 units of action).	Appointment for adults and children over 12 years of age: 2 tablets 4 times a day (take one tablet, after 20 minutes - the second). Appointment for children under 12 years of age: 1 - 2 tablets 4 times a day. Total duration taking Gramicidin for alveolitis is usually 5 to 6 days.
Neomycin (synonyms: Colimycin, Mycerin, Soframycin, Furamycetin)	Antibiotic a wide range- effective against a large number of types of microorganisms.	After cleaning the hole, the dentist puts powder in it Neomycin and covers it with a tampon. Soon after, pain and other symptoms of alveolitis disappear. Often it is necessary to repeat the procedure after 1 - 2 days.
Olethetrin	Combined antibacterial drug. Is a mixture Oleandromycin and Tetracycline in a ratio of 1:2.	Olethetrin used similarly Neomycin: antibiotic powder is placed in the well. Sometimes, to reduce pain, a local anesthetic, anestezin, is added to the antibiotic.

Complications of alveolitis:

periostitis- inflammation of the periosteum of the jaw
abscesses and phlegmons- ulcers under the mucous membrane, skin
osteomyelitis- inflammation of the jaw

Rare complications after tooth extraction

Osteomyelitis

Osteomyelitis is a purulent inflammation of the upper or lower jaw. It is usually a complication of alveolitis.

Symptoms of osteomyelitis of the jaw:

severe pain that gets worse over time
severe swelling on the face at the site of the extracted tooth
increase in body temperature
malaise: headaches, fatigue, drowsiness
subsequently, inflammation can spread to neighboring teeth, capture more and more areas of the bone, while the patient's well-being worsens

Treatment of osteomyelitis of the jaw is carried out in a hospital.

Directions of treatment:

surgical intervention

antibiotic use

Nerve damage

Sometimes a nearby nerve can be damaged during tooth extraction. This happens when the complex shape of the root of the tooth is incorrect, with insufficient experience of the dentist.

If the nerve is damaged during tooth extraction, numbness of the oral mucosa is noted in the area of the cheeks, lips, tongue, and palate (depending on the location of the tooth). Nerve injuries are usually minor and resolve within a few days. If recovery does not occur, you should consult a doctor. Physiotherapy will be scheduled.