Circuit 3, station 8

Indications for tooth extraction encompass various dental issues, including advanced periodontal disease, abscesses, non-restorable caries, residual roots, tooth fractures, failed endodontic treatments with persistent periapical granulomas or cysts, and impacted third molars. Additionally, tooth extraction may be part of orthodontic or prosthodontic treatment plans. However, after surgical procedures, patients may experience a range of complications, such as alveolitis, edema, trismus (lockjaw), bone spicules, post-operative bleeding, and paresthesia.

The origins of these complications are multifactorial, stemming from either the patient’s health status or habits or systemic and local factors. Firstly, the increasing lifespan of patients has led to more medically compromised individuals seeking dental care. Secondly, the most common complications following surgical procedures can be influenced by a patient’s medical history.

Numerous clinical conditions can impact the wound healing process. For instance, conditions like diabetes mellitus (DM) can impair healing due to abnormalities in local cytokines and cellular functions, leading to reduced angiogenesis and collagen synthesis. Human Immunodeficiency Virus (HIV) infection, characterised by progressive immune system destruction, can also hinder healing. Chronic obstructive pulmonary disease (COPD) reduces oxygen supply, while conditions like Cushing’s Syndrome, anaemia, malnutrition, and concomitant oncologic treatments (radio or chemotherapy) negatively affect wound healing.

The final stages of healing involve the deposition and remodelling of woven bone, facilitated by blood filling post-extraction sockets. Smoking has a detrimental effect on wound healing, as nicotine negatively impacts osteoblasts, inhibits fibroblast growth, reduces collagen and fibronectin production, while promoting collagen breakdown.

Drug consumption can also contribute to intra and postoperative complications, particularly bleeding resulting from anticoagulant or antiplatelet therapies and platelet disorders associated with liver disease or hypertension-related bleeding.

Furthermore, complications are more likely to arise during complex or multiple extractions and specific anatomical conditions. For instance, maxillary tuberosity fractures or oro-antral fistulas may occur when root apices of maxillary teeth connect with the maxillary sinus. In the mandible, proximity to the inferior alveolar nerve can pose risks. Surgical interventions for impacted, decayed, or fractured teeth, which often require more invasive procedures, can also lead to postoperative complications such as swelling, infection, and bleeding.

The administration of antibiotic therapy before or after extractions to prevent complications remains a subject of debate. The literature lacks consensus on the effectiveness and appropriateness of antibiotic prescriptions in preventing surgical site infections like alveolitis.

Complaints Procedure

The 6 core principles of managing complaints as per the General Dental Council in managing complaints from patients:

1. All of your feedback is important to us:

-The feedback from the patient is important to the dental practice / department

2. We want to make it easy for you to raise a concern if you need to:

-The aim is for patients to have an easy a process to make a complaint and not make it difficult

3. We follow a complaints procedure and keep you informed:

-All practices and departments need to have a publicly available complaints procedure

4. We will try to answer all your questions and any concerns you raise:

-All questions will be attempted to be answered and respond to any and all concerns raised

5. We want you to have a positive experience making a complaint:

-Complaints are always a challenge and as such the process should be as painless and positive as possible. 

6. Your feedback helps us to improve our service:

-All feedback is welcome to improve the service delivered

As per GDC standards:

5.2.1 You should not react defensively to complaints. You should listen carefully to patients who complain and involve them fully in the complaints process. You should find out what outcome patients want from their complaint.