What can go wrong with tooth extractions?

Complications can occur during or after the dental extraction procedure, but the vast majority can be prevented with good treatment planning and the use of appropriate surgical technique(s).

Root fracture is the most common complication. A retained root tip may cause persistent infection, osteitis, draining tract formation and/or chronic nasal discharge. Therefore a root tip should be carefully inspected following extraction and dental radiograph obtained. If a retained root fragment is noted, it should be carefully removed.

Blind attempts to remove the root tip are strongly discouraged, as this may result in significant trauma to the surrounding bone and/or dislodgement of the root tip into the mandibular canal, nasal cavity, or maxillary recess. Upon removal of the retained root tips, another dental radiograph should be performed to confirm vacated alveoli.

Hemorrhage may be a problem in patients with impaired hemostasis, or if it is severe due to damage of the infraorbital, major palatine or inferior alveolar artery. Other soft tissue injuries are related to flap tear during flap elevation, lip and cheek trauma, or trauma to the salivary ducts with rotary instruments, and puncture wounds due to instrument slippage (including orbital penetration with subsequent ocular and/or brain trauma).

Fracture of the alveolar process may occur with an aggressive technique. This is mostly a minor complication, unless the alveolar fracture extends to a jaw fracture (e.g., during extraction of a mandibular canine tooth or mandibular first molar tooth).

Damage to adjacent teeth, nerve damage, and air embolism are also possible, but usually avoided with careful technique(s).

Postoperative complications are related to postoperative swelling, pain (aggressive extraction techniques, poor pain management), infection (rare with good surgical technique), delayed wound healing or wound dehiscence (rare with good surgical techniques; possible with some systemic diseases or treatments or neoplasia), occlusal trauma (e.g., maxillary lip entrapment following extraction of maxillary canine teeth, especially in cats and ferrets), glossoptosis (e.g., following extraction of mandibular canine tooth the tongue may hang out of the oral cavity in dogs), oronasal fistula formation (communication between oral and nasal cavities), alveolar margin recession and weakening of the mandible.

If you have noted any problems with your animal, please consult your veterinarian.

Selected references
1. Lommer MJ (2012). Complications of extractions. In: Verstraete FJM, Lommer M, eds. Oral and maxillofacial surgery in dogs and cats. Saunders Elsevier, Edinburgh: 153-159.
2. Moore JI, Niemiec B (2014). Evaluation of extraction sites for evidence of retained tooth roots and periapical pathology. J Am Anim Hosp Assoc 50(2):77-82.
3. Smith MM, Smith EM, La Croix N, Mould J (2003). Orbital penetration associated with tooth extraction. J Vet Dent 20(1):8-17.