No one wants any complications; despite great care to avoid complications, it can happen.

1. Nerve injury (also known as paresthesia)

Unfortunately, nerve injury occurs resulting in altered or loss of sensation, numbness, pain, or altered feeling in the face, cheek, lips, chin, teeth, gums, and/or tongue (including loss of taste).  Some conditions may improve gradually (over 6 months or longer), while others can be permanent.  It may require additional treatment.  If nerve injury is suspected, contact the office as soon as possible.

Nerve injury can occur from:

• the injection of local anesthesia alone (one in a million),
• incision and reflection of soft tissue flaps,
• curettage of infected tissue near the nerve,
• during removal of lower third molars (0.5 to 2%),
• during the placement of dental implants.

To minimize the risk of nerve damage during extractions of lower wisdom teeth, a coronectomy (partial removal of the tooth) may be considered.   This procedure can be performed on teeth without prior infection, decay or abscessed pulp.  Remaining roots are resorbed over a period of time of up to 3 years, similar to resorption of primary (baby) teeth.  Patients are encouraged to look up the term, “coronectomy” in the Google site.

2. Dry Socket Dry socket is caused by early loss of blood clot from the extraction sockets, usually after extraction of lower wisdom teeth.  Patients may experience increasing pain starting around the third postoperative day.  Typical lower jaw pain radiates up to ear area.  Upon examination, raw bone surfaces can be seen with bad odor and taste.  This is treated with placement of dry socket dressing.  This occurs more often in smokers.   Contact our office if pain worsens after two to three days.

• To prevent dry sockets, avoid actions that may dislodge blood clots. Do not use drinking straws, water-picks, or vigorous gargling for the first 3–4 days after surgery.  Gently swish your mouth for the first few days.
• Do not use mouth rinse (Scope or Listerine) until 10 days after after surgery.

3. Stress or Damage to the Jaw Joints (TMJ) and possibly leading to Difficulty in Opening the Mouth or Chewing.

Certain individuals exhibit habits such as bruxism (teeth grinding) and jaw clenching, which may be further aggravated following tooth extraction.  Common symptoms of TMJ dysfunction are tired jaws, temporal headaches, sensitive teeth, and difficulty of opening mouth, etc.  If these symptoms occur, stop clenching altogether, gentle massage and warm compresses over the affected areas, and taking analgesics (Aleve) will help.  Normal jaw function will return in one to two weeks in most cases.  Contact our office if TMJ symptoms occur.

Sometimes, removal of key posterior teeth (resulting in loss of vertical stop) can cause impinging of the lower jaw (condyle) into the joint space and closed lock.  Contact our office if TMJ symptoms occur.

4. Opening into the nasal or sinus cavities

Opening into the nasal cavities is very rare, but opening into the sinus cavities is more common.  Abscess buildup follows the path of least resistance, erodes bone, a fistula can be created.  An opening into the sinus can be seen after extraction of teeth or removal of abscessed tissue in the socket.  Sometimes an opening into the sinus can occur during retrieval of broken roots near the sinus.

The oro-antral fistula can resolve spontaneously or may need further surgical intervention.