Complication

Risk Factors

Prevention

Treatment

Usual Course

Swelling

Prolonged surgery, difficult surgery, unpredictable

Intravenous cortisone given just prior to surgery

Head elevation, ice to face 20 min on and 20 min off for 36 hours

Swelling becomes maximal 3 days after surgery then subsides over the next 5 days

Difficulty Opening Mouth

Preexisting TMJ problems or muscular disorders, prolonged surgery, unpredictable

Appropriate treatment of TMJ and muscular dysfunction - surgery may exacerbate these conditions

Soft diet, gentle stretching exercises, warm moist compresses, anti-inflammatory medications

Depends on preoperative condition - usually resolves within 2 weeks - may need further treatment

Stretching of Corners of Mouth

Small mouth, dry and chapped lips, cold sores, prolonged and difficult surgery

Avoid dry chapped lips, wait until cold sores resolve prior to surgery

Keep lips moisturized, antiviral treatment

Resolves within 1 - 2 weeks

Bleeding

Use of non-steroidal anti-inflammatory medications such as aspirin and ibuprofen, blood thinners and anticoagulants, bleeding tendencies, anatomic variations such as arterio-venous malformation

Avoid non-steroidal anti-inflammatory medications prior to surgery, medical management of blood thinners, anticoagulants, and bleeding disorders

Appropriate medical or surgical management

Light bleeding or spotting of the guaze is expected up to 24 hours after surgery - profuse bleeding from the tooth extraction socket requires immediate attention

Dry Socket

Smoking, age over 30, early loss of blood clot from tooth extraction socket following surgery

No smoking or sucking through straws following surgery, early evaluation of wisdom teeth

Medication applied to socket in office will relieve symptoms

Occurs 5 - 7 days following surgery - resolves after application of medication to tooth extraction socket - may take several applications

Bruising

Use of non-steroidal anti-inflammatory medications such as aspirin and ibuprofen, blood thinners and anticoagulants, bleeding tendencies, thin and delicate skin, prolonged and difficult surgery

Avoid non-steroidal anti-inflammatory medications prior to surgery, medical management of blood thinners, anticoagulants, and bleeding disorders

Warm moist compresses to the face and head elevation

Resolves within 2 - 3 weeks

Infection

Preexisting infection, smoking, diabetes, immunocompromised states 

Smoking cessation, stabilization of medical condition, antibiotic therapy

Appropriate surgical management and antibiotic therapy

Resolution after three to ten days

Numbness to Lower Jaw, Lip and Chin

Roots of lower wisdom tooth overlap or wrap around the nerve of the lower jaw (inferior alveolar nerve), presence of pathology or infection that involves the nerve of the lower jaw

Early evaluation of wisdom teeth before roots fully develop and before infection or pathology develop

Observation if there is  low suspicion of direct nerve injury - surgical exploration or nerve repair may be necessary in cases of partial or complete nerve injury

Resolution of symptoms depends on the degree of injury to the nerve - condition may be temporary or permanent

Sinus exposure

The roots of upper wisdom teeth are typically located very close to the maxillary sinuses.

None

Appropriate surgical management.

The opening will normally close without treatment if the opening persists additional surgery would be necessary to permanently close the opening.

Bone Splinters

Bone splinters or bony sequestrae are common occurrences following tooth removal - a thin shell of bone often surrounds a tooth and a small piece of that shell may die off and work its way out of the gum tissue following tooth removal 

None

Removal of bone splinter if it becomes infected or irritating

May occur days to weeks after tooth removal - resolved once bone splinter is removed or falls out on its own

Jaw Fracture

Thin jaw, presence of significant bony destruction due to infection or pathology, abnormally large wisdom tooth

Early evaluation of wisdom teeth, avoid potential trauma to the jaw (i.e. contact sports) and avoid hard or chewy foods for 3 weeks following wisdom tooth removal

Appropriate surgical management

6 - 8 weeks for jaw fracture to heal