Extractions

Extractions are a very serious business for all dentists, human and veterinarian. More can go wrong with this procedure than almost all other dental treatments combined. In dogs and cats, one needs to be aware of a plethora of complications that arise from even simple extractions. This is why we have dentistry as a specialty in veterinary medicine just like dentistry is a specialty area for human medicine.

Complications prior to extractions:

• Proper diagnosis of what the actual problem really is. Is it just a simple extraction or an oronasal fistula or some other draining tract that simply won’t heal after the removal of the offending tooth?
• Are there blood work abnormalities that are contra-indications for general anesthesia? Is the pet diabetic?
• Is the tooth periodontally involved or is there a long term cyst formation at the apex of the tooth?
• Will this extraction damage adjacent structures such as nerves, blood vessels, bone, or sinuses? On the maxilla, sinus perforations are a real danger and on the lower jaw, you have the mandibular canal which innervates the entire jaw. Damage it and your pet never feels his lower jaw again.
• Is there infection, cancer, chronic non healing ulcerations, or any other auto immune deficiency present that would prevent proper healing?
• Any root structure issue present such as bulbous roots, curves roots or roots that stick up into the sinuses or down into the mandibular canal?

As you can see, there is a myriad of issues that your vet might not be familiar with before you even get started. A veterinary dentist and your human dentist or oral surgeon look at all these issues very closely before extracting any teeth!

Complications during extractions:

• The most common is root fracture. Roots on teeth can be very fragile. Any wrong or excessive force can easily break root tips which are then challenging to remove. A root tip left in place can create ongoing problems if not removed. Chronic infection, bone destruction, cyst formation and a perpetual drainage tract are just a few of the problems caused by retained infected root tips. As a dentist with over 28 years of experience, removal of broken root tips are one’s worst nightmare. It is not uncommon for Dr. Bloom and I to spend upwards of two hours, using every tool in our arsenal and 28 years of experience retrieving root tips. I have already outlined the problems if left in place, lets look at the problems of removal.
• It is easy to push a root tip into the sinuses or worse yet, into the mandibular canal.
• The delicate removal of surrounding bone has to be done to get the proper instrumentation into a boney socket for root tip retrieval. There are very few veterinarians with this kind of training unless they are specialists in dentistry or have done a multi year residency program in dental procedures.
• Cutting of a nerve or artery. Very common and very easy to do on lower premolars.
• Bone necrosis due to heat, inappropriate or aggressive cutting, inadvertent fracture of the alveolar plate, etc.
• Damage to adjacent teeth from elevators or drill bits.
• Root tip fracture and retrieval complications.
• Excessive bleeding.
• Dry socket or non healing wounds.
• Oronasal fistula (a communication or hole between the mouth and the sinuses).
• Jaw fractures…these are very common when extraction protocols are violated.

Finally, post op complications:

• Non healing sockets
• Non closure of oronasal fistulas
• Damaged adjacent teeth becoming non-vital (dead)
• Excessive bleeding
• Nerve damage
• Infection, swelling and even death
• Non union of bone following a mandibular fracture or a cortical plate fracture

This is why we take extractions so very seriously. They are fraught with pre-op, op and post op problems that even the dental specialist, with extensive post graduate training, finds challenging to handle.

Dr. Ken Karger, DDS
Dr. Bonnie Bloom, DVM, Fellow in the Academy of Veterinary Dentistry