Upper molar extraction complications

Upper molar extraction is a common dental procedure that involves removing one or more molars located in the upper jaw. However, like any other surgical procedure, it carries some risks and complications that may occur during or after the extraction, due to the location of the tooth root and its proximity to the sinuses and other structures.

Various upper and lower molar extraction complications may occur during the extraction procedure, such as excessive bleeding, injury to surrounding soft tissues, displacement or damage to adjacent teeth, and fracture of the tooth root, maxillary tuberosity (upper jaw) or the mandible (in lower jaw)

Complications that may arise after the extraction include swelling, pain, prolonged bleeding, trismus (TMJ), dry socket, infection and sensory alterations of the inferior alveolar nerve (IAN) or lingual nerve (LN) – nerve damage in the lower jaw.

Some potential complications of upper molar extraction include:

upper molar extraction complications

1. Sinus perforation

Sinus perforation is a condition that occurs when the sinus membrane is accidentally perforated during an upper molar extraction. This may happen due to the proximity of the upper molars to the maxillary sinuses, which are air-filled spaces located in the bones of the upper jaw. The sinus membrane is a thin layer of tissue that lines the sinuses, and when punctured, air escapes into the sinus cavity, resulting in discomfort and sometimes infections.

Symptoms of sinus perforation during or after an upper molar extraction may include a sudden increase in nasal discharge, sinus pain or pressure, nasal congestion, and difficulty breathing. In some cases, the patient may also experience bleeding from the nose.

If a sinus perforation occurs during an upper molar extraction, the dentist or oral surgeon will take immediate steps to repair the hole. This may involve suturing the tear or using a bone graft material to fill the gap. The patient will also be prescribed antibiotics and may be advised to avoid blowing their nose or performing any strenuous physical activity for several days after the extraction.

If a sinus perforation is not repaired promptly, it can lead to more serious complications, such as sinus infections, chronic sinusitis, or even the development of a fistula, which is an abnormal connection between the sinus and the mouth.

2. Nerve damage

During an upper molar extraction, the roots of the tooth are close to important nerves, such as the infraorbital nerve and the maxillary nerve. If these nerves than run through the upper jaw get damaged during the extraction, patients may experience temporary or permanent numbness, tingling, or pain in the lips, cheeks, tongue, or gums.

The symptoms of nerve damage may vary depending on the extent and location of the injury. Some patients may experience a burning or shooting pain, while others may feel a loss of sensation or a tingling sensation. In severe cases, the nerve damage may result in permanent loss of feeling or function.

To prevent nerve damage during an upper molar extraction, dentists and oral surgeons take special care to avoid the nerves. They may use advanced imaging techniques, such as CT scans or panoramic X-rays, to map out the location of the nerves and plan the extraction accordingly. In some cases, they may also use special tools or techniques, such as a surgical microscope or nerve monitoring system, to minimize the risk of injury.

If nerve damage occurs during an upper molar extraction, prompt treatment is essential. The dentist or oral surgeon may refer the patient to a specialist, such as a neurologist or a pain management physician, for evaluation and treatment. Treatment options may include medications, physical therapy, or surgery, depending on the severity and location of the nerve damage.

Overall, nerve damage is a rare but serious complication of upper molar extraction. Patients should be aware of the risks and discuss any concerns with their dentist or oral surgeon before the procedure.

3. Maxillary tuberosity (bone) fracture

The roots of upper molars can be curved or positioned in a way that makes them difficult to remove. In some cases, the force required to extract the tooth can result in a fracture of the surrounding bone.

Maxillary tuberosity fracture is a potential complication that can occur during or after an upper molar extraction. The maxillary tuberosity is a bony protrusion on the upper jaw, just behind the last molar. During extraction, excessive force or movement of the tooth can cause the tuberosity to fracture, or it can occur due to weakened bone from previous infection or periodontal disease.

Symptoms of a maxillary tuberosity fracture include severe pain, swelling, and bleeding in the extraction site. Patients may also experience difficulty opening their mouth, as well as pain and clicking sounds in the jaw joint.

Treatment typically involves rest and immobilization of the area. A soft diet is recommended, and patients may be given pain medication or antibiotics to prevent infection. In severe cases, surgery may be required to repair the fracture.

To prevent a maxillary tuberosity fracture, dentists have to take care to apply only the necessary force during extraction and avoid excessive movement of the tooth. Patients with weakened bone or a history of periodontal disease may require additional treatment or monitoring to reduce the risk of complications.

as a complication for upper molar extraction

4. Injury to surrounding soft tissues

During the extraction process, the oral surgeon or dentist may accidentally damage these tissues with their instruments. This can cause bruising, bleeding, swelling, and pain in the affected area.

To prevent injury to surrounding soft tissues, the dentist or oral surgeon will usually take care to place retractors and other devices that help to protect the soft tissues from damage during the procedure.

However, sometimes injury can still occur despite these precautions. In that case, itis important to keep the area clean and follow the dentist or oral surgeon’s instructions for care. This may include rinsing with saltwater, avoiding hard or crunchy foods, and taking pain medication as prescribed.

Most soft tissue injuries will heal on their own within a few days to a week. However, in some cases, more severe injury may require additional treatment such as stitches or medication to manage prolonged pain and inflammation. In rare cases, further intervention may be required to correct damage to the soft tissues.

5. Displacement or damage to adjacent teeth

The roots of upper molars are often located in close proximity to the roots of adjacent teeth, and if not done carefully, the extraction process can cause displacement or damage to these teeth.

Displacement occurs when an adjacent tooth is pushed out of its normal position, which can result in misalignment and bite issues. Damage can range from minor chips or fractures to more severe damage that requires restorative treatment such as a crown or root canal.

To minimize the risk of displacement or damage to adjacent teeth during upper molar extraction, dentists may use specialized tools such as luxators or elevators to gently loosen the tooth and avoid excessive force.

In some cases, a protective barrier may be placed between the tooth being extracted and adjacent teeth to help prevent damage. Additionally, dentists may take x-rays before the extraction to better understand the position of adjacent teeth and plan the procedure accordingly.

If displacement or damage to adjacent teeth occurs during an upper molar extraction, the dentist will assess the extent of the damage and determine the appropriate treatment plan, which may involve restorative procedures such as fillings, crowns, or root canals. In some cases, orthodontic treatment may be necessary to correct misalignment caused by displacement.

6. Infection

Any time the oral tissues are disrupted, there is a risk of infection. In some cases, bacteria can enter the socket where the tooth was removed and cause an infection.

The risk of infection increases if proper post-operative care instructions are not followed or if the patient has an underlying medical condition that affects their immune system. Symptoms of an infection may include fever, swelling, redness, and pain at the extraction site.

To prevent infection, it is essential to keep the extraction site clean and avoid touching it with dirty hands or foreign objects. The dentist may prescribe antibiotics to prevent or treat infection in some cases.

If an infection does occur, you should seek treatment immediately. Treatment typically involves antibiotics and may involve additional procedures such as draining any abscesses that have formed. Delaying treatment can lead to the spread of the infection and further complications.

Final thoughts

It is important to choose an experienced and skilled dentist or oral surgeon to perform an upper molar extraction, and to follow all aftercare instructions carefully to reduce the risks of complications discussed above. Also make sure too report any prolonged pain or other unusual symptoms after tooth extraction to your dentist. They can help identify and treat any complications that may arise.


  • Editorial team

    A team comprising oral health care professionals, researchers, and professional Writers, striving to impart you with the knowledge to improve your oral health, and that of your loved ones. 

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