Complications after a dental procedure include swelling and pain, dry socket, osteomyelitis, bleeding, and osteonecrosis of the jaw.

Swelling and pain: Swelling is common after certain dental procedures, particularly tooth removal (extraction) and periodontal surgery. Holding an ice pack—or better yet, a plastic bag of frozen peas or corn (which adapts to facial contours)—to the cheek can prevent much of the swelling. Ice therapy can be used for the first 18 hours. Cold should be held on the cheek for 25-minute periods and then removed for 5-minute periods. If swelling persists or increases after 3 days or if pain is severe, an infection may have developed, and the person should contact the dentist.

Pain after a dental procedure can be moderate to severe. People can take various pain relievers (see Urgent Dental Problems: ).

Dry socket: A dry socket (exposure of the bone in the socket, causing delayed healing) may develop after a lower back tooth has been extracted and the normal blood clot in the socket is lost. Typically, discomfort lessens for 2 or 3 days after the extraction and then suddenly worsens, sometimes accompanied by an earache. Although the condition goes away by itself after 1 to 2 weeks, a dentist can place a dressing soaked with an anesthetic in the socket to eliminate the pain. The dentist replaces the dressing every 1 to 3 days until no more pain is felt after the gauze has been left out for a few hours.

Dry sockets are much more common among smokers. If at all possible, smokers should not smoke for several days before and after the extraction is done. Women also have a slightly higher rate of developing dry socket.

Osteomyelitis: Osteomyelitis is an infection of the bone and is usually caused by bacteria. When osteomyelitis occurs in the mouth, it typically occurs as an infection of the lower jaw. People usually have a fever, and the affected area is tender and swollen. Doctors or dentists use an x-ray to make the diagnosis. People with osteomyelitis need to take antibiotics for an extended period of time.

Bleeding: Bleeding after a tooth is removed is common. Bleeding in the mouth may appear worse than it is because a small amount of blood may mix with saliva and appear to be more blood than is actually present. Usually, the bleeding can be stopped by keeping steady pressure on the surgical site for the first hour, normally by having the person bite down on a piece of gauze. People may have to repeat the process 2 or 3 times. Keeping the gauze (or a tea bag) steadily in place for at least an hour is important. Most problems with bleeding occur because the person frequently removes the pack to see whether the bleeding has stopped. If bleeding continues for more than a few hours, the dentist should be notified. The dentist may need to clean out the bleeding area and surgically close it with stitches (sutures).

People who regularly take an anticoagulant (a drug that prevents clots) such as warfarinSome Trade Names
COUMADIN
or aspirinSome Trade Names
BAYER
(even if they take only one aspirinSome Trade Names
BAYER
every few days) should mention it to the dentist a week before surgery because these drugs increase the tendency to bleed. The dentist and the person's doctor may adjust the drug dosage or temporarily stop the drug a few days before surgery.

Osteonecrosis of the jaw: Osteonecrosis of the jaw (see Osteonecrosis: Osteonecrosis of the Jaw) is a disorder that involves exposure of the jaw bone through the gum tissue. The disorder usually causes pain, loosening of teeth, and a discharge of pus. The disorder may occur after

• Tooth extraction
• An injury
• Radiation therapy to the head and neck (osteoradionecrosis)

Osteonecrosis of the jaw may occur spontaneously. This disorder has developed in some people who were given drugs that decrease bone reabsorption (often used to treat osteoporosis). The most common of these drugs are bisphosphonates. Bisphosphonates seem to have a higher risk of causing osteonecrosis of the jaw in people who undergo oral surgery while taking bisphosphonates, who have previously been given high doses of bisphosphonates by vein (common with certain cancer treatments), or who have been taking bisphosphonates for a long period of time. The risk of developing osteonecrosis of the jaw is much lower, about 1 in 1,000, in people who are given bisphosphonates in standard doses for osteoporosis.

Treatment typically involves scraping away some of the damaged bone (debridement), taking antibiotics by mouth, and using antibacterial mouth rinses.

Last full review/revision December 2012 by David F. Murchison, DDS, MMS