How Do I Manage a Mandible Fracture During Extraction?

JCDA

Published by the Canadian Dental Association

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Cite this as: j can dent assoc 2013;79:d27

Date

February 14, 2013

Topics

diagnosis

treatment

Body

Mandible fracture during extraction

• Sudden, intra-operative fracture of mandibular bone

Presentation

Population

• Males and patients over age 30

Risk Factors

• Dental anatomy characteristics or anomalies: long or bulbous roots, hypercementosis, and multi-rooted teeth
• Pathoses: cysts, ankylosis, osteoporosis, and alveolar atrophy or, conversely, very dense bone
• Elevator use, particularly large elevators and elevators used as levers, rather than in a rotary fashion
• Impacted teeth requiring bone removal, particularly those that extend to the inferior border of the mandible

Common Sites of Occurrence

• Vertically impacted third molars, close to the inferior border of the mandible, but can occur with other molars (See Figs. 1 and 2).

Signs

• Crunch or loud crack of bone breaking
• Sudden loosening of the tooth or bone
• Bone comes away with tooth during extraction
• Observable malocclusion, opening of the bite, separation of teeth, or step defect
• Radiographic evidence of fracture which may be subtle, non-displaced, or greenstick

Symptoms

• Patient may complain of sharp pain at the time of fracture or may be completely asymptomatic
• Depending on displacement, the patient may be aware of malocclusion
• If the diagnosis is delayed, the patient may return with a complaint of altered sensation in the lip or chin, worsening malocclusion, persistent swelling, persistent pain, or signs of infection (fever, chills, or malaise)

Investigation

Confirm clinical suspicion of fracture and assess displacement

• Gently, with minimal force and movement, assess the degree of mobility across the suspected fracture site.
• Have the patient close into occlusion to assess changes in occlusal pattern.
• Obtain radiographic evidence of fracture with periapical or panoramic radiographs.
• Unless the diagnosis is delayed, assessment of altered sensation in the lip and chin will be masked by local anesthesia.

Diagnosis

1. Confirmed mobility of fracture fragments
2. Malocclusion
3. Radiographic evidence of fracture
4. State the displacement of the fracture fragments (none, minimal, moderate, or severe)

Treatment

If possible, the patient should be immediately referred to an oral and maxillofacial surgeon for the management of the mandibular fracture.

1. If the fracture is non-displaced: observation and soft diet may be all that is required.

   If the fracture is displaced or unfavourable:

   • open reduction with plate and screw fixation; or
   • maxillomandibular fixation with arch bars or attachment devices using wires or elastic traction
2. Advise patient about possible malocclusion, loss of vitality for teeth adjacent to the fracture, infection (including osteomyelitis), and paresthesia.
3. Advise patients with difficult extractions to return in 1 week as the majority of fractures associated with extractions are diagnosed either immediately or in the first postoperative week.

Figure 1: 52-year-old male with pericoronitis associated with a deeply impacted tooth 38.

Figure 2: 48-year-old female with bone loss due to pericoronitis around a deeply impacted, carious tooth 38.

THE AUTHOR

The author has no declared financial interests.

This article has been peer reviewed.

Suggested Resources:

• Hupp JR. Prevention and management of surgical complications. In: Hupp JR, Ellis E, Tucker MR, editors. Contemporary oral and maxillofacial surgery. 5th ed. St. Louis (MO): Mosby; 2008. p. 185-200.
• Wagner KW, Otten JE, Schoen R, Schmelzeisen R. Pathological mandibular fractures following third molar removal. Int J Oral Maxillofac Surg. 2005;34(7):722-6.
• Iizuka T, Tanner S, Berthold H. Mandibular fractures following third molar extraction. A retrospective clinical and radiological study. Int J Oral Maxillofac Surg. 1997;26(5):338-43.

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My Jaw Was Fractured During a Dental Procedure

The short answer is yes, though it should be remembered that you can pretty much sue for any medical or dental injury, but that doesn’t mean you’ll win. Still, if a skilled dental malpractice attorney like Lance Ehrenberg, Esq. of Dental & Podiatry Malpractice Lawyers of New York agrees to take your case, you may have a distinct edge. 

He has decades of successful litigation experience in this particular field of law so he has a strong sense of when compensatory damages are worth fighting for. Nonetheless, verdicts are never guaranteed. Fortunately for you, you will pay nothing for his services until he wins your case.

Jaw Fractures as a Result of Dental Negligence Are Not Uncommon

While the most gruesome dental fractures are typically the result of car accidents, violent assaults, and sports or industrial accidents, dental fractures may also occur when dentists do not take necessary care when performing tooth extractions, dental implant surgeries or other dental procedures. 

A jaw fracture involves a crack or break in the mandible, the large major bone of the lower face.

Like other fractures, jaw fractures can range from mild to severe. Without careful adherence to dental techniques designed to prevent harm to the surrounding bone and tissues, a dentist may put the patient in jeopardy. Incorrect positioning during bone grafting or inserting dental implants can result in an excruciating and disabling jaw fracture. 

If your dentist’s negligence is evident in his or her failure to adhere to reasonable measures a dental professional is expected to follow, and that failure resulted in your jaw fracture, you are well within your rights to seek legal compensation. Lance Ehrenberg will examine pertinent dental and medical records thoroughly, interview any witnesses to the incident, and seek expert testimony that will bolster your case.

What are the symptoms of a broken jaw?

Depending on the nature and severity of the jaw fracture, patients may experience some or all of the following:

• Pain in the face or jaw that worsens with movement
• Numbness of the face, especially the lower lip
• Ear pain on the affected side
• Bruising and swelling of the face, bleeding from the mouth
• Difficulty chewing and/or talking
• Jaw stiffness, difficulty opening or closing the mouth 
• Asymmetrical jaw movement when opening the mouth
• Jaw tenderness or pain, exacerbated by biting or chewing
• Loose or damaged teeth
• Abnormal appearance of cheek or jaw

Jaw fractures require urgent medical attention since they may result in life-threatening complications, such as obstructed breathing, heavy bleeding, aspiration of food into the lungs, and serious infection.

How are fractured jaws treated?

The treatment required for a fractured jaw depends on the severity of the break. Minor fractures may heal on their own, but the patient will still need pain medication and will undoubtedly have to stay on a diet of liquids and very soft food until the jaw is fully healed.

Moderate or severe jaw fractures require surgery during which jaw wires are attached to the teeth of the opposite jaw to ensure stability during healing. These wires are left in place for 6 to 8 weeks, while small elastic bands hold the teeth together. Gradually elastic bands are removed so the patient can begin to exercise the jaw and reduce joint stiffness. As you would expect, the surgery and apparatus are painful, uncomfortable, and extremely intrusive on the patient’s daily routine. Sometimes, surgery to install a plate and screws is required.

Why You Need an Experienced Dental Malpractice Attorney to Recover Damages

Dental malpractice is difficult to prove so you need the services our practice will provide to give yourself the best possible chance of receiving the compensation you are entitled to for:

• Uncovered medical, dental, and rehabilitation costs
• Lost income, present and future
• Pain and suffering
• Loss of enjoyment of life

Although most patients heal completely from jaw fractures, some are left with TMJ (temporomandibular joint disorder) which may cause long-term pain and dysfunction. The dentist whose negligence led to this end result is liable for such aftereffects of the jaw fracture as well. Contact us soon to receive the excellent legal representation you deserve.

Features of the removal of a broken tooth – Tekhno-Dent Dentistry

Find:

1. Features of the procedure for removing a broken tooth

2. Cases where surgery is necessary

A broken tooth is a common occurrence in dentistry. Patients are always at risk of getting a crack / chip or complete fracture of the tooth with a strong physical impact, and if too thin enamel is present, then damage cannot be avoided. What to do in this case? Firstly, professional help is required – only the dentist will determine the method of treatment. Secondly, doctors in some cases can restore the integrity of the tooth. Thirdly, if a crack or chip has touched the root, then the removal of a broken tooth will be required.

Features of this procedure:

1. Special tool required. This is due to the fact that dentists will not be able to catch on the visible part of the “object” with ordinary forceps – they will need to move the gum to find a whole surface for work.
2. The procedure is performed under anesthesia. Please note : if the tooth was previously depulped (nerves removed), then broken, and especially crumbled, it is removed without problems and without anesthesia. But usually a patient comes to the dentist not only with complaints about a broken tooth, but also with severe pain. In this state, removal without anesthesia is contraindicated – the patient must be calm, otherwise the banal manipulation will develop into a hypertensive crisis, fainting and other unpleasant situations.
3. Careful inspection of the hole. If the dentist does not examine the hole, then the patient will have to remove fragments of the tooth in the future – it is in the cases under consideration that this most often happens. What do the fragments left in the hole lead to? Trite – to inflammatory processes, abscesses, but there are cases of the spread of pathology to bone tissue, and such a condition will require the services of plastic surgeons.

If the tooth is broken at the root, or there are too many fragments, and its visible part is very low in relation to the gum, then the dentist may resort to minor surgery. If it is impossible to work with forceps, the doctor makes an incision along the gum, exposes the tooth, and only then performs a full extraction. Please note : any manipulations related to the incision of the gums are carried out only under local anesthesia.

The dentist must make every effort to preserve the natural tooth – extraction and subsequent implantation are not a panacea. If the root remains intact, then the visible part can be restored, but endodontic treatment of the teeth (cleaning / filling of the canals) must be carried out.

After the extraction procedure, the patient should rinse the mouth every hour with a solution of baking soda or sage decoction, avoid eating hot / cold foods, and visit the dentist after 3-4 days – monitoring the healing process of the wound surface is necessary until complete recovery.

Removal of a broken tooth or broken off part of a tooth

Broken tooth is a fairly common event in dentistry. Any person is threatened with a crack or a chip, up to a complete fracture of the tooth with a powerful physical impact. And in combination with a thin layer of enamel, this is practically inevitable. What to do if a tooth is broken? First, you need qualified help, because only a dentist can prescribe the right treatment. Secondly, in certain situations, the dentist can restore the integrity of the tooth. Thirdly, keep in mind that in the case when a crack or chip has affected the root, then removal of a broken tooth .

Features of the extraction of a broken tooth.

A special tool will be needed, since the doctor cannot grasp the visible part of the tooth with ordinary forceps, you will need to move the gum in order to find the whole surface.
Extraction of a broken tooth is performed under anesthesia. At the same time, if the tooth is depulped (i.e., without nerves), then both a broken and crumbled tooth can be removed without anesthesia. However, patients come to the appointment not only with problems with broken tooth but also severe pain. It is obvious that in this case the extraction of a broken tooth can only be carried out under anesthesia, otherwise the simplest movements can turn into a painful shock, up to fainting.
Careful inspection of the hole. In the event that the examination of the hole is not followed, the patient may be threatened with the removal of a fragment of the tooth in the future. This is what happens most often. What threatens the fragments remaining in the hole? The most obvious is inflammation, an abscess, and when the pathology passes to the bone tissue, this threatens the intervention of plastic surgeons.

Peculiarities of removing tooth fragments

When the crown wall is destroyed, the remaining root is removed with a special tool. The dentist, through a surgical operation, removes the affected tissue, relieving inflammation. Such an operation is complicated by the fact that the fragments of the tooth may not be strong and collapse during the procedure. Therefore, the dentist takes an x-ray in advance, which allows assessing the condition of the root, its location, size, etc. In order to extract tooth fragments, sometimes soft tissue detachment is required. When removing the root, it may also be necessary to excise the gums, as well as the use of local antiseptics.

When a tooth is fractured near the root, or there is a sufficient number of fragments, with the visible part of the tooth low to the gum, then the dentist is likely to undertake minor surgery. If it is impossible to work with forceps, the dentist will make an incision along the gum, expose the tooth, and then perform the extraction of the tooth. In this case, any intervention made with a gum incision is carried out only under local anesthesia.