ASK THE DENTIST
THURSDAY, NOVEMBER 19, 2009.

Dear Dr. Mady: My 18 year old daughter recently had a couple of wisdom teeth removed and the surgery was fairly uneventful without any complications. Anytime she has any kind of surgery she seems to get infection. About two days later she started to swell quickly and her face became red and hot. She smokes but told me she did not smoke after the teeth were extracted. I took her back to our dentist and he advised us to go to the emergency room at the local hospital immediately for I.V. antibiotics and an evaluation because he said if the swelling increases it could block her airway and be life threatening. He also said oral antibiotics would not work quickly enough. I did take her to emergency and a cat scan revealed a pocket of pus and in addition to antibiotics, she was sedated and had the pus surgically drained. I am relieved that she will be alright, but is this common and what could have been done to avoid it? Sandra in Tecumseh

Dear Sandra, Like with any oral surgery, post-surgical infection is always a possible complication that can arise. No one can determine whether or not it will happen, especially in young healthy individuals. The possibility of infection is greater however with those who have systemic diseases, other health problems or people that already have a compromised immune system. In addition, smokers who smoke within a few days after oral surgery increase their chances for post-operative problems considerably.
            Most dentists do not routinely prescribe antibiotics after every tooth extraction, especially if there are no major health issues present. The reason for this is because when antibiotics are taken too often it can possibly create an unhealthy situation. Antibiotics do not aid the immune system as much as they replace some of its function, inhibit certain enzymatic processes of bacteria, and alter essential mineral balances. Another reason overuse of antibiotics weakens the immune system is because normal cells are also affected by antibiotic use. Other toxic effects of antibiotics, such as their effects on normal bowel flora, may also contribute to a weaker immune system.
            If an abscess does occur and grow, it can lead to a dangerous life threatening situation. Abscesses in the maxilla (upper jaw) can lead to things like brain infection and in the lower jaw can lead to a blocked airway if not managed quickly enough. These infections, if advanced far enough, must be treated immediately with the administration of high dose intravenous antibiotics. Even this alone is sometimes not enough as in your daughter’s case. Most likely a lack of surgical intervention would have allowed the acute spreading of this infection to progress into a life threatening situation.
            If this happens, the first treatment after antibiotic administration is airway management prior to the draining of the pus. If the swelling has not increased to a state where the tongue is pushing on the roof of the mouth, then an endotracheal tube can be placed to help manage the airway during surgical drainage. If this can not be achieved, then there is a possibility that a tracheotomy will have to be performed. Also if the mouth can not be opened enough for the oral surgeon to drain the pus through the inside of the mouth, then on occasion the drain will have to be placed extra-orally or on the outside of the face or neck. The only downfall to a tracheotomy and an external drain is that a small scar may remain after healing. This however would be a small price to pay if the abscess could have ended up fatal if left untreated.
            The incidence of fatalities from these situations is low due to the proper use of antibiotics and prompt intervention by proper health professionals. Without proper management of odontogenic infections complications such as facial cellulitis, mediastinitis, brain abscess, septicemia and thromboembolism could result. With respect to avoiding this from happening, any oral surgery patient should follow all post-operative instructions given and if you think there is a problem with getting infections easily or a medical problem that could weaken your immune system, advise your dentist or oral surgeon prior to the procedure. Other than that, these situations do occur and can be dealt with by following the proper channels and it sound like you did exactly that. You should be proud of yourself for being a loving parent and not ignoring the situation and acting fast to get advice and treatment.

            Any questions for Dr. Mady can be e-mailed to drmady@drmady.com and also visit his blog at www.dentalden.com (dental education network)
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This column is reprinted with the permission of the author and The Windsor Star. "Ask the Dentist" is written by Windsor dentist (and ECDS member), Dr. David Mady Jr.. The column appears the first Thursday of each month in the Windsor Star. Readers with questions can write to "Ask The Dentist", c/o The Windsor Star, 167 Ferry St., Windsor Ontario, N9A 4M5

 
     


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