Wisdom tooth extraction, although a common dental procedure, can sometimes lead to unexpected complications, including tooth displacement, foreign body retention, and jaw pain.
Displacement of Wisdom Teeth and Tooth Fragments
In some cases, a wisdom tooth or a fragment may become dislodged during extraction and migrate to an unusual location within the body. For example, a 27-year-old patient underwent the removal of a lower left wisdom tooth in the U.S., but the extraction was incomplete. A few months later, he visited an oral and maxillofacial surgeon in the U.K., experiencing pain and restricted jaw movement. A CT scan revealed that the wisdom tooth fragment had lodged in the tonsillar soft tissue and medial pterygoid space. The fragment was successfully removed under general anesthesia.
Similarly, a 23-year-old patient had a partially impacted lower left wisdom tooth extracted under local anesthesia. However, during the procedure, the patient experienced a gag reflex, causing the tooth to be accidentally aspirated. A chest X-ray and CT scan later confirmed that the tooth had entered the right bronchus, a part of the respiratory tract. Bronchoscopy was performed under general anesthesia to successfully retrieve the wisdom tooth.
Another case involved a 20-year-old patient who had all four impacted wisdom teeth removed under sedation with nitrous oxide, diazepam, and meperidine. During the extraction, one of the teeth was accidentally dislodged and aspirated into the respiratory tract. A thoracic X-ray confirmed its presence in the right bronchus, and a bronchoscopy was performed to retrieve it.
Foreign Body Retention During Wisdom Tooth Extraction
Dental instruments, such as elevator blades, burs, or anesthesia needles, can sometimes fracture and remain embedded in the oral tissues or respiratory tract. In one case, a 35-year-old woman underwent lower right wisdom tooth extraction and later developed difficulty opening her mouth, swelling, and pain. A panoramic X-ray revealed that a fragment of the wisdom tooth and a foreign object were left in the socket. A CT scan confirmed that a 20-mm broken dental bur had migrated to the submandibular region, requiring surgical removal.
In another instance, a woman in Texas had her molars extracted but later discovered that a broken drill bit had remained embedded in her mouth for several years. The dentist had failed to inform her about the missing fragment, and it was only identified after persistent discomfort.
Needle fractures are another risk associated with local anesthesia administration. A 21-year-old patient undergoing wisdom tooth extraction had a 27-gauge needle break inside his mouth during an injection. A CT scan helped locate the fragment, and it was surgically removed under general anesthesia. In a similar case, a 20-year-old woman had a 30-gauge needle break at the hub during an anesthetic injection. Several attempts to retrieve the needle surgically were unsuccessful. She later filed a lawsuit against the dentist, but the court ruled that the dentist was not negligent.
To minimize the risk of needle fractures, dentists should avoid using 30-gauge needles for inferior alveolar nerve blocks, refrain from bending the needle before injection, and prevent deep insertion of the needle into soft tissues. If a needle breaks, antibiotics should be prescribed, radiographs should be taken to determine its location, and surgical removal should be performed under general anesthesia if necessary.
Wisdom Tooth Displacement and Jaw Pain
One of the most common complications following wisdom tooth extraction is jaw pain, particularly if the wisdom tooth was impacted or if the surrounding structures were affected during surgery. In some cases, jaw pain may result from nerve irritation, muscle strain, or infection at the extraction site.
A displaced maxillary wisdom tooth can sometimes migrate into deeper spaces, such as the pterygomandibular space or infratemporal fossa, leading to chronic pain and infection. These cases can be particularly challenging to manage and may require advanced imaging and surgical intervention.
Additionally, foreign body reactions can occur if small fragments of tooth, bone, or surgical materials remain in the extraction site. This can trigger granulomatous inflammation, where the immune system reacts to the retained material, causing persistent swelling, discomfort, and infection.
In rare instances, retained gauze or packing materials can also lead to sinus infections. One case involved a patient who experienced severe maxillary sinusitis and vision impairment after undetected surgical gauze remained lodged in the sinus following wisdom tooth extraction. Despite multiple sinus surgeries, the patient continued to suffer from recurrent infections and chronic pain.
Wisdom tooth extractions, though routine, can sometimes result in serious complications, including jaw pain, foreign body retention, and tooth displacement. Proper surgical technique, careful handling of dental instruments, and thorough post-operative evaluations are crucial to minimizing risks. Patients experiencing persistent pain, swelling, or difficulty opening their mouths after wisdom tooth removal should seek prompt evaluation to rule out underlying complications.
