COMPLICATIONS IN THIRD MOLAR EXTRACTION : MAIN APPROACHES

1. University Center North Paulista (Unorp) Dental School São José do Rio Preto – SP, Brazil. 2. Post Graduate and Continuing Education (Unipos), Department of scientific production, Street Ipiranga, 3460, São José do Rio Preto SP, Brazil. ...................................................................................................................... Manuscript Info Abstract ......................... ........................................................................ Manuscript History Received: 11 September 2018 Final Accepted: 13 October 2018 Published: November 2018


…………………………………………………………………………………………………….... Introduction:-
Third molar surgery is the most common procedure performed by bucomaxillofacial dental surgeons or by professionals without specific specialization [1]. These procedures can cause complications may be linked to the age of the patient as the tooth presents itself in the cavity; lack of anatomical knowledge are some factors that feed the probability of a more serious complication, regardless of the correct complication and prevent it before it happens, being able to be prevented with the control of the operative field, not exaggerating with the applied force, anxiety control of the patient ie once it is identified and must be effectively treated [1].
Thus, the complications that will be mentioned in this work are more focused on the extraction of third molars, but it may occur in extractions in general, once the extraction is indicated and a radiographic clinical examination is indispensable and some cases tomographic exams complementary tests such as blood, for we have an overview of the patient and in what state he presents himself, so that we can close the specific case for the individual [2].
In most cases of complications are associated with the position in which the dental element presents in the buccal cavity [1,2]. Teeth that present as non-erupted do not appear in the oral cavity and are called impacted inclusions are more likely to occur complications [2].

ISSN: 2320-5407
Int. J. Adv. Res. 6(11), 831-835 832 Therefore, the present work had the objective to present the main approaches on the possible complications in the third molar extraction.

Study design
Following the criteria of literary search with the use of the Mesh Terms that were cited in the item below on "Search strategies", a total of 36 papers that were submitted to the eligibility analysis were collated and, after that, 27 studies were selected.

B. Screening
Full-text articles excluded, with reasons (n =0) Full-text articles assessed for eligibility (n = 27)

C. Eligibility
Studies included in qualitative synthesis (n =27)

Search Strategy and Sources of Information
In general, as an example, the search strategy in MEDLINE / Pubmed, Web Of Science, ScienceDirect Journals (Elsevier), Scopus (Elsevier), OneFile (Gale) followed the following steps: -search for mesh terms: Third Molar. Extraction. Complications. Treatments., and use of the bouleanos "and" between mesh terms and "or" among historical findings.

Literature review
The complications that we have in the extraction surgery, which are what we expect to happen are the pain, edema, and tremor despite short duration and a source of discomfort for the patient also to those in which are not more severe complications like excessive bleeding and alveolar fractures [1].
After removal, the pain reaches its peak in the first 12 hours, when the anesthetic effect extinguishes, causing great stress and suffering to the patients and their surroundings [2][3][4][5]. The interpretation of the physical and chemical aspects of the noxious style and interaction of it with individual aspects such as mood, pain and a complex multifactorial phenomenon and difficult to be evaluated, in relation to the edemas can be cited that the factors contribute to this sequel is related to the inflammatory process initiated by the surgical act and has its maximum peak at 48 to 72 hours after the surgical act, to decrease the edema the patient should be advised, at the end of the surgical procedure to make compresses with ice packs on the area to help decrease increase the volume and remove discomfort from it [6][7][8][9][10].
However, for the prevention of postoperative edema, no measure is made as to the use of drugs aimed at combating inflammation [11,12]. Therefore, the use of spheroidal anti-inflammatory drugs in the preoperative period together with non-spheroidal anti-inflammatory drugs reduces facial pain and limited mouth opening [13].
Further, trismo is also known as a common complication that is reported by patients who have undergone surgical extraction [14]. Described as muscular pain, due to a myofascial spasm that injures muscle fibers, multiple local anesthetics can cause tourism, especially if it penetrates the masticatory muscle, tourism occurs in more than 50% of the removals of 3º molar in the period of two days after the surgery, having its relevant reduction in 2 days [15][16][17].
To avoid this inconvenience, less traumatic removals with decreased surgical time may help to resolve tourism or its volume increase, this is because a moist surface transfers lower temperature to the skin, can also be used in the preoperative and anti-corticosteroids non-spheroidal inflammations postoperatively [18][19][20].
There is a large difference between bleeding and bleeding, bleeding occurs any surgical intervention, but in cases where bleeding becomes excessive in which blood does not coagulate and hemostasis does not occur naturally and the patient is at risk of death in extreme cases [21]. ]. It is important to prevent excessive blood leakage both for the patient's well-being and for a decrease in the visibility of the operative process, an increase in the edges of the wounds that enhances the development of an infection [22][23][24].
In the literature some treatments that can be used in the control and treatments of hemorrhages such as fibrin sponge, oxidized cellulose, gelatin sponge, compression on top of the region to avoid all this disorder the ideal and do a preoperative to have the knowledge of the dipsomania of each patient [24,25].
The general hemostatic medication: it is a valuable complement of local methods, in many cases, it becomes indispensable [26]. It is constituted by drugs that act in the coagulation, activating or correcting factors that promote it, or by agents that act on the vessels [26].
The great decrease of blood causes a decrease in tension, resulting in a circulatory deficiency in the tissues. The importance of compensation is to quickly restore the normal volume of mass in large blood loss. The Isotonic solution or Dextrose may be indicated [27]. In emergencies, blood plasma transfusions are now being used because they can be easily administered anywhere, either in hospitals, offices or in the patient's own home. After the emergency period has passed, blood transfusions can be administered later, when necessary [27].
The alveolar bone presents clinically through an exposed alveolus with a defective or totally absent coagulation, with exposed bone walls, it presents itself in two ways to dry violet, moist or suppurative violet [2]. The dry violet and the most stubborn and unpleasant complication erected by intense and prolonged pains and can last up to 15 834 days, in this case, observed an alveolus exposed without any clot formation with exposure of alveolar bone, with bone walls without any protection and with a white-ivory coloring [2].
Although not very frequent, the complications of removal would be more complex, such as severe high-cost hospital and medication costs and some with irreversible sequelae, some cases requiring the intervention of a maxillofacial surgeon, making it possible to hospitalize, some of which are fractures of maxilla and mandible, infections, nerve damage, tooth dislocations, these are the complications described in the literature [2,3].
Also, nerve injuries can be caused during any surgery to extract any dental element, not only in the third molars, the lesions so many in the upper and lower nerves have their different severities. The most important and complex accidents are those of the inferior and lingual alveolar nerve, due to the proximity of the nerves between the roots of the third molars, the paresthesias are alterations of sensibility that can with direct or indirect traumas like incisions to the nerves by lack of knowledge anatomical, compression and edema [2][3][4].
To avoid this disorder the anatomical and essential knowledge to prevent the occurrence of the same, the pair parrhesia presents with the following symptoms, sensation in the region sensation of numbness, tingling and in some cases itching [1,2]. The common lesions are in restored teeth, with great concentration of caries and dislocation of the neighboring tooth, these lesions occur when a very great force is used on the elevators on the surrounding teeth and its roots if diagnosed it must inform the patient and do the procedure soon after surgery [2].

Conclusion:-
To avoid such complications should be made a very well detailed planning with a vast anatomical knowledge of the professional and bear in mind that the larger and more complex surgical techniques will be the greater the chances of complications during and after the surgical act have a proper postoperative to each procedure in which it was submitted to all these complications among others can be avoided with a good postoperative.