Dentaltown December 2017 - 40
message board
Severe Submandibular Space
Infection Post-Extractions
A Townie initiates discussion about the role of postoperative antibiotics
in extractions, and the legal implications of their use
extr
Member Since: 12/06/12
Post: 1 of 88
Patient is a healthy 37-year-old woman. Smoker. Came in with pain on LR side pointing to
#27, 28, and 31 root tips. Extractions were done Aug. 2. X-rays looked like this:
Patient came back Aug. 5 with severe swelling on the submandibular area extending past
the midline and trismus. Swelling was soft on touching. It was a Saturday, so sent the patient to
the ER for draining the abscess. ER took CT scan and said there was nothing to drain; it was
cellulitis. They gave her IV antibiotics and released her. No improvement until today. Patient
came back today (eight days after extraction) with swelling looking worse and trismus worse,
and the swelling is hard as a rock. Spoke to oral surgeon and sent her to him and he will be
getting her admitted to OR tomorrow to put drains. Today patient looked like this.
This is the first time I've had a complication this bad after some simple root tips extractions.
How would you have handled this case differently? Looks like #30 root tip is under her gums
that I didn't extract but don't think that would be causing this. ■
8/10/2017
davidpalmer
Member Since: 04/14/00
Post: 7 of 88
extr
Member Since: 12/06/12
Post: 8 of 88
Did you prescribe antibiotics after the extractions? ■
8/25/2017
No, not on the day of extractions. She didn't have any swelling or any other indications for
antibiotics on day of extraction; I prescribed her some on the first day when she came back with
swelling, which was three days later. ■
8/26/2017
Flyfishindoc
Member Since: 04/06/04
Post: 9 of 88
Am I reading your OP correctly that you left one of the root tips? If that's the case, then
there is your problem. ■
8/26/2017
davidpalmer
Member Since: 04/14/00
Post: 10 of 88
40
OK. So, by the book you did nothing wrong. We were taught, that in the absence of an active
infection, that antibiotics post-extraction are not indicated. But, when extracting necrotic root
tips, this can and does happen obviously. ■
DECEMBER 2017 // dentaltown.com
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