Fractured Upper / Lower Jaw secondary to Tooth Removal
Incidence: 2 - 4% (including alveolar and lingual plate fractures, so the incidence of actual fractures of the upper and lower jaws is likely to be
much less.  Some studies have cited 0.0049% and also 0.29%).

This is probably the most feared of all complications following
Minor Oral Surgery and like the majority of them, is largely preventable.  It is a
recognised complication of lower wisdom tooth removal and should be listed as such on a routine consent form.

Fracture of the mandible / lower jaw is a very unpleasant but fortunately rare complication that is associated almost exclusively with the
extraction of impacted lower
wisdom teeth.

The peak incidence is in patients over 25 years of age with a mean of 40 years.  As men have a greater
masticatory (chewing) force, men
are thought more likely to have 'late' fractures (these occur 13 - 21 days post-op).

There are a number of predisposing conditions, such as:

  • use of excessive force with the dental elevator, when an adequate pathway for removal of the impacted tooth has not been created
  • mandibular atrophy (reduced height and width of jaw)
  • deeply impacted tooth
  • a tooth with 'firm anchorage' / bulbous roots / hypercementosis (increased thickness of root cement)
  • extensive œdentulous (toothless) regions
  • an ankylosed (fusion of tooth with surrounding bony socket) tooth
  • osteoporosis and
  • the presence of associated pathology such as a cyst (dentigeous cyst) or tumour (ameloblastoma).
The X-Rays show an attempt to remove the LL8 (Lower Left Wisdom Tooth) without any attempt to remove bone around the tooth to
facilitate its removal.
Last Updated 7th October 2016
Useful Articles:

J Oral Maxillofac Surg 2000.  Late Mandibular Fracture After 3rd Molar Surgery.  A Survey of Connecticut Oral & Maxillofacial Surgeons

J Oral Maxillofac Surg 2000.  Mandibular Fracture After 3rd Molar Removal

J Oral Maxillofac Surg 2000.  Discussion.  Mandibular Fracture After 3rd Molar Removal

J Oral Maxillofac Surg 2002.  Immediate & Late Mandibular Fractures After 3rd Molar Removal

J Can Dent Assoc 2004.  The Association of 3rd Molars with Mandibular Angle Fractures. A Meta-Analysis

J Can Dent 2004.  Third molars may double the risk of an angle fracture of the mandible

EBD 2004.  3rd Molars may double the risk of an angle fracture of the mandible

J Oral Maxillofac Surg 2010.  Prevention of Mandibular Fractures Caused by Difficult Surgical Extractions.  Report of a Borderline Case

BJOMS 2011.  Characteristics of Iatrogenic Mandibular Fractures associated with Tooth Removal.  Review & Analysis of 189 cases

BDJ 2012.  Iatrogenic Mandibular Fractures Following Removal of Impacted 3rd Molars.  An Analysis of 130 cases

BDJ 2016.  Letters to the Editor.  Oral Surgery. Mandibular Fracture Risk

Dent Update 2016.  A Pathological Fracture of the Mandible due to Osteomyelitis following a Full Dental Clearance