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.
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).