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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 13  |  Issue : 5  |  Page : 602-607  

Knowledge and awareness of postextraction complications among dental seniors and interns in Riyadh Province


1 Department of Oral and Maxillofacial Surgery, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
2 General Dentist, Ministry of Health, Riyadh, Saudi Arabia
3 Dental Intern, Prince Sattam bin Abdulaziz University, Al-Kharj, Saudi Arabia

Date of Submission01-Nov-2020
Date of Decision19-Nov-2020
Date of Acceptance21-Nov-2020
Date of Web Publication05-Jun-2021

Correspondence Address:
Adel Alenazi
Department of Oral and Maxillofacial Surgery, Prince Sattam Bin Abdulaziz University, Al-Kharj
Saudi Arabia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jpbs.JPBS_721_20

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   Abstract 


Background: Postextraction complications are multifactorial. Taking proper medical and dental history, thorough planning, and a skillful dentist can help the prediction and reduction of these complications. Objective: This study aims to assess and compare the knowledge of senior students and interns regarding postextraction complications in government and private colleges in Riyadh Province. Materials and Methods: A random sampling technique was used to select a minimum of 250 participants for this study. A self-designed, close-ended questionnaire was disseminated through an online platform in a manner. Sixth-year (senior) dental students and interns were included in the study. Data were coded and entered into spreadsheet software and analyzed using Chi-square tests. Results: More than half were dental interns (54.04%), and the rest were senior students (45.96%). Male participants comprised 52.57% of the total participants, whereas females were 47.43%. Most participants were from government colleges (53.31%), whereas 46.69% belonged to private colleges. Male interns from government colleges demonstrated the best knowledge among all the participants. In private colleges, females demonstrated better knowledge than males in both the senior and intern groups, and the difference was statistically significant. The difference in knowledge between participants from government and private colleges was found to be statistically significant (P = 0.001). Government colleges were found to demonstrate more complications than private colleges, and the difference was statistically significant (P = 0.003). Conclusion: Male interns from government colleges had the best knowledge about the postextraction complications among the candidates.

Keywords: Awareness, dry socket, extraction complications, government colleges, interns


How to cite this article:
Alenazi A, Aleidan A, Alotheem M, Alqahtani R. Knowledge and awareness of postextraction complications among dental seniors and interns in Riyadh Province. J Pharm Bioall Sci 2021;13, Suppl S1:602-7

How to cite this URL:
Alenazi A, Aleidan A, Alotheem M, Alqahtani R. Knowledge and awareness of postextraction complications among dental seniors and interns in Riyadh Province. J Pharm Bioall Sci [serial online] 2021 [cited 2021 Jul 29];13, Suppl S1:602-7. Available from: https://www.jpbsonline.org/text.asp?2021/13/5/602/317650




   Introduction Top


Exodontia is removal of the tooth from its alveolar socket and supportive structures by means of surgical instruments. Lack of knowledge, surgical experience, or skills in extractions might lead to many complications. Such complications can be minimized by properly taking medical and dental history, correct planning of the surgical procedure, and skillful removal by dentists.[1],[2] Earlier study has shown that about 78.3% of the undergraduate dental students have agreed on the fact that taking proper medical history can reduce the occurrence of postextraction complications.[3]

Extraction is a very common procedure in dental clinics worldwide.[3],[4] Extraction can be of two types, simple and transalveolar extractions. Teeth are extracted for a variety of reasons such as caries, pulpal necrosis, periodontal disease, orthodontic reasons, malposed teeth, cracked teeth, impacted teeth, supernumerary teeth, teeth associated with pathologic lesions, radiation therapy, teeth involved in jaw fractures, and financial issues. Every surgical procedure may induce some complications, and for frequent procedures like dental extractions, every dentist should be well trained, aware of its common and rare complications and their management, even though they occur infrequently.[5],[6],[7],[8]

Complication means a secondary disease or condition aggravating an already existing one. Dental extraction may cause pain or even swelling.[3] Different types of postextracted complications include prolonged bleeding (the most common complication). Patients who are on medications such as anticoagulants, uncontrolled hypertension, liver diseases, platelet deficiency, hemophilia, von Willebrand factor deficiency, or Vitamin K deficiency may also pose a significant risk for postoperative bleeding.[7],[8] Dry socket (alveolar osteitis) causes postoperative pain inside and around the extraction site, which increases in severity at any time between the 1st and 3rd days after the extraction. In a study, the total incidence of dry socket following the removal of 642 third molar teeth was 114 instances or 17.8% of the total cases.[9] Ecchymosis is the next most common complication following a tooth extraction, and it usually occurs in elderly patients. Pain, trauma to adjacent structures, oroantral communication, and sinus perforation (the floor of the sinus is usually the closest to the palatal root of the upper first molars) are few complications after the extractions of upper molars.[7],[9],[10],[11],[12]

Nerve injury (inferior alveolar nerve and artery are both contained within the inferior alveolar canal) is one of the complications after the extraction of the mandibular molars. The lingual nerve travels medially to the lingual plate near the second and third molar regions. The aggressive technique, sectioning of the molar during extraction, and the lingual flap can result in injury to the lingual nerve. The overall incidence of inferior alveolar nerve and lingual injury during mandibular molar extractions ranges between 0.6% and 5%.[7] Rare complications such as necrotizing fasciitis, herpes zoster, Ludwig's angina, parapharyngeal infection, and infections of the submandibular and submasseteric spaces can occur after the extraction of the teeth.[13] The dentist should have adequate knowledge about these complications and the correct way to diagnose and manage these complications or to refer them to the physician. Some of the risk factors for postextraction complications are age, sex, medical status, medications, habits (such as smoking), history of past complications, and the nature of the extraction itself – whether traumatic or atraumatic. Moreover, operator-related risk characteristics such as level of experience and the duration of the procedure are considered relevant risk factors. Extraction difficulty increases when the following conditions such as excessively dense supporting bone, difficult root morphology, teeth with large restorations or decay, adjacent teeth with large restorations, and brittle teeth associated with endodontic treatment.[10],[11],[12],[13],[14]


   Materials and Methods Top


This is a cross-sectional study conducted in Riyadh Province. A random sampling technique was used to select 250 participants for this study. A self-designed, close-ended questionnaire was disseminated through an online platform. Sixth-year (senior) dental students and interns were included in the study. Senior students who had not completed the oral surgery clinical rotation/course were excluded. Data were coded and entered into spreadsheet software and analyzed using Chi-square tests.


   Results Top


A total of 273 respondents answered the survey in this study. More than half the participants were dental interns (54.04%), and the rest were senior students (45.96%). Male participants comprised 52.57% of the total participants in the survey, whereas females were 47.43%. Most participants were from government colleges (53.31%), whereas 46.69% belonged to private colleges. The demographic distribution of participants is depicted in [Figure 1].
Figure 1: Frequency distribution of participants

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We assessed the frequency distribution of participant responses on knowledge regarding postextraction complications. Dry socket (51.47%) was the complication most faced by the participants during their clinical work, whereas 33.82% did not face any complications at all. The rest experienced pain (19.49%), swelling (17.28%), and bleeding (12.50%). When asked what was the most common postextraction complication, the majority of the participants (76.10%) responded with a “dry socket,” whereas some (10.29%) chose “swelling.” Very few chose “pain” (8.46%) and “prolonged bleeding” (3.68%) [Table 1].
Table 1: Knowledge and awareness of postextraction complications among the sample (Question 1-7)

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Most participants (47.06%) responded that they will take a radiograph if they encountered a dark area under the apex after the extraction of an upper first molar that had a granuloma associated with a palatal root. 33.82% chose that they would ask the patient to blow the nose to confirm communication with the sinus, whereas 14.34% will use a sharp instrument into the socket to confirm the same. Very few (4.78%) chose the option of placing a bone graft. When asked about the management of a case where a patient has communication between the oral cavity and the maxillary sinus for more than 5 weeks along with fever and pus discharge from the fistula, majority of the participants (40.44%) chose that the appropriate action would be drainage and administering antibiotics after closure communication. The next most common response was “removal of fistula at the time of communication” (38.24%). Few (12.13%) believed that the Caldwell-Luc procedure was necessary to close the fistula, whereas some (9.19%) would ask the patient to blow the nose to confirm the presence of the communication [Table 1].

In case of subluxation of a tooth not planned for extraction, the majority of the participants (59.96%) believed that stabilization was the best management strategy, whereas 31.62% thought that it is best to leave it and let it heal naturally. Few thought root canal treatments should be done (7.35%), whereas very few (1.47%) also thought that extracting the tooth and replacing it with an implant was an option. When participants were asked which tooth was most commonly displaced into the maxillary sinus, the majority of them (75.37%) responded with “maxillary first molar.” Maxillary second molar and third molar were the next responses (4.78% and 3.68%), whereas 16.18% responded with all of the above. Almost all participants (96.32%) thought that the patient must be informed in case a complication occurred postextraction [Table 1].

When participants were asked which radiograph is the best option to take in case of a missing distal root that was broken during the extraction of a lower second molar, most participants chose the chest X-ray (31.99%). The rest chose cone-beam computed tomography (CT), orthopantomogram, and CT scan (28.68%, 26.47%, and 12.87%, respectively). Participants were also asked which nerve is the most likely to have been injured if the patient complained of loss of sensation in the tongue after the extraction of a lower third molar. Majority of the participants (58.46%) chose the lingual nerve, whereas the rest chose the inferior alveolar and mylohyoid nerves (22.43% and 13.60%, respectively). Very few chose the buccal nerve (5.51%). Most participants (66.91%) thought that disruptive movement tongue can disturb the healing clot, whereas 21.69% chose passage of food. 4.04% thought that normal speech can disturb a clot, whereas 7.35% did not know [Table 2].
Table 2: Knowledge and awareness of postextraction complications among the sample (Question 8-14)

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When asked how the participants managed bleeding primarily, most of them (53.68%) chose “direct pressure over the socket,” whereas 21.69% chose “applying hemostatic agents.” 18.75% of the participants thought that suturing is the best option, whereas few (5.88%) thought that crushing the foramen socket with hemostat is the best option [Table 2].

Most of the participants (46.32%) did not know what was the type of bleeding present in a patient who returned after a week along with pain in the extraction site. 25.00% of those who knew thought that it was secondary bleeding, whereas 19.49% thought that it was primary bleeding. Only 9.19% thought it to be tertiary bleeding. Smoking was the factor that was thought to be most associated with pain 2 days after extraction (80.88%), whereas some participants (9.19%) thought that acidic drinks consumed immediately after extraction can cause pain 2 days postextraction. Only a few thoughts that mouth breathing could be the reason for the pain (6.25%), whereas 3.68% responded with “none of the above” [Table 2].

Finally, participants were asked about the management of a case wherein the patient developed pain in the extraction site with halitosis and bad taste 3 days after the extraction of a lower third molar. The majority of them (60.29%) responded that irrigation of the socket with the placement of a sedative dressing was the best option, whereas 22.79% thought that curettage of the socket must be done to induce bleeding. 15.81% were of the opinion that an antibiotic regimen should be started, whereas very few (1.10%) believed that the site should be left untreated and observed for a few days [Table 2].

Chi-square tests were done to compare the association of correct responses of participants with respect to gender, year of study, and type of school [Table 3]. The difference in knowledge between participants from government and private colleges was found to be statistically significant (P = 0.001). Male interns from government colleges demonstrated the best knowledge among all the participants as they had the highest percentage of correct responses to all questions as compared to other groups. However, when compared with female interns in government colleges, the difference in correct responses was not statistically significant (P > 0.05 for all questions). On the other hand, female seniors from government colleges demonstrated better knowledge than male seniors from government colleges with respect to all questions except question 1, yet the difference was not statistically significant (P > 0.05 for all questions) except for question 9 (P = 0.01). Furthermore, the difference in knowledge between interns and seniors in the government school was also not statistically significant (P = 0.07).
Table 3: Comparisons of knowledge between gender, year of study and type of University-based on correct responses to each question

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In private colleges, females demonstrated better knowledge than males in both the senior and intern groups, and the difference was statistically significant (P < 0.05 in all questions for both the intern and senior groups except question 9 in the senior group with P = 0.6). However, the difference between the overall knowledge of seniors and interns in private colleges was also not statistically significant (P = 0.9).

Comparisons were also made between complications occurring in private and government colleges [Table 4]. Government colleges were found to demonstrate more complications than private colleges, and the difference was statistically significant (P = 0.003). More participants from the private university did not report any complications (70.66%) than from government universities.
Table 4: Postextraction complications faced by participants in government and private universities

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   Discussion Top


Complications after any surgical procedure are possible. Dental extraction is one of the most common surgical procedures in the dental clinic.[8],[9] In our study, we aimed to have an overview at our dental student seniors and the dental interns' knowledge of postextraction complications. The incidence of these complications is predictable if the students and interns have the basic knowledge and skills of treating surgical cases. The knowledge of our interns and senior students is fair for the most common postextraction complications, but it is less than the study conducted by Derrbishi et al., 2017.[4]

We assumed in the present study that both senior dental students and dental interns have adequate knowledge about the postextraction complication in Riyadh Province. Our study showed that there is a statistically significant difference in knowledge between females and males in private colleges and the incidence of facing complications between participants in government and private colleges. This difference may be related somehow because a lot of studies confirmed that the clinical experience is the best way for treating postextraction complications. In private colleges, more than half of their participants, i.e., 70.66%, did not face postextraction complications due to less requirement they have because of decreased patient flow. However, female students have good theoretical knowledge in both diagnosis and management of these complications. Furthermore, a similar study was conducted in Riyadh Elm University on its intern with almost the same result.[14] We hypothesized that there is no significant difference in knowledge between seniors and interns, which our study proved. The exposure of the intern on the surgical procedures needs to be increased to improve the knowledge of the complication's management.


   Conclusion Top


The exposure of dental students and dental interns in oral surgical procedures has to be increased to improve knowledge of postextraction instructions.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

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Kumar A, Ganapathy D. Knowledge among dental students about post-extraction complications and management. Drug Invent Today 2019;12:1086-9.  Back to cited text no. 1
    
2.
MacMillan HW, Diagnosis and treatment of post-extraction complications. J Am Dent Assoc 1930;17:70-8.  Back to cited text no. 2
    
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Kumar M, Lavanya P. Knowledge about post extraction complications among undergraduate dental students. J Pharm Sci Res 2016;8:470-6.  Back to cited text no. 3
    
4.
Derrbishi AA. A study about knowledge and awareness regarding post extraction complications among dental interns of the College of Dentistry. J Int Med Dent 2017;4:76-85.  Back to cited text no. 4
    
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James MS. Contemporary Oral and Maxillofacial Surgery James r Hupp. 7th ed. New York: Elsevier Publishers; 2020.  Back to cited text no. 5
    
6.
Vettori E, Costantinides F, Nicolin V, Rizzo R, Perinetti G, Maglione M, et al. Factors influencing the onset of intra- and post- operative complications following tooth exodontia: Retrospective survey on 1701 Patients. Antibiotics (Basel) 2019;8:264.  Back to cited text no. 6
    
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Devarajan H, Somasundaram S. Post-operative complications after extraction: A review of literature. Drug Invent Today 2019;11:1553-5.  Back to cited text no. 7
    
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Akinbami BO, Godspower T. Dry socket: Incidence, clinical features, and predisposing factors. Int J Dent 2014;2014:796102.  Back to cited text no. 8
    
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Kolokythas A, Olech E, Miloro M. Alveolar osteitis: A comprehensive review of concepts and controversies. Int J Dent 2010;2010:249073.  Back to cited text no. 9
    
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Al-Khateeb TL, El-Marsafi AI, Butler NP. The relationship between the indications for the surgical removal of impacted third molars and the incidence of alveolar osteitis. J Oral Maxillofac Surg 1991;49:141-45.  Back to cited text no. 10
    
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Adeyemo WL, Ladeinde AL, Ogunlewe MO. Clinical evaluation of post-extraction site wound healing. J Contemp Dent Pract 2006;7:40-9.  Back to cited text no. 11
    
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Krogh HW. Incidence of dry socket. J Ame Dent Assoc Dent Cosmos 1937;24:1829-36.  Back to cited text no. 12
    
13.
Simon E, Matee M. Post-extraction complications seen at a referral dental clinic in Dar Es Salaam, Tanzania. Int Dent J 2001;51:273-76.  Back to cited text no. 13
    
14.
Alfaqeeh A, Dawoad FB, Alabdulkarim A, Albaqami M, Alshamrani H, Busaleh M, et al. Awareness and knowledge of tooth extraction complications management among Riyadh elm university dental interns. J Appl Dent Med Sci 2018;4:2.  Back to cited text no. 14
    


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