J Clin Exp Dent. 2020;12(1):e65-70.

Infectious complications in oral surgery

Journal section: Oral Surgery doi:10.4317/jced.55982

Publication Types: Research https://doi.org/10.4317/jced.55982

Infectious postoperative complications in oral surgery. An observational study

Matías Dallaserra 1, Francisca Poblete 2, Cristian Vergara 3, Ricardo Cortés 3, Ignacio Araya 1, Nicolás Yanine 1,
Julio Villanueva 1

1
Oral & Maxillofacial Surgery Department. Cochrane Associated Center at School of Dentistry. University of Chile. Sergio Li-
vingstone 943. 8380492. Independencia Santiago de Chile
2
School of Dentistry. University of Chile
3
Cochrane Associated Center at School of Dentistry. University of Chile

Correspondence:
Sergio Livingstone 943
CP: 8380492
Independencia
Santiago de Chile Dallaserra M, Poblete F, Vergara C, Cortés R, Araya I, Yanine N, Villanueva
javm@uchile.cl J. Infectious postoperative complications in oral surgery. An observational
study. J Clin Exp Dent. 2020;12(1):e65-70.
http://www.medicinaoral.com/odo/volumenes/v12i1/jcedv12i1p65.pdf
Received: 12/06/2019
Accepted: 04/11/2019 Article Number: 55982 http://www.medicinaoral.com/odo/indice.htm
© Medicina Oral S. L. C.I.F. B 96689336 - eISSN: 1989-5488
eMail: jced@jced.es
Indexed in:
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Pubmed Central® (PMC)
Scopus
DOI® System

Abstract
Background: The main objective of this investigation was to determine the incidence of infectious postoperative
complications in oral surgery.
Material and Methods: A observational and descriptive study was developed, with the use of prospective registry
of the patients admitted for oral surgery at the San Borja Arriarán Hospital Complex during twelve months obser-
vation period (April 2017 to March 2018).
Results: The sample consisted of 532 patients undergoing surgical procedures of oral surgery and 19 cases of in-
fectious postoperative complications. The incidence of complications reached 3,57% and it was observed predomi-
nantly in exodontic type interventions. The most commonly observed complication was dry socket, reaching 2,5%
of third molar surgeries and 3,7% of extractions of other teeth. Other postoperative complication were 7 cases of
facial spaces abscesses, also observed predominantly in exodontic type interventions.
Conclusions: The results were similar to those reported in the literature both in their frequency and in the type of
complication.

Key words: Oral surgery, incidence, postoperative complications, dry socket, third molar.

Introduction The extraction can be a simple or complex procedure

Extraction is one of the most performed procedures in and this will depend on the factors that affect its removal
oral surgery and its objective is to remove affected teeth (2-3).
with any pathology that compromises the health of the In the case of the lower teeth, the thickness of the mandi-
mouth, with third molars being the most frequent (1). bular cortex compared to the maxilla and the proximity

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to the inferior alveolar nerve, if the tooth is included, 7 days before the intervention, patients with psychiatric
erupted or semi erupted and the need to make a flap, illnesses that require special procedures, such as seda-
osteotomy and / or odontosection, the degree of impac- tion or anesthesia , immunocompromised (due to their
tion, the age of the patient, experience of the surgeon inherent higher risk of complications, especially infec-
and time of surgery and the anatomical considerations tious) and those who did not attend the control appoint-
of the tooth (2,3). ment or who did not answer control calls.
The complications that may occur after a tooth extrac- All surgeries were performed with surgical instruments
tion correspond to the alveolitis, hemorrhage, wound de- properly sterilized and complying with the health requi-
hiscence, fracture of the bone cortices, among others (4). rements of the Ministry of Health. Surgeons performed
Despite being a routine procedure, patients have repor- surgical hand washing for 4 minutes with 2% chlorhexi-
ted complications ranging from 1% to 30.9% (5-9). The dine gluconate gel soap, and used sterile gloves. The
most frequent post-extraction complication is alveolitis surgeries were performed under locoregional anesthe-
(10-15) and occurs with a frequency that varies from 0 sia. The postoperative indications were delivered and
to 35% of all dental extractions (5). Other commonly re- explained both orally and in writing. Operators were
ported complications are paresthesia of the mandibular recommended to use one gram of paracetamol every ei-
nerve, pain and infections (3,16,17). ght hours for three days in simple procedures and add
The main objective of this study was to determine the another non-steroidal anti-inflammatory for moderate or
incidence of infectious complications after oral surgery complex procedures.
in patients over 12 years of age treated at the San Borja The patient was referred to control at 7 days to be eva-
Arriarán Hospital in Santiago de Chile. The secondary luated and called by phone at 30 days. In case of com-
objectives correspond to performing a descriptive analy- plications, they were treated at the time the patient con-
sis in relation to the characteristics of the patients inclu- sulted. The clinical parameters were evaluated by the
ded, describing the rate of complications according to data collector who was a trained dental surgeon in the
the procedure of oral surgery performed and describing diagnoses of complications. These data were recorded in
the different types of complications and the incidence the data registration form prepared for this study.
according to the type of procedure. This study was ela- The presence or absence of postoperative complications
borated using the STROBE statement guideline (18). was considered. To determine infectious complications,
the criteria for the CDC (Center for Disease Control and
Material and Methods Prevention) classification for nosocomial infection of
This study corresponds to a descriptive and exploratory the oral cavity were used.
study that expects to report the frequency and distribu- The presence of alveolitis was defined in the clinical
tion of the event of interest (infectious complications af- examination when disintegration or absence of the clot
ter oral surgery procedures) in a highly complex urban associated with moderate or intense pain was observed
center, in the Maxillofacial Surgery Unit of the San Bor- (about 4 on the analogue visual scale, from 0 to 10) after
ja Arriarán Hospital Complex, in Santiago de Chile from 48 hours of the intervention.
the registration of the complete casuistry of twelve mon- The independent variables were considered with respect
ths of study (April 2017 to March 2018). To carry out to the patient as age, sex, systemic diseases, smoking
this research, the approval of the Ethics Committee of habit and alcohol or marijuana consumption, to the ope-
the Central Metropolitan Health Service was previously rator and his expertise as a dental surgeon, resident of
obtained. All the Dentists of the Unit participated. the specialty of maxillofacial surgery or maxillofacial
All patients with indication of oral surgery were selec- surgeon, surgical time (0 to 15 minutes, 16 to 30 minu-
ted, who approved their participation in the study throu- tes and 31 and more minutes) and surgery variables such
gh an informed consent and who fulfilled all the selec- as surgical difficulty according to whether it was mild,
tion criteria defined below: moderate or high. Defining as moderate those in which
• Inclusion criteria: Patients over 12 years old, systemi- it was necessary to perform a flap and high difficulty
cally healthy or with controlled pathologies. procedures in which osteotomy and / or odontosection
• Exclusion criteria: Patients with allergies or contrain- was also performed. It was also considered if there was
dications to the use of paracetamol or nonsteroidal an- use of antibiotic medication as antibiotic prophylaxis or
tiinflammatory drugs (postoperative medication of first later antibiotic therapy by dental indication.
choice in oral surgery, the use of other alternatives could Statistical analysis: A descriptive analysis of the infor-
create confusing factors), who have undergone anti- mation was carried out. The incidence of complications
biotic treatment for at least 30 days before surgery (for after oral surgery was calculated in a general manner,
possible residual effects of the antibiotic that modify the by type of procedure and according to the type of com-
normal microbiota and decrease the probability of in- plication, using rates. Complications in their totality as
fectious complications), history of pericoronaritis up to a numerator and total procedures as denominator were

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considered for the general calculation. For the calcu- representing 0.75% of the total. On the other hand, 350
lation of incidence according to type of procedure, the patients presented a history of previous oral surgery, of
numerator was the associated complications for each of which 11 presented complications representing 2.06%
them and the denominator was the total of procedures of of the total. With respect to the habits of the patients
each type. All analyzes were performed using the Stata / included, 132 consumed tobacco of which 4 presented
SE version 15.0 program. complications, representing 0.75% of the total. Alcohol
consumption occurred in 207 patients, of which 6 had
Results complications, representing 1.12% of the total. Table 1
During the twelve months of the study, 682 oral sur- details the characteristics of the patients included and
gery procedures were performed, of which a total of their incidence of postsurgical complications.
106 did not meet the selection criteria and 44 were pa- The most frequent oral surgery procedure that presented
tients who did not attend the control appointment and the most complications was the extraction of third mo-
did not answer the telephone calls. These patients were lars. Of the 363 patients undergoing this type of surgery,
excluded from the study and the total number analyzed 16 presented complications, which corresponds to an in-
reached 532 patients undergoing oral surgery of which cidence of 4.4% for this procedure. While the extraction
67% were women, 35% were patients with some basic of other teeth presented an incidence of 3.7%. Patients
pathology and 74% had some type of habit of consump- undergoing other surgeries that were considered in this
tion (alcohol, tobacco or marijuana). The average age study did not present complications. Table 2 details the
was 30.4 years with a standard deviation of 17 and 66% percentage of incidence for each type of procedure in
of the patients had already undergone some procedure of oral surgery.
oral surgery previously. The most frequent complication after oral surgery co-
The most performed procedure were third molar extrac- rresponds to the dry socket, which developed in 9 pa-
tions, reaching 68% (n=363) of the total surgeries per- tients who underwent third molar surgery (incidence of
formed. All the complications occurred postoperatively 2.47%) and in 3 patients who underwent extraction of
and were mainly concentrated in the procedures of type other teeth (3.7% incidence). The other complication
exodontia. that arose was the abscess of facial spaces that only oc-
Of the patients included in the study, 357 correspond to curred in patients who underwent third molar surgery
women, of which 13 presented complications that repre- (incidence of 1.92%). Types of complications observed
sent 2.4% of the total. On the other hand, 175 patients are detailed in Table 3.
correspond to men of whom 6 presented complications, Regarding the operator-dependent factors, the category
which represent 1.1% of the total. Regarding the medi- of resident of the maxillofacial surgery specialty presen-
cal history of the patients included, 188 presented sys- ted the highest level of incidence of complications after
temic antecedents, of which 4 presented complications oral surgery (5.29%), followed by the category of maxi-

Table 1: Characteristics of patients who presented complications.

Variables N° of procedures / Incidence per group/
present complication total (%)

Total 532/19 3,57%

Sex
Female 357/13 3,6% / 2,4%
Male 175/6 3,4% / 1,1%

Medical History
With medical history 188/4 2,1% / 0,75%
Without medical history 344/15 4,3% / 2,81%
Previous Oral Surgery 350/11 3,1% / 2,06%
Without surgical history 182/8 4,39% / 1,5%
Habits
Tobacco 132/4 3,03% / 0,75%
Alcohol 207/6 2,89% / 1,12%
Marihuana 55/0 0% / 0%
Without habits 138/7 5% / 1,3%

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Table 2: Complications by type of procedure in oral surgery.

Type of procedure N° of realized procedures/ Total incidence/by
present complication procedure (%)
Extraction of third molars 363/16 3% / 4,4%
Extraction 81/3 0,56% / 3,7%
Multiple Extraction 38/0 0
Biopsy 29/0 0
Flange regularization 6/0 0
Other surgery 8/0 0
Cysts enucleation 3/0 0
Frenectomy 1/0 0
Fenestration 3/0 0
Total 532 3,57%

Table 3: Types of postsurgical complications and their incidence according

to surgical procedure.
Type of complication N° Extraction N° Third molar
(% incidence) extraction
(% incidence)
Without complication 78 (96,2%) 347 (95,6%)
Alveolitis 3 (3,7%) 9 (2,47%)
Abscess facial spaces 0 7 (1,92%)
Total 81 (100%) 363 (100%)

llofacial surgeon (3.3 %) and dentist surgeon (1.85%). gh there is no documentation of other studies equivalent
On the other hand, the surgical time interval that pre- to the present, it is possible to make comparisons with
sented the most complications was surgeries that took research whose methodologies and objectives are simi-
more than 30 minutes (5.2%), followed by the interval lar. The difference with respect to the total occurrence
of 16-30 (3.44%) and 0-15 minutes (3 , 08%). of complications may be due to the definition that exists
With respect to the factors depending on the procedu- about these events, since, for these authors, edema, pain
re, the surgical difficulty that presented the highest in- and trismus are considered postsurgical complications,
cidence of complications after oral surgery was severe however, in this study, these situations were considered
(5.8%), followed by mild (3%) and moderate (0.7%). expected within the context of an inflammatory process
Finally, patients who received prescription antibiotic that is inevitable after oral surgery.
prophylaxis had an incidence of 4.4% of complications A study with results similar to those described in this
after oral surgery. Table 4 contains the characteristics of study is carried out by Bui (9) who, with 583 patients
the surgeries and the operator in the group that presented undergoing third molar extraction surgery, obtained a
complications. total of 4.6% of complications and 3.4% of alveolitis.
In a favorable way, we can compare the results with the
Discussion study by Eshghpour and Nejat (19) with a sample of
The incidence of complications in oral surgery of this 256 surgical procedures for extraction of impacted third
study reached 3,57%, mainly observed in procedures of molars where they observed a prevalence that reached
exodontia and postoperatively. The highest percentage 19.14% of alveolitis. However, this favorable difference
of complications was observed in the extractions of third could be due to the complexity of the procedures inclu-
molars, in 3% of the total procedures and 4,4% of the to- ded, since in the cited study only impacted third molars
tal of surgeries of this type. Most of these complications were contemplated, however, the design of this study
were alveolitis, reaching an incidence of 2.47% for third included surgeries with equivalent surgical complexity
molar surgery. The observed result is within the wide levels and also of lower degree.
range existing in the reports of the referring literature, Another similar prospective study was carried out by
since these fluctuate between 1% to 30% (5-9). Althou- Chuang (20) with a total of 4,004 patients undergoing

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Table 4: Complications by type of procedure in oral surgery.

Variables Total procedures / Incidence per
N° complications group/total (%)
Total 532/19 3,57%
Operator
Experience
Dentist 162/3 1,85% / 0,56%
Resident 189/10 5,29% / 1,87%
Maxillofacial 181/6 3,3% / 1,12%
Surgical time
0 to 15 min 259/8 3,08% / 1,5%
16 to 30 min 174/6 3,44% / 1,13%
≥ to 31 min 99/5 5,2% / 0,9%
Procedure
Surgical difficulty
Mild 166/5 3% / 0,9%
Moderate 142/1 0,7% / 0,18%
Severe 224/13 5,8% / 2,4%
Antibiotic prescription
Profilaxis ATB 23/1 4,4% / 0,2%
Antibiotherapy 33/0 0
Without medication 476/18 3,7% / 3,3%

third molar extraction surgery who observed a prevalen- res, considering that the great majority of these were
ce of complications of 18.3% and 7.4% in the case of extractions makes it difficult to obtain conclusive results
alveolitis. regarding the incidence of postoperative complications
When we consider the incidence of alveolitis in isola- in other types of oral surgery interventions.
tion to the other postsurgical complications, it is obser- The results obtained show an incidence of postoperative
ved that the procedure with greater frequency of this infectious complications in the San Borja Arriarán Cli-
event is tooth extractions other than third molars. For nical Hospital in patients older than 12 years of 3,57%,
this type of intervention, the incidence reached 3.7%. It being similar to that reported in the literature.
should be noted that this type of procedure was mostly
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Funding
Funded by the Dental Research Fund 17-002 (FIOUCh) Faculty of
Dentistry Research Department University of Chile.

Conflict of interest
The authors declare no conflicts of interest.

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