Fatal hemmorhage following extraction of first molar.

A case involving extraction of right upper 1st molar leading to massive hemorrhage and death in an undiagnosed case of Arteriovenous Venous Malformation of maxilla is presented along with the relevant investigations, standard treatment to be given and the related medicolegal issues. A 16 year old male presented to a dentist with history of Grade III mobility of right upper 1st molar without any known etiology. The dentist extracted the tooth without properly assessing the patient clinically and advising any relevant investigations thereby leading to massive hemorrhage and death of the patient. Proper clinical assessment, relevant investigations adequate treatment is to be given or the surgeon faces the risk of legal action for medical negligence under the provisions of Sec.304A of IPC. History taking, proper clinical examination, relevant investigations and adequate treatment are imperative in treating any case and in case of complications, the patient must be shifted to the ED of the nearest hospital without any delay.

prevalence and risk factors of dry socket in dental surgery clients following tooth extraction at Qazvin Faculty of Dentistry

Dry socket is one of the complications occurs following tooth extraction. The prevalence of such condition is reported to be highly different ranging from 0.5-68.4%. The etiology and pathogenesis are not clearly known but many related predisposing factors have been discussed. To evaluate the prevalence and risk factors of dry socket after tooth extraction. This cross-sectional study was carried out at the department of oral and maxillofacial surgery in Qazvin university of medical sciences [Jan 2002 to Jan 2003]. Out of 1402 patients, those having their teeth extracted and returned with dry socket were chosen. Characteristics such as, age, sex, site of extraction, extracted tooth, trauma during extraction, periapical lesion, oral hygiene, smoking, systemic diseases, and OCP in women [oral contraceptive pill] were determined. Over the one-year period of study, 1402 teeth were extracted and in the meantime, 12 patients returned with dry socket. Our results showed that the incidence of dry socket was 0.85% and the ratio of females to males was 2.5 to 1. Dry socket in mandible was two times higher than maxillae [1.12% versus 0.57%]. Mandibular third molars were more often involved than other areas. Periapical lesion, trauma, poor oral hygiene and OCP increased the incidence of dry socket. Prevalence of dry socket after tooth extraction in Qazvin oral and maxillofacial surgery clinic was not higher than other centers. Seemingly, application of atraumatic techniques, aseptic procedures, ability of surgeon, oral hygiene and so on can lead to a lower prevalence of dry socket

Combined triple approach for management of persistent oro - antral fistula

Fourteen patients with persistent oro-antral fistula following dental extraction were managed by a combined endonasal, sublabial and per-oral approach, under cover of antibiotic and metronidazole therapy. Endoscopic endonasal ethmoidectomy with middle meatal antrostomy, modified Caldwel-Luc approach and per-oral closure of the fistula mouth by a posteriorly based palatal flap was our surgical technique. Results were very satisfactory without any major complications