• Acute Pericoronitis • End-Stage Renal Disease • Acute Infectious Stomatitis an Acute Apical Abscess Should Not Be a Contraindication to Extraction

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• acute pericoronitis • end-stage renal disease • acute infectious stomatitis An acute apical abscess should not be a contraindication to extraction. It has been shown that these infections can resolve very quickly when the affected tooth is removed. However, it may be diffi - cult to extract such a tooth, either because the patient is unable to open sufficiently wide enough or because adequate local anesthesia cannot be obtained. There are few true contraindications to the extraction of teeth. Note: In some instances, the pa - tients’ health may be so compromised that they cannot withstand the surgical procedure. Examples of contraindications include: • End-stage renal disease • Severe uncontrolled metabolic diseases (i.e., uncontrolled diabetes mellitus) • Advanced cardiac conditions (unstable angina) • Patients with leukemia and lymphoma should be treated before extraction of teeth • Patients with hemophilia or platelet disorders should be treated before extraction of teeth • Patients with a history of head and neck cancer need to be treated with care because even minor surgery can lead to osteoradionecrosis. Note: These patients are often treated with hyperbaric oxygen therapy prior to (20 sessions) and following extractions (10 sessions). • Pericoronitis: infection of the soft tissues around a partially erupted mandibular third molar Note: This infection should be treated prior to removal of the maxillary third molar. • Acute infectious stomatitis and malignant disease are relative contraindications • Treatment with IV bisphosphonates increases the risk of osteonecrosis of the jaw Note: Causes of excessive bleeding after dental extractions include: injury to the inferior alveolar artery during extraction of a mandibular tooth (usually the third molar), a muscular arteriolar bleed from a flap procedure, or bleeding related to the patient’s history (i.e., patients who are on warfarin or drugs for platelet inhibition, patients who have hemophilia or von Willebrand disease, or who have chronic liver insufficiency)..

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