The tooth should be extracted in the early morning, as we then have the day before us should hæmorrhage occur. Some hæmostatic should be administered at the time of the operation and the socket plugged at once; for it is most important to remember that in these cases it is far easier to prevent the hæmorrhage occurring than to arrest it when once it has commenced. The subsequent treatment will consist in the continued administration of hæmostatic drugs.
(f) Injury of the arteries in the neighbourhood of the teeth.—Wound of the lingual artery has been referred to under the heading of injuries to the tongue. Laceration of the ranine, anterior and posterior palatine arteries may also occur. Such accidents are usually the result of the forceps slipping and are therefore avoidable. Treatment consists in pressure or in twisting or tying the divided vessel. In the case of the anterior or posterior palatine artery it may be found necessary to plug the foramina which give passage to these vessels.
(g) Pain following tooth extraction.—The causes giving rise to pain following the extraction of a tooth are:—
(1) Incomplete extraction of the tooth, more especially when the remaining portion contains an exposed pulp.
(2) Too rapid healing of the orifice of the socket.—It sometimes happens that the margins of the wound left after extraction unite very early, and when this occurs the discharges which naturally come away from the granulating surface at the base of the socket, have no exit; the consequence is that they are retained and set up a local traumatic inflammation, leading to swelling of the surrounding tissue.
(3) Suppuration in the tooth socket.—This may be due in the first instance to the use of dirty forceps, and under such circumstances it may be classed as a poisoned wound. An examination will reveal the presence of greenish putrid pus, while the tissue around will be much inflamed, and the portion immediately bordering the wound will have a tendency to slough. A condition of this kind is often seen in hospital nurses and medical students and is no doubt due to infection met with in their daily duties.
Suppuration in the socket may be due to a lowered vitality of the tissue, produced by some such local causes as acute or chronic inflammation, and is especially well seen in cases of extraction for the relief of periodontitis, or where the operation has been performed in patients suffering from general debility, syphilis, struma or in fact any of those systemic diseases which tend to lower the vitality of the organism.
(4) Extensive laceration of the hard and soft tissues in the neighbourhood of the socket; and
(5) Necrosis of the socket of the tooth are also fruitful sources of pain following tooth extraction.
(6) The presence in the wound of a foreign body.—A curious example of this came under notice a few years ago. A patient applied for the extraction of the left first permanent molar. During the operation a portion of one of the cusps disappeared; a search was made for it but, as it was not found, the natural supposition was that it had been removed in rinsing the mouth. The patient for the next three weeks complained of slight pain in the socket for which remedies were tried but proved of little use. Eventually the patient discovered the cusp on the top of the granulation tissue which had filled up the socket. In another case of the same character which came under notice, the offending material was a piece of an amalgam filling. A fractured blade of forceps may likewise act as the offending body.