ABSOLUTE CONTRAINDICATIONS FOR EXTRACTION

Systemic contraindications
Brittle uncontrolled diabetes Stress of surgery Metabolic Perturbation (hypersecretion of counterregulator hormones like catecholamines, glucagons, cortisol and growth hormones that anatognised the effect of insulin

Change glucose homeostasis + persistent hyperglycaemia

Precipitate Diabetic Crisis Endothelial Dysfunction Postoperative Sepsis Impaired Wound Healing Cerebral Ischaemia

Severe renal disease

Greater incidence of Dry Socket Prone to develop infection (due to high glucose level of blood) Deposition of cholesterol in peripheral circulation atherosclerosis Alteration in calcium and phosphate metabolism bone demineralization, decrease trabeculation, decresased thickness of cortical bone jaw fracture and abnormal healing after extraction Bleeding tendency (renal anaemia + alteration in platelet aggregation) Mechanical damage + heparin anti-coagulation during dialysis ecchymosis + petechiae + haemorrhage Susceptible to infection (in kidney transplant paitnet due to immune suppressive therapy) Uncontrolled Tendency to bleed: intraoral bleeding peetechiae + ecchymosis + leukaemia and haematoma lymphoma Increased risk of infection (compromised lymphocyte function) Risk of developing osteonecrosis if jaw of patient treated with radiotherapy / IV bisphosphonate Anaemia: fatigue easily + not able to tolerate time consuming dental treatment Corticosteroid treatment secondary adrenal insufficiency Secondary malignancy Severe uncontrolled LA + Adr inducing cardiac arrhythmia / collapse cardiac disease Patient takes anticoagulants blood less likely to clot Stress + anxiety cardiac arrhythmia Recent MI Likelihood of reinfarction within 6 months Toxic goitre Precipitate thyroid crisis cardiac embarrassment and heart failure

Local contraindications
Teeth located in malignant tumour Vascular lesion (Arteriovenous malformations + Haemangiomas) Disseminated cells hasten metastatic potential Bleeds easily Dramatic bleeding

RELATIVE CONTRAINDICATIONS FOR EXTRACTION

Systemic contraindications
Pregnancy 1st Trimester: Vulnerability of fetus + organogenesis 2nd Trimester (wk14 wk28): Safest period. Advisable to avoid X-rays + postpone extensive reconstruction + major surgery procedure until after delivery 1st part of 3rd Trimester (wk27 delivery): Good period for elective treatment. Sitting for long period of time is not advisable (Supine hypotension Syndrome) 2nd part of 3rd Trimester: Dental treatment should be postponed due to risk of premature delivery Use of dental X-ray Drugs used cross placental barrier fetal toxicity / teratogenicity Dramatic bleeding Excessive bleeding Can be performed if INR within 2-4 with proper local haemostasis

Severe bleeding disorder Polycythaemia Vera Patients on Anticoagulant Therapy Medication: Corticosteroid, immunosuppressive drug

Cirrhosis of liver

Jaundice Rheumatic Heart Disease Nephritis Syphillis

Postoperative infections Suppression output of adrenocorticotrophic hormone from anterior pituitary gland adrenal cortical atrophy (Give cortisone prep: 50-100mg cortisone orally 2 hours preoperatively; 100mg of hydrocortisone sodum succinate IV; 12 hours postoperatively, 50mg of cortisone orally) Coagulopathy + thrombocytopenia Abnormal results in PT / INR, PTT Increased susceptibility to infection Potential for bacteraemias occurring and spontaneous bacterial peritonitis Unpredictable hepatic metabolism of drugs administered Prolonged haemorrhage (Should receive prophylactic dose of Vitamin K before extraction) Danger of contracting endocarditis (roughened endocardium provides place for bacterial organisms to lodge, vegetate, interfere with valvular functions) Extraction of large numbers of chronically infected teeth ppt acute nephritis Delayed healing postoperative infection (Should undergo antisyphilitic treatment before extraction) Osteoradionecrosis Spread of bacteria to lower head and neck region

Local Complications
Radiotherapy Severe pericoronitis Acute maxillary sinusitis Acute gingival inflammation

Spread of bacteria