Fracture of the mandible during an extraction is rare.If it does occur it is either because of some predisposing weakness of the jaw which then exhibits a pathological fracture when normal forces are applied to a tooth or that excessive force sufficient to break a normal mandible has been used.
Pathological fracture of the mandible can seen in the following conditions:
1.Large cysts.
2.Tumours.(including bone metastases)
3.Impacted teeth.
4.Generalised osteoporosis.
5.Paget’s disease.
6.Osteogenesis imperfecta.
7.Hyperparathyroidism.
When a weakness in the jaw is suspected pre-operatively,the patient should be warned about the possibility of fracture and the extraction should be conducted in an enviornment where any complication can be adequately managed by an immediate reduction or fixation.Care ans restraint must always be exercised when applying force to extract any tooth.
Avoid doing the following given below:
1.Using an elevator that is too wide between two lower teeth thus forcing them apart mesio-distally.
2.Using straight elevators as class I levers.
3.Excessive bone removal,particularly if both buccal and lingual cortices are reduced.
If fracture of the mandible occurs during an extraction,the procedure must be immediately stopped and radiographs must be taken.A oral surgeon must be called in.A full explanation must be given to the patient along with prescribed antibiotics and analgesics.