Extractions of indicated teeth have several local contraindications. the most important and most critical is a history of therapeutic radiation for cancer.Extractions performed in the area of radiation may result in osteoradionecrosis and therefore must be done with extreme caution chapter 19 discusses in detail.
Teeth that are located within an area of tumor especially a malignant tumor should not be extracted. The surgical procedure for extraction could disseminate cells and therby hasten the metastatic process.
Patients who have severe pericoronitis around an impacted mandibular third molar should not have the tooth extracted until the pericoronitis has been treated.Nonsurgical treatment should Include irrigations, antibiotics, and removal of the maxillary third molar to relieve impingement on the edematous soft tissue overlying the mandibular impaction. If the mandibular third molar Is removed in the face of severe pericoronitis, ‘the incidence of complications increases. If the pericoronitis is mild and the tooth can be removed easily, then immediate extraction may be performed.
Finally, the acute dentoalveolar abscess must be mentioned.It Is abundantly clear from many prospective studies that the most rapid resolution of an infection secondary to pulpal necrosis is obtained when the tooth is removed as early as possible. Therefore acute Infection Is not a contraindication to extraction. However, It may be difficult to extract such a tooth because the patient may not be able to open the mouth sufficiently wide, or It may be difficult to reach a state of adequate local anesthesia.
If access and anesthesia considerations can be met, the tooth should be removed as early as possible.