High fever and shivering after immediate extraction implant placement: causes?

I installed 2 implants in a young healthy female in the maxillary second molar and second premolar at the time of extraction of these 2 teeth.  I did a Sumers lift [osteotome technique] so that I could extend the imlants into the maxillary sinus.   Patient did not experience any pain the region of the surgery.  However the patient suddenly developed a high fever of 103.5 F and has been shivering.  I had already prescribed amoxicillin 500mg tid  with ibuprofren and paracetamol [acetaminophen].  Do you think the spike in fever and shivering are related to the implant surgery?  What do you recommend that I do?

10 thoughts on “High fever and shivering after immediate extraction implant placement: causes?

  1. High fever and shivering is likely a bacteremia. Have the patient see a physician ASAP. Greg Steiner Steiner Laboratories

  2. The fever is unrelated to the implants, I agree with Greg . It could be viral vs bacterial but is systemic. You probably don’t need both ibuprofen and acetaminophen since both are antipyretic. A wound infection takes a week to develop. Without knowing the patients medical history or symptoms could be a lot of things but unrelated to the implant surgery.

  3. The teeth involved needed extraction. We’re they infected ? Placement of the implants into an already infected site, or into the sinus area could certainly be problematic . Immediate placement into a healthy site is best. Extraction , allow for healing prior to implant placement. It would be good to see the pre extraction and post insertion radiographs.

  4. It’s interesting that would would qualify this patient as a “young healthy female” when, in fact, you should have stated that you did implant surgery in a diseased area on a patient with no other medical issues. Sure sounds like a bacteremia as the other posters suggested but, without radiographs, we can’t be sure of the pre-op pathology that led to your decision to perform extraction/immediate implant placement. Were these teeth lost as as result of rampant decay, periodontal issues, failed endodontics, or fractures? Were they combination perio/endo defects or was there sinus involvement? Each one of these may require a different surgical protocol, sequencing of procedures and use of medications. Does the patient have a history of sinusitis and, if so, was there a potential perforation at time of implant placement? One thing that we teach our residents is that there is no such thing as a simple surgery and that each site requires a complete understanding of existing pathology, anatomical variants, potential for untoward sequalae, and the limitations of our own capabilities. If the patient is not getting better after a few days, perhaps a culture and sensitivity would be in order to change the antibiotics she is using as amoxicillin is not that effective for these cases.
    RJM

    • When you state “residents” do you mean a hospital based residency. If so I would think they would be taught a fever of unknown origin work up, just curious.

  5. A primer on dental infections, patients develop swelling and a cellulitis first, abscess can followed especially after antibiotics which help the abscess develop. A sudden fever can be caused by a thrombophlebitis, atelectasis, or drugs within the first 24hrs. Since these were not factors. If the site were infected it should have been obvious at surgery. The patient has a systemic issue causing the fever it is not dental she should see her MD if the fever persists. This is how post surgical fevers are triaged. If you want, blood cultures taken at the fever spikes will show if there is a bacterial etiology. This is just silly have the patient call her doctor if symptoms persist. It is unlikely of dental origin at this point in a healthy patient. The antibiotic is a good idea in case of a bacteremia. Wound infections take 5-7 days. However sometimes a drug can cause a fever. Time will help the diagnosis other symptoms may develop to help the systemic diagnosis good luck thanks for reading

  6. I agree with you in your posts with only one exception. We teach that ALL extraction/immediate implant cases should be treated as infected sites either because of the etiology of tooth loss, or the propensity for infection post surgery because of the extraction site defect and compromised soft tissue coverage. You also left out infections of fungal origen which can produce the same symptoms but will not respond to antibiotics alone.
    RJM

  7. Actually the mouth is considered a “clean-contaminated”site not truly an infected site. Most oral surgery procedures don’t routinely require antibiotics but due to patient comfort levels I’ll prescribe. Fungal infection are usually seen in immunocompromised patients which are not candidates for implants. Primary closure is a nice way to go to help keep a surgical site clean. Fortunately the mouth has an excellent blood supply and mucosa heals well. I wanted to make the point that is doubtful dental etiology and explain the development of dental infections since I routinely treat head and neck infections, often this is confusing for dentists.

  8. The high fever and shivering is not related to the procedure unless there was gross contamination of the water supply. Tap water does not cause problems. The US Army Dental Corps did a study in the early 80′s, with third molar removal using sterile saline and tap water. There was no difference in the results.
    Something else is going on with the patient. This infection has origins elsewhere.

  9. I had a perf a few weeks ago and aborted implantation just as a precaution. I had extracted a hopeless tooth and amputated a tooth root next to the site and grafted prior to the attempted implant. The bdy heals well but I don’t push the envelope and have good results staying on the conservative side. Abx are great but can’t solve all things. Sit back and try to determine what’s caused the fever. Any dental infectious involvement will kill an attempt at placement. If there is any existing infection in the area or if the patient has a fever, don’t place. That’s my two cents. Bill

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