8 - Exodontics

Question 1

What abnormalities are indicated for a tooth extraction?

Answer 1

grade 4 periodontal dz
tooth root abcess
grade 3 furcation exposure
very deep periodontal pockets
complicated fracture that is not amenable to the root canal (cost, loc, or type of fracture)
tooth resorption affecting the neck or crown of the tooth
when a client is unable tor unwilling to perform home care
ensure client is consulted prior to any extraction

Question 2

In terms of SVMA bylaws on dental extractions by vet techs, can we make a diagnosis? And can we determine a course of tx?

Answer 2

No, we cannot make a diagnosis or determine any course of tx

Question 3

As a RVT, under the direction and supervision of a licensed member, what can we administer?

Answer 3

a drug, a medicine, an appliance or other application for the tx or prevention of bodily injury or dz of animals

Question 4

Can a RVT assist with surgery and dentistry?

Answer 4

IF they are under the direct and immediate supervision of a vet, yes

Question 5

What does direct and immediate supervision mean?

Answer 5

In the room/within yelling distance

Question 6

What are gray areas about dentistry that are okay?

Answer 6

likely extractions of baby teeth + simple extractions are permissible (mobile teeth, single rooted teeth)
potentially surgical extractions are okay, but we don’t receive multi root extractions training
in the end, vet is responsible for what we can do
always vets job to diagnose/tx decisions

Question 7

What are dental elevators?

Answer 7

used to release the tooth from the root socket
lots of size variety - size of instrument should conform to the size of the root you are working on
each manufacturer uses own ID system
also has diff handles + lengths

Question 8

What styles of dental elevators are there?

Answer 8

standard elevator
luxating elevator - thinner and sharper at tip, used in wristrocking motion to cut PD ligament, do not twist or apply pressure cause they break
winged elevator - head flares out wider than the shaft
notched elevator - in the tip of the elevator
special shapes to accommodate specific teeth

Question 9

What are extraction forceps? What are they used for?

Answer 9

to grasp tooth once released from socket + is loose
some techniques use forceps to loosen final attachments, reqs additional training cause can -> broken/retained root tips

Question 10

What are some methods of sterilization? Why?

Answer 10

bc extraction is surgical procedure and the instrument enters tissue,s terile instruments should always be used, to prevent introduction of a different species of bact into the area
chem sterilization not recommended - req complete cleaning of instrum b4 use to remove chemicals - negating sterilization procedure - can dull sharp instruments/weaken metals
gas sterilization - health hazard
steam sterilization - preferred

Question 11

Which 2 ways can tooths be removed?

Answer 11

force technique - NO
breaks bone/root, more trauma

stretch + tear GOOD
uses rotational mothan than see saw
maintain 10s of pressure to stretch ligament
tooth eased out of socket
PATIENCE

Question 12

What is the procedure for removing roots

Answer 12

All root should be removed, exception is when attempts to retrieve root will cause more damage. X-ray b4 and after extraction.

Question 13

What are some examples of when you’d leave a root in during an extraction?

Answer 13

ex. tooth resorption in a cat where there is complete loss of PD ligament. Acceptable to remove crown of tooth only prior to closing gingiva - called coronal amputation
Ex. toothr oot accidentally pushed into mandibular canal. Huge risk of massic hemorrhage with retrieval

Question 14

What are some useful exodontic techniques?

Answer 14

Step-by-step important
the object is to remove the tooth with as little trauma as possible
use of each part of the technique may not be necessary for every extraction, nor is the order of steps followed each time
combinations of vertical extraction, horizontal extraction and cutting of PD ligament may be used

Question 15

What teeth in k9’s and fel’s are single rooted?

Answer 15

K9 - I’s, C’s, 1st P, Mand M3
Fel - I’s, C’s, Max P2, Max M1

Question 16

How are canines extracted?

Answer 16

they require creation of a gingival flap to close the extraction site. Therefore, extraction of canine teeth usually preformed by vet

Question 17

What is step 1 to single root extraction?

Answer 17

In healthy mouth, gum attachment to tooth is very fibrous and cannot be stretched/torn easily as PD ligament
Root tip pick or dental elevator common to sever attachment
Uncommon is scalpel blade
ensure you release attachment all around tooth
gentle wedge + slight rotation movement if using elevator
w/ severe gingivitis + gum recession, attachment is lost, so skip this step

Question 18

What is step 2 of single root extraction when you stretch the liagament?

Answer 18

Need about 10-20s of pressure to stretch.
Technique 1: vertical rotation
elevator parallel to root, work elevator btw room + alveolus pocket with wrist-wrock to seat elevator in PD space. Slowly rotate and hold
Technique 2: horizontal rotation
elevator is placed perpendicular to crown + tooth root
pressure is applied to the coronal aspect of the tooth to be extracted
be careful not to luxate the tooth ur using as a fulcrum
method only used when you can almost pull the tooth out

Question 19

what is step 2 of single root extraction if yu are using the wedge and cut technique?

Answer 19

Generally, used if you have sharp instruments (luxating elevators)
use a wrist-rock technique as you insert them into the PD space to cut the ligament
Can also wedge them into the space and hold that position to loosent he ligament (do not twist or pry, tooth will break)

Question 20

What is step 3 of single root extraction?

Answer 20

Remove tooth from socket after PD ligament is broken down. Can grasp tooth w/ extraction forecepts for easy removal
using forceps too early results in fracture of the tooth with retention of the root tip

Question 21

What is step 4 of the single root extraction?

Answer 21

clean socket
to spead healing/prevent infection, use curette to scrap out socket
flush socket with chlorhex solution
after curettage and flush of socket, optional materials may be placed into socket to assist bone healing depending on vet preference
calcium gluconate?

Question 22

What are the steps of single root extraction?

Answer 22

1. sever gum attachment
2. separate attachment of tooth to socket (damage PD liagement)
3. remove tooth from socket
4. Clean socket
5. Gingival closure

Question 23

What is step 5 in single root extraction?

Answer 23

gum closure - unless defect is vry small
to prevent food material/bact going into socket, speeds healing, greatly reduces risk of “dry socket” which is a inflam of dental nerves
use rapidly absorbable suture like (4-0 and 5-0 monocryl and vicryl common)
usually close in simple interrupted or cruciate pattern - can use continuous pattern but increased likelihood of dehiscence
MUST be closed without tension on the suture line - if tension is present, gingival flap needed

Question 24

What is the procedure of multi-rooted teeth?

Answer 24

splitting tooth is easiet but must know anatomy of tooth, after splitting, each section removed like single root, must wear eye protection and a mask during tooth sectioning.

Question 25

How are two rooted premolar extraction done?

Answer 25

section the tooth from the furcation to the tp of the crown

Question 26

How is the maxilary 4th premolar extracted?

Answer 26

Must be separated btw the furcations and the crown of each of the 3 roots
first cut is made btw cusps over the mesial-buccal and distal roots
second cut is made to separate the mesial/buccal and palatal root

Question 27

How are the maxillary 1 + 2 molars in dogs extracted?

Answer 27

t cut is made
first split off the mesial and distal roots from the palatal root
then separate mesial and distal roots
once crown is split, each individual root is treated like a single rooted tooth
adjoining roots may be used as fulcrum for extraction before/after root has been elevated

Question 28

What are some helpful hints when extracting?

Answer 28

cradle jaw with opposite hand
hold elevator down the shaft
keep index finger near cutting tip
select appropriate sized elevator for the tooth and the job
give it a rest and have patience
advanced hands-on training is required b4 attempting flap surgery (job of vet)

Question 29

What are some complications of extractions?

Answer 29

trauma due to instrument slippage - hold instrumate as close to tip as possible, finger will act as stop
Hemorrhage - controls via pressure, ligation or manual? products
removal of canines -max (hold upper lip away from lower teeth bc lip biting) mand (keep tongue in the mouth, tongue may now hang out the side)