Basic Extraction Principles

Question 1

What reasons might an extraction be indicated for a tooth?

Answer 1

• Grossly carious
• Pulpitis
• Periapical periodontitis
• Pericoronitis
• Abscess
• Fractured teeth
• Apical pathology
• When misplaced, impacted or supernumerary
• As part of orthodontic treatment
• If they are retained primary teeth

Question 2

Why is understanding the morphology of teeth useful when extracting them?

Answer 2

Because it can give handy information to understand how to remove the teeth, including:

• Number of roots
• Cross sectional shape of teeth
• Anatomical areas to be careful of

Question 3

Outline the typical process of an uncomplicated XLA.

Answer 3

1. Paperwork in order
2. Risks explained to Px
3. Consent obtained from Px
4. Achieve anaesthesia
5. Break PDL with luxator, and generate some mobility.
6. Elevators can be used to create space for forceps to be applied.
7. Apical pressure with forceps to further widen PDL.
8. Movement appropriate to tooth morphology to remove the tooth.
9. Achieve haemostasis.
10. Give patient post-ops.

Question 4

What is the primary movement when extracting a tooth?

Answer 4

The initial movement of the forceps used to break the PDL, such as apical pressure.

Question 5

What is the secondary movement when extracting the tooth?

Answer 5

The movement of the forceps which further dialates the socket of the PDL. This will be specific to the tooth being extracted.

Question 6

What movement is typically advisable for extraction of upper 1s, 2s, and 3s?

Answer 6

Rotational around the long axis of the tooth.

Question 7

What movement is typically advisable for extraction of upper 4s, 5s?

Answer 7

Limited buccopalatal movement with limited rotation. This is to avoid breaking the apicies of the two roots typically found.

Question 8

What movement is typically advisable for extraction of upper 6s, 7s, and 8s?

Answer 8

Figure of 8 motion, with buccal expansion.

Question 9

What movement is typically advisable for extraction of lower 1s, 2s, and 3s?

Answer 9

Labial and lingual movements, though some slight rotational movement is permitted.

Question 10

What movement is typically advisable for extraction of upper 4s and 5s?

Answer 10

Rotational movements.

Question 11

What movement is typically advisable for extraction of upper 1s, 2s, and 3s?

Answer 11

Figure of 8 motion, with buccal expansion.

Question 12

Explain how extraction forceps are used.

Answer 12

• Forceps gripped in hand properly.
• Beak is placed along long axis of the tooth.
• Apical pressure is maintained
• The bone either side of the tooth is supported.

Question 13

What can be a complication of appling buccal expansion when extracting a tooth?

Answer 13

Fracture of the buccal plate, can happen in areas of thinner buccal bone.

Question 14

What is the optimum dose of paracetemol a patient should take?

Answer 14

2 x 500mg, four times daily. (Never excede 4g dose)
Send 40 tablets to cover 5 days.

Question 15

What is the optimum dose of ibuprofen a patient should take?

Answer 15

1 x 400mg (or 2 x 200mg) four times daily
(Maximum adult dose 2.4g daily)
Send 20 tablets to cover 5 days.

Question 16

Outline the common risks you would give to the patient before undergoing routine XLA.

Answer 16

• Pain
• Bleeding
• Bruising
• Swelling
• Soft tissue damage
• Damage to adjacent teeth
• Sensitivity
• Infection
• Dry socket
• Trismus (Stiff jaw)
• Rarely nerve damage depending on tooth.

Question 17

Outline the post-op instructions for a routine XLA.

Answer 17

• Expect pain, that almost always will settle over the next few days, but can be 1-2 weeks of they get a dry socket.
  • Can also be bruising and sensitivity as body heals, as well as swelling. There can also be stiffness of the jaw muscles.
  • Use typical analgesia (2x500mg Paracetamol, no more than 4g a day, 2x200mg ibuprofen, no more than 2.4mg a day).
  • Post operative is bleeding, but we want to avoid disturbing the blood clot in the socket. Avoid exercise, rushing about, anything that increases blood pressure. Don’t disturb it with your tongue, finger or toothbrush. Avoid alcohol consumption.
  • Avoid hot/spicy foods, as can irritate the extraction site, and can cause vasodilation which may encourage bleeding.
  • Avoid hard foods as it may traumatise the socket, keep to a softer diet and eat on one side of the mouth for the next few days.
  • Can rinse with warm salty water gently the day after extraction, around four times a day to clean out the area and lower risk of infection.
  • If bleeding occurs bite on damp gauze for 20-30 minutes, if it persists do this again for up to an hour. If it persists beyond this, contact emergency details as per contact sheet.

Avoid smoking if applicable as this delays healing and increase the risk of a dry socket.

Question 18

Outline the post-op instructions for local anaesthetic.

Answer 18

• Numbness can last anywhere from a short time to a long time. Avoid exerting yourself.
  • Try not to eat until it wears off in case you bite your lip.

Avoid hot food as you might accidentally burn yourself.