Basic Extraction Skills

Question 1

What is the patient positioning for Upper extractions?

Answer 1

Head at shoulder/elbow height

Chair at 45 degrees

Question 2

What is the operator positioning for Upper Extractions?

Answer 2

Stood in FRONT of the patient

• legs back
• back straight
• leaning in towards the pt

Question 3

How should the forceps be held?

Answer 3

Held from underneath and curve of the handle resting in the palm of hand

Question 4

When extracting the tooth, what should be done with non-dominating hand?

Answer 4

support the alveolus

Question 5

How can you distinguish between LH and RH forceps?

Answer 5

The curve of the handle should be on the left for Right Handed operators

Question 6

Which forceps are universal for both LH and RH operators?

Answer 6

Forceps for upper anteriors and lower extractions

Question 7

When extracting molars using forceps, where should the beak be facing?

Answer 7

Towards the cheek

Question 8

For premolar extractions - how can you tell which forceps to use?

Answer 8

They have curved handle but no beak

Question 9

Once correct forceps identified and supporting structures what should you do?

Answer 9

Ensure correct tooth, blades applied bucco-lingually into gingival crevice, vertically down the long axis of tooth
• ensure fingers are removed from between the handles

Question 10

What kind of pressure should be applied when extracting?

Answer 10

Apical pressure

Question 11

What do you do once tooth is extracted?

Answer 11

Ensure apices are intact and squeeze the socket to ensure haemostasis

Question 12

What is the patient positioning for Lower Extractions?

Answer 12

head at elbow height, chair at 45 degrees

Question 13

What is the operator positioning for Lower Right Extractions?

Answer 13

Stood BEHIND the patient

• legs back
• back straight
• leaning in towards the pt

Question 14

What movement is used for Lower molars?

Answer 14

Figure of 8

Question 15

What movement is used for Lower Premolar/canine/incisors?

Answer 15

Rotational

Question 16

What movements are used for Upper Molar extractions?

Answer 16

Buccal to midline

Question 17

What movements are used for Upper premolar extractions?

Answer 17

Rotational (some buccal movement)

Question 18

What movements are used for Upper incisors/canines?

Answer 18

Rotational

Question 19

For Lower Extractions, what should non-dominating hands be doing?

Answer 19

Supporting the mandible, ensure thumb is lingual and fingers are buccal and underneath the mandible

Question 20

What are the risks associated with extractions?

Answer 20

• pain
• swelling
• bleeding
• bruising
• infection
• dry socket (alveolar osteitis)
• stiff/painful jaw
• damage to adjacent teeth
• tooth fracture
• time off work
• generally feeling unwell

Question 21

Who is at greater risk of dry socket?

Answer 21

• Females (taking the contraceptive pill)

* Someone who has had dry socket in the past

Question 22

Which nerve is at risk for extracting Lower 3rd Molars?

Answer 22

Inferior Alveolar Nerve and lingual nerve

Question 23

What anatomical structure is at risk when extracting upper 3rd molars?

Answer 23

Maxillary antrum

Question 24

What factors are there to consider prior to extraction?

Answer 24

• Access (pt with trismus or little mouth)
• Mobility of tooth (grade 3 mobile will be easier)
• Crown of the tooth (is it likely to fracture?)
• Radiographic picture (number of roots, quality of bone or pathology)

Question 25

What potential relationships to vital structures are there?

Answer 25

* Mental foramen/ mental nerve * Maxillary Sinus * Inferior dental nerve and lingual nerve

Question 26

What kinds of thing are you looking for with condition of surrounding bone? (on x-ray)

Answer 26

* How dense the bone is * radiolucent vs radiopaque * apical pathology or furcation involvement that will make XTN easier or tooth more likely to fracture?

Question 27

What kinds of thing are you looking for with configuration of roots on the x-ray?

Answer 27

* number of roots * curvature of roots * degree of root convergence * size and shape of roots (bulbous, conical, long, short, hooked) * other: root resorption, caries, RCT, ankyloses, PDL

Question 28

What do you do once the blood clot has formed?

Answer 28

Open gauze, roll it into sausage and wet the end. Ask pt to bite on it • wet it to avoid pulling clot out

Question 29

What are the post-operative instructions for XLA?

Answer 29

* expect pain for first 2-3 days (advise analgesics +/- NSAIDS eg Ibuprofen) * severe throbbing pain could be alveolar osteitis * bleeding - normal to see blood stained saliva, if occurs bite on gauze for 30mins, if persists get in contact * no exercise for 24hrs * no smoking or vaping for a week * no alcohol for 24hrs * no rinsing or mouthwashing * warm salt water mouth rinses 24hr post op 3 x daily for 5/7 (1 tablespoon of salt in tumbler)

Question 30

What are the contraindications for NSAIDS?

Answer 30

* not good for asthma * COPD * pt with GI bleeding * pt taking aspirin * pt with gastric or duodenal ulcerations

Question 31

Why should you avoid smoking after an XTN?

Answer 31

smoking reduces blood supply to the oral cavity which reduces healing

Question 32

What are the steps post extraction?

Answer 32

* compress the socket * place wet gauze in the socket (ensure it is visible EO) * give post-op instructions (oral and written - include contact details) * confirm bleeding has stopped * clean around the mouth