Basic Extraction Skills Flashcards
What is the patient positioning for Upper extractions?
Head at shoulder/elbow height
Chair at 45 degrees
What is the operator positioning for Upper Extractions?
Stood in FRONT of the patient
- legs back
- back straight
- leaning in towards the pt
How should the forceps be held?
Held from underneath and curve of the handle resting in the palm of hand
When extracting the tooth, what should be done with non-dominating hand?
support the alveolus
How can you distinguish between LH and RH forceps?
The curve of the handle should be on the left for Right Handed operators
Which forceps are universal for both LH and RH operators?
Forceps for upper anteriors and lower extractions
When extracting molars using forceps, where should the beak be facing?
Towards the cheek
For premolar extractions - how can you tell which forceps to use?
They have curved handle but no beak
Once correct forceps identified and supporting structures what should you do?
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
What kind of pressure should be applied when extracting?
Apical pressure
What do you do once tooth is extracted?
Ensure apices are intact and squeeze the socket to ensure haemostasis
What is the patient positioning for Lower Extractions?
head at elbow height, chair at 45 degrees
What is the operator positioning for Lower Right Extractions?
Stood BEHIND the patient
- legs back
- back straight
- leaning in towards the pt
What movement is used for Lower molars?
Figure of 8
What movement is used for Lower Premolar/canine/incisors?
Rotational
What movements are used for Upper Molar extractions?
Buccal to midline
What movements are used for Upper premolar extractions?
Rotational (some buccal movement)
What movements are used for Upper incisors/canines?
Rotational
For Lower Extractions, what should non-dominating hands be doing?
Supporting the mandible, ensure thumb is lingual and fingers are buccal and underneath the mandible
What are the risks associated with extractions?
- pain
- swelling
- bleeding
- bruising
- infection
- dry socket (alveolar osteitis)
- stiff/painful jaw
- damage to adjacent teeth
- tooth fracture
- time off work
- generally feeling unwell
Who is at greater risk of dry socket?
- Females (taking the contraceptive pill)
* Someone who has had dry socket in the past
Which nerve is at risk for extracting Lower 3rd Molars?
Inferior Alveolar Nerve and lingual nerve
What anatomical structure is at risk when extracting upper 3rd molars?
Maxillary antrum
What factors are there to consider prior to extraction?
- 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)
What potential relationships to vital structures are there?
- Mental foramen/ mental nerve
- Maxillary Sinus
- Inferior dental nerve and lingual nerve
What kinds of thing are you looking for with condition of surrounding bone? (on x-ray)
- How dense the bone is
- radiolucent vs radiopaque
- apical pathology or furcation involvement that will make XTN easier or tooth more likely to fracture?
What kinds of thing are you looking for with configuration of roots on the x-ray?
- 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
What do you do once the blood clot has formed?
Open gauze, roll it into sausage and wet the end. Ask pt to bite on it
• wet it to avoid pulling clot out
What are the post-operative instructions for XLA?
- 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)
What are the contraindications for NSAIDS?
- not good for asthma
- COPD
- pt with GI bleeding
- pt taking aspirin
- pt with gastric or duodenal ulcerations
Why should you avoid smoking after an XTN?
smoking reduces blood supply to the oral cavity which reduces healing
What are the steps post extraction?
- 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
