Complication Of Extraction

Question 1

A 35-year-old male consulted a dentist about the 26 tooth extraction. After the patient had been given tuberal anaesthesia, he presented with progressing tissue edema and limited mouth opening. This condition was caused by:

Answer 1

A. Vessel trauma

Question 2

Before extraction of a left upper tooth a 49-year-old patient had been given plexus anaesthesia with Ultracaine Forte. After the operation the socket didn’t get filled with a blod clot. What is the way to prevent alveolitis development in this patient?

Answer 2

. To fill the socket with a loose iodoform tampon

Question 3

In the process of root extraction of the 38th tooth with Lecluse root elevator a dentist has pushed the root through into the perimandibular soft tissues. The root is situated under the alveolar arch mucosa and can be clearly palpated. What approach should the doctor choose in the given case?

Answer 3

A. Dissection of soft tissues covering the root followed by root extraction

Question 4

What’s elevator function ?

Answer 4

Loosen the gingival fiber + PDL fibers attached to tooth.
Confirmation of good anesthesia.
Allow apical to CEJ placement of foreceps.
purchase point where you can get between tooth and bone
Expansion of bone , tearing the PDL

Question 5

How do we use the elevator ?

Answer 5

Placing of periosteal elevator and pushing with severing of soft tissue 360 degree around tooth.
Place the blade face against the tooth to be extracted
Back of blade against the crest
Clockwise or antilock wise movement occlusionally
Hold the elevator in point of resistant up to 10 sec
Support the alveolar ridge or tuburisity with your opposite hand to ensure don’t apply much force on the ridge

Question 6

What’s the difficulty in upper canine removal ?

Answer 6

The eminences and roots long make it difficult to extraction ,
May require mucousal flap and make though around the tooth to avoid removing of entire socket

Question 7

Why the difference in lower canines and incisors during extraction?

Answer 7

Lower roots a little less conical and circular than upper , mandibular incisors are flattened mesiodistally.
So less rotation , more buccolingual movement
Lower region also the site of crowding so access for foreceps is difficult
The cortical bone here is very thin so be careful to avoid fracture

Question 8

Why in upper premolars especially the first we don’t apply rotational force ?

Answer 8

Cause there roots split at apical 1/3 and it become easy to crack off espicially when applying rotational force

Question 9

Why we can do rotational movement in lower premolars ?

Answer 9

They very conical and tend to be straight single root.
So we extraction same as upper but with rotation

Question 10

Why we don’t force or apply pressure in the maxillary molars espicially the PALATAL roots ?

Answer 10

They are close to the sinus cab be pouched there and the PALATAL in the longest , and we force apical pressure on buccal and take it out Buccally.

Question 11

Why lower molars hardest teeth to be removed ?

Answer 11

Roots is divergent and bone is dense
Don’t rotate

Question 12

What’s the movement for primary teeth ?

Answer 12

Lingual / PALATAL

Question 13

Why do we smooth the bone after extraction ?

Answer 13

Cause if left delay healing and irritate .

Question 14

What we do after extraction ?

Answer 14

Direct pressure 30 min
Irrigate with saline syringe
Curretage with currete
Bind back with 2 fingers
Analgesic
Avoid , strew , hot , exercise

Question 15

Which is the 2 indications of elevator ?

Answer 15

1. Sever soft tissue attachment
2. Luxate tooth with elevator

Question 16

What’s the causes of Vasovagal collapse ?

Answer 16

The most common systemic complications following local anaesthesia
due to emotional reactions to the way the anaesthesia is administered.

Question 17

What’s vasovagal collapse symptoms ?

Answer 17

reduction in heart rate
dilatation of the arterioles in muscles, inducing a temporary shortness of blood flow to the brain.
looks pale, perspires and may lose consciousness.
clonic cramps occur which resemble an epileptic convulsion.

Question 18

How does the collapse occur ?

Answer 18

Psychogenic anticipation of the possible pain of the injection

activate the parasympathetic nervous system as well as inhibit the orthosympathetic nervous system.

Question 19

How to manage the vasovagal collapse ?

Answer 19

the dental chair should be placed in the Trendelenburg position,
with the body flat on the back
and the feet higher than the head,
whereupon consciousness will return in a short time.

Question 20

Hyperventilation syndrome development

Answer 20

Fear of injection of a local anaesthetic serve as a trigger for abnormally fast and deep breathing,
reducing the level of carbon dioxide in the blood (pCO2).
The pH of the blood increases
and the concentration of ionised calcium decreases.
Muscle contractions develop, which can present periorally.

Question 21

What’s the hyperventilation symptoms ?

Answer 21

the patient perceives a tingling sensation in the hands and feet.
Sometimes the patient feels light-headed
and can experience chest pressure.

Question 22

How to manage the hyperventilation?

Answer 22

reassurance, and asking the patient to breathe into a paper bag.
Rebreathing expired air will increase the pCO2 and usually resolves the condition rapidly.

If possible, the dentist should ‘dictate’ the correct breathing frequency to the patient.
Supplying accurate information to the patient about the administration of local anaesthesia, combined with fear-reducing treatment, reduces the risk of hyperventilation and vasovagal collapse.

Question 23

How do we get toxicity ?

Answer 23

oral administration of a local anaesthetic, toxic concentrations may develop elsewhere in the body.
An accidental intravascular injection can cause a short-lived toxic concentration of the anaesthetic in the blood.
An increased resorption rate – which may exist in inflamed tissue with increased blood flow – could also result in unexpectedly high levels of anaesthetic in the blood.
Comparable toxic effects may be observed if topical anaesthetics are sprayed directly onto (inflamed) mucosa.
An overdose is usually the result of using a higher dose than the maximum allowed, generally caused by repeat injections.
Most cases of overdose occur in children
Liver problems, absence of acetylcholiestrase

Question 24

Why local anesthesia can effect CNS rapidly ?

Answer 24

cross the blood–brain barrier easily because of their lipophilic nature.

Question 25

What’s occur in 5-10 mg local anesthesia and more than 10 ?

Answer 25

Higher concentrations of the anaesthetic (5–10 μg/ml) lead to an inhibition of the action potential conduction in the heart. This results in decreased frequency of the heartbeat and reduced contraction strength of the myocardium.
At concentrations over 10 μg/ml the severity of these effects increases, as a result of which ultimately even loss of circulation may occur.