deciduous tooth extraction

Question 1

Why are deciduous teeth removed?

Answer 1

• Dental caries
• Orthodontic reasons (aesthetics)
• Retained
• Incomplete natural exfoliation

Question 2

Before you start, what 6 things are must you check for deciduous tooth extraction?

Answer 2

1- Correct patient and notes
2-Written prescription
3- Written consent
4- Check medical history (extraction contra-indicated if e.g. bleeding risk is high)
5- Check which tooth!
6- Radiographs (ideally)

Question 3

What 3 things can improve success of extraction appoitnment?

Answer 3

1- good pain control
2- good patient management
3- good surgical technique

Question 4

What rule can you follow to ensure a child has good pain control for their age if they are undergoing deciduous tooth extraction?

Answer 4

follow the rule of 10.

Add the number of tooth (upper C: 3) to the age of the child (6 years).

If it is below 10: infiltration analgesia
if it is above 10: dental nerve block

Question 5

What can you do to have good patient management for a child undergoing deciduous tooth extraction?

Answer 5

• Good pain control
• Instruments already prepared and out of sight
• Leave extractions to the end of the treatment
• Child friendly language
• Distraction
• Positive reinforcement

Question 6

What 6 things can you do to have good surgical technique for a child undergoing deciduous tooth extraction?

Answer 6

1- assess tooth
2- choose correct forceps
3- patient position
4- operator position
5- non working hand
6- working hand

Question 7

What can you consider when assessing a deciduous tooth for extraction?

Answer 7

• accessible
• mobility
• submerged
• associated infection

Question 8

What forceps are used for upper deciduous tooth extraction?

Answer 8

all upper forceps have straight, simple blades

• anterioirs: upper straight forceps. straight handles with simple beaks
• posterioirs: upper primary molar forceps. slightly curved handles with larger simple beaks

Question 9

What forceps are used for lower deciduous tooth extraction?

Answer 9

all lower forcers have blades set at a right angle to the handle

• anterioirs: lower primary anterior forceps. simple blade set at right angle to handle.
• posteriors: lower primary molar forceps. the blades are shaped like beaks this allows them to engage with the bifurcations of the molars. These are also set at right angles to the handle

Question 10

how is the patient positioned for deciduous tooth extraction?

Answer 10

slightly reclined, not on their back.

At a 30° angle

Question 11

how is the operator positioned for upper deciduous tooth extraction?

Answer 11

• stand IN FRONT of patient
• back straight
• patient’s mouth level with shoulder

Question 12

how is the operator positioned for lower deciduous tooth extraction?
for a right handed person:
left hand side?
right hand side?

Answer 12

left hand side:

• in front of patient
• back straight

right hand side:

• behind patient
• chair low as possible

Question 13

how is the non working hand positioned in deciduous tooth extraction?
what does the non working hand do?

Answer 13

position: thumb and forefinger hold tooth and associated alveolar sulcus. Remaining fingers can support mandible for lowers.

-retracts soft tissue: visibility and access
-protects soft tissue
-provides resistance against exctraction force
-provides feedback of when tooth is moving
-

Question 14

What is the purpose of the working hand in deciduous tooth extraction?

Answer 14

• to force blades down into periodontal ligament between tooth root and bony socket wall
• to grip root mass between forceps blades
• to gently expand socket walls

Question 15

what are elevators?

when are they used?

Answer 15

• instruments used in dental extractions, can be straight or left/right curved
• used to remove root fragments.

Question 16

What should you do (as a DHT) if a root fragment is left deep?

Answer 16

leave it! don’t attempt to extract it

Question 17

What forceps movement is used for extraction of upper or lower anteriors?

Answer 17

• blades must engage onto root (not just crown)
• rotation (clockwise/anticlockwise) along long axis of tooth
• some labial expansion

Question 18

What forceps movement is used for extraction of upper or lower molars?

Answer 18

• blades must engage onto root (not just crown) with beaked blades engage this into bifurcations (lowers)
• push forceps downwards to break apical periodontal fibres
• small lingual/palatal movement to expand plate
• continuous buccal force/slight rotation

Question 19

once deciduous tooth is extracted, what can you do to achieve haemostasis?

Answer 19

-squeeze buccal and lingual plates of socket together
-get patient to bite on damp GAUZE for 10 minutes
-remove and check for clot
don’t let patient leave until haemostasis has been achieved
-record in notes

Question 20

what post-operative instructions can you give the patient following a deciduous tooth extraction?
avoid?
pain?
bleeding?

Answer 20

on the day:

• avoid exercise
• foods to avoid: hot/cold/spicy/hard
• avoid rinsing/spitting
• avoid biting soft tissues

if painful:

• paracetamol, child dose varies (180mg-750mg 4-6 hours)
• may be blood on pillow in morning
• if bleeding continues for more than 20 minutes contact doctor

Question 21

what is the ideal order of extraction for deciduous tooth extraction?

Answer 21

1- symptomatic (painful) teeth first
2- lower than uppers
3- posterioirs than anterioirs