Exodontia (2) Flashcards
Describe the anatomy of the teeth with regards to exodontia
Very robust and designed to withstand masticatory forces
Describe the anatomy of the alveolar bone with regards to exodontia
Thin, elastic and can be deformed, but very variable depending on patient
Describe the anatomy of the PDL with regards to exodontia
- Extremely strong
- Composed of collagen which has high tensile strength but is very inelastic
Describe the anatomy of the adjacent structures with regards to exodontia
Inferior alveolar nerve or maxillary sinus may complicate the procedure
Why are robust teeth relevant to exodontia?
Significant forces can be transmitted through it to the underlying bone and PDL
Why is thin and elastic bone relevant to exodontia?
It will deform when forces are applied through teeth
Why is an inelastic PDL relevant to exodontia?
It will fracture which will allow the tooth to be extracted
Describe the root morphology of the upper arch
Incisors - 1 root
Canines - 1 root
Premolars - 2 roots (buccal and palatal)
Molars - 3 roots (mesiobuccal, distobuccal and palatal)
Describe the root morphology of the lower arch
Incisors - 1 root
Canines - 1 root
Premolars - 1 root
Molars - 2 roots (mesial and distal)
What is important to note about the roots of lower molars?
Lower 6s show high tendency to have 3 roots - Mesiobuccal, mesiopalatal and distal
Describe Coupland’s elevator
- Come in 3 sizes (1 smallest, 3 largest)
- Held in hand with index finger on shaft to provide control
Name 3 functions of Coupland’s elevator
- Assess anaesthesia
- Separate gingival cuff and prevent tearing of mucosa
- Elevate teeth
Describe the basic shape of upper and lower forceps
Upper - Straight to anterior teeth but curve slightly for posterior
Lower - Blade set at 90 degrees to handles
Describe the patient positioning during the extraction
- Allows good vision, access and allow forces to be delivered down long axis of tooth
- Dentist and patient should be comfortable
- Cervical spine must be supported
- Dentists stands to ensure maximum stability and support
Describe the positioning of the dentist and patient during maxillary teeth extraction
- Chair should be tipped back so maxillary plane at 60 degrees to floor
- Chair height should be patient’s mouth is at elbow house
- Patient’s head should be turned towards the dentist
- Forefinger and thumb support tooth to be extracted
Describe the position of the patient and dentist for extraction of mandibular teeth
- Chair position should be such that tooth is below level of operators elbow
- Chair positioned so mandibular occlusal plane is parallel to floor
- Chair position for removal need to be reclined further back in mouth
- Stand behind when removing tooth corresponding to hand you are using and in front when the opposite (ie LL using left hand stand behind)
Name 3 functions of the supporting hand during extractions
- Counters force applied through the forceps
- Feed-back through supporting hand to detect deformation of alveolar bone and movement of the tooth
- Support offered by fingers protects tissue against damage if forceps incorrectly applied
Describe the positioning of the forceps on the tooth
- Beaks should engage roots of the tooth
- Positioned as apically as possible
- Place beak with most limited vision first
Name 3 forces used during exodontia
- Gripping
- Apical drive
- Dilation of Socket
Describe the “Gripping Force”
- Once beaks are in position should be gripped tightly as possible
- Prevents slipping
- If beaks move tooth is more likely to fracture during extraction
Name 3 functions of apical pressure
- Retract the gingival soft tissues
- Place the PDL fibres under pressure and dilate PDL space
- Help prevent the forceps beaks slipping once other forces are applied
Describe the root and dilatation movement of maxillary central incisor
Root - Single, straight with circular cross section
Movements - Rotation and labial expansion
Describe the root and dilatation movement of maxillary lateral incisor
Root - Oval cross section and may have distal curve at apex
Movements - Minimal rotation and labial expansion
Describe the root and dilatation movement of maxillary canine
Root - Long, robust root with triangular cross section
Movements - Rotation first then labial expansion if required
Describe the root and dilatation movement of maxillary premolars
Root - Possible fine twin apices
Movements - Bucco-palatal movements only
Describe the root and dilatation movement of maxillary molars
Roots - 2 buccal and 1 palatal
Movements - Buccal and palatal only
Describe the root and dilatation movement of mandibular incisors
Root - Single, fine, flattened and ovoid
Movement - Labio-lingual movement with emphasis on labial
Describe the root and dilatation movement of mandibular canine
Root - Single robust root with ovoid or triangular cross section
Movement - Rotation with occasional need for labio-lingual movement
Describe the root and dilatation movement of mandibular premolar
Root - Single with circular cross section
Movements - Rotation only usually needed but bucco-lingual may be used
Describe the root and dilatation movement of mandibular molars
Root - 2 roots, one mesial and one distal
Movement - Bucco-lingual movement but may be figure of eight
Describe the delivery of teeth
- Once tooth has loosened it should be removed along the least line of resistance
- Compress socket with fingers
- Achieve haemostasis (biting on gauze)
Describe 3 post-op instructions to give the patient on the day of extraction
- Do not rinse mouth for 12 hours
- Do not take alcohol, very hot foot or drink and avoid smoking for 7 days
- Keep fingers and tongue away from woudn
Describe post-op instructions for the following day
- Rinse gently after each meal using half teaspoon of table salt in glass of warm water
- Salt water mouth rinses continue 4 days until wound is healed
Describe post-op instructions if bleeding occurs
- Place damp pad of clean linen or handkerchief over wound area and bite firmly for 20 minutes
- Replace if necessary with clean pad and repeat for another 20 minutes
- Remain quiet, lying down with head elevated
- If bleeding continues, contact the dentist / oral surgeon
Describe post-op instructions for pain and swelling following extractions
- Take pain medication as prescribed or what patient normally does for pain
- Swelling is normal and takes 2 days to reach peak (most swollen for 5-7 days), anything above this, contact GDP / oral surgeon
