Exodontia armamentarium and post operative care Flashcards
List all the armamentarium required for an extraction procedure
- Instruments: mirror, probe, tweezers, flat plastic, triplex, extraction forceps, suction (slow speed)
- Topical local anaesthetic gel and Local Anaesthetic
- Gauze to wipe tooth dry
- Rolled gauze to prepare a few to achieve haemostasis
- Post-operative Care
- Written post-op instructions to give to parent/guardian
- A packet of sterile gauze
Explain how the design of the forceps enables extraction
- Beaks are ‘scoop’ shaped on the inner surface to fit the roots
- Beaks are ‘wedge’ shaped on the outer surface to expand the socket
- The beaks are hinged to allow a close grasp of the root surface
- The handle acts as a lever which gives the clinician a mechanical advantage
- The farther from the beaks the clinician grasps the handles the less effort is needed
- A palm grasp is used with the handle of extraction forceps
Discuss the mechanism of forceps extraction
- The roots of teeth are held firmly in the alveolar process in sockets by the periodontal ligament
- During the extraction process, the repeated forces from extraction movements slowly and deliberately expands and dilates the alveolar bone of the socket
- Once the socket has been expanded enough and there is complete tearing of the periodontal ligament, the tooth can be extracted
Explain the pre-operative steps you’d take when treating your patient
- Explain the sensation of LA before administration
- Tooth is going to sleep, tingling feeling of numbness‘ pins and needles’
- The sensation of pressure from the forceps may be misinterpreted as pain, can be upsetting and uncomfortable. Explain the feeling of ‘pushing’ or ‘squeezing’
- Explain that the ‘cracking and popping’ sounds are normal and to be expected
Know the correct positioning of the dental chair, clinician and patient for extraction
Clinician
• The correct position allows the clinician to keep the arms close to the body and provides support and stability
• It enables the clinician to keep the wrist straight enough to deliver the force with the arm and shoulder and not the hand and wrist
• Extractions are usually done standing up but can also be done seated
• Clinician is at 7 o’clock for all quadrants except quadrant 4, where they are at 11 o’clock
• CLINICIAN IS TO SUPPORT THE ALVEOLAR PROCESS AND RETRACT SOFT TISSUES WITH NON-DOMINANT HAND
• For ALL teeth, extraction is delivered buccally
Patient
• Chair should tipped backward so that the maxillary occlusal plane is at an angle of about 60 degrees to the floor
• For mandibular extractions, the chair is positioned more upright so that the occlusal plane is parallel to the floor
Describe the steps and procedures in extraction of primary teeth
- Administer LA and allow a few minutes for the local anesthetic to take effect Check that profound local anaesthesia has been achieved with a blunt -ended instrument, such as a small flat plastic
- When checking, ensure you have a good stable finger rest close to the tooth being extracted to avoid slipping of the instrument which would injury the patient
- Adapt the flat plastic with gentle, increasing pressure in the gingival sulcus on both the buccal and lingual/palatal
- Ask the patient if they can feel any pressure
- Once profound anaesthesia has been achieved the forceps can then be seated onto the tooth with slight apical pressure so that the tips of the beaks are beneath the soft tissue and engaging onto the root surface of the tooth just below the CEJ • Gradually increase apical pressure to loosen the soft tissue attachment (if any) from the cervical portion of the tooth
- Before you seat the forceps, it’s a good idea to use gauze to wipe the tooth dry to facilitate a stable grasp of the tooth and it is recommended to place a piece of gauze at the back of the mouth to prevent accidental swallowing or aspiration of the tooth/fragments
- Support alveolar process on either side of the tooth with 2 fingers of the non dominant hand. Fingers can also retract the soft tissues – lips/ cheek/ tongue
- Slight tractional force, usually directed buccally can be used to deliver the tooth buccally
Explain the rationale for post-operative care after dental extraction
- Examine the tooth and socket. Any tooth/root fragments remaining. Any debris or exudate? if so, gently wash with water (no air) and suction
- Gently compress the buccal and lingual/palatal walls of the socket with finger pressure
- Ask the patient to bite down firmly on rolled up piece of gauze for 5 minutes
- Return the patient an upright position and ask patient to swallow saliva
- After 5 minutes, remove gauze to check for haemostasis
- If still bleeding, place another gauze and ask patient to bite for 10 minutes
- In the meantime, give the parent/carer written and verbal instructions for post- operative care and a sterile pack of gauze
- Once haemostasis has been achieved, dismiss the patient
- Provide precautions with regards to LA; No eating or hot drinks until LA wears off, no sport or excessive play for the remainder of the day and swallow saliva, no spitting or using a straw
- DO NOT take aspirin for pain relief. Take Panadol or Nurofen
- Reinforce the importance of good oral hygiene and that gentle toothbrush can start the next day
- Advise parents that halitosis often occurs following an extraction
- If bleeding recurs, open sterile packet of gauze, roll up and place it over the socket and have the patient bite down firmly for 5-10 minutes. However if bleeding continues, contact the clinic ASAP
Describe the requirement for writing a concise treatment record
- TOP (time out procedure)
- Detailed pain history (if this is a relief of pain appointment)
- Clinical presentation (extraoral and intraoral, hard and soft tissue)
- Radiographic findings
- Diagnosis (reason for extraction)
- LA administered (which LA used and amount, type of injection)
- If haemostasis was achieved
- Verbal and written post-operative instructions given
- How the patient handled the extraction
