Exodontics And Local Anesthesia Flashcards
Extractions are indicated when a tooth cannot be salvaged, what are some examples of when a tooth cannot be saved?
Grade 4 periodontal disease
Tooth root abscess
Grade 3 furcation exposure (3 classes)
Very deep periodontal pockets
Complicated fracture that is not amendable to root canal (cost/location/type of fracture)
Tooth resorption affecting neck or crown
When the client is unable to unwilling to perform home care
Primary tools for extractions
Dental elevators
Extraction forceps
Scalpel blades and Luxators
Describe the use of dental elevators
Used to release the tooth from the root socket
Comes in a variety of sizes for different teeth (size should conform to the size of the root)
Several hand styles and lengths
Describe the different types of elevators
Standard elevator
Luxating elevator (thinner and sharper tip) used in a Wrist rocking motion to cut the periodontal ligament (these break easy)
Winged elevators: head flares out wider than the shaft
Notched elevators: notched in the tip
Describe the use of extraction forceps
Used to grasp the tooth once it have been released from the periodontal ligament and remove from its socket when it is very loose
Can lead to broken/retained roots if you try and pull a tooth with only this
Describe chemical vs gas vs steam sterilization of tools
Chemical: NOT recommended: requires complete cleaning of the instrument before use to remove the chemicals. Can full sharp instruments and weaken some metals
Gas: potential health hazard to personnel
Steam: preferred method: autoclaving
What two methods are used to remove teeth
Force technique
Stretch and tear technique
Describe the force technique
NOT recommended
Breaks bones and tooth roots
Causes more trauma than needed
Describe the stretch and tear technique
Recommended
Used rotation motion rather than a see saw motion
Must retain pressure for at least 10 seconds (preferably 20 seconds) to stretch the ligament
Tooth should be eased out of the socket
Use PATIENCE
Normally the entire tooth and root needs to be removed during extractions, when are some exceptions to when a root may not need to be removed
When retrieving the root will cause more damage
In tooth resorption when there is complete log of the periodontal ligament it is acceptable to remove the crown only (called coronal amputation)
When the tooth root has been pushed into t the mandibular canal (huge risk of hemorrhage)
Combinations of ____ extraction, ____ extraction and ____ of the periodontal ligament are used to remove teeth
Vertical
Horizontal
Cutting
What teeth are single rooted in dogs
Canines
Incisors
First premolar
Mandibular third molars
Sometimes mandibular second premolars and mandibular second molars due to fusion of their roots
What teeth are single rooted in cats
Incisors
Canines
Maxillary second premolar
Maxillary first molar
Although canine teeth are single rooted, they almost always require the creation of a ____ ____ to close the extraction site
Gingival flap
What are the 5 steps in removing a single rooted tooth
1) sever the gingival attachment
2) separate the attachment of the tooth to the socket (damage the periodontal ligament)
3) remove the tooth from the socket
4) clean the socket
5) gingival closer
How do you sever the gingival attachment
In a healthy mouth it is hard to stretch or tear the gingival attachment
A root tip pick or dental elevator is most commonly used to sever it
May be cut with a scalpel blade
Ensure you release attachment all the way around the tooth
Gentle wedge and slight rotation movement of using elevator
With severe gingivitis and gingival recession this attachment is already lost
What are the two options for separating the attachment of the tooth to the socket (damaging the periodontal ligament?
Stretching the ligament
Or
Wedge and cut the ligament
When attempting to damage the ligament how long should you hold pressure?
Minimum of 10-20 seconds
Gold standard 30 seconds
What are the two techniques used to stretch the ligament?
1) vertical rotation: elevator is parallel to the root. Pressure is applied between the root and alveolus
2) horizontal rotation: elevator is perpendicular to the crown and root and pressure is applied to the coronal aspect of the tooth
How do you use the wedge and cut option for damaging the periodontal ligament?
Need very sharp instruments
Wrist Rock technique to insert into periodontal space and cut the ligament
Do not twist or pry
After the periodontal ligament is completely broken you can
Remove the tooth from the socket using forceps
How should you clean the socket after tooth extraction? What does this prevent?
Preventing infections
Use a special tool to scrape the socket and then flush with dilute chlorhexidine
Optional materials may be placed in the socket to help in bone healing
How is the socket closed? What does this prevent?
Prevents material/bacteria from entering the socket, speeds healing of gingiva, reduces the risk of dry socket (very painful inflammation of the dental nerves)
Suture close with a cruciate pattern. Must be closed without tension
How do you extract multi rooted teeth
Must split the tooth before extraction and then after splitting each section is treated like a single rooted tooth
