Extraction of teeth

Question 1

Reason for extracting teeth

Answer 1

Unrestorable caries
Pulpitis
Periodontal disease
Trauma
Failed restorative treatment including endodontics
Orthodontics
Teeth involved with pathology
Prophylactically e.g. prior to radiotherapy

Question 2

Instruments used for extraction

Answer 2

Forceps
Elevators
Luxators

Question 3

Anatomy of forceps

Answer 3

Blades
Hinge
Handles

Question 4

Application of forceps

Answer 4

Forceps are applied to roots of teeth
Force is applied apically to dilate socket
Cone will be forced out
Cutting PDL
Direction of further movement depends on anatomy

Question 5

Exodontia prior to radiotherapy

Answer 5

Teeth with poor prognosis - need to have long/ strong roots

Question 6

Summary of movements

Answer 6

1st movement - always apical
Upper anterior teeth and lower premolars - rotation
Lower anterior teeth - buccal movement
Lower molars - figure of 8 and / or bucally
Upper pre-molars - gentle bucco-palatal movement
Upper molars - buccal movement

Question 7

Summary of movements

Answer 7

1st movement - always apical
Upper anterior teeth and lower premolars (all cones) - rotation
Lower anterior teeth (oval shape) - buccal movement
Lower molars - figure of 8 and / or bucally
Upper pre-molars (4 has highly variable roots) - gentle bucco-palatal movement (tend to take it buccally for 4)
Upper molars - buccal movement

Question 8

Upper 6

Answer 8

Apply forceps
Lean on it, wait for bone to expand
Roll tooth out bucally

Question 9

Upper straight forceps

Answer 9

1 or 2
-upper centrals, laterals and canine
-apply forceps at long axis of tooth
29N (narrow blades)
-upper anterior roots

Question 10

Upper premolar and molar forceps

Answer 10

76 for upper premolars
76N (narrow) for upper roots
76H for upper molars
-curve so that handle comes out of the mouth

Question 11

Beak to Cheek

Answer 11

Full molar forceps
Normal blade on one side, beak on other side in furcation
Read handles
94 for right handers, 95 for left handers

Question 12

Upper third molar forceps

Answer 12

Bayonettes or 101s

Question 13

Lower incisors forceps

Answer 13

74

74N for lower roots

Question 14

Lower premolars and molars forceps

Answer 14

75

Question 15

Full lower molar forceps

Answer 15

73

Beaks buccal and lingual

Question 16

Cowhorns

Answer 16

For lower molars

Forces beaks underneath teeth and lifts them in socket

Question 17

Elevators

Answer 17

Couplands - straight
-3 sizes (1-->3)
-round handles to hold in palm
Cryers
-point on the end
Warwick James
-fine handles

Question 18

Luxators

Answer 18

Dilating ligament and cutting PDL

Question 19

Elevators - principles of use

Answer 19

Applied to roots
Rotational movement to remove teeth and roots
Not used as a lever
Potentially dangerous

Question 20

Dentist position

Answer 20

Support mandible
Protect soft tissues
Ensure px is seated properly
Head is supported, goggles in place
Your posture is safe and comfortable
Ensure good lighting and visibility
Do not bend or crouch

Question 21

On completion of extraction

Answer 21

Assess contour of sockets
Place gauze in mouth
Give post op instructions
Confirm haemostasis
Write notes

Question 22

Post operative advice/ instructions

Answer 22

Supported by written info leaflet 
Should cover
-bleeding - how to avoid and manage
-pain
-hygiene
-how to access help if required
-other info as appropriate

Question 23

Post op instructions: for 1st day

Answer 23

Avoid 
-mouth rinsing
-hot food or drink
-alcohol
-smoking
-strenuous activity
If bleeding develops, bite on clean handkerchief or cloth for 10 mins
Take simple analgesics as required

Question 24

Post op instructions: from 2nd day

Answer 24

Use hot salt mouthwashes - after meals until socket(s) healed over

Question 25

New patient on clinic

Answer 25

Introduce yourself
Check you have correct px
Check notes to see what px has been referred for
Which tooth is being removed and why
Are they medically fir and well
Review radiograph if one is available

Question 26

Medical history

Answer 26

Must be record of this in the notes
To be checked prior to treatment and updated each visit
Must include record of allergies
Must include record of current (and recent relevant) medication
*Ask about bisphosphonates: marked affect on how bone heals

Question 27

Pre-operative assessment - crown

Answer 27

Gross caries/ fractures
Restorations
Accessibility
Attrition

Question 28

Pre-operative assessment - the root

Answer 28

Number
Shape
Mobility
Fractured
Vitality/ RCT
Assessed radiographically - not always necessary

Question 29

Pre-op assessment - surrounding bone

Answer 29

Bone level
Bone loss
Bone pathology
Bisphosphonate therapy

Question 30

Pre-op assessment - nearby structures

Answer 30

Nerves e.g. lower 3rd molars

Maxillary antrum

Question 31

Consent

Answer 31

Px must consent to treatment before you start
In order to provide informed consent, px needs to understand reason for treatment, other options available and risks and benefits of each
Written or verbal
Record that this has been done

Question 32

Treatment plan

Answer 32

Clear
Tooth (/ teeth) to be written clearly in Palmer notation and in words
Do not use $ but state supernumerary tooth

Question 33

Duty of candour

Answer 33

Tell someone when something goes wrong