Extractions Flashcards
Why might we remove teeth
- Caries
- Pulpal necrosis
- Periodontal disease
- Othdontic reasons
- Recurrent infection
- Supernumerary
- Cracked tooth
- Pathology
- Trauma
Name the most common cause for removing teeth
Caries
Give some contra indications for exodontia
- General health of the patient
- Medical history
- Haemophiliacs
- Anxiety
- Suspicious lesion
- Acute inflammation
- No diagnosis
What things in a medical history might make us hesitant to remove teeth
- BRONJ
- Steroids (reduced healing)
- Poorly controlled diabetes (reduced healing)
- Anticoagulants
Why are suspicious lesions a contra indication for exodontia
As a malignant lesion on the mucosa won’t be resolved by taking the tooth out
Why is inflammation a contra indication for exodontia
As the pH is altered which will affect the anaesthetic
Also the needle may spread infection
What factors do we need to consider before carrying out exodontia
- Local anatomy
- Access (can patient open their mouth)
- Mobility
- Root morphology
- Bone morphology
What structures should we be aware of when considering extraction
- Maxillary molars lie close to the antrum (could spread infection)
- 3rd molars lie very close the IA nerve
- Mandibular pre molars lie very close to the mental nerve
When assessing the roots of teeth we want to extract what do we look at
- The number of roots
- Curvature of the roots
- Shape of the roots
- Caries
- Has it been root canaled
What happens to bone density as age increases
Bone density increases with age
How can apical pathology affect bone density
Cysts lead to apical bone loss
What should all patients be aware of post extraction
Pain, swelling, bleeding, bruising and infection
Possibility of stiff/ painful jaw
What should be received from the patient before carrying out any treatment
Consent
What can increase the risk of dry socket
- Females on the pill
- Xerostomia
- Smokers
List the 3 principles of removing teeth
- Expansion
- Separation of the PDL and soft tissues
- Controlled force
What do we use to remove teeth
- Elevators
- Luxators
- Forceps
Describe Luxators
Sharp thick instruments that fit into tight spaces easily that cut the PDL
How should Luxators be used
Should be pushed in the direction of the long axis of the tooth
Luxators are __________ ________ as they…..
Technique sensitive as they break easily
What should Luxators not be used as
Elevators
Talk through the technique of using Luxators
- Finger should be placed on the buccal plate an thumb on the palate
- Use a controlled movement and push in the long axis of the tooth
- Patient should start to feel the pocket start to expand
Name the standard instrument for extractions
Elevators
What do elevators act as
The act as a fulcrum and applies force to bone and tooth
When are elevators difficult to use
Difficult to use when:
- embrasure is too small,
- almost no crown left,
- Adjacent tooth has restoration
How do you use an elevator
- Placed in between teeth and bone
2. Rotation and elevating motion us used to sever PDL fibres and expand the socket
Name the different types of elevators
- Couplands
- Cryers
- Warwick James
What are cryers good for
Good for breaking inter septal bone, retained roots and 3rd molar
What are Warwick James
A compromise between elevators and luxators
Describe the structure of forceps
They have a beak, hinge and handle
Post extraction what should we check for
- Check apices are intact and the whole tooth is out
- Is anything on the tooth pathology wise
- Squeeze the socket walls to encourage blood clots to form
What post op instructions should we give to patients
- Expect pain
- Bleeding is normal
- No exercise for 24 hrs
- No smoking or vaping for a week
- No alcohol
- No mouth wash
- Warm salt water rinse
- Try not to eat on the extracted tooth side
What is a complication
Any event that would not normally occur or an unanticipated problem that arises following a procedure, treatment or illness
How can we prevent/ limit complications prior to surgery
- Take a thorough history and exam
- Know the patient and their problem
- Know your own ability
- use appropriate investigations and come to an appropriate diagnosis
- Warn the patient of any completions the tmay arise
What complications can occur following extractions
- Fracture of tooth or incomplete extraction
- Fractures tuberosity
- Pushing roots into the antrum
- Iatrogenic complications
- Fractured mandible
- Paraesthesia/ Anaesthesia/ Nerve damage
- Inhalation of tooth fragments
