Extractions

Question 1

Why might we remove teeth

Answer 1

1. Caries
2. Pulpal necrosis
3. Periodontal disease
4. Othdontic reasons
5. Recurrent infection
6. Supernumerary
7. Cracked tooth
8. Pathology
9. Trauma

Question 2

Name the most common cause for removing teeth

Answer 2

Caries

Question 3

Give some contra indications for exodontia

Answer 3

1. General health of the patient
2. Medical history
3. Haemophiliacs
4. Anxiety
5. Suspicious lesion
6. Acute inflammation
7. No diagnosis

Question 4

What things in a medical history might make us hesitant to remove teeth

Answer 4

1. BRONJ
2. Steroids (reduced healing)
3. Poorly controlled diabetes (reduced healing)
4. Anticoagulants

Question 5

Why are suspicious lesions a contra indication for exodontia

Answer 5

As a malignant lesion on the mucosa won’t be resolved by taking the tooth out

Question 6

Why is inflammation a contra indication for exodontia

Answer 6

As the pH is altered which will affect the anaesthetic

Also the needle may spread infection

Question 7

What factors do we need to consider before carrying out exodontia

Answer 7

1. Local anatomy
2. Access (can patient open their mouth)
3. Mobility
4. Root morphology
5. Bone morphology

Question 8

What structures should we be aware of when considering extraction

Answer 8

1. Maxillary molars lie close to the antrum (could spread infection)
2. 3rd molars lie very close the IA nerve
3. Mandibular pre molars lie very close to the mental nerve

Question 9

When assessing the roots of teeth we want to extract what do we look at

Answer 9

1. The number of roots
2. Curvature of the roots
3. Shape of the roots
4. Caries
5. Has it been root canaled

Question 10

What happens to bone density as age increases

Answer 10

Bone density increases with age

Question 11

How can apical pathology affect bone density

Answer 11

Cysts lead to apical bone loss

Question 12

What should all patients be aware of post extraction

Answer 12

Pain, swelling, bleeding, bruising and infection

Possibility of stiff/ painful jaw

Question 13

What should be received from the patient before carrying out any treatment

Answer 13

Consent

Question 14

What can increase the risk of dry socket

Answer 14

1. Females on the pill
2. Xerostomia
3. Smokers

Question 15

List the 3 principles of removing teeth

Answer 15

1. Expansion
2. Separation of the PDL and soft tissues
3. Controlled force

Question 16

What do we use to remove teeth

Answer 16

1. Elevators
2. Luxators
3. Forceps

Question 17

Describe Luxators

Answer 17

Sharp thick instruments that fit into tight spaces easily that cut the PDL

Question 18

How should Luxators be used

Answer 18

Should be pushed in the direction of the long axis of the tooth

Question 19

Luxators are __________ ________ as they…..

Answer 19

Technique sensitive as they break easily

Question 20

What should Luxators not be used as

Answer 20

Elevators

Question 21

Talk through the technique of using Luxators

Answer 21

1. Finger should be placed on the buccal plate an thumb on the palate
2. Use a controlled movement and push in the long axis of the tooth
3. Patient should start to feel the pocket start to expand

Question 22

Name the standard instrument for extractions

Answer 22

Elevators

Question 23

What do elevators act as

Answer 23

The act as a fulcrum and applies force to bone and tooth

Question 24

When are elevators difficult to use

Answer 24

Difficult to use when:

1. embrasure is too small,
2. almost no crown left,
3. Adjacent tooth has restoration

Question 25

How do you use an elevator

Answer 25

1. Placed in between teeth and bone

2. Rotation and elevating motion us used to sever PDL fibres and expand the socket

Question 26

Name the different types of elevators

Answer 26

1. Couplands
2. Cryers
3. Warwick James

Question 27

What are cryers good for

Answer 27

Good for breaking inter septal bone, retained roots and 3rd molar

Question 28

What are Warwick James

Answer 28

A compromise between elevators and luxators

Question 29

Describe the structure of forceps

Answer 29

They have a beak, hinge and handle

Question 30

Post extraction what should we check for

Answer 30

1. Check apices are intact and the whole tooth is out
2. Is anything on the tooth pathology wise
3. Squeeze the socket walls to encourage blood clots to form

Question 31

What post op instructions should we give to patients

Answer 31

1. Expect pain
2. Bleeding is normal
3. No exercise for 24 hrs
4. No smoking or vaping for a week
5. No alcohol
6. No mouth wash
7. Warm salt water rinse
8. Try not to eat on the extracted tooth side

Question 32

What is a complication

Answer 32

Any event that would not normally occur or an unanticipated problem that arises following a procedure, treatment or illness

Question 33

How can we prevent/ limit complications prior to surgery

Answer 33

1. Take a thorough history and exam
2. Know the patient and their problem
3. Know your own ability
4. use appropriate investigations and come to an appropriate diagnosis
5. Warn the patient of any completions the tmay arise

Question 34

What complications can occur following extractions

Answer 34

1. Fracture of tooth or incomplete extraction
2. Fractures tuberosity
3. Pushing roots into the antrum
4. Iatrogenic complications
5. Fractured mandible
6. Paraesthesia/ Anaesthesia/ Nerve damage
7. Inhalation of tooth fragments