Extractions

Question 1

What are the indications for tooth extraction?

Answer 1

1. Periodontal disease
2. Relief of tooth crowding
3. Tooth resorption
4. Fractured teeth
5. Luxation
6. Pulp necrosis
7. Caries
8. Feline chronic gingivostomatitis
9. Ectopic, unerupted or impacted teeth
10. Failed restorative treatment

Question 2

What must you do with multi-root teeth before trying to perform a closed extraction?

Answer 2

Section the teeth using a high speed dental hand piece and water cooling
Identify the furcation and section appropriately

Question 3

How should you use a dental elevator?

Answer 3

As close to the tooth as possible, in the space between root and alveolus
Rotate not lever

Question 4

Once all the periodontal ligament is broken down how can you move the tooth?

Answer 4

Extraction forceps gripping as low as possible on the tooth

Large sockets should be sutured closed, but naturally packing the socket is sufficient in most cases

Question 5

Name some complication ps encountered using the closed technique?

Answer 5

Ankylosis
Iatrogenic soft tissue damage, broken jaw
Root remnants
Displaced root fragments
Oro-nasal fistula - always suture canine tooth sockets
Dry socket - pain & pyrexia 2-3d post op

Question 6

How can you treat a rostral mandibular fracture?

Answer 6

Cerclage wire

Question 7

When is an open extraction indicated?

Answer 7

All dog canine teeth, cat lower canines
FORL Lesions
When a closed extraction doesn’t progress
When a complication is encountered during closed extraction
Extracting several neighbouring teeth

Question 8

What shape should you make a gingival flap?

Answer 8

Broader at the base

Question 9

What layers should you include in your flap?

Answer 9

Full thickness, including the periosteum

Raise this with a periosteal elevator, starting at the caudal corner

Question 10

How should the flap be held whilst removing the bone?

Answer 10

Stay sutures

Question 11

How should you remove the bone when performing an open extraction?

Answer 11

Using a dental drill, by making 2 bone gutters

Question 12

How can you extract the tooth after removing the bone in an open extraction?

Answer 12

Place the elevator in the gutters and rotate
Once the periodontal ligament has been broken down use the forceps to extract the tooth

THE SITE MUST BE SUTURED CLOSED - high risk of oronasal fistula

Question 13

How should you close an open extraction site?

Answer 13

4-0 absorbable monofilament eg: monocryl

Simple interrupted pattern

Question 14

What post operative care should you provide after an open extraction?

Answer 14

Meloxicam & buprenorphine 5-10 days
Withold chew toys for 5 days
Chlorhexidine mouth wash
Prophylactic antibiotics

Question 15

What consideration should you make when removing mandibular canine?

Answer 15

Root points medially in the mandible

Can make a large flap on the floor of the mouth

Question 16

What nerve block could you use for rostral maxilla mouth extractions, and where does it desensitise?

Answer 16

Infra orbital nerve block
Landmark - infraorbital canal
All teeth and soft tissues rostral to the 4th premolar on the maxillary arcade

Question 17

What nerve block would you used for a maxillary molar extraction, and what structures does this desensitise?

Answer 17

Maxillary nerve block
Landmark - caudal to the last molar

Hard and soft tissues including the 4th premolar and caudal to it

Question 18

Which nerve block would you use for extraction of the mandibular molars?

Answer 18

Inferior alveolar / mandibular block
Landmark - by palpation caudal to the last molar on lingual aspect
Desensitises all of the teeth and soft tissues of the mandible

Question 19

What nerve block would you use for extracting the mandibular canines?

Answer 19

Mental nerve block
Landmark - mental foramen
Desensitises the mandibular incisors, canines and 1st and 2nd premolars

Question 20

What is the onset and duration of lidocaine?

Answer 20

Onset 5-10 mins, duration 1-2 hours

Question 21

What is the onset and duration of bupivicaine?

Answer 21

Onset 10-20 mins, duration 4-6 hours