Extractions and Minor Oral Surgery Flashcards
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Simple ext-roots teeth no soft tissue or bone
Surgical ext-roots tooth soft tissue or bone to be again access to get to the tooth
Operculectomy-surgical removal flap partial erupted
Alveolectomy- surgical adjustment bone removal alveolar ridge crest a smooth base dentures after extract
Gingivetomy and gingivoplasty helps for OH periodontal to tissues adjusted
Periodontal flap surgery-surgical raising replacing enable subgivgival debridement carried out
Soft tissue biopsi-pathology investigation diagnosis partial or complete removal of oral tissue lesion
Extraction-
Pontic of a bridge,denture,implant
Reason for tooth extraction
Pain infection
Position for denture prosthesis Poor aligned, ortho failed root canal pericoronitis food trapping deciduous tooth favourable positions
No reason and has to extract
Continual infection in mouth infection can spread to blood stream repeat prescriptions is poor practice
Different extraction categories
*Simple extraction
*Surgical extraction involving soft
tissues removal to expose an unerupted tooth or buried root
- surgical extraction Involving dissection tooth socket in sections
- surgical extraction involving raising mucoperiosteal flap and bone removal gain full access root or tooth
Deciduous tooth points considered
Resorption-attached to gingivae
Permenent successor- underlying tooth Attached damaged?
Infection makes procedure unnecessary painful
Age cooperation
Medical history
Tooth status if surgical extraction lots of caries differcutl to sit thru
Permanent tooth points considered
Infection
Medical history
Medications hospitalisation because of their side effects
Co operation may need anxiety control
Age older patients jaw brittle and damaged tissues
Tooth status grossly carious=surgical extraction
Cost implications after missing tooth
Simple extractions instruments
Forceps-grip from neck of tooth applying wrist action
Luxators-used to widen socket serve periodontal ligaments
Elevators-prise the tooth and root of the socket-winters cryers Warwick James
Fine bore aspirator-disposable suction tip all blood sucking tooth debris
Haemostats-gelatine sponges or oxidised cellulose packs inserted into socket after extraction aid blood clotting
Special precautions
Sterile bagged instruments individually
PPE for dental team prevent blood contamination
Disposable items cross infection scopale blades needle aspirators sutures
Contamination policy not used must be thrown anways
Suction equipment-run through inner workings
Operative field-sodium hypochlorite blood wiped down
Equipment coverage-dental chair covered before procedure
Sterile field-no touch technique
Pre op
Local anaesthesia will nessary
Not be painful once that’s given
Surgical extraction suture be required
Take all meds before unless dentist says not to no aspirin
Light snap before procedure 2h avoid fainting
Full post of given I’m writing
Child patient or adult nervous accompy adult
Post op
Pain swelling bruising occur
Analgesics expect aspirin
Alcohol hot drinks excercise avoid 24 hr
No mouth rinsing the day of procedure
Hot salt water rinses after meal for a week
Bleeding occur bite cotton pack 30 mins
Give emergency telephone number advise problems
Further appointments of suture to be removed
Surgical extraction reasons
Will call into categories
Extraction sectioning or raising mucoperiosteal flap
Roots left retained in alveolar bone small lives left in situ can come to the
bone later on and be a normal extraction
Too rotten held by forceps
Curved roots impossible for normal extraction
Tooth is partially erupted or impacted tooth becomes a stagnation
Tooth unerupted has association to pathology cyst
Can cause problems prosthesis or ortho treatment
Deciduous tooth fails to exfoliate because roots cemented to bone -ankylosed
Tooth Sectioning extraction
Multirooted teeth root that is curved or gross carious
Maybe necessary sometimes to remove septal bone lies between root and socket wall
High speed turbine diamond bur usually for crown prep bur
Use of couplands chisel achieve final separation of roots twist to snap them apart
High speed suction remove water
Careful retraction of soft tissues
Extractions invoking mucoperiosteal flap
Unerupted tooth or impacted
Buried retained root
Root curved=extensive bone removal
Gross root
Role as a dental nurse flap procedures
Correct suction and irrigation solution
Correct and accurate fine bore asipirator
Careful retraction without being forceful
Cutting suture or assistant keeping it taut
Prep bite pack assist placement of gelatine sponge
SURGICAL INSTRUMENTS FOR FLAP PROCEDURE
- scalpel blade and handle-create flap incision thru full thickness
- Osteotrimmer-raise corner flaps- Mitchell’s trimmer
- periosteal elevator-elevation flap over bone surface peeling it off the bone
- hand piece surgical bur-remove alveolar bone gain access
- irrigation syringe-irrigate surgical field sterile saline or sterile water
- austin and Kilner retractors-protect check and lips and tongue
- rake retractor-retract mucoperiosteal it self
- bone rongeurs-nibble away Bony spicules smooth base
- dissecting forceps-holds loose flap taut during sutures
- needle holder-pre threaded needle Firm suturing
- suture pack-half moon needle silk black Vicryl Suture bad into position alveolar bone
- suture scissors-cut suture end
Tooth impaction
Vertical impaction impacted to the ramps of the mandible
Horizontal impaction slacker sidewards
Mesio angular impaction titled side ways into second molar
Disto angular backwards into Ramus
Risk of extraction
Extensive bone removal weaken mandible
Pain and swelling
Inferior dental nerve and lingual dents nerve close to operation damage temp or perm
Eating and talking diffecult
Limited mount opening
Complications of extractions
Orantral fistulas - maxillary sinus extracting upper premolar and molar lies of those roots so it can cause infection or trauma pushed into the root=oral specialist..long rooted can leave a hole for a week antrum and oral cavity told not to blow their noses week..air bubbles in socket confirmed pinches nose and blows.. large openings direct suturing or gingival flap off palate across seal fistula
Unexpected tooth fracture it it has been heavy or root filled grossly carious if roots are fine and curved can cause a fracture can be left in situ to rise to alveolar ridge over time then remove
Loss of tooth-respiratory or digestive inhaled sent immediately hospital chest X-ray abdominal radiographs cause cause infection respiratory one can be removed in the use of a bronchoscope if lodged inside main bronchi if not then further has to be thru thoracic surgery
Left surgery
Bleeding
Within 1-23 hours REACTIONARY HAEMORRHAGE
After24 hours SECONDARY HAEMORRHAGE due to infection at site
INFECTION
2-4 days loss blood clot boney socket walls infected LOCALISED OSTEITIS
Bleeding
Blood vessels in the periodontist are torn during procedure
Usually stops 5 mins after PRIMARY HAEMORRHAGE
if extensive bleeding can use sutures
TORN blood vessels constrict blood flow
Then platelets come help with air and create sticky clump together
Clotting mechanisms-protein fibrinogen converted =fibrin= chemically seals cut vessels haemorrhage ends
INR international normalised ratio indicate whether done in the practice or hospital setting Score more then 4 out to hospital
Haemostatic sponge solve problem
Infection
Painful 2-3 days after cute inflammation bone(osteitis) socket cause by a micro invasion the blood clot is the protection but it ain’t there
Infection of blood clot
Failure of formation
Disturbance of blood clot
Microorganism invade socket overwhelms the defending white blood cells
And disingets it more common in mandible then upper thick bone
TREATING —irrigation use tweezers sedative dressing alvogyl socket anti inflammatory analgesic and hot water rinses
DENTAL nurse role
Dental nurse duty reassure patient
Give a pad to bite down
Awaiting arrival of dentist Mouth wash for unpleasant taste or go to dental hospital
Accidental extraction
Replanting premolar back in don’t allow periodontal ligament infected or dried
Same with little children insicsal teeth come out avulsed as long as periodontal membrane remains vital
Reassure patient treatment might be possible
Hold tooth my crown warm water
Don’t disinfect
They can put it back inside immerse in milk come surgery straight away
Splint needed to mobilise for a week or so
Antibiotics MOS
Back up to treatment
Evidence of infection only
Evidence symptoms raised body temp
Better removed form extraction
Resistant to bacteria
Long term affects to body bacteria
Dangerous antiolgant drugs have on antibiotic don’t stop bleeding
Other drugs conception and alcohol
Hypersensitivity for the use of antibiotic
All drugs avoid when pregnant
FIRST CHOICE-amoxicillin 250 mg 4 times for 5 days
SECOMD CHOICE-metronidazole 200 mg 3 day or 3 days
THIRD CHOICE-erythromycin 250mg 4 times 5 days allergic penicillin
Serve 1/2 given together
Operculectomy
Surgical removal gingival flap partially erupted
Cause cause pericoronitis and then trismus
Treatment
Mouth wash called peroxyl mouthwash (oxygen realising solution)
Irrigation under flap remove debris cholorhexidine
OHI
Ibruprofen
Surgical removal using electrical cautery unit controls bleeding
3 days course of mertrondizole
Alveolectomy and alveoplasty
A mucoperiosteal flap raised to gain access to ridge the. Bone rongeurs nuts used to remove help sit denture not make bone sharp
Gingivectomy gingivoplasty
Helps with Oral health measures more better to remove plaque
Excess gum removed with gingivectomy knife Blake’s most common
Removed with tweezers RAW AREA covers with ZINC OXIDE EUGENOL periodontal pack=Coe-park
Rapid painless healing
Removed a week later thru scaling
Used for crown lengthening
Gingivoplasty carried out using electro surgical unit
Given analgesics Drugs soft diet mourn wash
Periodontal flap surgery
Performed under local Anastasia And refer to a periodontal specialist
Helps for plaque control sub gingival
Incision made through the gingival palatal of the tooth down to the surface
piece of tissue is removed from the area
Then plaque calculus
Removed ultra sonic scaler
Antibiotics- gengigel dentomycin periochip used healing
Then put back into place sutures
But gingival margin repositioned
Exposing more of the route to make cleaning easy in the future
Soft tissue biopsies
Large lesions are called incisor biopsies
Whole tissue removed and small lesions are referred to as excisions biopsies
Could be cancer
Cyst removal
is a fluid filled sac combine with soft tissue lining
It can happen when the tooth is dead apex apical cyst or preventing a eruption dentigerous follicular cyst
If left it can displace of a tooth and it should be removed in oral surgeon hospital
Frenectomy
Removal frenum fibrous tissue muscle membrane
Wide gap upper central Invisalign median diastema affect denture fit upper
