Primary Extractions Flashcards
At what position should a child be seated for an extraction and why?
Conscious child should be seated at 30 degrees to the vertical - protects childs airway to prevent aspiration of tooth
Give a general overview of how the operator should be positioned when extracting teeth:
- operator standing at right hand side and facing patient
- exception being the lower right molars - operator is behind the patient
Lower right = right behind
How should the operator be positioned to extract upper teeth?
For all upper teeth:
- operator should stand infront of patient with a straight back
- patients mouth should be at the level of the operators shoulder
How should the operator be positioned to extract:
a) teeth in the lower left quadrant?
b) teeth in the lower right quadrant?
Lower left quadrant:
- operator stands infront of patient with patients mouth at the same level as the operators elbow
Lower right quadrant:
- operator stands behind patient with the chair as low as possible to improve access and visibility
What types of forceps are available?
Upper forceps are straight handled
Lower forceps have a right angled beak
Elevators are not routinely used for primary extractions - can remove permanent successor or cause damage
Give a brief overview on how to extract an incisor or canine:
- choose forceps (upper straights or universals for uppers, lower universals for lowers)
- place forceps on root of tooth
- apply apical pressure and rotate tooth smoothly as far clockwise as possible, then counter clockwise
- support alveolus and retract lip/soft tissues with non-working hand
- nip alveolus immediately after extraction
Give an overview on how to extract primary molars:
- use upper or lower universals depending upon which arch tooth is
- place forceps correctly on root of tooth at furcation area
- apply apical pressure to expand socket and move tooth buccally smoothly and slowly
- if there is little movement, rotate the tooth using full rotations (stirring movements) then remove in a buccal direction using smooth ,buccal movements
- nip both sides of the socket with fingers to apply pressure to area which has just expanded
How do you achieve haemostasis?
- place a bite pack into the socket and instruct the child to bite firmly for at least 5 minutes
- remove pack and examine the socket for haemostasis, repeat if required
- haemostasis must be achieved before the child leaves the surgery
What POIG should be given to both the child and parent?
POIG must be given orally and in writing to patient and parent
- saliva washing over socket will tinge pink - reassure this is normal
- if bleeding starts when home, roll a clean cotton handkerchief and bite for 20 mins
- if bleeding persists, call surgery or A&E if out of hours, surgery phone number must be on POIG
- good OH should be encouraged
- if LA has been administered, do not bite, chew or suck lip/cheek/tongue
- avoidance of injury in socket area through foodstuffs - soft diet for a couple of days
- avoid hot drinks
- do not rinse or spit for rest of day
- avoid exercise for rest of day
- pain relief - simple analgesics - best started prior to anaesthetic completely worn off
- review in 1 week
- return if any problems with bleeding, excessive pain, swelling occurs
What should you check at review appointment following extraction?
- OH will in most cases have deteriorated in area of extraction due to avoidance, this needs to be corrected and reinforced
- check healing is taking place and some sort of socket coverage is intact
What are the correct doses for paracetamol?
Sugar free paracetamol suspensions are indicated:
- 120-150mg every 4-6 hours for 1-5 years
- 250-500mg for 6-12 years
- 500mg for 12-18 years
- aspirin is contraindicated in children - can cause Reye’s syndrome
