primary extractions Flashcards
at what angle should a child be positioned?
at 30 degree angle from the vertical
what teeth require an operator to stand behind the patient?
the lower right molars
where should you stand except for lower right molars?
rhs and infant of patient
what is the operator position for all upper teeth?
infront of pt- RHS- straight back- pt mouth at level of the our shoulder
what is the operator position for lower left Q?
RHS infront of pt- mouth at elbow level of operator
what is the operator position for lower right q?
behind pt- with patient and chair as low as possible
what teeth should be extracted first?
symptomatic and lower teeth
why should lower teeth be extracted first?
bleeding from uppers will reduce visibility
what instrument do you use for extractions?
universal forceps
what shape are forceps for upper teeth?
straight
what shape are forceps for lower teeth?
right angled beak
what elevator may be used for deciduous teeth?
Warwick James elevator
why would WJ elevator be used?
to remove root fragments
what should the non-working hand be doing during an extraction?
protecting soft tissues and supporting the jaw
what is the mechanism to remove teeth?
an apically directed push and then socket expanding movements
in what direction should tooth removal be?
in a buccal direction
how do you extract a tooth?
open forceps and slide subgingivally against the root-then close forceps and have handle against the palm of the hand for best force
how do you remove upper anteriors (single rooted)?
straight upper universal forceps- slide subgingivally and apply apical pressire- twist as far clockwise as poss then anticlockwise
how do you remove lower anteriors?
right angle lower universal forceps- slide subgingivally and apply apical pressire- twist as far clockwise as poss then anticlockwise
for molars, how do you remove?
for uppers slide straight universal forceps subgingivally, push apically and expand in buccal direction
for lowers slide right angle forceps subgingivally, push apically and expand in buccal direction
if molars move only a little with buccal expansion, what should you do?
do full rotations- then remove bucally
what is haemostasis?
blood clotting in response to injury
how do you achieve haemostasis after extraction?
nip both sides of socket to apple pressure- then use a bite pack
what instructions do you give to a child when applying a bite back?
to bite down firmly for 5 mins
when can a child leave the surgery following an extraction?
when haemostasis is achieved
what do you do if the bite pack does not achieve haemostasis ?
repeat the process for another 5 mins
how should POI be given to patients and parents?
verbally and written including phone number
what may saliva do after an extraction?
may cause pt to think bleeding is still happening- reassure that a pink tinge is ok
what should a to do if socket bleeds at home?
roll up clean hankerchief and bite down firmly for 20 mins
if bleeding persists at home, what advice should be given?
call surgery and if out of hours go to a&e
what other instructions are important after an extraction?
LA POI
what 4 other bits of advice should be given?
- do not rinse for 24 hrs
-do not exercise for rest of day
-avoid foodstuffs that can traumatise socket
-avoid hot and spicy food
when should pain relief be started?
before LA wears off
what pain relief can be administered for 1-5 yo?
120-250 mg paracetamol every 4-6 hrs
what pain relief can be administered for 6-12yo?
250-500mg paracetamol every 4-6 hrs
what Ian relief can be given to over 12s?
500mg paracetemol every 4-6 hrs
what pain medication is a contraindication in children?
aspirin
when should an extraction be reviewed?
after 1 week- to check gum is healing
what can deteriorate post-extraction?
oral hygiene in that area- must e reinforced at review
what may be required after early loss of deciduous teeth?
space retention orthodontics
what is the rule of 10 for LA?
Childs age+tooth number
if LA number is over 10, what would you do?
IDB
what would you do in place of palatal/lingual injection?
inter papillary infiltration
if la number is less than 10, what would you do?
infiltration
how do you work out the maximum LA dosage for child?
1/10th cartridge to 1kg body weight
