PRIMARY TOOTH EXTRACTION

Question 1

what angle should a conscious child be positioned when XLA a tooth

Answer 1

30 degrees to the vertical

Question 2

what is the operator positioning when XLAing a tooth

Answer 2

ALL teeth are taken out with the operator standing at the right hand side and facing the patient, EXCEPT FOR LOWER RIGHT MOLARS which are extracted with the operator behind the patient

Question 3

what is the operator positioning for the LOWER RIGHT QUADRANT

Answer 3

the operator stands behind the patient with the chair AS LOW AS POSSIBLE to improve access and visibility

Question 4

what is the order when extracting teeth?

Answer 4

• SYMPTOMIATIC teeth XLA first
• lower teeth before upper to avoid bleeding, reducing visibility.

Question 5

what are the different types of forceps

Answer 5

• in general, only universal primary upper and lower and primary molar forceps will be available
• UPPER FORCEPS - straight handled
• LOWER FORCEPS - have a RIGHT ANGLED BEAK
• elevators are not routinely used for deciduous extractions, Warwick James elevator may occasionaly be useful for removing root fragments

Question 6

what is the operating technique for XLA in primary tooth (4)

Answer 6

• non-working hand must protect the soft tissues and support the jaw
• all teeth are removed with an apically directed push and then socket expanding movements
• the alveolus must be supported at all times.
• REMOVE ALWAYS IN A BUCCAL DIRECTION !!!!!!!

Question 7

what is the operating technique for extracting upper anteriors/canines (2)

Answer 7

• USE UPPER STRAIGHT deciduous forceps
• once the forceps are correctly placed, apply apical pressure and rotate the tooth smoothly as far CLOCKWISE as possible then counterclockwise

Question 8

what is the operating technique for XLA of lower anteriors/canines (2)

Answer 8

• use LOWER UNIVERSAL deciduous forceps
• once the forceps are correctly placed, apply apical pressure and rotate the tooth smoothly as far clockwise as possible, the counterclockwise.

Question 9

what is the operating technique for xla of UPPER primary molars (4)

Answer 9

• MORE SOCKET EXPANSION REQUIRED
• upper primary molar forceps are used
• once forceps are correctly placed, move tooth buccally, smoothly and slowly.
• if little movement, rotate the tooth using full rotations then remove buccally.

Question 10

operating technique for xla of LOWER primary molars (3)

Answer 10

• lower primary molar forceps used
• move tooth buccally, smoothly, and slowly
• if little movement, again, rotate the tooth using full rotations then remove buccally.

Question 11

what MUST we do immediately after every XLA?

Answer 11

both sides of the socket are nipped by fingers as a method of applying pressure to the area.

Question 12

how do we achieve haemostasis post XLA (3)

Answer 12

• place a bite pack into the socket and instruct the child to bite firmly for at least 5 mins
• remove the pack and examine the socket for haemostasis
• MUST BE ACHIEVED BEFORE THE CHILD LEAVES SURGERY.

Question 13

what POIG do we give post XLA (11)

Answer 13

• must be given orally and in writing to the pt and parent
• bleeding will have stopped before the patient leaves surg but saliva washing over the socket will tinge pink - reassure this is normal
• if bleeding starts once home, roll up a clean cotton hankerchief and bite for 20 minw
• if bleeding persists, call surgery, if out of hours - A&E
• good oral hygiene should be encouraged
• advise patient and carer if LA has been administered not to bite, chew or suck the lip or tongue!
• avoidance of injury in socket area through foodstuffs
• avoid hot drinks
• do not rinse or spit for the rest of the day
• avoid exercise for rest of the day.
• REVIEW IN 1 WEEK