Surgical Extractions & Nerve Blocks

Question 1

Name some of the clinical signs that may indicate a surgical extraction may be necessary.

Answer 1

Halitosis
Pawing at mouth
Ptyalism
Oral hypersensitivity
Facial swelling
Oral hemorrhage
Sneezing
Nasal discharge
Expopthalmia
Abnormal behavior
Changes in eating habits

Question 2

What is the general order of events for a dental extraction?

Answer 2

1. perform dental nerve block
2. create surgical flap
3. remove alveolar bone
4. section multi-rooted teeth
5. elevate tooth
6. extract tooth
7. smooth alveolar bone
8. post-extraction radiograph
9. closure of flap w/o tension

Question 3

What 2 drugs are used for dental nerve blocks?

Answer 3

lidocaine and bupivacaine

Question 4

of the 2 drugs used for dental nerve blocks, which has a SLOWER onset but LONGER duration of action?

Answer 4

bupivicaine – onset is 5-15 minutes, but lasts for 6-10 hours.

Question 5

what is the onset and duration for lidocaine for use of dental nerve block?

Answer 5

1-2 min onset
1-2 hour duration

Question 6

Can you combine lidocaine and bupivicaine for dental nerve block? if so, what is the effect on onset and duration?

Answer 6

yes. the onset and duration become “medium” length compared to their short and long onset/duration individually.

Question 7

T/F: you can add an opioid (ex. buprenorphine) to local anesthetic agent to increase and prolong analgesia

Answer 7

true

Question 8

When doing a dental nerve block, why is it important that you aspirate?

Answer 8

the nerves are in a neuroVASCULAR bundle. We do not want these drugs to go IV.

Question 9

What does the infraorbital block?

Answer 9

rostral maxillary teeth (from distal root of 107 and 207 forward)

Question 10

Of the 2 approaches for infraorbital block, which do we do?

Answer 10

intraoral (open their mouth)

Question 11

What does the maxillary nerve block block?

Answer 11

ALL maxillary teeth, palate, bone, and lips.

Question 11

In what animals should you NOT do a maxillary nerve block and why?

Answer 11

cats and brachycephalic dogs.
The position of their eyes. You have the potential to create septic eyeball and subsequent enucleation.

Question 11

Of the 2 approaches to the maxillary nerve block, which do we do?

Answer 11

intraoral
we go directly behind the commissure of the lips and insert the needle vertically behind 110 or 210.

Question 11

Why is the mental dental block not very useful?

Answer 11

it only blocks the mandibular incisors, not even the mandibular canines.

Question 12

For which block does the needle NOT actually enter the foramen?

Answer 12

mandibular

Question 13

What does the mandibular nerve block block?

Answer 13

ALL mandibular teeth, bone, lips, rostral tongue, gingiva, and skin

Question 14

Of the 2 approaches to perform a mandibular nerve block, which do we use?

Answer 14

extraoral
we feel for the notch and insert the needle perpendicular to the jaw

Question 15

What flap technique is best for premolars and molars, especially when you are doing multiple-teeth extractions?

Answer 15

envelope flap

Question 16

T/F: the envelope flap technique has NO vertical releasing incisions

Answer 16

true – the incision is made along the gingival margin and the gingiva is gently elevated only to expose the alveolar bone.

Question 17

What flap technique is best for the canine, 4th premolar, 3rd incisors, as well as single tooth extractions in general?

Answer 17

mesial-based pedicle flap

Question 18

Describe how to perform a mesial-based pedicle flap.

Answer 18

incise along the mesial edge on the gingiva and create an L shaped cut.
gently elevate the gingiva to expose the alveolar bone

Question 19

what # blade do you use to incise the gingiva?

Answer 19

11 or 15

Question 20

what tool do you use to elevate the flap and expose the alveolar bone?

Answer 20

molt elevator

Question 21

what 3 sides of alveolar bone do you need to remove with your round bur?

Answer 21

1. buccal/labial
2. mesial
3. distal

Question 22

how much alveolar bone do you need to grind away?

Answer 22

enough until you can elevate the tooth

Question 23

why do we section multirooted teeth?

Answer 23

roots have more strength when they are together.

Question 24

what tool and technique do we use to elevate the tooth?

Answer 24

wing-tipped elevator
we hold it with an underhanded palm-grip and twist.

Question 25

in what direction should you apply force when elevating a tooth?

Answer 25

The axis of strength ie the long axis of the tooth.

Question 26

T/F: you should apply force in the horizontal axis of the tooth when extracting it with extraction forceps

Answer 26

false – still apply force in the long axis of the root.

Question 27

what are the 2 reasons that we do post-extraction radiographs?

Answer 27

1. verify you got all the roots out and there is no bone damage/fractures
2. legal documentation

Question 28

what is the purpose of an alveoplasty?

Answer 28

smooth rough or protruding edges of the alveolus to make the flap easier and more comfortable to close.

Question 29

what suture do we use to close flaps?

Answer 29

4-0 or 5-0 absorbable suture
(monocryl or gut)