tooth extractions Flashcards
- What are the different types of patients in dental extractions?
👩⚕️ Emergency patients - Patients requiring immediate dental care due to trauma, infection, or severe pain.
👨⚕️ Inpatient referrals - Patients referred from hospitals for extractions during their stay.
🦷 Elective patients - Patients who seek extractions for non-urgent reasons (e.g., orthodontic treatment, preparation for dentures).
What is the structure of history taking in dental practice?
📝 Presenting complaint - Always note the patient’s words exactly as they describe it (e.g., “I have severe tooth pain”).
📊 SOCRATES:
Site – Where is the pain located?
Onset – When did it start?
Character – What type of pain (sharp, throbbing)?
Radiation – Does the pain spread anywhere?
Associated symptoms – Any other symptoms like swelling or fever?
Timing – Is it constant or intermittent?
Exacerbating/Relieving factors – Anything that makes it better or worse?
Severity – On a scale of 1-10, how bad is the pain?
What questions should be asked in medical history?
🩺 Focused and system-based approach
👨⚕️ “Are you seeing a doctor for any treatment?”
💊 “What medications are you currently taking?”
⚠️ “Do you have any allergies?”
🏥 “Any hospital admissions in the past?”
🤔 “Is there anything else you think I need to know about your health?”
What is a systems-based approach to medical history?
💨 Respiratory:
“How well-controlled is your asthma?”
“What triggers your asthma?”
“Do you take any inhalers or medications for it?”
💉 Cardiovascular:
“Do you have any heart conditions?”
“Any high blood pressure or heart surgeries?”
🌬️ Respiratory:
“How often do you have respiratory problems? Last time you were hospitalized?”
🛌 General:
“Ever been ventilated during a hospital stay?”
What family history factors should be considered?
🧬 Inherited diseases – Family history of genetic conditions (e.g., cystic fibrosis, sickle cell anemia).
🍷 Alcohol-related conditions – Liver damage, pancreatitis, heart disease, weakened immune system.
🚬 Smoking-related diseases – Chronic lung diseases, stroke, heart disease, gum infections, blindness, etc.
🧠 Cancers – Head/neck, lung, kidney, bladder, stomach, pancreas, etc.
What is the surgical sieve for differential diagnosis?
🩻 VITAMIN C DEF - A systematic method to exclude differential diagnoses:
Vascular (e.g., bleeding disorders)
Infective/Inflammatory (e.g., abscess, gingivitis)
Trauma (e.g., fracture, dislocation)
Autoimmune (e.g., lupus, rheumatoid arthritis)
Metabolic (e.g., diabetes, hypothyroidism)
Iatrogenic (caused by medical treatment)
Neoplastic (e.g., cancer)
Congenital (e.g., cleft lip/palate)
Degenerative (e.g., osteoarthritis)
Endocrine/Environmental (e.g., hypothyroidism, exposure to toxins)
Functional (e.g., temporomandibular joint dysfunction)
What factors are assessed during extra-oral and intra-oral clinical assessments?
👨⚕️ Extra-oral:
Cervical lymphadenopathy – Check for swollen lymph nodes.
TMJ (temporomandibular joint) – Assess for dysfunction or pain.
Facial symmetry/swelling – Look for signs of infection or trauma.
Cranial nerve function – Ensure neurological health.
👄 Intra-oral:
Soft tissues: Check the tongue, floor of the mouth, buccal mucosa for lesions or abnormalities.
Hard tissues: Assess the teeth for decay, fractures, or restorations.
What factors to consider for a tooth extraction procedure?
👩⚕️ Patient Factors:
Age, periodontal status, oral hygiene, anxiety levels.
⚖️ Medical Factors:
ASA (American Society of Anesthesiologists) grade, medications, BMI, comorbidities.
🔧 Surgical Factors:
Tooth anatomy, bone density, impaction, adjacent pathology.
🦷 Surgical Complexity:
Straightforward: Routine extraction with minimal complications.
Advanced: Extraction requiring more complex techniques or patient management.
Complex: Extractions involving high-risk factors, like impaction or nearby vital structures.
What imaging is used in dental extractions?
📸 OPT (Orthopantomogram): A panoramic X-ray for overall dental and bone health.
🔬 PA (Periapical): X-ray focusing on specific teeth or regions.
🧭 CBCT (Cone Beam CT): Provides detailed 3D imaging for complex cases like impacted teeth.
What are red flags in radiographic assessment?
⚠️ Loss of symmetry – Indicates potential pathology or trauma.
⚠️ Distorted anatomy – Could suggest infection, tumors, or cysts.
⚠️ Bone erosion – A sign of infection, tumor, or advanced disease.
⚠️ Teeth floating – Indicates loss of supporting bone, possibly from severe periodontal disease or tumor growth.
What is the role of local anesthesia in dental procedures?
💉 Esters & Amides: Types of anesthetic agents used for pain relief.
⚡ Adrenaline: Used to constrict blood vessels, control bleeding, and prolong the effects of local anesthetics.
🔬 Felypressin: Acts similarly to adrenaline, helping with vasoconstriction in dental procedures.
What are the principles of exodontia (tooth extraction)?
🦷 Tooth Extraction Principles:
Expansion of the alveolar socket (bone surrounding the tooth).
Separation of the periodontal ligament (PDL) and soft tissue.
Controlled force to minimize trauma.
Avoid damage to adjacent teeth, nerves, or bone.
What is the healing process after tooth extraction?
🗓️ Week 1:
White blood cells remove bacteria.
Fibroblasts and capillaries begin growing into the socket.
The epithelium starts migrating down the socket wall.
Week 2:
Granulation tissue fills the socket.
Osteoid deposition (early bone formation) begins.
Week 3-4:
Cortical bone starts resorbing, and trabecular bone forms.
The socket begins to fill with new bone.
Week 4-6:
Lamellar bone formation begins, and the socket heals.
By 6 weeks, the bone is nearly healed, and reorganization continues.
What are the post-operative care instructions for tooth extractions?
🩹 Expect pain – Advise analgesics (NSAIDs and Paracetamol).
💥 Severe throbbing pain could indicate alveolar osteitis (dry socket).
🩸 Bleeding – Normal; bite on gauze for 30 minutes to control it.
🏋️♂️ No exercise for 24 hours to avoid complications.
🚬 No smoking/vaping for 7 days to prevent delayed healing.
🍷 No alcohol for 24 hours to avoid interaction with medications.
💧 No mouth rinsing/washing for 24 hours.
🧂 Warm saltwater rinses after 24 hours, 4 times a day for 1 week.
What is guided bone regeneration and its role in healing?
🔬 Platelet-Rich Fibrin (PRF): Promotes accelerated healing and bone regeneration.
🩺 Benefits of PRF:
Delays bone resorption, enhancing socket preservation.
Reduces postoperative pain.
✅ INDICATIONS FOR EXTRACTION
Unrestorable caries
Pulpal necrosis
Periodontitis (severe)
Orthodontic treatment
Pre-radiotherapy
Dental infection
Why preserve bone?
Buccal plate loss:
Up to 56% horizontal
30% vertical in first year
techniques to preserve bone
Atraumatic extraction (minimise buccal trauma)
Piezosurgery – precise ultrasonic bone cutting
Platelet-Rich Fibrin (PRF):
Autologous
Promotes angiogenesis, bone/soft tissue regeneration
Reduces post-op pain and bone resorption
