Tooth extractions in locals Flashcards
What is oral surgery
The diagnosis and management of pathology of the mouth and jaws that requires surgical intervention
List some indications for exodontia
- Caries
- Pulpal necrosis
- Periodontal disease
- Orthodontic treatment
- Infection
- Trauma
- Radiotherapy
- Pathology
- Dental anomalies
List soem contra indications for exodontia
- Suspicious lesions
- No diagnosis
- Acute inflammation
- Infection
What patient factors do we need to consider when looking at a patient who needs teeth extracted
- Age
- General health
- Anxiety
- BMI
Why do we need to consider age when thinking about extraction teeth
Increased age increases chances of complications
Neoplasia
Medical complexities more prevalent in elderly patients
List some drugs that may make us hesitant to carry out exodontia
- Anticoagulants
- Steroids
- Biphosphonates
- Immunosuppressants
What operator factors do we need to consider before carrying out an extraction
- Competence
- Experience
- Environment
- Assistance
What surgical factors do we need to consider before carrying out an extraction
- Access- does the mouth open sufficiently
- Imagining of the bone, tooth, surrounding structures and surgical anatomy
- Associated pathology
- Clinical picture of the tooth
During an extra oral assessment what do we need to look for
- Cervical lymphadenopathy
- Mouth opening
- TMJ
- Facial asymmetry
- Facial swelling
- VII and V nerves
During an intra oral assessment what do we need to look for
- Soft tissues (tongue, FOM, buccal mucosa etc)
- Hard tissues ‒ dentition
- Focus on area in question
- Special tests
When carrying out an exam what other factors may you find that may be a contra indication for exodontia
- Thick dense bone
- Short clinical crowns
- Signs of attrition
- Hyper cementosis
- Long divergent roots
- Extensive caries, root caries, large amalgom restorations
- Deciduous teeth in permanent dentition
List some red flags we might see on an X-ray
Loss of symmetry
Distorted anatomy
Bone erosion
Teeth floating in air
Name the 2 chemical structures that LA can have
- Esters
2. Amides
What are LA usually made up of
A drug and vasoconstrictor
What is the benefit of having a vasoconstrictor
Increased speed of onset
Extends duration
Increased depth of anaesthesia
Reduction of intra operative haemorrhage
Name a Sympathomimetic Amine
Adrenaline
What does adrenaline do
- Increases rate and force of contraction of
- Increase sBP and C.O.
- Vasoconstrictor
Name a Synthetic Polypeptide
Felypressin
What does Felypressin do
- Vascualr smooth muscle contraction
- Coronary artery vasoconstriction
- Oxytocic effects on uterus
Name the most common LA we use
2% Lidocaine with 1:80,000 Adrenaline
What is the max dose of 2% Lidocaine with 1:80,000 Adrenaline we can give
Maximum dose 4.4mg per kg
What is 2% Lidocaine with 1:80,000 Adrenaline made up of
44mg lidocaine
27.5 micrograms adrenaline
Give example of another LA type we could use
4% article with 1:100,000 Adrenaline
What is the max dose of4% article with 1:100,000 Adrenaline we can give
7mg per kg
What is 4% article with 1:100,000 Adrenaline made up of
88mg articane
22 micrograms adrenaline
Describe what happens in the first week as the tooth socket is healing
- White blood cells remove bacteria and break down debris
- Fibroplasia begins
- Ingrowth of fibroblasts and capillaries
- Epitheiulm migrates down socket wall
- Osteoclast accumulate along crestal bone
Name the 4 phases of acute wound healing
- Hemostasis
- Inflammatory phase
- Proliferative phase
- Remodelling phase
When extracting a tooth what structures do we need to be aware of
- Periodontal ligament
- Bone
- Socket expansion
How do we carry out extraction
- Expansion of the alveolar socket
- Separation of attachment of periodontal ligament
- Controlled force
Luxators, Elevators, Forceps - Expand (fracture) alveolar socket
- Avoid damage to the adjacent structures / local anatomy
What do we need to check after extracting a tooth
- Check apices
- Check socket
- Gain haemostasis
What post operative instructions should we give to patients following an extraction
- Expect pain and severe throbbing could occur
- Bleeding is normal
- No exercise for 24 hours
- No smoking or vaping
- No alcohol
- No rinsing or mouth washing
- Use a warm salt water rinse 24 hours post op
