uncomplicated exodontia

Question 1

presurgical medical assessment

Answer 1

1) SOAP
2) vital signs
- BP, pulse, respirations
3) can patient tolerate the procedure
4) break multiple extraction TP up into quadrants or teeth near others
- bilateral IA blocks are difficult
- multiple maxillary teeth in two quads ok

Question 2

anticoagulant therapy

Answer 2

1) coumadin/warfarin
2) clopidogrel (plavix)
3) apixaban (eliquis)
4) dabigatran (pradaxa)
5) aspirin
–
contraindications

Question 3

other contraindications for removing teeth

Answer 3

1) bisphosphonate
2) radiation
- causes thin bone
3) chemo
- immunocompromised

Question 4

why remove teeth

Answer 4

1) caries
2) pulpal necrosis
3) periodontal disease
4) orthodontic reasons
5) malpositioned
6) cracked teeth
7) impacted
8) supernumerary teeth

Question 5

clinical evaluation

Answer 5

1) access to the tooth
2) mobility of the tooth
3) condition of the crown
4) radiographic interpretation

Question 6

radiographic evaluation

Answer 6

1) relationship to vital structures
2) configuration of roots
3) condition of surrounding bone
4) endodontic treatment caution

Question 7

principles of elevator and forceps use

Answer 7

1) luxation
- rotating
2) elevation
3) displacement
- wedging
4) traction
- pulling (limit this force)

Question 8

mechanical principles involved

Answer 8

1) levers
2) wedge
3) wheel and axle

Question 9

level

Answer 9

1) the longer the lever arm, the more force on the other end
2) wheel and axle
3 )crane pick

Question 10

wedge displacement force

Answer 10

1) forceps are designed to slip into the space as you squeeze
2) can create a displacement force

Question 11

9 molt periosteal

Answer 11

1) disruption of periodontal attachment
2) elevation of interdental papillae after incision
3) expansion of the bone alveolar socket

Question 12

procedure for closed extraction

Answer 12

1) routine technique
- adequate access and visualization
- unimpeded pathway
- controlled forces
- throat pack
- bite block for mandibular stabilization
2) teeth are delivered on the long axis with buccal bias
- care is taken not to fracture the alveolar bone
- soft tissue expansion
- alveolar bony expansion

Question 13

role of the opposite hand

Answer 13

1) retraction of cheek, tongue, FTMPF
2) protection of nearby teeth
3) stabilization of the head
4) stabilization of the maxillary and mandibular alveolar process
- maxillary pinch grasp
- mandibular pinch or sling grasp
5) no fingers in mouth when using sharp instruments

Question 14

role of assistant

Answer 14

1) visualization retraction
- use both hands with instrumentation
???

Question 15

removal of maxillary teeth

Answer 15

1) #150, #1/99, rongeur
- incisor
2) canines
- same as above
- cuspid eminence
- long root
- mainly cortical bone
3) molars
- most likely three roots
- evaluate proximity to SINUS!!!
- section dilacerated roots in T or Y fashion
- #150, #53 R or L, #88 R or L
- try to use less aggressive instruments, you can rip out the floor of the sinus

Question 16

removing mandibular teeth

Answer 16

1) anterior
- #151, #74, rongeurs
2) canines
- cortical bone is prevalent
- long roots
- delicate removal of bone with 701 bur
3) bite block for edentulous
3) molars
- #151, #23, #17 (for small jaw opening)

Question 17

23

Answer 17

1) not used in a child
2) ONLY for 1st and 2nd molars
- for 3rd molars, you can rip out the lingual nerve on accident
3) aka cowhorn

Question 18

primary teeth

Answer 18

1) roots of molars are long and dilacerated
2) care is taken to elevate spindly retained roots to not damage permanent teeth