definition surgical procedures includes simple tooth extractions, surgical removal of teeth or soft...
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Definition
Surgical procedures includes Simple tooth extractions, Surgical removal of teeth or Soft tissue lesions.
Special consideration
• Preoperative evaluation * Medical history
* Dental evaluation
* Being prepared to treat any emergency situation
• Child management • Growth and development • Developing dentition • Degree of parental concern
Exodontia
An ideal extraction is the painless removal of the whole tooth or remaining root or tooth portion with minimal trauma to the investing tissues, so that the wound heals uneventfully and no future problems are created.
Indications for Tooth Removal
Broken down teeth with periapical lesions / cellulitis
Indications……
Supernumerary teeth
Indications……
Submerged (ankylosed)teeth
Over retained primary teeth
Indications……
Natal or Neonatal Tooth
Relative Contraindications
• Acute Oral Infection as as stomatitis or or herpetic stomatitis
• Congenital heart disease, rheumatic fever• Blood Diseases as hemophilia or leukemia• Uncontrolled Diabetes Mellitus• Renal disease• After radiotherapy
Oh ….Noo…….oo!!!
Professionals
It is important that the principles & techniques of removing teeth are understood by all those in the dental profession who would pick up a pair of extraction forceps.
Principles of Exodontia in Pediatric Dentistry
• Differences between primary and permanent teeth that modify extraction procedures:
Size and shape of primary teeth - alveolar bone
• Recommended instruments
• Care of soft tissues
• Topical and profound local anesthesia
Discuss with the parents the causes of extraction
Preoperative as well as postoperative instructions
Informed consent
Minimize anxiety and fear of patients to injections, wound pain, anesthetic action .
Describing the procedure Tell -Show- Do, avoid the use of technical words .
Explain to the child what sensation may be experienced
(digital pressure)
Techniques of Exodontia
• Patient positionChair is positioned about 45" to the floor during extraction of the upper teeth and at about 90° for lower teeth
• Operator position- Working hand ( dominant) - Non-working hand ( non- dominant)
Working hand
Non-working hand
Retracts soft tissue allow visibility and access
Protects tissues if instrument slips
Provides resistance to the extraction force on the mandible prevent dislocation
Provides ‘feel’ to the operator
Upper Primary Anteriors
operator stands in front of patient + patient’s mouth just below the operator’s shoulder.
Apply forceps beaks to the root, using clockwise and anticlockwise rotation about the long axis
Lower Primary Anteriors
* Similar position for upper teeth + patient’s mouth just below the operator’s elbow.
*Same manner as their upper counterparts with rotation about the long axis using lower primary anterior or root forceps
Upper Primary molars
• widely splayed roots considerable expansion
of socket is required
• Upper primary molar forceps are applied to the
roots with initial movement palatally , Continued
with buccal directed force delivery of tooth
Lower Primary Molars
Those teeth are removed by bucco-lingual expansion of the socket. After it is loosened, a counterclockwise rotation delivers the tooth from the socket.
removing lower right teeth the operator stands behind the patient.
Soft tissue surgeries
Cysts on apex caused by
trauma
Abnormal frenum
Post- extraction Instruction
• Bite down on gauze 20-30 minutes, do not chewing the gauze (Do not disturb the clot)
• After surgery ice pack
• Eat soft and cool foods
• If there is stitches rinse with mouth wash, day after surgery
• Seek medical attention if pain after 48 hours or abnormal bleeding
Post -operative Complications
• Aspiration or swallowing of teeth or roots may occur, especially under general anesthesia with the mouth forced open
• Post-operative hemorrhage
Complications…….
• self inflicted trauma
• Dry socket rarely happens within children
