Extractions

• if in doubt?

  call dentist sooner rather than later
• what can occur after an extraction?

  • bleeding
  • pain
  • infection
• order of extraction?

  • symptomatic teeth first
  • lowers then uppers
  • posterior then anteriors
• Mrs Douse's method:

  • Benzocaine 'topical sleepy' jelly 5 minutes
  • 'Ever had a wobbly tooth? We’re going to do all the wiggling in one day!'
  • have premade packs
  • 'we don't pull teeth out, we push' show on finger
  • tell show do with la, cap on, cap off and small drip and cap off LIA, IP and P/L
  • probe to check
  • describe noices - crackly like eating ice, squelchy like mud
  • finger too bit so need special instruments
  • reiterate lots of pushing
  • stop bleeding - making sure dry before you go home
• good pt managment?

  • good pain control
  • instruments prepares
  • xla at end of treatment
  • language
  • distraction
  • positive reinforcement
• Pain control?

  • LA
  • sedation and LA
  • GA
• post op instruction:

  • avoid exercise, hot food/drink, hard food, rinsing/spitting, biting soft tissues
  • painkillers
  • bite down on gause if bleeding starts
  • 111 if emergency
  • blood on pillow in morning
• following XLA:

  Post-operative instructions verbally and in writing• CRT (consent to retain tooth) is documented as necessary• The notes are completed• The tutor sees the patient before discharge• Debrief• What went well?• Could anything be done to improve?
• how do we achieve haemostasis?

  • squeeze socket bringing b and p plates together
  • pt bite on gause 10 mins
  • remove and check for blood clot
  • do not let pt leave until haemostasis obtains
  • record in notes
• extraction:

  • display consent
  • tutor supervise - verbally confirm
  • count teeth - pause check do
  • recheck tooth if instruments removed
• assessment of tooth?

  • access
  • mobility
  • submerged
  • infectiion
• before pt appointment:

  • mh, prescription, treatment plan
  • rads
  • dental history
  • social history - who has PR? whos been brought today
  • 3 point identity check
  • written consent - display
• problems?

  • lack of co-op
  • LA failure
  • tooth not moving
  • fractured crown
  • uncontrolled bleeding
• DO NOT go digging for roots as will damage tooth bud
• problems with xla specific to children?

  • infra-occlusion of teeeth
  • fusion/germination
  • damage to perm successor
  • dislocation of mandible
• why might we xla a primary tooth?

  • dental caries
  • ortho
  • retains
  • incomplete natural exfoliation
• upper forceps - straight

  lower forceps - bent
• elevators:

  • warwick james elevators
  • right/left and straight
  • superficial root fragments
• pt postiton?

  30 degrees
• non working hand?

  • Retracts soft tissue to allow visibility and access
  • Hold tooth and associated alveolus
  • Provides ‘feel’, gives information re resistance to removal
  • Provides resistance to extraction force
  • Protects soft tissue if instrument slips
• general principles: To force blades down into periodontal ligament between tooth root and bony socket wall, To grip root mass between forceps blades, To gently expand socket walls