Tooth extraction

1. TOOTH EXTRACTION
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2. Definition
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Exodontia or tooth extraction is defned as the
painless removal of a whole tooth or tooth root,
with minimal trauma to the investing tissues, so
that the bone heals uneventfully and no
postoperative prosthetic problem is created.

3. Tooth extraction
Indications:
1. Grossly carious tooth which cannot be restored
2. Acute/chronic pulpitis
– which can’t be restored by RCT
3. Periodontal diseases
– More than half of alveolar bone loss
4. Fracture of tooth
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4. Indication cont..
5. Bony lesion lies over the tooth
– Cyst, Tumor,OM
6. Impacted tooth
7. Aesthetic indication
8. Orthodontic appliances
– Teeth crowding
9. Supernumerary and malpositisoned teeth
10. Retained deciduous tooth
11. If tooth hurting the soft tissue
– Upper 3rd molar damaging the lower 3rd molar gum tissue
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5. Contraindications:
General
1. Cardiac diseases - Valvular heart diseases, RHD,
Hypertension,Patients on anticoagulation therapy
2. Blood disorders (Severe anemia, Leukemia, Hemophilia)
3. Liver disease (Vitamin K deficiency, Clotting factor
deficiency)
4. DM
5. Pregnancy- 1st and 3rd trimester
6. Epilepsy patient
7. Allergic to local anesthesia
8. Psychiatric patient
9. Very old age patient
10. Uncooperative patient/ Lack of consent
11. Patient on steroids
12. High grade fever
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6. Contraindications :
Local
1. Acute gingivitis
2. Acute periodontitis
3. Acute pericoronitis
4. Acute cellulitis
5. Acute osteomyelitis
6. Malignancy
Any acute infection except Acute pulpitis is not contra
indication of tooth extraction but it is rather indication of
extraction
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9. Antibiotic prophylaxis:
Under L.A
Amoxycillin 3gm 1 hour before surgery,If allergic
to Amoxycillin then give
Clindamycin 600mg
Under G.A
Amoxycillin IV + oral 1gm at induction and 0.5
gm 6 hours later,If allergic then
Vancomycin IV infusion1gm over 1
hour+Gentamycin120mg IV
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11. Choice of anesthesia in dental procedure
 2% lidocaine/Xylocaine with 1:100,000 epinephrine is a
good choice. This provides about
 1 hour of dental pulp analgesia
 3 to 5 hours of soft-tissue analgesia
 For temporary relief of pain, the preferred agent is 0.5%
Bupivacaine with 1:200,000 epinephrine
 1 to 3 hours of dental pulp analgesia
 4 to 9 hours of soft-tissue analgesia
 Duration of analgesia is less with supraperiosteal
injections than with regional nerve blocks
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12. Supraperiosteal infiltration
 Also called ‘local infiltration’
 Teeth affected
 Any maxillary tooth
 Only can anesthetize
2 or 3 adjacent teeth
 Poor option for mandibular tooth because of relatively high
density
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13. • Aim is to deposit solution around the inferior alveolar nerve as it enters
the mandibular foramen underneath the lingula
• The patient's mouth must be widely open, inferior border being parallel to
ground
• Palpate the landmarks of external and internal oblique ridges and note the
line of the ptyerygomandibular raphe
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14. Position of patient and Doctor
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16. Steps
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1)Gingival Retraction - Soft tissue attachment is
loosened from the cervical portion of tooth Can be
effectively done using scalpel blade
2)Luxation of tooth using Elevators -Straight
elevator is inserted perpendicular into the
interdental space , This expands alveolar sockets
and tears periodontal ligaments
3)Application of Forceps to the tooth - Tooth is
grasped apical to cervical line with appropriate
forceps

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19. • Upper central and lateral incisor
– Rotation only
• Upper canine
– Rotation initially, some labiolingual movement may be
needed
• Upper premolar and molar
– Buccopalatal movement
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20. • Lower central and lateral incissor
– Labiolingual movement
• Lower canine
– Rotatory and labiolingual
• Lower premolar
– Rotatory
• Lower molar
– Buccolingual movement
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21. Post extraction instructions:
1. Bite on cotton or gauge for half an hour
2. Don’t spit or rinse as far as possible
3. Don’t take hot water or food at least for 12 hour
4. No physical activity for 24 hours
5. Soft lukewarm comfortable foods
6. Intake of antibiotics and analgesics
7. Cold compress with ice packs
8. No smoking / Alcohol / Tobacco
9. If any bleeding, pain or complications contact hospital
10. Warm saline wash after 24 hrs for next 2 or 3 days
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22. Complications
1. Fracture of
 Crown, Root, Alveolar bone, Adjacent tooth
2. Dislocation of TMJ
3. Trauma to Gingiva, Lips, Tongue, Palate
4. Intraoperative and post operative hemorrhage
5. Trismus
6. Infection : local /systemic
7. Anesthesia related complication
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