1. According to American Society
of Anesthesiology
((ASA
Patients Classified into
ASA I; ASA II; ASAIII ;ASA IV
& ASA V
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2. ASA I
Healthy, normal patient
Physiologically able to tolerate the stress
Without psychological problems
No treatment modifications are indicated
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3. ASA II
Mild systemic disease
Can perform normal activity without
experiencing distress
Healthy patient with more extreme anxiety
May need modification in treatment
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4. ASA III
Severe systemic disease
Limited activity but not incapacitated
Need stress reduction method during dental
treatment
May need to alter treatment
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5. ASA IV
Has an incapacitating disease that is life
threatening
Patient is in distress at rest
No elective dental therapy
Emergency treatment should be in hospital
setting
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6. ASA V
Moribund patient - not expected to live 24
hours with or without operation
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8. Indications for removal of teeth
• Sever caries
• Pulpal necrosis not amenable to
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•
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•
•
•
endodontic treatment
Sever periodontal disease with
excessive bone loss
Orthodontic reasons
Malopposed or malpositioned
teeth
Supernumerary teeth
Cracked teeth
Preprosthetic extractions
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9. Indications for removal of teeth
• Impacted teeth
• Teeth associated with
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•
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pathologic lesions
Preradiation therapy
Teeth involved in jaw
fractures
Esthetics
Economics
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12. Systemic contraindications
• Uncontrolled or poorly controlled medical
conditions: diabetics, Leukemia , cardiac
disease ;end stage renal disease
• Severe bleeding diathesis as hemophilia ,or
platelet disorder
• Pregnancy is a relative contraindication? Safe in
the second trimester
• Patients on special medications: corticosteroids,
immunosuppressive, or chemotherapy
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15. Level of co-operation
• All patient to be consented for dental extraction
and the procedure explained to them
• Most patients are co-operative and can be
treated under LA
• Conscious sedation and GA should be
considered in the following conditions:
• Irreconcilable dental phobia
• Handicapped patients
• Young children below the age of reason
• Long procedure
• Contraindication to LA
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16. Medical history
• Patient medical history has to be
thoroughly evaluated e.g.:
Bleeding problems
Immunocompromised patients
Ischemic heart disease, cardiac infarction
Infective endocarditis
Patients with previous radiotherapy to the
jaws
• Others
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•
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17. Choice of anaesthesia
Judged by: Medical history and Level
of co-operation
a. Local anaesthesia( LA):
Simple procedures (30-45min)
Single operative site
Accessible areas
b. General anaesthesia (GA):
Complicated procedures
Multiple operative sites
Difficult accessibility
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18. Clinical Examination
.The tooth to be extracted is examined
Teeth misplaced palatally or lingually ,
rotated , inclined or single standing teeth
.in occlusion , are all potentially difficult
Certain teeth have abnormal root formation,
particularly the upper and lower third
.molars . Heavily filled and dead teeth
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19. Clinical evaluation of teeth for
removal
• Mobility of tooth
• Roots
• Surrounding bone
• Condition of the crown
• Access to tooth
• Neighboring vital
structures
• Radiographic examination
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20. Radiographic Examination
The dental radiographs
reveals the following :
1-Abnormal number, shape
or pattern of roots
2-Caries extending into the
roots
3-Fracture,resorption,
ankylosis or
hypercementosis of the
roots
4-Approximation of
maxillary sinuses; nasal
cavity or neurovascular
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canal
21. Requirements of Pre-extraction
Radiograph
A-It should show the whole root structure
B-It should show the bone investing
C-It should show the relation to any
important anatomical structure
Types of Radiograph :
A-Intra-oral radiograph
B-Extra-oral radiograph
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22. • Mobility of the teeth
• Roots configuration:
• Numbers
• length
• width
• ankylosis
• hypercementosis
• resorption
• Surrounding bone:
• Bone level
• Bone density
• Bone pathology
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