3DefinitionSurgical procedures includes Simple tooth extractions, Surgical removal of teeth or Soft tissue lesions.
4Special consideration Preoperative evaluation* Medical history* Dental evaluation* Being prepared to treat any emergency situationChild managementGrowth and developmentDeveloping dentitionDegree of parental concern
5ExodontiaAn 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.
6Indications for Tooth Removal Broken down teeth with periapical lesions / cellulitis
7Indications……Carious/ fractured non restorable tooth
13PREEXTRACTION PREPARATION ProfessionalsIt 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.
14Principles of Exodontia in Pediatric Dentistry Differences between primary and permanent teeth that modify extraction procedures:Size and shape of primary teeth - alveolar boneRecommended instrumentsCare of soft tissuesTopical and profound local anesthesia
15Parent PreparationDiscuss with the parents the causes of extractionPreoperative as well as postoperative instructionsInformed consent
16Child PreparationMinimize 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)
17Techniques of Exodontia Patient positionChair is positioned about 45" to the floor duringextraction of the upper teeth and at about 90°for lower teethOperator position- Working hand ( dominant)- Non-working hand ( non- dominant)
19Non-working hand Retracts soft tissue allow visibility and access Protects tissues if instrument slipsProvides resistance to the extraction force on the mandible prevent dislocationProvides ‘feel’ to the operator
20Upper 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
21Lower 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
22Upper Primary molars widely splayed roots considerable expansion of socket is requiredUpper primary molar forceps are applied to theroots with initial movement palatally , Continuedwith buccal directed force delivery of tooth
23Lower Primary MolarsThose 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.
25Cysts on apex caused by trauma Soft tissue surgeriesCysts on apex caused by traumaAbnormal frenum
26Post- extraction Instruction Bite down on gauze minutes, do not chewing the gauze (Do not disturb the clot)After surgery ice packEat soft and cool foodsIf there is stitches rinse with mouth wash, day after surgerySeek medical attention if pain after 48 hours or abnormal bleeding
27Post -operative Complications Aspiration or swallowing of teeth or roots may occur, especially under general anesthesia with the mouth forced openPost-operative hemorrhage
28Complications……. self inflicted trauma Dry socket rarely happens within children