Overall Classification: UNCLASSIFIED//REL TO NATO/ISAF

 Perform specific exams pertaining to the extraction of teeth  Determine indications for extraction  Determine the level of difficulty of extraction  Determine the appropriate instrumentation for the extraction  Determine the appropriate pre-operative and peri-operative pharmacotherapeutics

 Determine the appropriate local anaesthetic techniques and solutions to provide profound analgesia  Perform appropriate elevation and forceps techniques  Render a timely and accurate decision as to need to change to surgical extraction  Perform curettage of socket

 Perform Alveoloplasty  Establish Hemostasis  Determine need for and placement of sutures  Provide post-operative instructions  Prescribe appropriate post-operative medications

 Review: ◦ Chief complaint ◦ History of present illness ◦ Medical history ◦ Present medications ◦ Allergies ◦ Habits and social history

 Do the appropriate specific examination (vitality testing, percussion, probing, etc…)  Review the radiographs

 Once you have all the necessary information, you establish the diagnosis.  Once you have established the appropriate diagnosis, you elaborate a treatment plan

 Severe decay  Pulpal necrosis  Odontalgia  Severe periodontal disease  Orthodontics  Malposed teeth  Cracked teeth  Impacted teeth  Preprosthetic extractions  Supernumerary teeth  Dentition associated with pathologic lesions  Preradiation therapy  Teeth associated with jaw fractures  Aesthetics  Economics

 You must correlate clinical and radiographic findings to provide the basis for estimating the degree of difficulty of the extractions  Clinical assessment: ◦ The crown ◦ Supporting structures ◦ Adjacent structures

 Radiographical assessment: ◦ The root ◦ The bone  Final estimation ◦ Access ◦ Pre-extraction assessment

 AHA guidelines 2000 ◦ Risks for endocardidits  High  Moderate  Negligible ◦ Risk procedure  High-risk procedures  Prophylaxis not recommended

 Standard prophylaxis: ◦ Amoxicillin: 2g PO 1h before procedure  Cannot take PO ◦ Ampicillin: 2g IM/IV within 30min before procedure  Penicillin allergy ◦ Clindamycin 600mg PO 1h before procedure ◦ Azithromycin 500mg PO 1h before procedure

 Use of a Bite Block  Sling Support  Digital Support by Operator or Assistant

 To remove soft tissue pathologies  To remove bone chips

 Compression  Gauze compression

 Discomfort  Hemorrage  Edema  Alveolitis (dry socket)  Avoid coarse or hard foods  Do not suck on the extraction site  Do not expectorate  Do not chew gum or smoke  Do not apply heat

 Non-narcotic agents ◦ ASA ◦ Acetaminophen ◦ Ibuprofen

 You can often get away with an non-surgical extraction, if needed refer the patient to a stomatolog.

 Five indications of removing a tooth.  Three factors that will increase the difficulty of removing a tooth.  What should you do if you break a root tip during the extraction.  Why can’t a patient drink with a straw after an extraction?  What postop medication would you give a patient who is allergic to morphine?

Overall Classification: UNCLASSIFIED//REL TO NATO/ISAF