Minor Oral surg. In Pediatric Dentistry
Tooth extraction: it is the painless removal of the whole tooth or tooth
root with minimal trauma to the investing tissue, so that the wound
heals uneventfully and no post- operative prosthetic problems.
Requirements of Ideal Extraction
1. Satisfactory visualization and access of the field of surgery.
2. An unobstructed pathway for removal of the tooth.
3. The use of controlled force to luxate and remove the tooth.
Principles of Ideal Extraction
1. Avoid injury to the soft tissues such as cheeks, lips, tongue and
gingiva.
2. Avoid injury to the underlying developing permanent tooth and
other hard tissue such as bone and adjacent or opposing teeth.
3. use radiograph to determine
a. size and shape of roots
b. amount and direction of root resorption
c. position and stage of development of of underlying permanent
tooth
d. any pathology
Differences bet. Primary and permanent teeth
1. size:- primary teeth are smaller in every dimension compared to
their permanent counterpart.
2. Shape:- crowns of primary teeth are more bulbous, the furcation
of primary molars roots is positioned more cervically than in
corresponding permanent tooth.
3. Physiology:- roots of primary teeth resorbs naturally where as in
resorption is a sign of pathology.
4. Support:- the bone of alveolus is much more elastic in younger
patient.
Modifications of extraction technique in children
1. Type of forceps:- the beaks and handles are smaller, the beaks are
more curved to accommodate the bulbous crown of primary
teeth.
2. More expansion of the socket is required due to the wide splaying
of the roots of primary molars.
3. Due to the relatively cervical position of the bifurcation of the
roots of primary molars it is injudicious to use forceps with deeply
plunging beaks.
4. Avoid blind investigation of primary socket.
5. Because of physiological resorption it is preferable to leave small
fragment of fractured root in situ
Indication for extraction of deciduous teeth
1. Badly carious cannot be restored .
2. Over retained primary teeth preventing the eruption of
permanent successor.
3. Infection of periapical area cannot treated without extraction.
4. For orthodontic purpose.
5. Supernumerary teeth if not needed in dental arch
6. In traumatic injury of teeth if vertical fracture occur
7. Ankylosed primary teeth that have permanent successor that
failed to exfoliate naturaly.
8. Impacted teeth
9. Ectopically positioned teeth cannot brought to function
Contraindication of extraction of teeth in children
1. Child having bleeding disorders
2. Acute infections
3. Malignancy
4. Teeth getting radiation
5. Acute or chronic heart disease
Preoperative preparation of the child and parents
Parents
1. Get parent consent before the procedure
2. Instruct the parents not to discuss with child what the dentist
will do.
Child
1. Armamentarium should kept behind the chair.
2. Never hold the needle in front of the child always keep it
hidden by fingers.
3. Before giving local anesthesia explain to child that sensation of
pinching or ant biting may be felt.
4. Child realize the difference between pressure and pain
5. Explain the sensation of numbness to the child
Extraction technique
Patient position
The child should be seated in dental chair reclined at 30 degrees to the
vertical for extraction under local anesthesia, and supine position for
extraction under general anesthesia.
Operator position
When removing upper teeth under local anesthesia the operator should
stand in front of the patient with straight back and the patient mouth at
a level just below the operators shoulders .
For lower left teeth the operator position similar to upper teeth except
the pt. mouth at height just below the operators elbow.
When removing the teeth from lower right the operator position behind
the pt. with the chair as low as possible.
Function of non working hand during tooth extraction
1. It retracts soft tissues to allow visibility and access.
2. It protect the tissue if the instrument slip.
3. It provide resistance to the extraction force on the mandible to
avoid dislocation.
4. It provides feel to operator during the extraction and gives
informations about resistance to removal.