BY DR. MANISHA MISHRA

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Tooth extractionIndications:1. Grossly carious tooth which cannot be restored2. Acute/chronic pulpitis

which can’t be restored by RCT3. Periodontal diseases

More than half of alveolar bone loss4. Fracture of tooth

Root Longitudinal If tooth lies on jaw # line

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Indication cont..5. Bony lesion lies over the tooth

Cyst, Tumor,OM6. Impacted tooth7. Aesthetic indication8. Orthodontic appliances

Teeth crowding

9. Supernumerary and malposed teeth

10. Retained deciduous tooth if permanent successor is present

11. If tooth hurting the soft tissue Upper 3rd molar damaging the lower 3rd molar gum tissue

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Contraindications: General1. Cardiac diseases - Valvular heart diseases, RHD,

Hypertension,Patients on anticoagulation therapy2. Blood disorders (Severe anemia, Leukemia, Hemophilia)3. Liver disease (Vitamin K deficiency, Clotting factor deficiency)4. DM5. Pregnancy- 1st and 3rd trimester6. Epilepsy patient7. Allergic to local anesthesia8. Psychiatric patient9. Very old patient10. Uncooperative patient/ Lack of consent11. Patient on steroids12. High grade fever

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Contraindication :Local1. Acute gingivitis2. Acute periodontitis3. Acute pericoronitis4. Acute cellulitis5. Acute osteomyelitis6. 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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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 as prescribed by dentist

7.Cold compress with ice packs

8.No smoking / Alcohol / Tobacco

9.If any bleeding, pain or complications contact hospital or dentist immediately

10.Warm saline wash after 24 hrs for next 2 or 3 days

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Complications1. Fracture of

Crown, Root, Alveolar bone, Adjacent tooth2. Dislocation of TMJ3. Trauma to Gingiva, Lips, Tongue, Palate4. Intraoperative and post operative hemorrhage5. Trismus6. Infection : local /systemic7. Anesthesia related complication

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Antibiotic prophylaxis:

Under L.A Amoxycillin 3gm 1 hour before surgery,If

allergic to Amoxycillin then give Clindamycin 600mgUnder 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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Position

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Extraction movement Primary movement: Along longitudinal axis of root Secondary movement: Main extracting movement

Rotatory Buccolingual or labiolingual Mesodistal Lifting the tooth

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Upper central and lateral incissor Rotation only

Upper canine Rotation initially, some labiolingual movement may be needed

Upper premolar and molar Buccopalatal movement

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Lower central and lateral incissor Labiolingual movement

Lower canine Rotatory and labiolingual

Lower premolar Rotatory

Lower molar Buccolingual movement

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Nerve supply:

Maxilla Posterior superior alveolar nerve: Molars Middle superior alveolar nerve: Premolars Anterior superior alveolar nerve: Canines and Incissor Sensory supply of palate from greater and lesser palatine nerves as

well

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Mandibular nerve:Lingual nerveInferior alveolar nerve : Enters the mandibular

canal

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Dental block Types of blocks

Supraperiosteal injectionMental nerve blockAnterior superior alveolar (Infraorbital) nerve blockPosterior superior alveolar nerve blockInferior alveolar nerve block

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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 analgesia4 to 9 hours of soft-tissue analgesia

Duration of analgesia is less with supraperiosteal injections than with regional nerve blocks

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Inferior alveolar nerve block Most widely used anesthetic procedure in dentistry All mandibular teeth to midline Anterior 2/3 of tongue Floor of oral cavityComplication:

InfectionPatient having tendency

to bite tongue or lips

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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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Index finger is used to stretch the tissues over the injection site, maximizing visibility and minimizing the pain of the injection.

Orient the syringe so that the barrel is in the opposite corner of the mouth, resting on the premolars

Aim toward your index finger and slowly penetrate the mucosa until bone is contacted, usually a distance of about 2.5 cm

Needle should be parallel to occlusal surface

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Withdraw slightly and aspirateIf no blood is returned, inject 1.5 to 2 mL of anesthetic If aspiration is positive, pull back and redirect slightly, then repeatIf a lingual nerve block is required 0.5 ml of LA is injected after withdrawal of 0.5cm of the needle

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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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The aim is to deposit LA supraperiosteally in as close proximity as possible to the apex of the tooth to be anaesthetized. The LA will diffuse through periosteum and bone to bathe the nerves entering the apex. Reflect the lip or cheek to place mucosa on tension and insert the needle along the long axis of the tooth aiming towards bone. At approximate apex of tooth, withdraw slightly and deposit LA slowly

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Mental nerve block Apex of the second premolar

Tissue and teeth affectedBuccal soft tissues from 2nd mandibular premolar to

midline skin of lower lip and chin

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Infraorbital block

Just inferior to the infraorbital notch Teeth affected

IncisorsCaninespremolars

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