Exodontia Ug Class

7/27/2019 Exodontia Ug Class

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EXODONTIA IN

PEADIATRIC DENTISTRY


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INDICATIONS &

CONTRA INDICATIONS

ARMAMENTARIUM

Topical Anesthetic

Local Anesthetics

Introduction

Extraction


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5

Child Patient

Fear of Dental

procedures

Child

Psychology

Anesthetic

Agents

Behavior

guidance

Empathy

Extraction

Patience


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EXTRACTION

EXTRACTION IS THE PAIN LESS REMOVAL OF THE WHOLE

TOOTH OR TOOTH ROOT WITH MINIMAL TRAUMA TO THE

INVESTING TISSUE, SO THAT WOUNDS HEALS

UNEVENTFULLY.


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INDICATIONS FOR TOOTH REMOVAL

Broken down teeth withperiapical lesions / cellulitis


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INDICATIONS

Carious/ fractured non

restorable tooth
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INDICATIONS

Supernumerary teeth


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INDICATIONS

Submerged (ankylosed)teeth

Over retained primary teeth
http://www.kidsdentistry.com/photos/pediatric/ped18.JPG


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INDICATION FOR EXTRATION

OF PRIMARY TEETH

Ectopically positioned teeth that can not be brought intofunction.

For orthodontic purpose.


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INDICATIONS

Natal or Neonatal

Tooth
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CONTRAINDICATIONS FOR EXTRACTIONS

OF TEETH IN CHILDRENS

CHILD HAVING BLEEDING DISORDER.

ACUTE INFECTIONS LIKE STOMATITIS AND ACUTE VINCENTS

INFECTIONS.

HERPETIC STOMATITIS.

ACUTE PERICEMENTITIS.

ACUTE DENTOALVEOLAR ABSCESS.

ACUTE CELLULITIS.

MALIGNANCY.

TEETH GETTING IRRADIATION.

ACUTE OR CHRONIC HEART DISEASE, CONGENITAL HEART

DISEASE AND KIDNEY DISEASE.


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SIZE- PRIMARY TEETH ARE SMALLER IN EVERY DIMENSIONS

SHAPE- CROWN OF PRIMARY TEETH ARE MORE BULBOUS.

THE FURCATION IS POSITIONED MORE CERVICALLY

PHYSIOLOGY- ROOT OF PRIMARY TEETH RESORB

NATUTRALLY IN THE PERMANENT DENTITION RESORPTION

IS NORMALLY A SIGN OF PATHOLOGY.

SUPPORT- THE BONE OF ALVEOLUS IS MUCH MORE

ELASTIC IN THE YOUNGER PATIENT.

DIFFERENCE BETWEEN PRIMARY &

PERMANENT TEETH


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These difference means that there are some modification to

Extraction technique in children.

1.Type of forceps The beaks & handles are smaller, to

Accommodate more bulbous crown the beaks are more curved

In forceps design for removal of primary teeth.

2. The wide splaying of primary molars roots means that more

Expansion of the socket is required.

3. Due to relatively cervical position of the bifurcation in primary

molars it is injudicious to use forceps with deeply plunging beaks.

4. Avoidblind investigation of primary socket with instruments.

5. Because ofphysiological resorption it is often preferable to

Leave small fragments in situ if root fractures.


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PRE - OPERATIVE PREPARATION OF THE

PARENT AND CHILD

PARENT-1. Parental consent before the procedure.

2. Instruct the parent not to discuss with the child what thedentist will do rather let the dentist do it.

CHILD-

1. Armamentarium should be kept behind the chair.

2. Never hold the needle in front of child always hidden byfingers.

3. Before giving the LA, explain to the child that sensation ofpinching or an ant biting may be felt.

4. Make the child to realize the difference between pressure andpain.

5. Explain the sensation of numbness to child.


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Topical La for 1 min preferably longer for maximum effect

Lidocaine3-5 min onset of action

Benzocaine30 sec


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SELECTION OF NEEDLES


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Children 3 years - Below the occlusal plane

6 years - At occlusal plane

12 years - above occlusal plane


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EXTRACTION TECHNIQUE

PATIENT POSITION-

The child should be seated in a dental chair reclined about

30 degree to the vertical for extraction under LA.

Under GA- supine position.


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OPERATOR POSITION

When removing upper teeth under la the operator should be infront of the patient with straight back and the patient mouth ata level just below the operators shoulder.

A right handed operator removes lower left teeth from similarposition in front of the patient except that the patient mouth isat a height just below the operators elbow.

When removing the teeth from the lower right the righthanded operator should be behind the patient with the chair aslow as possible to allow good vision.


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PATIENT AND PEDIATRIC DENTIST POSITION

For the extraction of mandibular

teeth, the patient should be

positioned in a more upright position.

the occlusal plane is parallel to the

floor. The chair should be lower

than for extraction of maxillary

teeth.

For a maxillary extraction the chair

should be tipped backward and

maxillary occlusal plane is at 60

degrees to the floor. The height of the

chairshould be patient's mouth is at

or below the operator's elbow level


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Forall maxillary teeth and anterior mandibular teeth, the

dentist is to the front and right (and to the left, for left-

handed dentists) of the patient.

For the posterior mandibular teeth the dentist is

positioned in front of or behind and to the right (or to the

left, for left-handed dentists) of the patient


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WORKING HAND


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THE NON-WORKING HAND

1. It retract soft tissues to allow visibility and access.

2. It protects the tissues if the instruments slips.

3. It provide resistance to the extraction forces on themandible to prevent dislocation.

4. It provides feel to the operator during the extractionand gives information about resistance to removal.


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ORDER OF EXTRACTION

When performing multiple extractions in all quadrants of

the mouth (especially if under general anesthesia) the orderof extraction is as follows:

1. Symptomatic teeth are extracted before 'balancingextractions' on the opposite side.

2. Lower teeth are extracted before upper teeth (toeliminate bleeding interfering with the surgical field).

3. If there are symptomatic teeth in all quadrants right-handed operators should begin with lower right extractions.This minimizes the number of changes of position of thesurgeon, which will reduce general anaesthetic time.

U P i & P t A t i


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Upper Primary & Permanent Anteriors

When these teeth are in normal position:

Forceps usedFor Primary teethupper primary anterior

Primary roots - upper primary root forceps.

Permanent teethupper straight forceps


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UPPER PRIMARY ANTERIORS

operator stands in front of patient + patients mouth just below the

operators shoulder.

Apply forceps beaks to the root, using clockwise and anticlockwise

rotation about the long axis


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Upper Primary & Permanent Anteriors


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UPPER PRIMARY MOLARS

widely splayed rootsconsiderable expansion

of socket is required

Upper primary molar forceps are applied to the

roots with initial movement palatally , Continued

with buccal directed force delivery of tooth

Upper primary molars


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Upper primary molars


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Upper premolars

Forcep usedupper premolar forceps Removed by the buccal expansion

Upper permanent molars

Forcepsleft & right upper molar forceps

Removed by expanding the socket in the buccaldirection


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Lower primary anterior

Forcepslower primary anterior or root forceps

Extracted same as upper anterior.

Similar position for upper teeth + patients mouth just below the

operators elbow.

Same manner as their upper counterparts with rotation about

the long axis using lower primary anterior or root forceps
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Lower primary anterior


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Lower permanent anterior

Root of lower incisors are thin mesiodistally & rotation is likely

To cause root fracture so the most effective method of removal

Is to apply lower root forceps & expand the socket labially.

Permanent lower canine may be delivered by rotatory movement or By buccal expansion.


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LOWER PRIMARY MOLARS

Forcepslower primary molarforceps.

Two pointed beaks which engage thebifurcation.

Buccolingual expansion of socket

After application of the forceps asmall lingual movement is followedby a continuous buccal force, which

delivers the tooth.

removing lower right teeth theoperator stands behind the patient.


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Lower primary molars

l


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Lower premolars

Forcepslower premolar forceps

Removed by rotatory movement around the long axis of root

Lower permanent molars

Two designs of forceps used 1.lower molar forceps2.forcep of cowhorn design

Lower molar forceps have two pointed beaks which are applied in

the region of bifurcation buccally & lingually.

Applied the forceps & move the tooth in buccal direction to

expand the buccal cortical plate.


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CONTROL OF HEMORRHAGE IN CHILDREN

Compress the socket

Keep gauze firmly between the jaws

Bleeding is more cannot controlled by pressure.

Adrenalin on gauze , Thrombin on gauze, gel foam dippedin Thrombin.


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Any bleeding should be arrested before the patient is allowed toleave the surgery.

The patient and parent should receive instructions on simplemethods of haemorrhage control.

After surgeryice pack

Eat soft and cool foods

Seek medical attention if pain

after 48 hours or abnormal bleeding


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POST OPERATIVE INSTRUCTION

FOR CHILD-

1. THE CHILD SHOULD NOT BE DISMISSED UNTILL BLOOD CLOT ISFORMED

2. HOLD A SMALL COTTON ROLL BETWEEN HIS TEETH FOR HALF ANHOUR

3. NOT TO BITE HIS LIP.

4. DO NOT DISTURB THE AREA WHERE TOOTH WAS REMOVED.

5. DO NOT RINSE MOUTH FOR 24 HRS. AFTER EXRACTION.

FOR PARENT-

1. REINFORCE THE CHILD FOR INSTRUCTIONS THAT ALREADY GIVENTO THE CHILD.

2. LIGHT MEAL WITH NO HARD FOOD.

3. ANALGESICS IS PRESCRIBED IF THE EXTRACTION WAS TRAUMATICAND ANTIBIOTIC COVERAGE IS DONE IF THE AREA WAS INFECTED.


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PAIN RELIEF

Simple analgesics are usually required,

Paracetamol elixir (120 mg/5 ml four times daily for those

under 6 years of age; 250 mg/5 ml four times daily forchildren aged 6-12 years) is ideal. The patient is given a

review appointment but should return sooner if there are

any problems with bleeding, excessive pain, or swelling.

A telephone number for contact in an emergency must be

provided.

OS C O O S


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POSTEXTRACTION PROBLEMS

Post extraction problems are rare in children.

Dry socket does not seem to occur after the removal ofprimary teeth but it can affect older children

Postoperative haemorrhage is an occasional problem withchildren and can be impressive following multiple extractionsunder general anaesthesia.

Usually pressure applied with gauze or a handkerchief is

effective. If not, sutures with or without haemostatic gauzemust be used.


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FACTORS TO BE CONSIDERED

Avoid injury to soft tissues such as the tongue, lips,

gingiva and cheeks.

Avoid injury to underlying developing permanent teethand other hard tissues such as bone and adjacent oropposing teeth.

use radio graph to determine

Size and shape of roots.

Amount and directions of root resorption. Position and stage of development of underlying

permanent tooth.

Any pathology.


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CONCLUSION

For the young child who requires the removal of primary

teeth, the dentist should recognize the proper sequence

of all the procedures. The dentist prepares the child by

using a sensitive approach through his selection of words

that indicate to the child the nature of the procedure.


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REFERENCES

1. Textbook of Pediatric Dentistry: Richard R. Welbury.

2. Pediatric Dentistry: Stephen H.Y. Wei.

3. Pediatric Dental Medicine Donald.J. Forrester, Mark L .

Wagner, James Fleming 1981.

4. Pediatric Dentistry infancy Through Adolescence Jimmy

R. Pinkham Paul casamassimo fourth Editio

5. Pediatric Dentistry Principles & Practice first edition M.S

Muthu N. sivakumar6. Textbook of pedodontics : Shobha Tandon.


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