Oral Surgy In Children N.A.GH

Definition Surgical procedures includes Simple tooth extractions, Surgical removal of teeth or Soft tissue lesions.

Special consideration Preoperative evaluation * Medical history * Dental evaluation * Being prepared to treat any emergency situation Child management Growth and development Developing dentition Degree of parental concern

Exodontia An 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.

Indications for Tooth Removal Broken down teeth with periapical lesions / cellulitis

Indications…… Carious/ fractured non restorable tooth

Indications…… Supernumerary teeth

Indications…… Over retained primary teeth Submerged (ankylosed) teeth

Natal or Neonatal Tooth Indications…… Natal or Neonatal Tooth

Relative Contraindications Acute Oral Infection as stomatitis or herpetic stomatitis Congenital heart disease, rheumatic fever Blood Diseases as hemophilia or leukemia Uncontrolled Diabetes Mellitus Renal disease After radiotherapy

Oh ….Noo…….oo!!!

PREEXTRACTION PREPARATION Professionals It 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.

Principles of Exodontia in Pediatric Dentistry Differences between primary and permanent teeth that modify extraction procedures: Size and shape of primary teeth - alveolar bone Recommended instruments Care of soft tissues Topical and profound local anesthesia

Parent Preparation Discuss with the parents the causes of extraction Preoperative as well as postoperative instructions Informed consent

Child Preparation Minimize 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)

Techniques of Exodontia Patient position Chair is positioned about 45" to the floor during extraction of the upper teeth and at about 90° for lower teeth Operator position - Working hand ( dominant) - Non-working hand ( non- dominant)

Working hand

Non-working hand Retracts soft tissue allow visibility and access Protects tissues if instrument slips Provides resistance to the extraction force on the mandible  prevent dislocation Provides ‘feel’ to the operator

Upper 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

Lower 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

Upper Primary molars widely splayed roots considerable 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

Lower Primary Molars Those 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.

Cysts on apex caused by trauma Soft tissue surgeries Cysts on apex caused by trauma Abnormal frenum

Post- extraction Instruction Bite down on gauze 20-30 minutes, do not chewing the gauze (Do not disturb the clot) After surgery  ice pack Eat soft and cool foods If there is stitches rinse with mouth wash, day after surgery Seek medical attention if pain after 48 hours or abnormal bleeding

Post -operative Complications Aspiration or swallowing of teeth or roots may occur, especially under general anesthesia with the mouth forced open Post-operative hemorrhage

Complications……. self inflicted trauma Dry socket rarely happens within children

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