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