2. Oral Surgy In Children
N.A.GH

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

4. 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

5. 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.

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

7. Indications……
Carious/ fractured non restorable tooth

8. Indications……
Supernumerary teeth

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

10. Natal or Neonatal Tooth
Indications……
Natal or Neonatal Tooth

11. 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

12. Oh ….Noo…….oo!!!

13. 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.

14. 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

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

16. 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)

17. 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)

18. Working hand

19. 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

20. 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

21. 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

22. 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

23. 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.

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

26. Post- extraction Instruction
Bite down on gauze 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

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

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

29. THANK YOU