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
 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!!!
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

 Discuss with the parents the causes of extraction

Preoperative as well as postoperative instructions

Informed consent
 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 + patients

mouth just below the operators shoulder.

Apply forceps beaks to the root, using clockwise

and anticlockwise rotation about the long axis
 Lower Primary Anteriors

* 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
 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.
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