Home » ANATOMICAL AND PHYSIOLOGICAL FEATURES OF THE DEVELOPMENT AND STRUCTURE OF TISSUES AND ORGANS MAXILLOFACIAL AREA (SCHLD) IN CHILDREN

ANATOMICAL AND PHYSIOLOGICAL FEATURES OF THE DEVELOPMENT AND STRUCTURE OF TISSUES AND ORGANS MAXILLOFACIAL AREA (SCHLD) IN CHILDREN

June 28, 2024

ANATOMICAL AND PHYSIOLOGICAL FEATURES OF THE DEVELOPMENT AND STRUCTURE OF TISSUES AND ORGANS MAXILLOFACIAL AREA (SCHLD) IN CHILDREN. LOCAL AND GENERAL ANESTHESIA IN CHILDREN (TYPES AND METHODS OF LOCAL ANESTHESIA IN CHILDREN, INDICATIONS, CONTRAINDICATIONS). INDICATIONS, CONTRAINDICATIONS FOR TOOTH EXTRACTION IN CHILDREN, TECHNIQUE, TOOLS FOR REMOVING TEETH.FEATURES DELETING TEMPORARY AND PERMANENT TEETH IN CHILDREN, PREVENTION OF EARLY AND LATE COMPLICATIONS.

Anesthesia – a state feedback inhibition of the central nervous system in which no consciousness and response to painful stimuli and accompanied by depressed tion of all vital functions. Theories of anesthesia Anesthesia used in surgical practice over a hundred years, but its mechanism of action is not fully understood. There are many theories, each of them in one way or another to explain its effect on the body, but the contradictions that were, the theory could not explain. Lipoid theory proposed by Herman in 1886 (developed by Meyer and Overton in the 1890-1901 g), based on the solubility of drug in the lipid membranes of cells ¬ them in violation of their functions. The ratio of the solubility of anesthetic substances ¬ fault in oil to its solubility in water is called the Meyer-Overton. BBA-zhalosya, the higher the ratio, the stronger narcotic effect, although further research ¬ we found that a number of substances with a high coefficient not VIC ¬ Laka drug action and low – have expressed narcotic effect. The theory of boundary tension Traube proposed in 1904-1913, the lies that drugs used for general anesthesia, settling on cell membranes ¬ them, changing boundary tension between the membrane and fluid surrounding the cells ¬ well, and freely penetrate the cell. However, some substances have the ability to change the boundary tension, not possessing narcotic properties, and vice versa, substances that do not have this ability to cause general anesthesia.
Theory violations oxidation processes proposed Fervornom in 1912 Fervorn believed that anesthetic blocks the enzymes that regulate the redox processes in the cell. At the same time, there are drugs that inhibit them and do not cause narcotic effects, and barbiturates, which have no effect on oxidative phosphorylation, have a pronounced narcotic effect. Coagulation theory proposed by several authors: K. Bernard in 1875, Bancroft and Richter 1931, P. Makarov in 1936 According to this theory the general Annecy ¬ tics cause reverse coagulation of protoplasm of nerve cells, followed by a handling ¬ narcotic sleep. The experimental data did not confirm this theory. Manifestations ¬ elk, the concentration of anesthetic, causing narcosis, much less one that gives koa ¬ hulyatsiyu colloids. * Theory of water microcrystals proposed Pauling in 1961. According to da ¬ by this theory, the molecules of drugs and side chains of protein molecules, Conn.- LIMITED, form stable water microcrystals that reduce chemical reactions in the body, the electrical activity of the brain, blocking the transmission of impulses from synapse to synapse. This theory also has not received confirmation. Thus, at present there is no theory of anesthesia that would explain quite clearly the mechanism of the body anesthetic agents. CLINIC anesthesia When injected into the body of drugs observed in the corresponding regular phasic response of its organs and systems that can be clearly demonstrated ¬ layered on the matter, which has become a classic – air. There are several classifications of air mononarcosis. The most common classification Hvedela and I. Zhorov. The difference between them is only in the interpretation of the fourth stage drug ¬ Law. For Hvedelom fourth stage – agonal by JS Zhorov – Stage awakening (clinical approach). Here Hvedela classification.
The first stage – analgesia (habituation, lulling). Length of 8.3 minutes. at a concentration of ether in the blood of 0,18-0,30 g / l. It covers the period from the beginning of sniffing the air to loss of consciousness. Consciousness and pain sensitivity in the first stage lost and removed at the end. Patients talkative, confused answer questions, gradually fall asleep. The second stage – the excitement (disinhibition), comes after the loss of conscious ¬ ness. Subcortical currently out-of-control cortex. Clinically phase flows varied. Patients often try to rip the mask and jump from one hundred operational ¬ lu, shouting words cry, swear. Pupils dilated, reacting to light, express ¬ weighted lockjaw chewing muscles, it is very difficult to unclench your mouth even with application of gag. Blood pressure rises, the pulse frequent, pharyngeal and gag reflexes increased. The third stage – surgical. Characterized fading processes of excitation vnas ¬ lidok saturation organs and tissues vapor of ether. At this stage it is possible to conduct surgery. Depending on the depth of anesthesia Hvedel highlights in her four levels, designated in anesthesiology as 3 5, 32, 33, 34. The transition from one stage to another depends on the content in the blood and tissues of ether. It is important to maintain anesthesia in stages 3 ^ 32, so that the transition to the stage of excitement or 33, and 34 under deep anesthesia dangerous for the patient’s life. Anesthesiologist must stabilize anesthesia at the right level for this he must navigate the levels surgical clinic ¬ tion anesthesia. At the first level of surgical anesthesia (C,) excitement subsides. Patient zahlyb ¬ dential in quiet sleep, breathing calm and deep. Eyeballs make slow circular motion or fixed eccentrically. Pupil reduced to normal limits, responds well to light. Saves corneal and laryngeal-pharyngeal reflexes. Pulse and arte ¬ cal pressure (BP) iormal muscle tone remains. At the second level of surgical anesthesia (32) eyeballs stop motion, eyes slightly widened, reaction to light is weak. Laryngeal and pharyngeal reflexes were absent. Corneal reflex disappears by the end of Grade 3,, breathing a little more frequent. Blood pressure is normal, pulse slightly accelerated, reduced muscle tone. At 32 good conduct operations on the abdominal cavity. The third level of surgical anesthesia (33) begins to manifest toxic effects of ether on vitals centers. Pupils dilated, do not react to light, the eyes become dry, lose their luster. Breathing is broken, it becomes superficial, ¬ async him. Blood pressure falls, the pulse accelerated. Muscle tone is greatly reduced. This is the maximum permissible level (for a short time, not more than 10-15 min.). The fourth level of surgical anesthesia (3) pupils extremely dilated, reac ¬ tion to light absent, the cornea is dull and dry, complete paralysis of the intercostal muscles, ¬ reduction target country abbreviations diaphragm, rapid pulse, low blood pressure, paralysis of the sphincters. Sup ¬ ka or deepening of anesthesia at this stage can lead to fatal consequences. This boundary state between life and death. Agonal fourth stage – the final stage of anesthesia characterized Stop ¬ Coy breathing disappearance rate, blood pressure was not measured. Appears clammy cold sweat, involuntary separation of urine and feces. After 3-5 min. stops the heart and following clinical death. Saving the patient is only possible with the use of resuscitation and elimination of hypoxia and hypercapnia, and Outage drug re ¬ substances. The best mode for carrying out operations is 3! 32rivni and, within these limits anesthesiologist and should work. Anaesthesia in the clinic caot bring to deep and ultradeep ¬ bokyh levels. The clinic is considered another anesthesia: ¬ stage you go with him or awakening. Stage revival following the cessation of the drug, in ¬ chynayetsya their excretion from the body through the lungs or kidneys, depending on the type of drug ¬ Law. Inhaled anesthetics are excreted through the lungs, neingalyatsionnyh – through the kidneys. Post-anesthetic awakening depends on many factors: the duration and depth of anesthesia, general condition of the patient, nature of operation, age and others. Sometimes it goes quickly and smoothly, but sometimes lasts for hours, complicated by vomiting, headache, agitation.
Whatever the period of awakening, it requires anesthetist vigilance and attention to the patient. Types of anesthesia General anesthesia – anesthesia, divided by inhalation, and neingalyatsionnyh neyroleptanalgezii (NFA). Inhalation anesthesia The effect is achieved by the inhalation of narcotic gases or vapors of volatile drugs. On ¬ penetration of inhaled drug in the blood through the lungs, their distribution in the body and discharge it occurs under the laws characteristic of inert gases. For the three indispensable conditions required by BS Uvarov (1973): Security in the inhaled mixture of the appropriate concentrations of the drug, enough oxygen in it, adequate removal of acid from the lungs. Drug mixture can be fed through a mask, in ¬ vitrovid or endotracheal tube. here are four types of anesthesia: 1) open loop when the air in ¬ walks during inspiration from the atmosphere and back into it, and 2) for the half-open circuit when the drug enters the cylinder in a mixture of oxygen and drug mixture exhaled into the atmosphere completely, 3 ) for semi-loop, where part of exhaled air is released into the atmosphere, and some passing through the absorber of carbon dioxide, return-nated to the patient, and 4) for closed type, when gas recirculation system in the machine completely isolated from the atmosphere. Mask anesthesia This type of anesthesia is associated mainly with the use of ether and chloroform. In their introduction originally used a simple mask design. Ether or chloroform country ¬ pelnym deposited through a mask and inhalation anesthesia patient occurred on the open type. Adjust the concentration of anesthetic with this method is very difficult to feed. With the advent of modern devices for anesthesia mask and a large selection of drugs appeared to dosage of anesthetic and the artificial ventilation le ¬ hen, so now we can recommend it to a wide anesthesia practice. However, its application in maxillofacial surgery in some cases impossible. Endotracheal anesthesia When endotracheal anesthesia anesthetic substances introduced into the body by inhalation through the endotracheal tube. The main advantages of endotracheal anesthesia are: the exclusion of such terrible complications during surgery as aspiration of blood and saliva into the airways of the patient, eliminating the dangers associated with the disorder and stop di-breathing, gas exchange and ensure proper ventilation, controlling most constructive ¬ vishymy functions body through the use of tools such as muscle relaxants, hanhliolityky, neyroplehiky ganglion block without hypotension. PK Dyachenko (1965) formulated the basic principles of endotracheal anesthesia: – Rejection of universal and long-term operating funds for the benefit of drugs selectively affect the desired direction, with easily manageable and reversible effect minimal toxicity and no properties that give harmful effects; – Substances from the group of these drugs given very modest role – VIC ¬ lyuchennya consciousness in the patient. All other conditions for interventions under general anesthesia (muscle relaxation, suppression of excessive reflex activity, inhibition of secretion glands, control of vascular tone) are based on certain indications appointment ¬ them means a strictly specific type of action; – Early awakening of the patient immediately after surgery with complete renewal ¬ leniem consciousness, reflex activity, proper gas exchange and circulation;
– Effective resuscitation, ie an optimal regime of the organism during anesthesia, surgery and in the postoperative period by eliminating ¬ lyshkovoyi of drugs used, and the harmful effects of surgical interventions ¬ supply (hemorrhage, pneumothorax, atelectasis or pulmonary edema, liver failure , kidney, adrenal, cardiovascular system, electrolyte disorders and hor ¬ monalnoyi balance of water and protein metabolism); – An objective evaluation of the general condition of the patient in the postoperative period of asset ¬ his recognition of late complications of anesthesia, surgery, new manifestations of primary and su ¬ Putnam diseases rational purpose of maintenance therapy. The features of endotracheal anesthesia is that endotracheal anesthesia in patients with pathology of the maxillofacial area shown in all the most traumatic, lengthy and complex operations. It is known that the various operations, such as jaw resection, radical uranoplasty ¬ ka, heyloplastyka, there is a risk of aspiration of blood and vomit in the airway dis ¬ cerned. Especially great this risk in patients with trauma, maxillofacial area, in a state of unconsciousness. The most common way of eliminating this terrible complications ¬ tion is endotracheal intubation and enter through it directly into the lungs of narcotic substances ¬ wines. During intubation the anesthesiologist isolates from patient airways empty HN company that provides free breathing during surgical interventions in the maxillofacial area. However, the implementation intubation in pathological processes in the maxillofacial area is sometimes very difficult. Other authors point to a work ¬ noschi during tracheal intubation: a short muscular neck, mikroheniyu, spray positioned ¬ bered upper teeth, prohnatiyu upper jaw, lower jaw property as a result of contractures or ankylosis of temporomandibular joint prohnatiyu mandible with a short neck, Long highly curved palate, combined with a long narrow mouth. There are a number of reasons that make it difficult intubation: spondylarthritis, cicatricial deformation of face and neck. These circumstances greatly complicate tracheal intubation and at ¬ lead to the development of hypoxia and even asphyxia. Performing intubation in a complex pathology, maxillofacial area can lead to injury of the oral cavity and pharynx, causing bleeding and blood flowing will the airways – to aspiration. Respiratory disorders arise during surgery under endotracheal nar ¬ kozom. They are determined by many factors: the volume of transactions uncomfortable provi ¬ ing the patient on the operating table, depth of anesthesia. The special features include endotracheal anesthesia and choice of intubation. If operations in general surgery intubation is done through the mouth under con ¬ rolem direct laryngoscopy, when operations in maxillofacial surgery, this method is rarely used in those patients with good open mouth and no abnormalities ¬ chnyh processes in the oral cavity and pharynx and if the endotracheal tube does not interfere with the surgeon in this area. In other cases, use other methods of intubation (through the nose, traheostomu). Means for inhalation anesthesia. Gaseous mixture, incoming from the body of the patient through the upper airways to the lungs, reaching a certain concentration, cause surgical anesthesia (3: and 32).
Nitrous oxide – veselyachyy gas obtained Priestley in 1772 Wells in 1884 applied for the first time in its pure form, this anesthetic in dental practice. Colorless gas, heavier than air. Volume 1 liter of gas weighs 1.977 g vypus ¬ repents steel cylinders of gray, in the liquid state under pressure of 50 atmospheres. 1 kg of liquid nitrous oxide gives 500 liters of gas. Now in its pure form is not applied ¬ adopts, but only in a mixture with oxygen at a ratio of 3:1. Nitrous oxide – Annecy weak ¬ tic, because it is used in combination with stronger anesthetics. In dental surgery is used mainly in short-term surgical interventions (opening abscesses and phlegmon).
Advantages: has pronounced analgesic properties without lights, low toxicity, has rapid induction and awakening does not cause irritating effects on the respiratory system and mucous membranes, rarely occurs nausea and vomiting.
Disadvantages: of hypoxia, twitching of muscles, had narkotyzuyucha force.
Contraindications: no.
Ftorotanom synthesized Suckling in England in 1951 under the name flyuotan. In the USSR AG Oshuyevym and EK Tsyrul (1960) obtained ftorotan. Without ¬ coloring clear liquid with a faint sweet smell. Has a strong narcotic effect, does not irritate the airways, stronger than ether three times. Available in dark bottles of 50 ml, as laid out in the light. In conjunction with other blends are not explosive, does not burn, and positive narcotic properties allowed him to take center stage in anesthesiology. Ftorotanom – strong anesthetic. In clinical use ¬ rystovuyetsya at a dose of 0.5 to 3 vol. % To maintain surgical anesthesia in ¬ given 0.5-1 vol. %. To apply anesthesia vaporizer ftorotek that has two scales, one providing for the filing by the half-open, the other – for semi type.
Advantages: does not cause irritation of the upper respiratory tract, the possibility of applica ¬ tion in ambulatory practice, spasmolytic action on the larynx and bronchi, does not light up in pure form and in mixtures, the rate of introduction of anesthesia and awakening, chemical stability, the use of high concentrations of oxygen, improving microcirculation.
Disadvantages: possibility of liver damage with repeated administration, overdose ¬ tion, as deepening of anesthesia – respiratory depression, cardiac toxicity, reduced cardiac output, decreased myocardial contractility, dilation of blood vessels, sen ¬ sybilizatsiya heart to catecholamines.
Contraindications: patients with liver disease.

Historically, dental extractions have been used to treat a variety of illnesses, as well as a method of torture to obtain forced confessions. Before the discovery of antibiotics, chronic tooth infections were often linked to a variety of health problems, and therefore removal of a diseased tooth was a common treatment for various medical conditions. Instruments used for dental extractions date back several centuries. In the 14th century, Guy de Chauliac invented the dental pelican, which was used through the late 18th century. The pelican was replaced by the dental key which, in turn, was replaced by modern forceps in the 20th century. As dental extractions can vary tremendously in difficulty, depending on the patient and the tooth, a wide variety of instruments exist to address specific situation.

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This picture of two to three centuries ago, shows what tooth extraction was like then. The picture of the face contorted by extreme pain says it all. It was also a common practice for tooth extractions to be performed on a stage in front of all passerby’s. Perhaps great entertainment then, but today we can take comfort in pain killing drugs and the privacy of our dentist’s surgery, when a tooth needs to be extracted.

Reasons for tooth extraction

The most common reason for extraction is tooth damage due to breakage or decay. There are additional reasons for tooth extraction:

Severe tooth decay or infection. Despite the reduction in worldwide prevalence of dental caries, still it is the most common reason for extraction of (non-third molar) teeth with up to two thirds of extractions.
Extra teeth which are blocking other teeth from coming in.
Severe gum disease which may affect the supporting tissues and bone structures of teeth.
In preparation for orthodontic treatment (braces)
Teeth in the fracture line
Fractured teeth
Insufficient space for wisdom teeth (impacted third molars). Although many dentists remove asymptomatic impacted third molars, American as well as British Health Authorities recommended against this routine procedure, unless there are evidences for disease in the impacted tooth or the near environment.The American Public Health Association, for example, adopted a policy, Opposition to Prophylactic Removal of Third Molars (Wisdom Teeth) because of the large number of injuries resulting from unnecessary extractions
Receiving radiation to the head and neck may require extraction of teeth in the field of radiation.
Deliberate, medically unnecessary, extraction as a particularly dreadful form of physical tortur.

Types of Dental Extraction

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Extractions are often categorized as “simple” or “surgical”.
Simple extractions are performed on teeth that are visible in the mouth, usually under local anesthetic, and require only the use of instruments to elevate and/or grasp the visible portion of the tooth. Typically the tooth is lifted using an elevator, and using dental forceps, rocked back and forth until the Periodontal ligament has been sufficiently broken and the supporting alveolar bone has been adequately widened to make the tooth loose enough to remove. Typically, when teeth are removed with forceps, slow, steady pressure is applied with controlled force.

Surgical extractions involve the removal of teeth that cannot be easily accessed, either because they have broken under the gum line or because they have not erupted fully. Surgical extractions almost always require an incision. In a surgical extraction the doctor may elevate the soft tissues covering the tooth and bone and may also remove some of the overlying and/or surrounding bone tissue with a drill or osteotome. Frequently, the tooth may be split into multiple pieces to facilitate its removal.

When is tooth extractioecessary?

in case of illnesses involving pain and extended inflammations, if there is no other solution
because of the extended inflammation, the surrounding tissues have to be protected, along with the other teeth
incase the disease is not painful, but the broken, loosened tooth cannot be use for further tooth replacement
fortunately, most teeth deemed irredeemable by the patient can still be saved

Extracting wisdom teeth

Before extracting wisdom teeth, the doctor is informed of the condition of the tooth, and the surrounding anatomical parts by a panorama X-ray.

A wisdom teeth operation may involve a flap establishment or the unification of the scar margins with stitches. Of course, this is completely painless. The benefit of the adequate size of sawing pin is that it can be removed without pain in the end, it almost slips out of its place.

Preparation for a Tooth Extraction:

Tooth Extraction Pain

In preparing for a tooth extraction, anticipate one big thing, pain and controlling that pain.

The morphine based drugs, if you can get them, appear to work well when the tooth extraction is less than three days old; such drugs also help to put you to sleep and can be taken every four to 12 hours, depending on the strength. The active ingredient is called oxycodone and, being a narcotic, it is normally a prescription medication.

The second type of pain medication to have on hand following a tooth extraction is ibuprofen, around the 400mg strength, which one caormally take every eight hours.

Paracetamol and codeine based pain killers can be taken according to directions, but wont likely help much with pain relief following a tooth extraction, if the pain is very great.

Do not take aspirin pain relievers, unless the risk of bleeding has passed and you have stopped the ibuprofen.

Other Preparations to Make for a Tooth Extraction

In preparing for a tooth extraction, be aware that the above pain relievers may cause constipation and thereby play havoc with hemorrhoids, so taking some high fibre capsules, such as Metamucil, may be quite important, so have some of these ready to take as well.

Taking about three to five days off work following a tooth extraction is suggested due to the pain and discomfort following the extraction of a tooth. So one may want to arrange this time off work beforehand.

Clean your teeth really well and have your mouth as hygienically clean as possible when the tooth is pulled.

Instruments for Tooth Extraction

Tooth extraction refers to removal of tooth from the socket. When an extraction has to be pain free then the right instruments have to be there. Extractions are recommended by the dentists for several reasons and one of the major ones is for tooth infection that is deep rooted. Tooth extraction may also be required for the braces treatment or may be required for giving dentures to the patient. In case of impacted infectious teeth also tooth extraction is required. There will be different instruments which will be used for tooth extraction. In case of simple tooth extraction, mainly forceps and elevators are used and in case of surgical tooth extraction, along with forceps and elevators, scalpels, dental drill, sutures are required.

The main instruments that a dentist needs in times of an extraction are the Forceps and Elevators.

Tooth extraction forceps

Tooth Extraction Forceps are primary instruments to remove the tooth from the socket. The main function of forceps is expansion of the bony socket by the wedge shaped beaks of the forceps and movement of tooth with the forceps. Forceps are also used to pull out the tooth from the socket.

Maxillary Extraction Forceps

Forceps look like tweezers and have a firm grip which allows the dentist to exert sufficient force. The forceps allow the tooth to be held firmly and yet the dentist will be able to move it back and forth before it is plugged out.

Mandibuar Extraction Forceps

The tooth needs to be pulled out from the roots and for that the forceps are just the rightly designed instruments. They can also maneuver themselves into any part of the mouth in the most effortless of ways. If the dentist wants to perform a non-surgical simple tooth extraction or closed or intraalveolar tooth extraction then they will certainly need forceps.

Dental Elevators

In case of teeth that are deeply entrenched and embedded in the gums then the use of the forceps is just not enough. In that case what is needed are Dental Elevator tools that need to be used along with the forceps. Dental Elevator tools can act as levers and these are put between the tissues and in between the teeth. Elevators are used for luxation of teeth. Elevators are frequently used to mobilize the teeth.

Elevator tools look just like tiny screwdrivers. They are of three different kinds of elevators. They are straight elevators, apexo elevators and cryers.

Cryer’s elevatorStraight Hockey stick and Apexo elevators

The main function of dental elevators is to luxate multirooted teeth prior to forceps application. They are used to luxate and remove the teeth which can’t be engaged by the beaks of the forceps like the impacted teeth, malposed teeth or badly carious teeth. Dental elevators can also be used to remove fractured root stumps or apical tooth tips.

Scalpels for incision in case of Surgical Tooth Extraction

In case of surgical tooth extraction which is also known as open tooth extraction, apart from dental elevators and forceps, instruments are required for giving incision and bone cutting. In case of surgical tooth extraction, tooth is damaged to such an extent that nothing is visible above the gums. For giving incision that is for making cut on the soft tissues, scalpel is used. Scalpel is used to cut directly through gum tissue down to the bone. Scalpel has 2 parts that are blade and blade handle. After giving the incision, flap is raised to expose the tooth.

Chisel and osteotomes for cutting or splitting bone in Surgical Tooth Extraction

Chisels are unibevelled instruments for cutting the bone and osteotomes are bibevelled instruments which split the bone. Chisels are used to remove chips of bone in case of surgical tooth extractions and to split the tooth in difficult tooth extractions.

Mallet

It is made of steel, lead or wood and is similar to a hammer. It is used for giving controlled taps on the chisel or osteotome.

Dental drill and burs for splitting tooth and bone cutting

It is a quicker method of bone removal by drilling the bone at high speed. Burs are rotary instruments that cut the bone. They are made of either stainless steel or carbide. They are available in different lengths, shapes and sizes. They aid in bone removal or splitting the tooth during surgical removal of teeth. Hand piece and burs can also be used to round off the sharp margins after tooth extraction. Irrigation should be done during drilling with copious amount of saline solution. There should be as less damage to the alveolar bone during the surgical tooth extraction as possible.

Rongeur Forceps, Bone file, Bone cutter

Bone file and Rongeur Forceps

Rongeur Forceps are used to nibble sharp bony margins after simple or surgical tooth extraction. Rongeur forceps have curved handles and have spring action. Bone file as the name suggests is used to smoothen any bony margins present in the surgical field. Bone cutter is similar to Rongeur forceps and is used to trim sharp bony margins after tooth extraction.

Sutures or stitches after tooth extraction procedure

Stitches are given to approximate the margins. The two basic types of suture materials are resorbable suture material which the body is capable of breaking down easily and the non-resorbable sutures. Resorbable suture material includes gut, polyglycolic acid and copolymer of glycolic and lactic acid.

Non-resorbable suture material includes silk, nylon, polyester and polypropylene sutures. Non-resorbable sutures can be monofilamentous, multifilamentous or can be both.

Apart from sutures, needle holder, tissue holding forceps and suture cutting scissors are also used to suture the tissues. Needle holder is a straight instrument with short working tip. Tissue holding forceps can be plain or toothed and are used to hold the tissues during the process of dissection or during suturing. Suture cutting scissors are used for cutting the suture ends and they may be straight or curved and angulated or nonangulated.

The tooth extraction:

You are now laying down on the dentist chair, mouth wide open, wondering how the dentist is going to get the tooth extracted. Assuming nothing goes wrong with the tooth extraction, the likely procedure will be:

1..The dentist rubs a cotton bud soaked in anesthetic round the tooth to be extracted. Front and back of the tooth.

2.. After a very little wait, he then starts a series of anesthetic injections around the tooth to be extracted. A little bit of pain may be experienced with each injection.

3… After a slightly longer wait, another series of deeper anesthetic injections around the tooth to be extracted and if there is a tooth abscess, an injection will likely be placed into the abscess – an extremely painful injection for the most part. I nearly flew through the roof.

4..If the dentist is caring, there may occur a minor wait, followed by another few deep anesthetic injections – the area is numb, so NO pain is likely to be felt.

5.. A small wait, then the dentist starts to peel down the gum from the tooth to be extracted, so that no flesh is left attached to the tooth – prevents the flesh being torn from the tooth when the tooth is extracted.

6.. The dentist uses a pair of purpose built pliers to grip the tooth to be extracted, then starts rotating the tooth in a figure 8 pattern. The figure 8 pattern is repeated several times until the dentist feels the tooth will come out.

7.. The dentist then pulls the tooth out and the tooth extraction as such is over.

8.. The dentist will then clean up the area, squeeze the area hard to remove any puss, push the loose gum tissue into the hole that’s left and possibly crush the tooth socket to promote a firmer area – to encourage good healing.

9… The dentist will place a wet cotton gauze, rolled up, across the hole left by the tooth being extracted, asking you to bite down on it hard for the next 30 minutes, so as to encourage a solid blood clot to form. Being wet beforehand, the cotton gauze should leave the blood clot intact in the hole when the gauze is lifted out at home by your self.

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A dental surgeon uses special forceps to pull out a tooth (A). In its place, a blood clot forms (B), which becomes new bone with gum tissue over the top (C). If the blood clot does not form or falls out, a dry socket occurs (D). No new bone forms, and the nerves are exposed, causing pain.

What To Do After The Tooth Extraction:

Tooth Extraction Care and Aftercare

The care and aftercare of a tooth extraction entails following the five suggestions below:

1.. DO NOT rinse your mouth out for 24 hours following a tooth extraction – doing so may cause the blood clot, that is sealing the hole and allowing healing to take place, to come away.

2.. NO SMOKING FOR 2 DAYS following the tooth extraction. Some dental associations recommend no smoking for two weeks.

3.. Only warm, soft foods and drinks to be taken, and kept as far from the extraction hole as possible – Definitely no swishing in the mouth, as the blood clot may be removed or a piece of food may enter the hole and become lodged in causing much pain. After 7 days, you caormally return to a normal diet.

4.. The day following the tooth extraction and for at least the next 5 days, stir a teaspoon of salt into 250 ml – a glass – of warm water until dissolved. Rinse the mouth GENTLY with the salt water and give the salt water a little time to be soaking the tooth extraction point. Use after eating or drinking anything, as it keeps the extraction wound clean and the salt helps to keep the area sterile from germs. Use the salt rinse every night before bed as well.

5.. Resume good teeth cleaning practices from about day 2 following the tooth extraction, but be careful near the extraction site.

Do’s And Don’ts After Tooth Extraction

Tooth extraction refers to painless removal of tooth or tooth roots with minimum trauma to the surrounding tissues so that the extraction socket wound heals uneventfully without any post-operative complications. Whenever any surgery or Tooth extraction takes place the first thing we want is to let it heal properly ,quickly and smoothly. As a common practice, most of the dental surgeons have standard post surgery instructions printed which are handed over to the patient. One must follow these instructions given by the dentist. Apart from those instructions there are few things which need to be taken care post tooth extraction. Following all the post-operative instructions after tooth extraction reduces the incidence of infection and chances of dry socket after tooth extraction. If aftercare instructions are not followed after tooth extraction, then it can cause dry socket which can further lead to delayed healing of the tooth extraction socket. So patient is advised to follow certain do’s and don’ts after tooth extarction procedure.

Try to take some rest after Tooth Extraction. You may feel great but don’t exercise at least for a day after tooth extraction.When taking rest,keep your head lifted on a pillow.

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Let the clot be formed on the tooth extraction site

, which covers it and allow it to heal. Bite on the gauze piece after tooth extraction, which the dentist has put on the extraction socket, minimum for an hour. Don’t chew on that gauze piece but put a steady pressure. This will help in stopping the bleeding and formation of clot which acts like a cork on the bottle. Change gauze after every half an hour depending on the amount of bleeding. If clot is dislodged,the nerve endings are exposed,nerves and capillaries spasm and constrict,limiting essential blood supply which causes delay in healing. If the bleeding doesn’t stop one should try putting a wet tea bag in the site, as tannic acid present in black tea helps stop bleeding.

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Ice Packs

: Apply ice pack on the side where surgery was performed. All this is done to reduce swelling. Though on simple extractions, swelling isn’t accompanied but in cases requiring severe cheek retractions, swelling can occur after operation. Though the swelling will not occur immediately but will reach maximum at 2^nd or 3^rd day. So, to minimize this swelling immediately apply ice packs. Various methods of applying ice packs are:

Sealed plastic bags filled with ice or
A bag of frozen peas or
Corn wrapped in a washcloth

Application of ice pack is most effective during the day of extraction as after 24 hours there is no significant beneficial effect. Ice packs should be applied 15 minutes on and 15 minutes off for 1-2 hours.

Blowing and sneezing: Make sure not to blow or sneeze after extraction as it creates a negative pressure thereby dislodging the clot and making the conditions favorable for dry socket.

Don’t spit minimum for 24 hours after tooth extraction because it can dislodge the clot. If the clot is dislodged you can have very painful condition known as dry socket. In case of dry socket, physiologic clot is lose both in quantity and quality. Afterwards one should spit 3-4 times in a day so that no food is lodged near the area where the tooth is removed. Dentist may advice CHLOROHEXIDINE mouth rinses as they kill bacteria.

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Anesthetic feeling:

It shouldn’t be a matter of worry if you feel numb even after surgery, as the period of numbness depends upon the area and dosage where anesthesia was given. So, it may vary for 6 hours to as long as a day. Make sure not to chew or bite something from that area.

Nausea: Feeling of nausea is also common after extraction. There are situations when anything you eat goes out. To get rid of nausea, take a teaspoon of Jell-O mix and 4 ounces of water, every minute until the feeling is gone. Two tablespoons every hour for 4 hours of coca cola syrup can also be taken. These methods will give you necessary sugar and fluids. After this soup can be taken.

Don’t smoke for 48 hours after tooth extraction as the chemicals in the smoke can effect the clot and hence the chances of developing dry socket 3-4 days after tooth extraction increases.

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Don’t take solids immediately after Tooth Extraction till the numbness

is there. When you start feeling your jaws you can start taking solids. After tooth extraction, take soft and liquid foods like soups, mashed potatoes, yogurts, milkshakes, smoothies etc.

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Warm saline rinses:

The main aim of rinsing is to clean the area of extraction as it is not possible to brush the socket. We mix salt to make the solution isotonic and similar to natural tissue fluid and thus it is less irritating than water. Rinsing is usually advised 12 hours after extraction. So, warm saline rinses help in cleaning and maintaining the hygiene of that area.

Take your medicines as prescribed by your dentist. Don’t skip the medicines. If antibiotics are given they should be taken regularly. Pain killers and anti-inflammatory drugs are to be taken after tooth extraction. It help in reducing the pain and swelling. If the pain continues even after two days of tooth extraction and bleeding starts then you should call your dentist.

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Avoid Aspirin:

Don’t ever take aspirin (Can take ibuprofen). Aspiring being a blood thinner will delay in clot formation thereby will prevent healing. Take the medications as prescribed by the physician and consult your dentist before taking any medicine.

Avoid Sucking of any type – SMOKING, SIPPING, EATING HARD VEGETABLES are to be avoided after tooth extraction. Try taking soft and liquid food options such as soups, mashed potatoes, yogurts, milkshakes, smoothies etc. after tooth extraction. Avoid hot drinks, spicy foods, sodas, etc.

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If you are daring enough to avoid these instructions, you may be a strong contender for some complications.

Don’t poke into the gap created: Though for initial few days, it will feel a bit awkward to have a gap but don’t poke that area with any toothpick or tongue as it may delay healing, may provoke bleeding and can also lead to dry socket.

Related Topics

Tooth Extraction in Children

Dental Implants after Tooth Extraction

Pain after Tooth Extraction

What is Surgical Tooth Extraction Procedure

What is Simple Tooth Extraction Procedure

Instruments for Tooth Extraction

Tooth Extraction During Pregnancy

Tooth Extraction Cost

Complications After Tooth Extraction

Complications During Tooth Extraction

What is Dry Socket

Swelling after Tooth Extraction

Bleeding after Tooth Extraction

Healing Of the Extraction Socket

Sutures or Stitches after Tooth Extraction

Pain During and After Tooth Extraction

What is Alveoloplasty in Dentistry

Do’s And Don’ts After Tooth Extraction

Ways Of Tooth Extractions

When The Tooth Needs To Be Extracted

Do’s And Don’ts After Tooth Extraction

Try to take some rest after Tooth Extraction. You may feel great but don’t exercise at least for a day after tooth extraction.When taking rest,keep your head lifted on a pillow.

Let the clot be formed on the tooth extraction site , which covers it and allow it to heal. Bite on the gauze piece after tooth extraction, which the dentist has put on the extraction socket, minimum for an hour. Don’t chew on that gauze piece but put a steady pressure. This will help in stopping the bleeding and formation of clot which acts like a cork on the bottle. Change gauze after every half an hour depending on the amount of bleeding. If clot is dislodged,the nerve endings are exposed,nerves and capillaries spasm and constrict,limiting essential blood supply which causes delay in healing. If the bleeding doesn’t stop one should try putting a wet tea bag in the site, as tannic acid present in black tea helps stop bleeding.

Ice Packs: Apply ice pack on the side where surgery was performed. All this is done to reduce swelling. Though on simple extractions, swelling isn’t accompanied but in cases requiring severe cheek retractions, swelling can occur after operation. Though the swelling will not occur immediately but will reach maximum at 2^nd or 3^rd day. So, to minimize this swelling immediately apply ice packs. Various methods of applying ice packs are:

Sealed plastic bags filled with ice or
A bag of frozen peas or
Corn wrapped in a washcloth

Blowing and sneezing: Make sure not to blow or sneeze after extraction as it creates a negative pressure thereby dislodging the clot and making the conditions favorable for dry socket.

Anesthetic feeling: It shouldn’t be a matter of worry if you feel numb even after surgery, as the period of numbness depends upon the area and dosage where anesthesia was given. So, it may vary for 6 hours to as long as a day. Make sure not to chew or bite something from that area.

Don’t smoke for 48 hours after tooth extraction as the chemicals in the smoke can effect the clot and hence the chances of developing dry socket 3-4 days after tooth extraction increases.

Don’t take solids immediately after Tooth Extraction till the numbness is there. When you start feeling your jaws you can start taking solids. After tooth extraction, take soft and liquid foods like soups, mashed potatoes, yogurts, milkshakes, smoothies etc.

Warm saline rinses: The main aim of rinsing is to clean the area of extraction as it is not possible to brush the socket. We mix salt to make the solution isotonic and similar to natural tissue fluid and thus it is less irritating than water. Rinsing is usually advised 12 hours after extraction. So, warm saline rinses help in cleaning and maintaining the hygiene of that area.

Avoid Aspirin: Don’t ever take aspirin (Can take ibuprofen). Aspiring being a blood thinner will delay in clot formation thereby will prevent healing. Take the medications as prescribed by the physician and consult your dentist before taking any medicine.

If you are daring enough to avoid these instructions, you may be a strong contender for some complications.

WHAT COMPLICATIONS CAN BE THERE AFTER TOOTH EXTRACTION?

1. Bleeding

2. Infection

3. Dry socket

4. Jaw fracture

5. Sinus perforation

6. Broken Bone Fragments (Sequestrii)

7. Part of the Tooth Left (Retained Roots)

8. Osteonecrosis

Bleeding After Tooth Extraction: If one follows the instructions of the dentist after Tooth extraction to take rest and to keep the gauze piece for 1 to 2 hours after extraction then the problem of bleeding is not there. The patients who are taking anticoagulants like Heparin or Coumadin or the patients who have bleeding disorders like hemophilia should give the history to the dentist. The patients who are taking aspirin or nonsteroidal analgesics have increased bleeding time.

Infection after Tooth Extraction: Infection is the most common complication after tooth extraction. Our mouth Is full of bacteria. One cannot sterilize it. Dentist decides whether to give antibiotics after the tooth extraction or not. Normally for the simple tooth extractions antibiotics are not required but if patient has pain and swelling or pus then it is better to go for preventive antibiotics. Bleeding continuing after 48 hours after tooth extraction, acute pain and swelling are very common signs of infection after the tooth extraction and the patient must visit the dentist in such circumstances to avoid further complications after tooth extraction.

Dry Socket: It is the most dreaded and painful condition which can happen after tooth extraction. For a day or two after dental extraction the patient is fine, and then he has acute pain and becomes very restless. Patient complains of bad taste in the mouth. It is more common after the dental extraction of lower teeth than the upper teeth. It can happen even after the simplest tooth extraction.

Healing of Extraction socket after Tooth Extraction

Jaw Fracture during Tooth Extraction: It can happen but very rarely and that too in lower jaw. The dentist who is doing the tooth extractions knows that how much pressure has to be put to pull out the tooth. But sometimes dentist before doing the extraction see the x-ray and tell the patient that the bone structure around the tooth has become fragile and chances of fracture are there. In such cases patient and the dentist are prepared beforehand to manage the situation.

Sinus Perforation during Tooth Extraction: The back teeth are in close proximation with the sinus. Sometimes if you see the x-ray it looks as if the roots of the back teeth are virtually in the sinus. It never happens. There is always a thin bone separating the sinus from the roots of the teeth. But sometimes during tooth extraction the piece of the bone comes along with the sinus. This normally happens when the tooth is close to the bone because of infection. In that case perforation occurs. If perforation occurs you cannot suck because in that case the air will rush from the nose to the sinus and through perforation to the mouth. If the perforation is small the patient complains of bleeding from nose. If the perforation occurs then the patient should follow certain instruction like:

1. Do not suck anything till the tooth extraction socket heals.

2. Do not do anything which will dislodge the clot. If the clot is not disturbed theo complication arises.

3. Do not smoke at least for a week after tooth extraction because the chemicals in the smoke either dissolve the clot or dislodge it.

4. Do not blow up the balloons or anything else, it will disturb the clot..

5. Avoid aerated drinks instead you can take fruit juices.

6. Don’t sneeze, it sneezing will surely dislodge the clot.

If the perforation is big and it does not heal by itself then another surgical procedure is carried out in which tissue graft is put to close the perforation.

Osteonecrosis: It is a rare dental condition which mostly occurs after dental extraction, implant surgery or other invasive dental procedure.

There is no sign of healing even after 8 weeks of dental treatment in case of osteonecrosis of jaw. The gums are worn away and the underlying bone is visible in this condition. It is mostly seen in cancer patients.

Complications During and After a Tooth Extraction:

Tooth Extraction Complications

1… Something goes wrong with the tooth extraction – the tooth may break up, which means the tooth extraction may take much longer to perform, as the dentist has to get it all out. This complication may also mean more pain and swelling, as the area may become more damaged at the extraction site.

2.. Infection following a tooth extraction is a rare complication, but can occur. The value of antibiotics perhaps should be sought if pain increases over the healing period, or if puss becomes noticed. Obviously, if more than the root area was infected at the the time of the tooth extraction, then antibiotics should perhaps be prescribed by the dentist before you leave the dental surgery.

3.. Swelling may continue to increase for two days following a tooth extraction, but should start to reduce by day 5. Ice packs can be used to help reduce swelling – 20 minutes on the cheek area next to the extraction site, followed by ten minutes off, then repeat. Also, the swelling may cause trouble in opening your mouth, so when the swelling reduces, your mouth should work better as well. On another note, some bruising may appear as the swelling recedes.

4. Pain and discomfort when trying to sleep. Sleeping with head face upward helps to relieve pressure on the jaw, using two pillows may help also. Certainly try and avoid laying down on the area of the tooth extraction site – to avoid pain and discomfort.

5… I personally found that I had heaps of referent pain going into the tooth above the extraction tooth, so when I clamped down for half an hour to keep the gauze in place on the extraction site, it turned very quickly into a living nightmare.

The pain became intolerable from the tooth above the extracted tooth site – all I could do was walk hard up and down the hallway at home – yelling, screaming and crying from the intense agonizing pain.

When the 30 minutes was up and I got the gauze out, the pain persisted at that level for hours.

Eventually the morphine based pill kicked in and I remember going quiet sitting in the sun with the sun on my cheek, still in pain, I climbed onto the bed and went to sleep. When I woke up the pain was all but gone, but once the pain medication wore off the pain returned.

As the days progressed, the pain got less – I stopped the morphine based pills, but the ibuprofen, being 8 hourly, didn’t quite cover me for those eight hours, but definitely feeling much better and in much less pain.

Another item that really helped me with the discomfort of the pain, was using a hot water bottle filled with hot, but NOT burning water. I placed this over the cheek of the tooth extraction site and found relief could be gotten that way quite well. I used that hot water bottle whenever the pain killers didn’t work starting from day 2 and, whenever I had trouble going to sleep because of the pain and so on.

6… It is possible that when the tooth is extracted that it may affect the alignment of the teeth in some people, in which case the teeth will tend to hit in certain areas of the mouth rather than uniformly across all the remaining molars. If this happens, further dental work will likely be needed to correct the problem, as if the teeth are left out of alignment, it is possible that the teeth that are taking the brunt of the force of the jaw will crack or splinter, cause pain, bruxism behavior – teeth grinding – cause pain in the jaw sockets and so on.

However, misalignment of teeth can be common in the first five days following extraction of teeth, as any swelling may cause some teeth to sit proud – be slightly elevated – causing them to hit the teeth above or below them when biting.

7… Following my tooth extraction, I also came down with an ear ache, which is also a common side effect of a tooth extraction.

8.. A little bleeding following a tooth extraction is common for the first day. If bleeding following a tooth extraction continues or gets heavier:

a. Rinse gently around the extraction site with cold water and

b. With clean hands and clean gauze or hanky, place the gauze in a roll and place over the tooth extraction site the same way the dentist did it and

c. Bite down gently for 60 minutes, with your head slightly elevated and rest.

If, after this, the bleeding persists or is severe contact your dentist straight away. If dentist unavailable, try your hospital’s emergency department.

9… A dry socket following a tooth extraction is a common complaint afflicting about 5% of people who have a tooth extracted. The tooth extraction dry socket, is where the blood clot that seals the extraction site comes away and is not replaced by another blood clot. The bone and nerves are exposed to air and anything else that may be in the mouth, thus causing pain and sometimes a foul odor as well. A dry socket normally clears up in about 5 to 7 days.

Following the “Tooth Extraction Care and Aftercare” section above, should minimize the risk of developing a dry socket following a tooth extraction.

10… Other teeth may become damaged, chipped or loosened during the extraction of a tooth or teeth, sometimes requiring more dental work.

11… If a top tooth, upper tooth was extracted, then a hole may have been made into one of the sinus areas. It will normally heal quickly of it’s own accord, if it doesn’t, you may need to go back to the dentist.

The Long Term Complications of a Tooth Extraction:

Long Term Problems from extracting a tooth: Other teeth may tilt into where the tooth was extracted from, thereby making eating difficult and teeth that tilt to fill the gap are at greater risk of tooth decay. The tilt is normally forwards. That is to say, for example, the tooth further back in the mouth next to the tooth that was extracted, will likely tilt into the gap somewhat.

Further, the cosmetic appearance of the mouth may be adversely affected by the extraction of teeth, particularly if the front teeth are involved.

If it was a molar that was removed, chewing food may be difficult to achieve, particularly if it was a large molar that made up a large section of the chewing area.

Further, when chewing food that is hard, like bread crust or an apple, pieces can be pushed down into the extraction socket by the tooth opposing it, causing pain.

Your dentist may suggest that as the tooth has no opposing tooth to bite against, that removing that opposing tooth could be considered. This is because the tooth has nothing to bite against and is therefore useless. However, without an opposing tooth, the tooth above or below the extraction socket will, over some years, like ten years, move out of it’s socket more and more, likely exposing it’s roots and becoming sensitive to variations in temperature and so on. A tooth relies on it’s opposing biting tooth to keep it firmly in place.

Another of the long term problems is thinning of the jaw bone, particularly when several teeth have been extracted – when the side of the extraction site is not chewed on as much, if at all, for example, then bone loss from the extraction area can become significant over time, making it more easier to break.

If a nerve is damaged during a tooth extraction, it will likely heal in several weeks to a couple of years, sometimes the nerve will never fully recover. Symptoms can include loss of feeling – numbness – and tingling in any of the parts of the mouth, including the tongue.

Tooth Extraction Healing + Warning

Tooth extraction healing takes only about five to seven days to be mostly complete. After seven days the healing is good enough to eat the harder foods without causing pain. Healing following a tooth extraction is rapid because the inside of the mouth is designed to heal quickly. When my tooth came out the pain was so great I was skeptical that I would heal so quickly, but it did. Healing can be delayed by smoking, so for a faster healing, try giving up the cigarettes. The gum area should be fully healed in three to four weeks following a tooth extraction. If the jaw was damaged during the tooth extraction, then it may take up to six months for full healing to take place.

WARNING: If you are taking an osteoperosis medication, such as Fosamax, try and save the tooth if you can. Some of these medications firmly attach the tooth and bone together and may also hinder the bone recovering from a tooth extraction – meaning you may be in pain for a lot longer than normal. Check it out with your dentist, prior to the tooth extraction.

Resources

BOOKS

Harris, N. O., and F. Garcia-Godoy. Primary Preventative Dentistry , 6th ed. Englewood Cliffs, NJ: Prentice Hall, 2003.

Peterson, L. J. Contemporary Oral and Maxillofacial Surgery , 4th ed. Amsterdam: Elsevier Science, 2002.

Scully, C. Oral and Maxillofacial Medicine: A Practical Guide. London, UK: Butterworth-Heinemann, 2003.

Tronstad, L. Clinical Endodontics. New York: Thieme Medical Publishers, 2003.

PERIODICALS

Devlin, H., and P. Sloan. “Early Bone Healing Events in the Human Extraction Socket.” International Journal of Oral and Maxillofacial Surgery 31 (December 2002): 641-645.

Magheri, P., S. Cambi, and R. Grandini. “Restorative Alternatives for the Treatment of an Impacted Canine: Surgical and Prosthetic Considerations.” Practical Procedures and Aesthetic Dentistry 14 (October 2002): 659-664.

Moscovich, H. “Fitting Restorations from Extracted Teeth.” Journal of the South African Dental Association 55 (August 2000): 411-412.

Rosted, P., and V. Jorgensen. “Acupuncture Treatment of Pain Dysfunction Syndrome After Dental Extraction.” Acupuncture in Medicine 20 (December 2002): 191-192.