Extractions in Primary Teeth

how is the child positioned

30 degrees to the vertical

to protect the airway

how is the operator positioned

standing always at RHS facing the pt

except for lower right molars when u stand behind the pt

what is positioning in upper teeth

all upper teeth extracted with operator infront with straight back

patient mouth at operator shoulder

what is positioning for lower left quadrant

pt down to level of ur elbow and operator is still in front

what is positioning for lower right quadrant

operator stands behinf the pt with chair as low as possible

lean over the back to extract it to improve access and invisibility

what order do we extract

symptomatic extractions first

lower teeth before upper to reduce bleeding ruining visibility unless symptomatic

what types of forceps

upper - forceps are straight handled, can have straight or universal

lower - have right angled beak

warwick james elevators - not routinely used for deciduous , occasionally useful for removing root fragments

what is the operating technique

aim is to remove primary tooth without damaging successor and minimise trauma

other hand is used to stabilise the alveolus/jaw

slide the forceps subgingivl onto the root and close gently

forcep should be in the palm of hand for max force min effort

first push and create the apical push and then start to use socket expanding movments tp lift it out

removal is always in a buccaal direction

what forceps do we use for upper canines and incisors

upper straight forceps

apply apical pressure and rotate far clockwise as possible and then back

what forceps do we use for lower canines and incisors

lower universal forceps

apply apical pressure push and rotate round clockwise as possible and then backl

what forcep for upper primary molars

upper universal

more socket expansion is required than single rooted teeth

if struggling buccally, use a rotational figure of 8 movement anf then move buccally

same basically for lowers

what do we do immediately after every extraction

put fingers immediatley on the socket

place a bite back into the socket and instruct the child to bite for at least 5 mins

remove and examine socket for haemostasis

this must be acheived before the child leaves

what are POI after extractions

given verbally to parent and child

saliva is washing over socket which is normal

if bleeding starts again when home- clean tissue bite down for 20 mins, if not then seek help

OH is encouraged

remember LA advice

do not rinse or spit for the rest of the day to avoid dry socket

avoid exercise for the remainder of the day - increases bp which risks bleeding again

advise to eat on other side for remainder of the day

what pain relief is advised

might not need but whatver taken for a head ache - ideally before LA wears off to work prohylactically

when do we review after extractions

1 week

to ensure OH is still ok

what can happen when tooth is extracted early

teeth on either side of extraction side will tilt and lose the gap for the permanent successor

successor does not have an eruption pathway so can erupt in strange places

what is rule of 10

for mandibular teeth to work out if IDB is needed

take number of the tooth and add to the child age

eg age 7 and extracting E

= 12 so need idb

>10 then IDB is needed

eg age 4 and extracting E

= 9 so no IDB

how do we do IDB in kids

alveolar foramen is lower

due to angle of mandible being more obtuse

might not need a long needle

what are the dosages of LA in kids

max dose - 1/10 cartirdge to kg of body weight

1/11 for prilocaine

5 years - 20kg

10 years - 40kg