Tooth Extraction

Indications:

1) Infectious process cannot be arrested
2) Bony support cannot be regained
3) The remaining tooth structure will not support a crown
4) Intrafurcal radiolucency or internal resorption is present on radiograph

Instruments and materials needed:

Exam Kit Extraction Kits (available at the module)
Sterile 4x4 gauze
Mouth Prop or Ratchet Printed Home Care Instructions
Local anesthesia set-up

  1. A preoperative x-ray including periapical tissue surrounding the tooth to be extracted must be obtained.

  2. Inform the parent of the procedure to be performed.

  3. Patient should be evaluated for the use of nitrous oxide/oxygen. If N2O2 is to be used, parent must sign N2O2 consent form and a chair must be reserved in the 9th floor Pediatric Dentistry Clinic.

  4. Topical anesthetic is placed for a minimum 1 minute. Local anesthesia is administered.

  5. A mouth prop or ratchet is placed.

  6. A 4x4 gauze is placed in the rear of the mouth as a throat screen to prevent aspiration or swallowing of the tooth.

  7. Elevators and forceps are used to remove the tooth. For primary molar teeth, luxation is necessary to expand the bone to allow for the removal of the intact tooth. Avoid excessive grasping pressure. Firm pressure is used in the luxation, using a straight elevator. The tooth should be luxated and elevated until it can be delivered easily with the forceps. Caution: The roots of primary teeth are long and slender thus easily fractured if proper technique is not used.

  8. The socket is checked for roots and bone fragments. It is curetted gently to remove granulation tissue, if necessary. (note: Caution must be taken not to injure the permanent tooth bud.).
  9. The patient is to bite on a folded gauze for 30 minutes.

  10. Hemostasis is assessed. Sutures are rarely needed.

  11. Home care instructions and sterile gauze packets are given to the parent. These handouts are available in the graduate pediatric dentistry clinic on the 9th floor.