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Extraction of teeth in children
The removal of teeth in children can be one of the most stressful procedures for both the operator and patient. While a tooth may be totally anaesthetized, the pressure felt during the extraction can be extremely upsetting and uncomfortable. As one of the most important aspects of clinical practice, dentists need to be skilled, efficient and sensitive in the removal of teeth in children. Teeth should be removed gently with good surgical technique rather than excessive force that may fracture roots or upset the patient.
General Principles Of Tooth Extraction In Children
Preoperative assessment
• Thorough medical history and informed consent for the procedure.
• Evaluate the tooth to be extracted both clinically and radiographically.
• Identify potentially difficult root anatomy and the proximity of other important structures prior to extraction. Be aware of implications for the permanent successor.
• Clearly identify the tooth to be extracted and confirm again prior to extraction.
• Profound local anaesthesia is vital. Explain the feeling of ‘numbness’ and the sensation associated with luxation of the tooth prior to commencing the procedure.
• If the child will be unable to cope with the extraction(s) then sedation or general anaesthesia should be considered. Ideally, the decision to sedate a child should be made at the assessment appointment NOT once the child has become upset during the procedure.
Other principles
• Primary teeth do not require a ‘primary drive’ that is often recommended for permanent teeth.
• Children tolerate the use of luxators or elevators much better than application of forceps. The alveolar bone in children is soft and teeth can be elevated easily to a high degree of mobility prior to a final delivery with forceps.
• If small apical root fragments remain after an extraction, they may be left to resorb, as attempted removal may damage the permanent successor.
• Choose a pair of extraction forceps suited to the required procedure. A wide range of forceps designed for primary teeth is available
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The extraction forceps of primary teeth , how grip it and how to extract primary teeth
Pediatric dentistry dentist