Primary Extractions

Question 1

At what position should a child be seated for an extraction and why?

Answer 1

Conscious child should be seated at 30 degrees to the vertical - protects childs airway to prevent aspiration of tooth

Question 2

Give a general overview of how the operator should be positioned when extracting teeth:

Answer 2

• operator standing at right hand side and facing patient
• exception being the lower right molars - operator is behind the patient

Lower right = right behind

Question 3

How should the operator be positioned to extract upper teeth?

Answer 3

For all upper teeth:

• operator should stand infront of patient with a straight back
• patients mouth should be at the level of the operators shoulder

Question 4

How should the operator be positioned to extract:

a) teeth in the lower left quadrant?
b) teeth in the lower right quadrant?

Answer 4

Lower left quadrant:

• operator stands infront of patient with patients mouth at the same level as the operators elbow

Lower right quadrant:

• operator stands behind patient with the chair as low as possible to improve access and visibility

Question 5

What types of forceps are available?

Answer 5

Upper forceps are straight handled

Lower forceps have a right angled beak

Elevators are not routinely used for primary extractions - can remove permanent successor or cause damage

Question 6

Give a brief overview on how to extract an incisor or canine:

Answer 6

• choose forceps (upper straights or universals for uppers, lower universals for lowers)
• place forceps on root of tooth
• apply apical pressure and rotate tooth smoothly as far clockwise as possible, then counter clockwise
• support alveolus and retract lip/soft tissues with non-working hand
• nip alveolus immediately after extraction

Question 7

Give an overview on how to extract primary molars:

Answer 7

• use upper or lower universals depending upon which arch tooth is
• place forceps correctly on root of tooth at furcation area
• apply apical pressure to expand socket and move tooth buccally smoothly and slowly
• if there is little movement, rotate the tooth using full rotations (stirring movements) then remove in a buccal direction using smooth ,buccal movements
• nip both sides of the socket with fingers to apply pressure to area which has just expanded

Question 8

How do you achieve haemostasis?

Answer 8

• place a bite pack into the socket and instruct the child to bite firmly for at least 5 minutes
• remove pack and examine the socket for haemostasis, repeat if required
• haemostasis must be achieved before the child leaves the surgery

Question 9

What POIG should be given to both the child and parent?

Answer 9

POIG must be given orally and in writing to patient and parent

• saliva washing over socket will tinge pink - reassure this is normal
• if bleeding starts when home, roll a clean cotton handkerchief and bite for 20 mins
• if bleeding persists, call surgery or A&E if out of hours, surgery phone number must be on POIG
• good OH should be encouraged
• if LA has been administered, do not bite, chew or suck lip/cheek/tongue
• avoidance of injury in socket area through foodstuffs - soft diet for a couple of days
• avoid hot drinks
• do not rinse or spit for rest of day
• avoid exercise for rest of day
• pain relief - simple analgesics - best started prior to anaesthetic completely worn off
• review in 1 week
• return if any problems with bleeding, excessive pain, swelling occurs

Question 10

What should you check at review appointment following extraction?

Answer 10

• OH will in most cases have deteriorated in area of extraction due to avoidance, this needs to be corrected and reinforced
• check healing is taking place and some sort of socket coverage is intact

Question 11

What are the correct doses for paracetamol?

Answer 11

Sugar free paracetamol suspensions are indicated:

• 120-150mg every 4-6 hours for 1-5 years
• 250-500mg for 6-12 years
• 500mg for 12-18 years
• aspirin is contraindicated in children - can cause Reye’s syndrome