dental disorders
How To Do an Emergency Tooth Extraction
Equipment
Dental chair, straight chair with head support, or stretcher Light source for intraoral illumination Nonsterile gloves Mask and safety glasses, or face shield Gauze pads Cotton-tipped applicators Dental mirror or tongue blade Suction, preferably narrow tip (3- to 5-mm) not Yankauer Rubber bite block for lower teeth (to help protect the TMJ by preventing excessive pressure on the mandible—pediatric size is usually adequate for both children and adults) Retractors (eg, Minnesota cheek retractor, Weider tongue retractor) Elevators—#9 Molt: periosteal elevator; #301 (narrow) or #34 (wide): straight elevators; #92: bayonet elevator Forceps—#150 or #150S (small): universal upper forceps; #151 or #151S (small): universal lower forceps Minimal basic dental instruments include small periosteal elevator (Molt or Freer), #301 elevator, and universal forceps (#150 – upper, #151 – lower). Equipment to do local anesthesia: Topical anesthetic ointment* (eg,lidocaine5%,benzocaine20%) Injectable local anesthetic such aslidocaine2% withepinephrine† 1:100,000, or for longer duration anesthesia,bupivacaine0.5% withepinephrine† 1:200,000 Dental aspirating syringe (with narrow barrel and custom injectable anesthetic cartridges) or other narrow barrel syringe (eg, 3 mL) with locking hub 25- or 27-gauge needle: 2-cm long for supraperiosteal infiltration; 3-cm long for nerve blocks * CAUTION: All topical anesthetic preparations are absorbed from mucosal surfaces, and toxicity may result when dose limits are exceeded. Ointments are easier to control than less-concentrated topical liquids and gels. Excessbenzocainerarely may cause methemoglobinemia. † Maximum dose of local anesthetics:Lidocainewithoutepinephrine, 5 mg/kg;lidocainewithepinephrine, 7 mg/kg;bupivacaine, 1.5 mg/kg. NOTE: A 1% solution (of any substance) represents 10 mg/mL (1 gm/100 mL).Epinephrinecauses vasoconstriction, which prolongs the anesthetic effect; this is useful in well-vascularized tissues such as the oral mucosa. Patients with cardiac disease should receive only limited amounts ofepinephrine(maximum 3.5 mL of solution containing 1:100,000epinephrine); alternatively, use local anesthetic withoutepinephrine. 