dental disorders
How To Do an Emergency Tooth Extraction
Step by Step Description of Procedure
Prior to the procedure, do periapical or panographic x-rays to evaluate the tooth in question, surrounding alveolar bone, and nearby structures. Wear nonsterile gloves and a mask and safety glasses, or a face shield. Provide local anesthesia Consider whether sedation is needed. For most lower teeth, do an How To Do an Inferior Alveolar Nerve Block . For most upper teeth, do How To Do a Supraperiosteal Infiltration . If supplemental anesthesia is needed, do local infiltration (field block) around the tooth. Extract the tooth Place a partially unfolded 4" x 4" gauze posterior to the tooth to prevent inadvertent loss of the tooth in the throat; do this gently to prevent gagging. Thekey stepsare to Release the cuff of gingiva attached to the tooth. Gain initial tooth mobility using an elevator. Further mobilize the tooth and then extract it using forceps. Irrigate and, if needed, curette the socket. Apply a gauze compression pad. Torelease the cuff of gingiva, insert the pointed end of a #9 periosteal elevator between the gingival cuff and the tooth. Keep the point in contact with the root of the tooth and advance the elevator along the long axis toward the root tip; as it is inserted, the elevator gently reflects the gingival cuff away from the tooth. Do this circumferentially all the way around the tooth. Also, on the buccal side only, reflect the small triangular papilla of gingiva between the tooth to be removed and the tooth/teeth directly adjacent. Gain initial tooth mobilityusing a straight elevator (eg, #301 or #92). Gently insert the elevator perpendicular to the tooth into the space between the tooth to be removed and the adjacent tooth. The elevator should be resting on the crest of the bone between the teeth. The elevator has 2 surfaces; the concave surface is the working side and should face the tooth being removed. One edge of the elevator is held against the alveolar bone between the teeth; this edge is kept in place and used as the fulcrum while the other edge is rotatedtowardthe tooth being removed to mobilize the tooth and expand the socket. DO NOT use the adjacent tooth as a fulcrum. Mobilization with the straight elevator is usually first done anterior to the tooth being removed and then posterior to the tooth. The straight elevator also can be inserted vertically along the long axis of the tooth between the root and the socket, and rotated to further expand the socket. Do not use the alveolar bone on the palatal or lingual side of the tooth as a fulcrum. Use the elevator repeatedly in these ways to continue mobilizing the tooth prior to using the forceps. A dental elevator is inserted perpendicularly with the concave surface facing the tooth to be removed. The edge towards the root is held in place as a fulcrum while the other edge is rotated towards the tooth being removed. Further mobilize the tooth and then extract itusing a forceps (#150 for upper teeth, #151 for lower teeth). Insert the beaks of the forceps beneath the loosened gingiva, along the root of the tooth and parallel to the long axis. Apply controlled apical (toward the tip of the root) force to slide the beaks along the root into the socket as far toward the apex as possible; this helps to further expand the socket. Then grasp the root firmly with the forceps and apply pressure apically, as though trying to push the tooth further into the socket. Place the thumb and forefinger of the opposite hand on both sides of the socket to support it and to help control forces and prevent unintended large fractures of the socket. Next, while maintaining apical pressure, rock the tooth side-to-side, continuing as needed to mobilize the tooth. In essence, this process is a controlled fracture of the socket. When the tooth is sufficiently mobile, remove it from the socket by gently pulling it straight out; do not begin pulling until the tooth is obviously loose and ready for extraction. The beaks of the dental forceps are inserted along the root of the tooth, parallel to the long axis. Irrigate the socketwith sterile saline (chlorhexidinesolution may be used if significant infection is present). Curette the socket only if chips of tooth, bone, or foreign debris are present. If the socket has been expanded, compress it using digital pressure to return it to its original shape. Place a tightly rolled gauze pad(2" x 2" or 4" x 4"), dampened with saline, directly over the socket (not on top of the adjacent teeth). Have the patient bite firmly on the pad to apply direct pressure on the socket continuously (without letting up even to speak) for 3 to 4 hours. 