PAINLESS EXTRACTION

Painless extraction is defined as the extraction in which there is the removal of the whole tooth or root along with minimum trauma to the adjacent of soft and hard tissues, so that the wound heals without any complications. There is no requirement of the pre-prosthetic surgery for the sound fitting of the appliance in that particular extracted area.

The dental extractions are complicated because of the following factors:

• The restricted movement of the lips, cheeks and tongue due to anatomically positioned or pathological problems enhance the level of difficulty while extracting the tooth. This is the most common complication which is reported by Dr.Tanvir and Dr. Gunita at Dentem clinic.
• Decrease mouth opening due to oral sub-mucousfiberosis or tresmus.
• The presence of severe periodontitis adjacent to the tooth which is extracted, leads to excessive bleeding. The presence of excess blood decrease the visibility in the working area.

INDICATIONS FOR THE EXTRACTIONS OF THE TOOTH.

1. The most common reason for the extraction of the tooth is abscen formation in the peri apical region of the tooth. Approximately 48% of the cases are repeated by Dr. Deepika along with the guidance of Dr. Gunita and Dr.Tanvir at Dentem.
2. Tooth in which pulp is completely reclosed and the tooth is not responding to the endodontic treatment is usually indicated for extraction.
3. The presence of deciduous tooth, even after the eruption of the permanent tooth.
4. Dr. Tanvir has diagnosed removal of the tooth for the success of the orthodontic treatment.
5. Tooth is removed for the placement of the prosthetic appliance and increase the longevity and the fitting of the appliance.
6. The tooth is placed lingualy or palatly and cause obstruction in the movement of the tongue.
7. Impacted tooth
8. Supernumerary tooth
9. The grossly decayed tooth which cannot be restored by endodontic treatment
10. The tooth which is present in the fracture line.\
11. The tooth which is associated with the cyst and tumor, e.g. – the tooth is usually embedded in dentigenous cyst cases.
12. The tooth which is present in the therapeutic irradiation area.

CONTRADICTIONS

1. The extraction of the tooth is delayed when there is local or systematic infection.
2. Necrotizing ulcerative, herpes ginginostomatitis and systematic infection, the extraction of the tooth is postponed.
3. If the patient undergoes radiation therapy then till 21 days, the extraction of the tooth is delayed until it is emergency procedure.

SYSTEMATIC CONTRADICTIONS

1. Acute blood dyscraisis such as acute leukemia, ageanulocytosis.
2. Untreated coagulopathies.
3. Untreated coagulopathies (congenital or acquired)
4. Adrenal insufficiencies.
5. History of myocardial infarction in last 6 months.

ABSOLUTE: In central haemangioma and arteriovenous malformations, the extraction is absolutely contraindicated.

RELATIVE: These are the contradictions in which extra care has to be taken for the extraction of the tooth, e.g. – acute cellulitis, uncontrolled systematic conditions such as diabetes, hypertension.

PRINCIPLES OF EXODONTIC:
For the removal of the tooth, there is the involvement of the elevators and forceps.
These are three basic principles that are used for the application of the elevators:
1. Lever and fulcrum.
2.Wedge principle.
3.Wheel and axle.
There are various types of elevators that are used on the basis of these principles at Dentem.
In case of forceps extraction, it is imperative to place the forceps as apically as possible with tight palm and thumb grasp.

TECHNIQUES OF EXODONTIA

These are the following techniques for the extraction of the tooth which is followed by Dr.Deepika along with the guidance of Dr. Gunita and Dr. Tanvir at Dentem clinic.

• For intra-alveolar extraction (closed technique)
• Forceps Technique
• Elevator technique

The basic principle used both the techniques are explained above.

This technique is usually used when the tooth is partially or completely impacted or the tooth cannot be extracted by the closed technique.After the removal of the tooth it is extremely important to take care of the healing wound so that there would be no infection at the socket.

POSTOPERATIVE INSTRUCTIONS
These instructions must be followed by the patient so as to expedite the process of natural healing.

1. It is mandatory to keep pressure on the extraction with the help of gauze piece. Keep the gauze piece on the socket for approximately 45 minutes after the surgery so that there is complete formation of the blood clot.
2. It is advised to the patient to not to take hot food or beverages after the surgery at least for 24 hours.
3. The patient is not supposed to rinse the mouth for 24 hours.
4. Eat soft and cold diet from the opposite side of the extraction.
5. Do not spit for 24 hours.
6. Do not drink carbonated beverages.
7. If the patient undergoes wisdom tooth extraction, then apply an ice pack on the face at the site of extraction.
8. In case of a pediatric patient, it is very important to take care of the bite on the anaesthetic part of the lip.
9. The patient is asked to take prescribed medications on time. If he/she feels any type of discomfort then feel free to call at Dentem clinic at any time.