Edited : Cahyo Nugroho

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Tooth extraction
Indications:
1. Grossly carious tooth which cannot be restored
2. Acute/chronic pulpitis
which cant be restored by RCT
3. Periodontal diseases
More than half of alveolar bone loss
4. Fracture of tooth
Root
Longitudinal
If tooth lies on jaw # line

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Indication cont..
5. Bony lesion lies over the tooth
Cyst, Tumor,OM
6. Impacted tooth
7. Aesthetic indication
8. Orthodontic appliances
Teeth crowding
9. Supernumerary and malposed teeth
10. Retained deciduous tooth if permanent successor is present
11. If tooth hurting the soft tissue
Upper 3rd molar damaging the lower 3rd molar gum tissue

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Contraindications:
General
1. Cardiac diseases - Valvular heart diseases, RHD,
Hypertension,Patients on anticoagulation therapy
2. Blood disorders (Severe anemia, Leukemia, Hemophilia)
3. Liver disease (Vitamin K deficiency, Clotting factor deficiency)
4. DM
5. Pregnancy- 1st and 3rd trimester
6. Epilepsy patient
7. Allergic to local anesthesia
8. Psychiatric patient
9. Very old patient
10. Uncooperative patient/ Lack of consent
11. Patient on steroids
12. High grade fever

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Contraindication :
Local
1. Acute gingivitis
2. Acute periodontitis
3. Acute pericoronitis
4. Acute cellulitis
5. Acute osteomyelitis
6. Malignancy
Any acute infection except Acute pulpitis is not contra
indication of tooth extraction but it is rather indication of
extraction

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Post extraction instructions:
1. Bite on cotton or gauge for half an hour
2. Dont spit or rinse as far as possible
3. Dont take hot water or food at least for 12 hour
4. No physical activity for 24 hours
5. Soft lukewarm comfortable foods
6. Intake of antibiotics and analgesics as prescribed by
dentist
7. Cold compress with ice packs
8. No smoking / Alcohol / Tobacco
9. If any bleeding, pain or complications contact hospital
or dentist immediately
10. Warm saline wash after 24 hrs for next 2 or 3 days

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Complications
1. Fracture of
Crown, Root, Alveolar bone, Adjacent tooth
2. Dislocation of TMJ
3. Trauma to Gingiva, Lips, Tongue, Palate
4. Intraoperative and post operative hemorrhage
5. Trismus
6. Infection : local /systemic
7. Anesthesia related complication

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Antibiotic prophylaxis:

Under L.A
Amoxycillin 3gm 1 hour before surgery,If
allergic to Amoxycillin then give
Clindamycin 600mg
Under G.A
Amoxycillin IV + oral 1gm at induction
and 0.5 gm 6 hours later,If allergic then
Vancomycin IV infusion1gm over 1
hour+Gentamycin120mg IV

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Position

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Extraction movement
Primary movement: Along longitudinal axis of root
Secondary movement: Main extracting movement
Rotatory
Buccolingual or labiolingual
Mesodistal
Lifting the tooth

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 Upper central and lateral incissor
Rotation only
Upper canine
Rotation initially, some labiolingual movement may be needed
Upper premolar and molar
Buccopalatal movement

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 Lower central and lateral incissor
Labiolingual movement
Lower canine
Rotatory and labiolingual
Lower premolar
Rotatory
Lower molar
Buccolingual movement

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Nerve supply:
Maxilla
Posterior superior alveolar nerve: Molars
Middle superior alveolar nerve: Premolars
Anterior superior alveolar nerve: Canines and Incissor
Sensory supply of palate from greater and lesser palatine nerves as
well

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Mandibular nerve:
Lingual nerve
Inferior alveolar nerve : Enters the mandibular
canal

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Dental block
Types of blocks
Supraperiosteal injection
Mental nerve block
Anterior superior alveolar (Infraorbital) nerve block
Posterior superior alveolar nerve block
Inferior alveolar nerve block

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Choice of anesthesia in dental procedure
2% lidocaine/Xylocaine with 1:100,000 epinephrine
is a good choice. This provides about
1 hour of dental pulp analgesia
3 to 5 hours of soft-tissue analgesia
For temporary relief of pain, the preferred agent is
0.5% Bupivacaine with 1:200,000 epinephrine
1 to 3 hours of dental pulp analgesia
4 to 9 hours of soft-tissue analgesia
Duration of analgesia is less with supraperiosteal
injections than with regional nerve blocks

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Inferior alveolar nerve block
Most widely used anesthetic procedure in dentistry
All mandibular teeth to midline
Anterior 2/3 of tongue
Floor of oral cavity
Complication:
Infection
Patient having tendency
to bite tongue or lips

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 Aim is to deposit solution around the inferior alveolar nerve as it
enters the mandibular foramen underneath the lingula
The patient's mouth must be widely open, inferior border being
parallel to ground
Palpate the landmarks of external and internal oblique ridges and
note the line of the ptyerygomandibular raphe

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 Index finger is used to stretch the tissues over the injection
site, maximizing visibility and minimizing the pain of the
injection.
Orient the syringe so that the barrel is in the opposite
corner of the mouth, resting on the premolars
Aim toward your index finger and slowly penetrate the
mucosa until bone is contacted, usually a distance of about
2.5 cm
Needle should be parallel to occlusal surface

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Withdraw slightly and aspirate
If no blood is returned, inject 1.5 to 2 mL of anesthetic
If aspiration is positive, pull back and redirect slightly,
then repeat
If a lingual nerve block is required 0.5 ml of LA is injected
after withdrawal of 0.5cm of the needle

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Supraperiosteal infiltration
Also called local infiltration
Teeth affected
Any maxillary tooth
Only can anesthetize
2 or 3 adjacent teeth
Poor option for mandibular tooth because of relatively
high density

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The aim is to deposit LA supraperiosteally in as close proximity as
possible to the apex of the tooth to be anaesthetized.
The LA will diffuse through periosteum and bone to bathe the
nerves entering the apex.
Reflect the lip or cheek to place mucosa on tension and
insert the needle along the long axis of the tooth aiming towards
bone.
At approximate apex of tooth, withdraw slightly and deposit LA
slowly

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Mental nerve block
Apex of the second premolar
Tissue and teeth affected
Buccal soft tissues from 2nd mandibular premolar to
midline
skin of lower lip and chin

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Infraorbital block
Just inferior to the infraorbital notch
Teeth affected
Incisors
Canines
premolars

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