Dental Extractions PVM V

Mucoperiosteal flap created Alveolar bone is removed Multi-rooted teeth are sectionedq

An open/surgical extraction requires what to be performed?

5 mg/ml 10 mg/ml

Bupivicaine 0.5% = ? Lidocaine 2% = ?

On single rooted teeth like incisors, first premolars, mandibular 3rd molars No flap, sectioning or alveolar bone is removed/performed

Closed extractions can be performed on which teeth? What characterizes closed extractions?

1. Pre-extraction radiographs 2. Incise gingiva with 15 c scalpel blade 3. Use a dental luxator or elevator to apply pressure apically and loosen the peridontal ligament, move around the tooth but don't rotate 4. Remove the tooth with extraction forceps 5. Examine and post-extraction radiographs 6. Clean alveolus if necessary 7. Place some sutures!

Describe how to perform a closed extraction

1. Pre-extraction radiographs 2. Create a mucoperiosteal flap 3. Elevate the flap with a periosteal elevator, ensure periosteum is lifted too 4. Buccal bone removal with a cutting bur to expose roots; remove 50-70% of bone 5. Section the multi-rooted teeth by working from furcation > crown 6. Use a luxator or elevator to loosen the periodontal ligament from each root 7. Once loose, remove each root 8. Post-extraction radiograph 9. Alveoplasty w/ diamond cutting bur 10. Suture the flap - FENESTRATE THE PERIOSTEUM

Describe how to perform an open extraction

Full mouth extraction

First line treatment for stomatitis?

Anesthesia, nerve blocks, and dental radiographs

2019 AAHA dental guidelines for dogs dictates that what is the minimum SOC?

quadrant or full mouth extractions for cats w/ stomatitis

A quadrant flap is useful for?

Same time

Healing time for open vs closed surgical extractions?

Bind to sodium channels and inhibit depolarization > no AP Duration of action affected by - low pH (infection ) decreases duration - high vasculature decreases duration

How do local anesthetics work? Their duration of action is affected by which factors?

- Intra-oral dental rads - Local anesthetics - dental unit w/ high speed handpiece - Carbide cutting burds - Diamond burs - Oral sx pack - SHARP - 4/0 absorbable suture with cutting needle

What equipment is needed for exodontics?

Retained fractured roots can lead to severe facial swelling

what is the most common exodontic complication? What can this lead to?

1 = triangle 2 = envelope 3 = pedicle

what kind of mucoperiosteal flaps are these?

Tooth resorption SHOULD BE EXTRACTED

Lesion and how to treat?

Create good visualization by removing more buccal bones, take lots of rads Use a small round burr to make a moat around the root and elevate the fragment coronally

If you have a broken root during extraction, what do you do?

1. luxator 2. elevator

Name these tools

Larger, or multi-rooted teeth Fractured roots

Open/surgical extractions are performed on which teeth?

Clinically normal. No gingivitis, peridontitis. NOrmal 3 mm sulcus in dogs and 1 mm sulcus in cats

PD0 IS?

Reversible gingivitis w/o attachment loss or bone destruction

PD1 is?

Gingivitis plus 25% attachment loss, may have stage 1 furcation involvement

PD2 is?

Moderate peridontal disease with 25-50% attachment loss, stage 3 furcation involvement

PD3 is?

Severe peridontal disease with 50% attachment loss, stage 3 furcation exposure. Often mobile.

PD4 is?

Extraction or root canal therapy with crown restoration

Possible treatment options for fractured teeth with pulp exposure?

Soft food for 2 weeks Antibiotics if needed, like if patient has a metal plate or something Pain control - NSAIDs or buprenex Recheck in 2-4 weeks

Post-op instructions following extractions?

Sharp instrument used to shear the periodontal ligament

What are dental luxators used for?

to lift the gingiva off the bone in an extraction

What are periosteal elevators used for?

- Retained deciduous teeth - Supernumerary teeth when crowded - Advanced peridontal disease - Tooth resorption - Impacted or embedded teeth - Caudal mucositis/stomatitis - Non-vital teeth or fractures if owner wants - Malpositioned teeth when orthodontics is not possible

What are some common indications for extraction of teeth?

Can alter occlusion > oral trauma Retained root tips Mandibular a laceration Jaw fracture Oronasal fistula Perforation or contusion of the eye

What are some possible complications of extractions?

- Health of patient - Anesthesia and monitoring - Pain management - Proper equipment - INFORMED CONSENT

What are some things to consider before performing peridontal therapy/extractions?

Fenestrate/release the periosteum to reduce tension on suture

What is important to do when suturing a mucoperiosteal flap?

Biofilm, gingival sulcus is favorable environment Plaque starts as gram + cocci aerobes then changes to gram - anaerobic rods that are motile

What is plaque made of at early and end stages? Where does plaque like to grow?

15c

What kind of scalpel blade is used for dental extractions?

bupivicaine 0.5%, lasts 2-10 hours

What local anesthetic is often used for dental extractions? How long does it last?

Absorable sutures with a reverse cutting needle! Like chromic gut or Moncryl 4-0 or 5-0 lasts 2-4 weeks

What suture should be used for exodontics?

dogs: 4/0 monocryl cats: 5/0 monocryl

What suture should be used to close extraction sites in dogs vs cats?

1st molar has increased calculus because 4th upper premolar cleans it usually!

When 108 is removed, what can occur to the mandibular teeth?

- patients in poor health that are not good anesthetic candidates - patients undergoing radiation or chemo - patients w/ unmanaged bleeding disorders - If owner wants to save the tooth with referral!

When are tooth extractions contraindicated?

To lengthen the duration of action of lidocaine

Why is epinephrine sometimes used with lidocaine?

Decreases amount of inhalant anesthetic needed Decreases other analgesics needed Eases transition to using oral pain meds at home Self-mutilation of extraction site is less likely to occur

Why should nerve blocks be used during extractions?