8 - Exodontics Flashcards
(29 cards)
What abnormalities are indicated for a tooth extraction?
grade 4 periodontal dz
tooth root abcess
grade 3 furcation exposure
very deep periodontal pockets
complicated fracture that is not amenable to the root canal (cost, loc, or type of fracture)
tooth resorption affecting the neck or crown of the tooth
when a client is unable tor unwilling to perform home care
ensure client is consulted prior to any extraction
In terms of SVMA bylaws on dental extractions by vet techs, can we make a diagnosis? And can we determine a course of tx?
No, we cannot make a diagnosis or determine any course of tx
As a RVT, under the direction and supervision of a licensed member, what can we administer?
a drug, a medicine, an appliance or other application for the tx or prevention of bodily injury or dz of animals
Can a RVT assist with surgery and dentistry?
IF they are under the direct and immediate supervision of a vet, yes
What does direct and immediate supervision mean?
In the room/within yelling distance
What are gray areas about dentistry that are okay?
likely extractions of baby teeth + simple extractions are permissible (mobile teeth, single rooted teeth)
potentially surgical extractions are okay, but we don’t receive multi root extractions training
in the end, vet is responsible for what we can do
always vets job to diagnose/tx decisions
What are dental elevators?
used to release the tooth from the root socket
lots of size variety - size of instrument should conform to the size of the root you are working on
each manufacturer uses own ID system
also has diff handles + lengths
What styles of dental elevators are there?
standard elevator
luxating elevator - thinner and sharper at tip, used in wristrocking motion to cut PD ligament, do not twist or apply pressure cause they break
winged elevator - head flares out wider than the shaft
notched elevator - in the tip of the elevator
special shapes to accommodate specific teeth
What are extraction forceps? What are they used for?
to grasp tooth once released from socket + is loose
some techniques use forceps to loosen final attachments, reqs additional training cause can -> broken/retained root tips
What are some methods of sterilization? Why?
bc extraction is surgical procedure and the instrument enters tissue,s terile instruments should always be used, to prevent introduction of a different species of bact into the area
chem sterilization not recommended - req complete cleaning of instrum b4 use to remove chemicals - negating sterilization procedure - can dull sharp instruments/weaken metals
gas sterilization - health hazard
steam sterilization - preferred
Which 2 ways can tooths be removed?
force technique - NO
breaks bone/root, more trauma
stretch + tear GOOD
uses rotational mothan than see saw
maintain 10s of pressure to stretch ligament
tooth eased out of socket
PATIENCE
What is the procedure for removing roots
All root should be removed, exception is when attempts to retrieve root will cause more damage. X-ray b4 and after extraction.
What are some examples of when you’d leave a root in during an extraction?
ex. tooth resorption in a cat where there is complete loss of PD ligament. Acceptable to remove crown of tooth only prior to closing gingiva - called coronal amputation
Ex. toothr oot accidentally pushed into mandibular canal. Huge risk of massic hemorrhage with retrieval
What are some useful exodontic techniques?
Step-by-step important
the object is to remove the tooth with as little trauma as possible
use of each part of the technique may not be necessary for every extraction, nor is the order of steps followed each time
combinations of vertical extraction, horizontal extraction and cutting of PD ligament may be used
What teeth in k9’s and fel’s are single rooted?
K9 - I’s, C’s, 1st P, Mand M3
Fel - I’s, C’s, Max P2, Max M1
How are canines extracted?
they require creation of a gingival flap to close the extraction site. Therefore, extraction of canine teeth usually preformed by vet
What is step 1 to single root extraction?
In healthy mouth, gum attachment to tooth is very fibrous and cannot be stretched/torn easily as PD ligament
Root tip pick or dental elevator common to sever attachment
Uncommon is scalpel blade
ensure you release attachment all around tooth
gentle wedge + slight rotation movement if using elevator
w/ severe gingivitis + gum recession, attachment is lost, so skip this step
What is step 2 of single root extraction when you stretch the liagament?
Need about 10-20s of pressure to stretch.
Technique 1: vertical rotation
elevator parallel to root, work elevator btw room + alveolus pocket with wrist-wrock to seat elevator in PD space. Slowly rotate and hold
Technique 2: horizontal rotation
elevator is placed perpendicular to crown + tooth root
pressure is applied to the coronal aspect of the tooth to be extracted
be careful not to luxate the tooth ur using as a fulcrum
method only used when you can almost pull the tooth out
what is step 2 of single root extraction if yu are using the wedge and cut technique?
Generally, used if you have sharp instruments (luxating elevators)
use a wrist-rock technique as you insert them into the PD space to cut the ligament
Can also wedge them into the space and hold that position to loosent he ligament (do not twist or pry, tooth will break)
What is step 3 of single root extraction?
Remove tooth from socket after PD ligament is broken down. Can grasp tooth w/ extraction forecepts for easy removal
using forceps too early results in fracture of the tooth with retention of the root tip
What is step 4 of the single root extraction?
clean socket
to spead healing/prevent infection, use curette to scrap out socket
flush socket with chlorhex solution
after curettage and flush of socket, optional materials may be placed into socket to assist bone healing depending on vet preference
calcium gluconate?
What are the steps of single root extraction?
- sever gum attachment
- separate attachment of tooth to socket (damage PD liagement)
- remove tooth from socket
- Clean socket
- Gingival closure
What is step 5 in single root extraction?
gum closure - unless defect is vry small
to prevent food material/bact going into socket, speeds healing, greatly reduces risk of “dry socket” which is a inflam of dental nerves
use rapidly absorbable suture like (4-0 and 5-0 monocryl and vicryl common)
usually close in simple interrupted or cruciate pattern - can use continuous pattern but increased likelihood of dehiscence
MUST be closed without tension on the suture line - if tension is present, gingival flap needed
What is the procedure of multi-rooted teeth?
splitting tooth is easiet but must know anatomy of tooth, after splitting, each section removed like single root, must wear eye protection and a mask during tooth sectioning.
