assessing the degree of difficulty of extractions Flashcards
(19 cards)
how does a very young pt impact the degree of difficulty of extraction?
anxious
how does a very old pt impact the degree of difficulty of extraction? 3
heavily restored teeth predisposed to tooth fracture
increased risk of alveolar fracture due to periodontal disease and loss of tissue elasticity
polypharmacy
how does ethnicity impact the degree of difficulty of extraction?
Afro-Caribbean have dense bone so may require surgical extraction
what can reduce access making the extraction more difficult
Crowding, tilting, rotation
Impaction
Maxillary third molars
can soft tissue impaction be managed in primary care?
yes
how is difficult access to maxillary third molars overcome?
bayonets
how does lone standing molars increase the degree of difficulty of extraction?
thickening of the alveolar bone and PDL around the tooth
risk of alveolar/tuberosity fracture
OAC - antrum erodes into the position where the adjacent teeth were
how to abrasion cavities affect the degree of difficulty of extraction?
○ Tooth fractures at level of the abrasion
- If fracture above alveolus can elevate
- If fracture below alveolus refer
how do endodontically treated teeth affect the degree of difficulty of extraction?
Brittle so more likely to fracture
how to crowned teeth impact the degree of difficulty of extraction?
○ Crowns and veneers mask caries
Ensure beaks engage below gingival margin
how does extensive caries impact the degree of difficulty of extraction and how is it overcome?
Inadequate tooth tissue to engage forceps
If there isn’t enough sound tissue above the alveolus needs surgical extraction
Elevators and cowhorns
how do retained roots impact the degree of difficulty of extraction?
If below alveolus require surgical extraction
If sound tissue above alveolus can be elevated
what clinical feature may indicate decreased difficulty of extraction?
Periodontal disease
what do curved roots of mandibular molars indicate?
Indicates close relationship to IDC - refer
when may multirooted teeth require surgical extraction?
If >1 path of withdrawal
is external or internal root resorption more difficult to extract?
internal more difficult to extract
remember
when to refer a pt to a specialist
- OAC
- Fracture below alveolus
- Canines with long curved roots
- Impacted/unerupted teeth
- Submerged teeth
- Ankylosis
- Multirooted teeth with more than one path of withdrawal
- Curved roots indicating a close relationship to IDC
- Hypercementosis
what guidelines should u follow for referral to a specialist
Follow NICE guidelines for third molar surgery and Royal College England, surgical endodontics, palatal canines, impacted incisors
remember
if fracture a tooth during extraction and need to refer, take pre and post op radiographs and send them
