Extraction in children's

Extraction

• Tooth extraction refers to painless removal of tooth or tooth roots with minimum trauma to the investing surrounding tissues so that the extraction socket wound heals uneventfully without any post-operative complications. A child doesn’t know what to expect during tooth extraction and anticipation of surgery itself exacerbates the apprehension of the child

Role of Pedodontist

• . Pedodontist who is children specialist dentist can reduce the anxiety and apprehension level of the child by educating the child. Pedodontist spends considerable time in attaining level of cooperation from the child in dental operatory. If the baby tooth can be saved, then emphasis should be laid on saving the tooth and not removing the tooth

• . People think that baby teeth are of no use and get their children’s baby tooth removed when they can be saved. Baby teeth guide the adult teeth in correct position and prevent crowding of adult teeth on eruption.

• . Child will often consider the tooth extraction procedure to be scary and will worry that the tooth extraction procedure will hurt

Causes of Tooth Extraction in Children

• 1. Dental extraction is done in children if the tooth is decayed to the point that tooth can’tbe restored.

• 2. If the tooth is fractured or is involved in jaw fractures, then the tooth is indicated for dental extraction.

• 3. If the baby deciduous teeth are interfering with the eruption of permanent adultsuccessor, then extraction of baby teeth is done.

• 4. If there are over retained baby teeth present, then baby teeth extraction is done.

• Planned Tooth Extraction is carried out to create room for the adult permanent teeth to come and for proper alignment of the adult teeth. It may also avoid the need for braces treatment later on.

• 5. If teeth are involved with dental cysts and dental tumors, then teeth are removed.

• 6. In case of impacted teeth and supernumerary teeth, dental extraction is done.

• 7. Primary teeth with furcation involvement are indicated for dental extraction.

• 8. In case of severe Periapical infection of baby tooth, tooth extraction is indicated.

• 9. Tooth extraction may be done for braces treatment. In case of crowding of dental arch, dentist may extract one or more teeth to create space for shifting the teeth. Some of the baby milk teeth are removed in child if crowding is likely to occur when the deciduous baby teeth are replaced with permanent adult teeth.

• To remove teeth that cannot be restored• To remove teeth that are not necessary to

restore• To remove potentially problematic teeth • To remove teeth necessary for orthodontic

treatment

• Although permanent teeth were meant to last a lifetime, there are a number of reasons why tooth extraction may be needed. A very common reason involves a tooth that is too badly damaged, from trauma or decay, to be repaired. Other reasons include:

• Risk of infection. If your immune system is compromised (for example, if you are receiving chemotherapy or are having an organ transplant) even the risk of infection in a particular tooth may be reason enough to pull the tooth.

Purpose of extraction in children

• A crowded mouth. Sometimes dentists pull teeth to prepare the mouth for orthodontia. The goal of orthodontia is to properly align the teeth, which may not be possible if your teeth are too big for your mouth. Likewise, if a tooth cannot break through the gum (erupt) because there is not room in the mouth for it, your dentist may recommend pulling it.

• Infection. If tooth decay or damage extends to the pulp -- the center of the tooth containing nerves and blood vessels -- bacteria in the mouth can enter the pulp, leading to infection. Often this can be corrected with root canal therapy (RCT), but if the infection is so severe that antibiotics or RCT do not cure it, extraction may be needed to prevent the spread of infection.

• Periodontal (Gum) Disease. If periodontal disease -- an infection of the tissues and bones that surround and support the teeth -- have caused loosening of the teeth, it may be necessary to the pull the tooth or teeth.

Prior to Extraction Procedure

• To determine severity of damage, an x-ray of tooth is taken. If tooth can’t be restored, then new appointment is given to the child for tooth extraction procedure. An antibiotic may also be given to the patient to reduce the infection.

• If the child is very nervous and anxious about the tooth extraction procedure, then anti-anxiety medication may be given to the child. It is typically to be taken at night before the tooth extraction.

Procedures

• Apply local anaesthetics to the tooth and oral structures to make them numb

• Using appropriate instruments to extract the tooth.

• Tightly bite on cotton roll or gauze to help stop bleeding.

What Dentist must know Before Having a Tooth Pulled

• Although having a tooth pulled is usually very safe, the procedure can allow harmful bacteria into the bloodstream. Gum tissue is also at risk of infection. If you have a condition that puts you at high risk for developing a severe infection, you may need to take antibiotics before and after the extraction. Before having a tooth pulled, let your dentist know your complete medical history, the medications and supplements you take, and if you have one of the following:

• damaged or man-made heart valves• congenital heart defect• impaired immune system• liver disease (cirrhosis)• artificial joint, such as a hip replacement• history of bacterial endocarditis•

• Removal of a seriously decayed tooth can prevent infective endocarditis for some patients who are suffering from some forms of heart disease.

Note to be given for parents

• The proper alignment of teeth depends on the size of the jaw bone. If deciduous teeth are extracted prematurely, the early loss of deciduous teeth may have an adverse result in irregular alignment of permanent teeth.

• Deciduous teeth will shed naturally during the period of transition from deciduous to permanent dentition. Even though they are loose, there is no need to extract the deciduous teeth.

• Never frighten a child by a threat to have their teeth extracted if they don't behave. It will cause fear towards dental treatments and the child will become less cooperative to dental procedures in the future.

• Points to note after extractionOn the day after extraction:

• Do not rinse your mouth vigorously• Do not disturb the wound with the tongue or

fingers• Do not do heavy exercise• Take pain control medication as given by dentist• Painful and swollen wound after extraction

• Generally, discomfort in the wound will be felt within few days after the extraction. The level of discomfort will decrease as the wound heals. If you follow the dentist's advices to give your child medications and keep his/her mouth clean, the wound should gradually heal.

After a Tooth extracted

• Following an extraction, your dentist will send you home to recover. Recovery typically takes a few days. The following can help minimize discomfort, reduce the risk of infection, and speed recovery.

• Take painkillers as prescribed.• Bite firmly but gently on the gauze pad placed by your

dentist to reduce bleeding and allow a clot to form in the tooth socket. Change gauze pads before they become soaked with blood. Otherwise, leave the pad in place for three to four hours after the extraction.

• Apply an ice bag to the affected area immediately after the procedure to keep down swelling. Apply ice for 10 minutes at a time.

• Relax for at least 24 hours after the extraction. Limit activity for the next day or two.

• Avoid rinsing or spitting forcefully for 24 hours after the extraction to avoid dislodging the clot that forms in the socket.

• After 24 hours, rinse with your mouth with a solution made of 1/2 teaspoon salt and 8 ounces of warm water.

• Do not drink from a straw for the first 24 hours.

• Do not smoke, which can inhibit healing.• Eat soft foods, such as soup, pudding, yogurt,

or applesauce the day after the extraction. Gradually add solid foods to your diet as the extraction site heals.

• When lying down, prop your head with pillows. Lying flat may prolong bleeding.

• Continue to brush and floss your teeth, and brush your tongue, but be sure to avoid the extraction site. Doing so will help prevent infection.

• • If the discomfort persists or has even

worsened , you should take your child to get a detailed check-up by the dentist.

Extraction of Baby Deciduous Lower Molar

• If the tooth is impacted or is not visible above the gum line, then surgical tooth extraction is done in child. Conscious sedation or general anesthesia may be given to the child before surgical tooth extraction. Nitrous oxide also called laughing gas or stronger sedation may be given to the patient through IV. In case of surgical tooth extraction, gum tissue is removed to pull the tooth out.

Tooth Extraction of Baby Deciduous Teeth

• Baby tooth is easier to remove from the socket. The roots of the baby tooth are mostly resorbed and are short which makes it easy to remove them. There is little or no discomfort.

What to Expect With Tooth Extraction

• Dentists and oral surgeons (dentists with special training to perform surgery) perform tooth extractions. Before pulling the tooth, your dentist will give you an injection of a local anesthetic to numb the area where the tooth will be removed. If you are having more than one tooth pulled or if a tooth is impacted, your dentist may use a strong general anesthetic. This will prevent pain throughout your body and make you sleep through the procedure.

• If the tooth is impacted, the dentist will cut away gum and bone tissue that cover the tooth and then, using forceps, grasp the tooth and gently rock it back and forth to loosen it from the jaw bone and ligaments that hold it in place. Sometimes, a hard-to-pull tooth must be removed in pieces.

• Once the tooth has been pulled, a blood clot usually forms in the socket. The dentist will pack a gauze pad into the socket and have you bite down on it to help stop the bleeding. Sometimes the dentist will place a few stitches -- usually self-dissolving -- to close the gum edges over the extraction site.

• Sometimes, the blood clot in the socket breaks loose, exposing the bone in the socket. This is a painful condition called dry socket. If this happens, your dentist will likely place a sedative dressing over the socket for a few days to protect it as a new clot forms.

When a Dentist should be called

• It is normal to feel some pain after the anesthesia wears off. For 24 hours after having a tooth pulled, you should also expect some swelling and residual bleeding. However, if either bleeding or pain is still severe more than four hours after your tooth is pulled, you should call your dentist. You should also call your dentist if you experience any of the following:

• Signs of infection, including fever and chills• Nausea or vomiting

• Redness, swelling, or excessive discharge from the affected area

• Cough, shortness of breath, chest pain, or severe nausea or vomiting

• The initial healing period usually takes about one to two weeks. New bone and gum tissue will grow into the gap. Long-term, however, having a tooth (or teeth) missing can cause the remaining teeth to shift, affecting your bite and making it difficult to chew. For that reason, your dentist may advise replacing the missing tooth or teeth with an implant, fixed bridge, or denture.

Extraction instruments