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What is the importance of extracting teeth?
provides relief from pain and infection for teeth that cannot be saved
What does the Virginia Board of Veterinary Medicine state about teeth extractions for LVTs?
surgery does not include routine dental extractions
Which dental extractions are LVTs not allowed to perform?
- sectioning teeth
- surgical extractions
What are the different categories of dental extractions?
- simple extractions (1 root)
- sectioned extractions
- surgical extractions
What are surgical extractions?
alveolar bone is removed to get to the tooth roots
What are simple extractions?
single rooted tooth
How do we remove simple extractions?
with a dental elevator and maybe extraction forceps
What are sectioned extractions?
- multi-rooted tooth is cut into one section for each root
- cut between roots to the surface of the crown because roots diverge
Can LVTs removed multi-rooted tooth after the veterinarian has sectioned them into single rooted sections?
What kind of pain management do we use for dental extractions?
- medical management - pre and post extraction medications
- nerve blocks (regional or local)
The top 1/3 of the alveolar bone surrounding the tooth has _____ of the holding power.
What can not withstand slow, continuous torque?
What must be preserved when extracting teeth?
How do we confirm a complete extraction of a root?
take a radiograph
Why do we close the alveolus after extracting a tooth?
maintain the blood clot
What are some indications for dental extractions?
- end-stage periodontal disease
- end-stage endodontic disease (abscessation)
- retained deciduous teeth
- pulp exposure when endodontic treatment is not elected due to cost or animals habits (keeps on chewing on things, breaking teeth)
- plaque intolerant animals
- feline odontoclastic resorptive lesion
What is the labial?
surface of tooth facing lips
surface of tooth facing check - caudal to commissure of lips
includes labial and buccal
surface of tooth facing palate - upper arcade
surface of tooth facing tongue - lower arcade
surface between teeth facing toward midline
surface between teeth, facing away from the midline
surface of upper and lower teeth that contact each other (chewing surface)
on the crown, towards the neck of the tooth
on the crown, toward the occlusal surface
on the root, toward the crown
on the root, toward the apex, or tip of the root
When should dental radiography be performed?
before and after extraction
Why should we perform dental radiographies before extracting teeth?
to know...how many roots, abscesses, fractures, widened periodontal ligament space
Why do we take dental radiographs after extracting teeth?
to make sure the entire tooth was removed - no tips left in
Which teeth in dogs are suitable for simple extractions?
- incisors (upper and lower)
- first premolars (upper and lower)
Which teeth in cats are suitable for simple extractions?
- incisors (upper and lower)
- canines (upper and maybe lower if loose)
- premolars (upper second premolars and no upper first premolars)
- molars (upper first)
What kind of equipment do we need for dental extractions?
- dental elevators
- luxators (not as common)
- extraction forceps
- suturing material
- mouth gags
- gauze sponges
- air/water syringe
- chlorhexidine flush
- analgesic syringe
Do dental elevators come in different sizes?
How do we know what size dental elevator to use?
should be narrower than the root, sharp at tip
What are luxators?
like elevators, but slimmer - for cutting periodontal ligament
Which uses harder steel, dental elevators or luxators?
What are extraction forceps?
Do extraction forceps come in different sizes and styles?
When do we use the extraction forceps?
use last, after tooth is significanly loosened
What can happen if we use the extraction forceps too soon?
if used alone or too soon, can fracture the tooth
What kind of equipment do we need for suturing after extracting a tooth?
- needle holders
- thumb forceps
- suture material (absorbable)
Why do we need to support the jaw when extracting teeth?
to prevent fractures
Describe the procedure for a simple extraction.
- sever attachment of gingiva to CEJ
- loosen gingiva from bone
- place elevator tightly to neck of tooth, as far mesially or distally as possible (between teeth)
- press elevator into periodontal ligament space
- use short, rotating movements and leverage to break down the periodontal ligament
The elevator acts as a _____ for extractions.
What happens when the elevator is pushed down into the periodontal ligament space?
it tends to force the root out of the alveolus
How do we press the elevator into the periodontal ligament space?
- pointing toward the tip
- extend your index finger along the blade of the elevator
- this acts as a stop if the instrument should slip
Why do we use short, rotating movements?
this breaks some ligaments, so you can push the elevator deeper
How do we use a leverage motion to remove the tooth?
- keep elevator still in socket, twist slightly
- hold in this poistion for at least 5 - 10 seconds until the fibers fatigue and break
After extracting the tooth, what do we need to curette out?
curette out (debride) any infected or necrotic tissue from alveolus
What should the alveolus always be filled with after an extraction?
If there is no clot in the alveolus after an extraction what should we do?
curette until it bleeds and clots
After we have removed the tooth, what do we do?
- lavage with disinfectant solution (chlorhexidine)
- suture extraction site if necessary
How do we extract deciduous teeth?
- take care not to damage the emerging adult tooth
- gradually work with elevator, with the tip against the deciduous root
- do not lever against the adult tooth - its root is not very subtantial yet