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What is the importance of extracting teeth?
provides relief from pain and infection for teeth that cannot be saved
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What does the Virginia Board of Veterinary Medicine state about teeth extractions for LVTs?
surgery does not include routine dental extractions
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Which dental extractions are LVTs not allowed to perform?
- sectioning teeth
- surgical extractions
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What are the different categories of dental extractions?
- simple extractions (1 root)
- sectioned extractions
- surgical extractions
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What are surgical extractions?
alveolar bone is removed to get to the tooth roots
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What are simple extractions?
single rooted tooth
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How do we remove simple extractions?
with a dental elevator and maybe extraction forceps
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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
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Can LVTs removed multi-rooted tooth after the veterinarian has sectioned them into single rooted sections?
yes
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What kind of pain management do we use for dental extractions?
- medical management - pre and post extraction medications
- nerve blocks (regional or local)
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The top 1/3 of the alveolar bone surrounding the tooth has _____ of the holding power.
2/3
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What can not withstand slow, continuous torque?
periodontal fibers
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What must be preserved when extracting teeth?
gingiva
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How do we confirm a complete extraction of a root?
take a radiograph
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Why do we close the alveolus after extracting a tooth?
maintain the blood clot
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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)
- malocclusions
- crowding
- plaque intolerant animals
- feline odontoclastic resorptive lesion
- disarming
- trauma
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What is the labial?
surface of tooth facing lips
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Define buccal.
surface of tooth facing check - caudal to commissure of lips
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Define facial.
includes labial and buccal
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Define palatal.
surface of tooth facing palate - upper arcade
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Define lingual.
surface of tooth facing tongue - lower arcade
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Define mesial.
surface between teeth facing toward midline
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Define distal.
surface between teeth, facing away from the midline
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Define occlusal.
surface of upper and lower teeth that contact each other (chewing surface)
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Define cervically.
on the crown, towards the neck of the tooth
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Define occlusally.
on the crown, toward the occlusal surface
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Defin coronally.
on the root, toward the crown
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Define apically.
on the root, toward the apex, or tip of the root
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When should dental radiography be performed?
before and after extraction
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Why should we perform dental radiographies before extracting teeth?
to know...how many roots, abscesses, fractures, widened periodontal ligament space
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Why do we take dental radiographs after extracting teeth?
to make sure the entire tooth was removed - no tips left in
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Which teeth in dogs are suitable for simple extractions?
- incisors (upper and lower)
- first premolars (upper and lower)
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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)
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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
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Do dental elevators come in different sizes?
yes
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How do we know what size dental elevator to use?
should be narrower than the root, sharp at tip
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What are luxators?
like elevators, but slimmer - for cutting periodontal ligament
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Which uses harder steel, dental elevators or luxators?
dental elevators
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What are extraction forceps?
like pliers
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Do extraction forceps come in different sizes and styles?
yes
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When do we use the extraction forceps?
use last, after tooth is significanly loosened
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What can happen if we use the extraction forceps too soon?
if used alone or too soon, can fracture the tooth
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What kind of equipment do we need for suturing after extracting a tooth?
- needle holders
- thumb forceps
- scissors
- suture material (absorbable)
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Why do we need to support the jaw when extracting teeth?
to prevent fractures
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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
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The elevator acts as a _____ for extractions.
wedge
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What happens when the elevator is pushed down into the periodontal ligament space?
it tends to force the root out of the alveolus
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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
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Why do we use short, rotating movements?
this breaks some ligaments, so you can push the elevator deeper
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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
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After extracting the tooth, what do we need to curette out?
curette out (debride) any infected or necrotic tissue from alveolus
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What should the alveolus always be filled with after an extraction?
a clot
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If there is no clot in the alveolus after an extraction what should we do?
curette until it bleeds and clots
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After we have removed the tooth, what do we do?
- lavage with disinfectant solution (chlorhexidine)
- suture extraction site if necessary
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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
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