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 25-28 September, 2018 | Singapore
WSV18-0251
WSAVA DENTAL GUIDELINES
DENTAL EXTRACTIONS MADE EASIER
B. Niemiec1
1Veterinary Dental Specialties and Oral Surgery, Dentistry, San Diego, USA
DENTAL EXTRACTIONS MADE EASIER
Brook A. Niemiec, DVM, DAVDC, DEVDC, FAVD
Southern California Veterinary Dental Specialties & Oral Surgery
San Diego, CA USA
Extractions are surgery, and therefore need to be treated with appropriate respect. Patience and gentle technique is the best way to achieve a successful outcome. All extractions can be broken down into simple, single rooted extractions. Therefore proper elevation and extraction techniques learned and performed on incisor teeth will make all extractions easier.
Proper and well maintained equipment is critical for successful extractions. This author prefers luxating elevators to standard or winged elevators. Small extraction forceps and needle holders will also benefit the surgeon. Step 1: OBTAIN CONSENT
NEVER extract teeth without owner consent (preferably written), no matter how bad the problem, or how obvious the decision is. Make sure that you have a valid daytime number (or numbers) for the client and inform them they must be available during surgery hours. Consider loaning pagers to clients for the day, as this author has found
this to be a very effective means to contact clients. If
the client cannot be reached and prior consent was not obtained, DO NOT PULL THE TOOTH. Document the problem, recover the patient, and reschedule the work. Remember, the tooth can always be extracted later, but it cannot be put back in!
Step 2: DENTAL RADIOGRAPHS
Dental radiographs should be exposed on all teeth
prior to extraction. Dental radiographs are invaluable resources for the practiconer. Radiographs allow
the practitioner to determine the amount of disease present, any root abnormalities or ankylosis. Help with radiographic interpretation is available while the patient is under anesthesia at www.vetdentalrad.com. In addition, the radiographs will serve as evidence for the extraction in the medical record. Radiographs should also be exposed post-extraction to document complete removal of the tooth.
Step 3: OBTAIN PROPER VISABILITY AND ACCESSABILITY
The patient should be positioned in such a way as to allow maximum visibility of the area as well as make
the surgeon most comfortable. Note that during the extraction procedure the ideal position may change and the patient should be adjusted appropriately. The lighting should be bright and focusable on the surgical field. Suction, air/water syringes, and gauze should be utilized continually to keep the surgical field clear, and mouth gags can be used to hold the mouth in proper position for surgery. Finally, magnification may help the surgeon locate furcations or retained root tips.
Step 4: PAIN MANAGEMENT
Extractions are surgical procedures and are moderately to severely painful for the patient. Depending on patient health, a multimodal approach (combination of opioids, NSAIDs, local anesthetics, and dissociative) should
be employed, as this provides superior analgesia. Preemptive analgesia is proven to be more effective than post-operative, and it is therefore important to administer the drugs BEFORE the painful procedure. (see notes in previous lecture for pain mamagement)
SINGLE ROOT EXTRACTIONS
Step 5: INCISE THE GINGIVAL ATTACHMENT
This is accomplished with a scalpel blade (number 11 or 15), elevator, or luxator. The selected instrument is placed into the gingival sulcus with the tip of the blade angled toward the tooth (this will help avoid going outside
the bone and creating a defect or cutting through the gingiva). The blade is then advanced apically to the
level of the alveolar bone, and the instrument is carefully worked around the entire tooth circumference.
This step is very helpful as the gingival attachment contributes approximately15% of the retentive strength of the periodontal apparatus. More importantly, however, this procedure will keep the gingiva from tearing during the extraction procedure. This is most important with mobile teeth where little elevation is needed, but one edge is still attached. Gingival tearing can cause defects that require closure or can make a planned closure more difficult.
Step 6: ELEVATE THE TOOTH
Elevation is the most dangerous step in the extraction procedure. Remember that you are holding a sharp surgical instrument and working in an area of numerous critical and delicate structures. There have been many reports of eyes that have been gouged and lost by extraction instruments as well as at least one confirmed fatality due to an elevator puncturing a patient’s brain. The index finger is placed near the tip of the instrument to avoid causing iatrogenic trauma in the event of instrument slippage or encountering diseased bone. In addition, the jaw should be gently held with the opposite hand to provide stability and avoid mandibular fracture.
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43RD WORLD SMALL ANIMAL VETERINARY ASSOCIATION CONGRESS AND 9TH FASAVA CONGRESS
































































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