EXODONTIAEXODONTIA

DefinitionDefinition::

Ideal tooth extraction is painless removal Ideal tooth extraction is painless removal

of whole tooth or tooth root with minimal of whole tooth or tooth root with minimal

trauma to investing tissues so that wound trauma to investing tissues so that wound

heals uneventfully & no post-operative heals uneventfully & no post-operative

problem is created.problem is created.

Indications for ExtractionIndications for Extraction::

Periodontal disease when support is destroyed.Periodontal disease when support is destroyed.

Dental caries & its sequale (teeth cannot be restored).Dental caries & its sequale (teeth cannot be restored).

Individual teeth with acute /chronic pulpitis.Individual teeth with acute /chronic pulpitis.

Periapical disease.Periapical disease.

Tooth mechanically interfering in the placement of Tooth mechanically interfering in the placement of

partial denture & bridges.partial denture & bridges.

Over retained deciduous tooth.Over retained deciduous tooth.

Therapeutic extraction – orthodontic treatment.

Impacted teeth responsible for malocclusion.

Supernumerary teeth.

Teeth with fractured / infected root & root fragments.

Teeth causing trauma to soft tissue.

Teeth responsible for focal sepsis causing systemic

disorder eg: endocarditis, obscure facial pain, rheumatic

disorders & kidney infection etc.

Teeth involving cyst eg: dentigerous cyst.

Teeth that cause bony pathology eg: osteomyelitis,

neoplasm.

Endodontic failure.

Failure of large restoration.

In patient of oral malignancy where radiation therapy

is to be given.

• Teeth that will cause trauma to the soft tissues esp. if

treatment of tooth viz grinding or orthodontic

movement does not prevent this trauma.

• Serial extraction : to provide enough space for

permanent successors to attain its position in the

dental arch & achieve stability of the dental arch.

In Primary TeethIn Primary Teeth

Teeth that are hopelessly carious.Teeth that are hopelessly carious.

Extensive decay which results in death of pulp & infection reaching Extensive decay which results in death of pulp & infection reaching

into bifurcation.into bifurcation.

When primary teeth interfere with normal eruption & alignment of When primary teeth interfere with normal eruption & alignment of

their permanent successors.their permanent successors.

1.1. Improper resorption of root causing deflection of erupting tooth.Improper resorption of root causing deflection of erupting tooth.

2.2. Irregular resorption of the roots of molars, one root being Irregular resorption of the roots of molars, one root being

resorbed more than the others.resorbed more than the others.

3.3. Retained primary teeth when a permanent tooth is present & in Retained primary teeth when a permanent tooth is present & in

normal position to erupt.normal position to erupt.

• When there is a sinus opening through the

mucoperiosteal membrane overlying the root

• Periapical pathosis

• Root fractured as result of trauma with subsequent

development of infection

• Suprenumerary teeth (mesiodens)

Contraindications:Contraindications:

1.1. Local :Local :

Acute infectionAcute infection like stomatitis, vincents infection & herpetic like stomatitis, vincents infection & herpetic

stomatitis, it could result in bacteremia.stomatitis, it could result in bacteremia.

– Exception of this condition is acute dentoalveolar abscess Exception of this condition is acute dentoalveolar abscess

with cellulitis which requires immediate extraction. with cellulitis which requires immediate extraction.

• Malignancy – trauma enhances the speed of growth & spread

of infection whereas extraction are strongly indicated if jaw

or surrounding tissues are to receive radiation therapy.

• Acute pericoronitis –as 3rd molar area has direct

access do deep facial plexus of neck .

• Extraction of tooth if irradiated jaws develop

osteoradionecrosis.

• Acute infection in max. premolar & molar area in

acute sinusitis.

2. 2. Systemic factors:Systemic factors:

Cardiac problemsCardiac problems

– Hypertension, coronary artery disease, ischaemic heart Hypertension, coronary artery disease, ischaemic heart

disease ,congestive heart failure, valvular & septal disease ,congestive heart failure, valvular & septal

defects.defects.

Uncontrolled diabetes mellitusUncontrolled diabetes mellitus

– Infection of the wound & thereby absence of healing is Infection of the wound & thereby absence of healing is

encountered. encountered. Pregnancy

– 1st trimester –nausea & vomiting 1st trimester –nausea & vomiting

– 3rd trimester –risk of premature delivery, supine 3rd trimester –risk of premature delivery, supine hypertensive syndrome.hypertensive syndrome.

Bleeding disorders– Anaemia, haemophilias, leukaemia & purpura.Anaemia, haemophilias, leukaemia & purpura.

• Patient on steroid therapy

- Such patient may not have sufficient adrenal

cortex secretion to withstand the stress of

extraction & need additional steroids.

• It is advisable to double the dose of steroids one

or 2 days preoperatively & continue the same 2

days postoperatively.

• Renal failure

- Can create a formidable problem in preparing pt.

for extraction.

Psychosis & neurosis

Can complicate extraction.

Patient on anticoagulant therapy

Can lead to prolonged postoperative bleeding .

Toxic goitre

Uncontrolled leukemis & lymphoma.

Absolute contraindications:

Haemangioma, Arteriovenous fistula,

Patient refusal

Requirements for extraction:

A good radiograph to frame diagnosis & study the

size, shape & number of roots.

Adequate anesthesia (local/general).

Adequate light, efficient assistance, good

instruments & suction apparatus.

Chain of sterilization & aseptic technique should be

maintained throughout the procedure.

Principles of extraction :

• Expansion of the bony socket.

• The use of a lever & fulcrum.

• The insertion of a wedge between the

tooth root & the bony socket wall.

Chair position for extraction:

Position of the operator Except for the right mand. cheek teeth, the operator

stands on the right hand side of the patient.

For removal of rt. Mand. cheek teeth, the operator

stands behind the pt. sometimes on a raised platform

to achieve optimal working position.

Height of the dental chair

For max. tooth - 3 inch below the shoulder level of

the operator.

For mand. tooth -6 inch below the level of operators

elbow.

Types of ExtractionTypes of Extraction::

1.1. Forceps / intra alveolar.Forceps / intra alveolar.

2.2. Transalveolar.Transalveolar.

Instruments used in extractionInstruments used in extraction::

1.1. ForcepsForceps

2.2. ElevatorsElevators

3.3. ProbeProbe

maxillarymaxillary mandibularmandibular

Forceps:

The use of dental forcep The use of dental forcep makes it possible for the makes it possible for the operator to grasp the root operator to grasp the root portion of a tooth & portion of a tooth & dislocate it out of it socket dislocate it out of it socket by exerting pressure. by exerting pressure.

Long axis of the blades Long axis of the blades should be either on or should be either on or parallel to the long axis of parallel to the long axis of

the tooth rootthe tooth root..

Dental forcepsDental forceps are designed to grasp the root. are designed to grasp the root.

Max.ant: Straight forcep.Max.ant: Straight forcep.

Max.premolar: Mirror image Max.premolar: Mirror image

blades for both right & left.blades for both right & left.

Max.molar: 2 blades of molar forceps are different.

Mand. Incisor, premolar & roots: Lower root forceps

with fine blade.

Mand.canine,large roots: Heavier blades.

Mand.molar: buccal & lingual blades of forceps are

similar in design.

Displacement of the tooth from its socketDisplacement of the tooth from its socket::

A firm grip of the root is taken & buccolingual & linguobuccal A firm grip of the root is taken & buccolingual & linguobuccal

movements are made in that order.movements are made in that order.

This pressure should be firm, smooth & controlled, & is This pressure should be firm, smooth & controlled, & is

applied by the operator moving his trunk from the hips. applied by the operator moving his trunk from the hips.

After few lateral movements-tooth is felt to loosen & begin to After few lateral movements-tooth is felt to loosen & begin to

rise out of its socket, after this rotatory or figure of eight rise out of its socket, after this rotatory or figure of eight

movements will effect delivery of the tooth in a very short movements will effect delivery of the tooth in a very short

period.period.

The expanded socket is compressed between the left thumb & The expanded socket is compressed between the left thumb &

fore finger. fore finger.

Grip of forcep:Grip of forcep:

The position of the thumb just below the joint of the The position of the thumb just below the joint of the

forceps & the position of the forcep handles in the palm of forceps & the position of the forcep handles in the palm of

the hand.the hand.

Little finger is placed inside the handle & used to control Little finger is placed inside the handle & used to control

the opening of the forceps blades.the opening of the forceps blades.

When the tooth is gripped ,the little finger is placed When the tooth is gripped ,the little finger is placed

outside the handle .outside the handle .

Application of forceps blade to the toothApplication of forceps blade to the tooth : :

Forceps blades are applied to the buccal & lingual Forceps blades are applied to the buccal & lingual surfaces of the root with their long axis parallel to surfaces of the root with their long axis parallel to that of the tooth.that of the tooth.

The blades are pushed through the PDL between the The blades are pushed through the PDL between the tooth root & the investing alveolar bone towards the tooth root & the investing alveolar bone towards the apex.apex.

Firm pressure upon the forceps is used to drive the Firm pressure upon the forceps is used to drive the blades along the surface of the root. blades along the surface of the root.

In carious tooth –blade should be applied to the In carious tooth –blade should be applied to the carious side first & the first movement made carious side first & the first movement made towards the caries.towards the caries.

Rotation of teeth:

Only max. central incisor & mand.2nd premolar have

straight conical roots.

Rotatory movements are useful in completing the

removal of teeth loosened by other means.

By the use of this secondary rotatory movements the

gross distortion of the buccal plate resulting from

excessive lateral movements are avoided.

Common errors in forcep Common errors in forcep

extractionextraction::

1.1. Failure to grip the root firmly Failure to grip the root firmly

in forcep blade.in forcep blade.

2.2. Grip crown in the forcep Grip crown in the forcep

blades instead of root.blades instead of root.

3.3. Incorrect alignment of the Incorrect alignment of the

forceps blade to the long axis forceps blade to the long axis

of the root.of the root.

Elevators:

used on the lever & fulcrum principle to force the tooth or used on the lever & fulcrum principle to force the tooth or

root along the line of withdrawal.root along the line of withdrawal.

Line of withdrawalLine of withdrawal: the path along which the tooth or root will : the path along which the tooth or root will

move out of its socket with least application of force.move out of its socket with least application of force.

The fulcrum used for the elevation of teeth should always be The fulcrum used for the elevation of teeth should always be

a bony one.a bony one.

Elevators may be forced down the PDL either mesially, Elevators may be forced down the PDL either mesially,

bucally or distally to the tooth being extracted. bucally or distally to the tooth being extracted.

Classification of elevatorsClassification of elevators::

1.1. According to useAccording to use

to remove the entire tooth.to remove the entire tooth.

to remove roots broken off at the gingival line.to remove roots broken off at the gingival line.

to remove roots broken off half way to the apex.to remove roots broken off half way to the apex.

to cut bone as well as to remove roots of teeth.to cut bone as well as to remove roots of teeth.

to cut & elevate the mucoperiosteum.to cut & elevate the mucoperiosteum.

2. 2. According to formAccording to form

StraightStraight

AngularAngular

Cross bar.Cross bar.

Indications:

• To luxate & remove teeth which cannot be

engaged by forceps.

• To remove roots

• To luxate teeth prior application of forceps.

• To split teeth which have had grooves cut in them.

• To remove intraradicular bone.

RulesRules::

Never use adjacent tooth as fulcrum.Never use adjacent tooth as fulcrum.

Never use buccal plate as fulcrum.Never use buccal plate as fulcrum.

Never use lingual plate as fulcrum.Never use lingual plate as fulcrum.

Always use finger guards to protect the patient in case Always use finger guards to protect the patient in case elevator slips.elevator slips.

Forces applied should be under control & in right Forces applied should be under control & in right direction.direction.

Parts:Parts:

Handle ,shank ,blade. Handle ,shank ,blade.

Principles:1. Lever2. Wedge3. Wheel & axle4. Combination

Pre-operative preparation of parent & Pre-operative preparation of parent &

childchild::

Parental consentParental consent

Discussion with parentsDiscussion with parents

Discussion with parent about post operative Discussion with parent about post operative

bleeding or pain.bleeding or pain.

Instruct parent not to discuss with the child what Instruct parent not to discuss with the child what

the dentist will do rather let the dentist do it. the dentist will do rather let the dentist do it.

Preparing the child• Younger children should be told on day of

appointment about procedure.

• 8-10yr child, if told 4-7 days before adjust better.

• Tray containing armamentarium kept behind chair.

• Never hold needle in front of the child,it should be

hidden with a finger.

• Before giving LA explain to child that sensation of

pinching or an ant biting may be felt.

• Realize difference between pressure & pain.

• Explain sensation of numbness.

• When checking for anesthesia by placing the elevator

into gingival crevices, note the eye reaction of child.

Forces exerted in extraction of primary toothForces exerted in extraction of primary tooth::

Max. anterior (round root cross section):Max. anterior (round root cross section):

– Initial forces is apical then slightly to the lingual. this slight Initial forces is apical then slightly to the lingual. this slight

lingual force expands the lingual gingival bone.the next lingual force expands the lingual gingival bone.the next

force is counter clockwise motion that loosens the tooth in force is counter clockwise motion that loosens the tooth in

an unscrewing motion then, in a single sustained labial an unscrewing motion then, in a single sustained labial

force, the tooth is delivered from its socket.force, the tooth is delivered from its socket.

Mand.anterior (oval root cross section):Mand.anterior (oval root cross section):

– Initial apical force, direction of force is to the labial in a Initial apical force, direction of force is to the labial in a

single sustained action after tooth is loosened counter single sustained action after tooth is loosened counter

clockwise motion delivers the tooth from its socket.clockwise motion delivers the tooth from its socket.

Max. molars:Max. molars:

– Since the palatal root is curved, the direction of force is Since the palatal root is curved, the direction of force is slightly to the lingual. A slight force is applied in order not slightly to the lingual. A slight force is applied in order not to fracture the curved palatal root, then in a single to fracture the curved palatal root, then in a single sustained force to the buccal, the tooth is loosened & sustained force to the buccal, the tooth is loosened & counterclockwise motion delivers the tooth out of socket.counterclockwise motion delivers the tooth out of socket.

Mand.molar:Mand.molar:

– Rotary motion is contraindicated since cross section of roots Rotary motion is contraindicated since cross section of roots is flat mesiodistally & elliptical. The initial force is slightly to is flat mesiodistally & elliptical. The initial force is slightly to the lingual then a single sustained force to the buccal until the lingual then a single sustained force to the buccal until it is loosened, then a counterclockwise rotation delivers the it is loosened, then a counterclockwise rotation delivers the tooth from socket.tooth from socket.

Permanent teethPermanent teeth::Maxillary:Maxillary:Central incisor-Central incisor- slight labial & palatal pressure with mesial rotation slight labial & palatal pressure with mesial rotation followed by slight traction.followed by slight traction.Lateral incisor-Lateral incisor- slight labio-palatal rocking with mesial rotation is slight labio-palatal rocking with mesial rotation is used followed by traction.used followed by traction.CanineCanine- labial pressure then lingual then again labial pressure with - labial pressure then lingual then again labial pressure with mesial rotation followed by traction.mesial rotation followed by traction.11stst premolar- premolar- buccal pressure, palatal pressure & then extract out buccal pressure, palatal pressure & then extract out to buccal side. No torsion used.to buccal side. No torsion used.22ndnd premolar- premolar- buccal pressure & lingual pressure with slight buccal pressure & lingual pressure with slight rotational force is used.rotational force is used.11stst & 2 & 2ndnd molar- molar- buccal & lingual rocking is done prior to removal on buccal & lingual rocking is done prior to removal on buccal side.buccal side.33rdrd molar- molar- buccal pressure along with distal & downward buccal pressure along with distal & downward movement is used. movement is used.

2.2. Mandibular:Mandibular:

Central & lateral incisor-Central & lateral incisor- labial & lingual rocking & labial & lingual rocking &

slight mesial & distal rotation followed by removal to slight mesial & distal rotation followed by removal to

labial side.labial side.

CanineCanine- labial pressure with mesial rotation & vertical - labial pressure with mesial rotation & vertical

pull yields the desired result.pull yields the desired result.

11stst & 2 & 2ndnd premolar- premolar- buccal pressure with slight mesio- buccal pressure with slight mesio-

distal rotation.distal rotation.

11stst & 2 & 2ndnd molar- molar- buccal & lingual rocking with removal buccal & lingual rocking with removal

to buccal side.to buccal side.

33rdrd molar- molar- buccal & lingual rocking with removal to buccal & lingual rocking with removal to

buccal or lingual side.buccal or lingual side.

Post operative instructionsPost operative instructions::1.1. Wound careWound care::

• Bite firmly on gauze pack for 30 min.Bite firmly on gauze pack for 30 min.• Donot smoke for 12hrs because this will promote bleeding & interfere Donot smoke for 12hrs because this will promote bleeding & interfere

with healing.with healing.2.2. Bleeding :Bleeding :

• Some blood will ooze from the area of surgery & is normal ,you may find Some blood will ooze from the area of surgery & is normal ,you may find a blood stain on your pillow.a blood stain on your pillow.

• Do not spit or suck through a straw.Do not spit or suck through a straw.• If bleeding begins again, place a small damp gauze pack over tooth If bleeding begins again, place a small damp gauze pack over tooth

socket & bite firmly for 30 min.socket & bite firmly for 30 min.• Keep head elevated with several pillows.Keep head elevated with several pillows.

3.3. Discomfort:Discomfort: • Some discomfort is normal after surgery.It can be controlled but not Some discomfort is normal after surgery.It can be controlled but not

eliminated by taking the pain pills prescribed.eliminated by taking the pain pills prescribed.4.4. DietDiet::

• It is important to drink large volume of fluids .donot drink through It is important to drink large volume of fluids .donot drink through straw,since may promote bleeding.straw,since may promote bleeding.

• Eat normal regular food as soon as possible after surgery .cold,soft food Eat normal regular food as soon as possible after surgery .cold,soft food such as icecream or yogurt may be the most comfortable for the first such as icecream or yogurt may be the most comfortable for the first day.day.

5.5. Oral hygieneOral hygiene: : • Do not rinse your mouth or brush your teeth for the first 8hr after Do not rinse your mouth or brush your teeth for the first 8hr after

surgery.surgery.• After that rinse gently with warm salt water .After that rinse gently with warm salt water .• Brush your teeth gently but avoid the area of surgery.Brush your teeth gently but avoid the area of surgery.

6.6. Swelling:Swelling:• Swelling after surgery is a normal body reaction reaches its Swelling after surgery is a normal body reaction reaches its

maximum abt 48 hr after surgery &usually lasts for 4-6 days.maximum abt 48 hr after surgery &usually lasts for 4-6 days.• Applying ice packs over the area of surgery for the first 12hr help Applying ice packs over the area of surgery for the first 12hr help

control swelling &may help the area to be more comfortable.control swelling &may help the area to be more comfortable.7.7. RestRest::

• Avoid strenous activity for 12hr after your surgery.Avoid strenous activity for 12hr after your surgery.8.8. MedicationMedication : :

• Take regular medication prescribed.Take regular medication prescribed.9.9. Call office if emergency.Call office if emergency.10.10. Stiffness:Stiffness:

• After surgery you may experience jaw muscle stiffness & limited After surgery you may experience jaw muscle stiffness & limited openingof your mouth .this is normal & will improve in 5-10 days. openingof your mouth .this is normal & will improve in 5-10 days.

Complication of ExodontiaComplication of Exodontia

1.1. Operative:Operative:

Fracture of tooth. Fracture of tooth.

Injury to the adjacent tooth.Injury to the adjacent tooth.

Fracture of alveolar bone.Fracture of alveolar bone.

Fracture of tuberosityFracture of tuberosity

Oroantral fistulaOroantral fistula

Displacement of tooth root into max. sinusDisplacement of tooth root into max. sinus

Tooth pushed into spaces of neck.Tooth pushed into spaces of neck.

Soft tissue laceration Soft tissue laceration

Excessive haemorrhage.Excessive haemorrhage.

Nerve damage Nerve damage

Breakage of instrumentBreakage of instrument

TMJ dislocationTMJ dislocation..

2.2. Postoperative:Postoperative:

Pain Pain

SwellingSwelling

HaematomaHaematoma

EmphysemaEmphysema

TrismusTrismus

Dry socketDry socket

Delayed bleedingDelayed bleeding

OsteomyelitisOsteomyelitis

bacteremia bacteremia

Management Management Operative;Operative;1.1. Fracture of tooth/rootFracture of tooth/root::

removed by open method if elevator technique removed by open method if elevator technique fails.fails.

2.2. Injury to adjacent toothInjury to adjacent tooth -loosening of adjacent teeth.-loosening of adjacent teeth. -avulsion of adjacent teeth.-avulsion of adjacent teeth. -fracture of adjacent teeth.-fracture of adjacent teeth. Splinting for 2-4 weeksSplinting for 2-4 weeks Reimplantation of avulsed tooth &check Reimplantation of avulsed tooth &check

occlusionocclusion Endodontic treatment.Endodontic treatment. Restore all amount of fracture.Restore all amount of fracture.3.3. Fracture of alveolar boneFracture of alveolar bone..

Pieces of bone remain attached to mucosa& are Pieces of bone remain attached to mucosa& are maintaining their blood supply should be maintaining their blood supply should be retained & held in place by suturing the retained & held in place by suturing the mucosa.mucosa.

4.4. Fracture of max. tuberosityFracture of max. tuberosityIf a fracture to soft tissue ,place it back & stabilize by splint for 4-6 If a fracture to soft tissue ,place it back & stabilize by splint for 4-6 weeks thereafter remove tooth by open method.weeks thereafter remove tooth by open method.

5.5. 0roantral communication0roantral communication If size less than 2mm– no treatment is required.patient should avoid If size less than 2mm– no treatment is required.patient should avoid blowing the nose,violent sneezing,sucking on straws&smoking.blowing the nose,violent sneezing,sucking on straws&smoking.If size 2-6mm– figure 8 suture should be placed over the socket to If size 2-6mm– figure 8 suture should be placed over the socket to maintain blood clot&antibiotic for 7 daysmaintain blood clot&antibiotic for 7 daysIf size more than 7mm– flap procedure.If size more than 7mm– flap procedure.

6.6. Tooth into soft tissueTooth into soft tissueAntibioticsAntibioticsTooth removed 4-6 weeks later after the fibrosis stabilises tooth in firm Tooth removed 4-6 weeks later after the fibrosis stabilises tooth in firm position .position .

7.7. Submandibular facial spaceSubmandibular facial spaceRoot can be forced back into socket by inserting index finger out of the Root can be forced back into socket by inserting index finger out of the lingual aspect of floor of the mouth in attempt to place pressure lingual aspect of floor of the mouth in attempt to place pressure against the lingual aspect of mandible .against the lingual aspect of mandible .If this is unsuccessful root tip is removed by reflecting soft tissue flap on If this is unsuccessful root tip is removed by reflecting soft tissue flap on the lingual aspect of mandiblethe lingual aspect of mandible

8.8. Soft tissue lacerationSoft tissue laceration

Control of bleeding Control of bleeding

The wound is left for drainage & not suutured.The wound is left for drainage & not suutured.

Control of infection.Control of infection.

9.9. Excessive haemorrhageExcessive haemorrhage

Pressure pack 30min postoperatively Pressure pack 30min postoperatively

If Vessel injury,socket is packed with haemostatic agent & If Vessel injury,socket is packed with haemostatic agent & sutured.sutured.

10.10. Nerve damageNerve damage

Careful extraction Careful extraction

11.11. TMJ DislocationTMJ Dislocation

Immediate reduction Immediate reduction

Immobilisation 2-3 weeks to prevent recurrent attack.Immobilisation 2-3 weeks to prevent recurrent attack.

Postoperatively soft diet &analgesics .Postoperatively soft diet &analgesics .

Postoperative:Postoperative:1.1. Pain &swellingPain &swelling

Cold application to the face Cold application to the face Use of analgesic & antiinflammatory drugs Use of analgesic & antiinflammatory drugs

2.2. Emphysema Emphysema Aspiration &decompression.Aspiration &decompression.

3.3. Haemorrhage Haemorrhage a)a) Soft tissueSoft tissue – digital pressure ,gauze ,suture. – digital pressure ,gauze ,suture.b)b) BoneBone – burnishing ,white head varnish,bone wax,gelatin ,sponge . – burnishing ,white head varnish,bone wax,gelatin ,sponge .

1) physical –vessel ligation ,haemostatic forcep,splints,postural rest.1) physical –vessel ligation ,haemostatic forcep,splints,postural rest. 2) thermal– ice pack, electrocoagulation ,thermocoagulation 2) thermal– ice pack, electrocoagulation ,thermocoagulation 3) chemical-3) chemical- topical : vasoconstrictor ,adrenaline, nor adrenaline.topical : vasoconstrictor ,adrenaline, nor adrenaline. absorbable agent : oxidised cellulose,gelatin ,fibrin foams.absorbable agent : oxidised cellulose,gelatin ,fibrin foams. thermoplastic agent : thrombin,russel viper venom.thermoplastic agent : thrombin,russel viper venom. chemical agent : tincture,silvernitrate ,tannic acid ,ferric chemical agent : tincture,silvernitrate ,tannic acid ,ferric

chloridechloride socket plugs.socket plugs.3.3. HaematomaHaematoma

Pressure Pressure Ligation of the vessel Ligation of the vessel Cold application Cold application Heat application after 24 hrsHeat application after 24 hrsAnalgesics & antibioticsAnalgesics & antibiotics

4.4. Trismus Trismus Antiinflammatory drugs Antiinflammatory drugs Muscle relaxants Muscle relaxants PhysiotherapyPhysiotherapyHeat application Heat application Warn saline washWarn saline washForcibly open with gag.Forcibly open with gag.

5.5. OsteomyelitisOsteomyelitisAntibioticsAntibioticsSeqestromySeqestromySaucerizationSaucerization

6.6. BacterimiaBacterimiaPreoperatively antibiotics i.e. penicillin 2gms one hour before Preoperatively antibiotics i.e. penicillin 2gms one hour before surgery&1gm 6hr after surgery.surgery&1gm 6hr after surgery.Or Erythromycin 1gm before surgery &500mg after surgery.Or Erythromycin 1gm before surgery &500mg after surgery.

7.7. Dry socketDry socketSocket irrigation with warm saline.Socket irrigation with warm saline.Remove degenerating blood clotRemove degenerating blood clotSharp bony spicules should be excised with rongers & Sharp bony spicules should be excised with rongers & smoothened with bone files.smoothened with bone files.Loose dressing with ZOE/ clove oil.Loose dressing with ZOE/ clove oil.Analgesics&hot saline rinses & ptatient is asked to report after 3 Analgesics&hot saline rinses & ptatient is asked to report after 3 days. days.

Other related diagrams:Other related diagrams: