Exodontia

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Exodontia

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Exodontia

  1. 1. Anesthesia and extraction in childrenDr. Masar Mohammed
  2. 2. LOCAL ANESTHESIA IN CHILDREN
  3. 3. Local Anesthesia for Dental Child Patient Introduction Preparation of the child patient Application of the topical anesthetics Injection the local anesthetic solution Nerve block anesthesia in the mandible.
  4. 4. Local Anesthesia for Children- Local anesthesia is the most common methodof pain control- Effective local anesthesia allows dentalprocedures to be carried out painlessly- Most cavity preparations, vital pulp therapy,extraction of teeth and surgical proceduresrequiere administration of local anesthetics
  5. 5. - This method of eliminating pain is painful itself and can be very distressing to the child
  6. 6. Local Anesthesia for Children1. Preparation of the child dental patient.•The child will be told that to treat his tooth properly and comfortably, this tooth is goingto be “put to sleep”• At first a paste “will be applied to put thegum to sleep”• The parents should be informed not tointerfere or comment
  7. 7. Local Anesthesia for Children 2. Application of the topical anesthetics• To act effectively, topical anesthetic pastehas to be applied to dried mucous membrane• Use one end of cotton roll to dry the site ofinsertion and the other end being used toapply the topical anesthetic• Topical anesthetic are available in gel, liquid,spray, and ointment
  8. 8. !Don’t do it!
  9. 9. Local Anesthesia for Children3. Injection the local anesthetic solution • Stretch the tissues prior to insertion of the needle, will result in easier penetration
  10. 10. Local Anesthesia for Children3. Injection the local anesthetic solution•The bevel of thesyringe should beagainst the bone• The concealment ofthe syringe from thechild isrecommended
  11. 11. Local Anesthesia for Children 3. Injection the local anesthetic solution• All maxillary and lower anterior teeth can beanesthetized by filtration anesthesia usingshort or extra-short needle• Lower primary molars can be anesthetizedby infiltration anesthesia or inferior dentalnerve block
  12. 12. Local Anesthesia for Children 3. Injection the local anesthetic solution• wait for the buccalinfiltration to have itseffect• inject the palatal of theinterdental papillae fromthe buccal side distal andmesial to the tooth
  13. 13. Local Anesthesia for Children 3. Injection the local anesthetic solutionWhen the buccal infiltration anesthesia isused in the lower jaw, lingual anesthesiawill be necessary for any extractionAn intrapapillary injection as mentionedwith maxillary teeth will be sufficent
  14. 14. Local Anesthesia for Children3. Injection the local anesthetic solutionNerve block anesthesia in the mandible:• Is used for all procedure in themandibular molars (primary andpermanent) in the children, except for thevery young• Is preferred when localized infectionexists in the area of the infiltration site.
  15. 15. Local Anesthesia for Children 3. Injection the local anesthetic solution Nerve block anesthesia in the mandible:• The size of the mandible is also smallerthan that of the adult• The mandibular foramen is situated at alower level
  16. 16.  The injection must be made slightly lower and more poteriorly than for the adult
  17. 17. Extraction of teeth in Children
  18. 18.  Introduction Indications for extraction of primary teeth Contraindications to extraction of primary teeth Indications for extraction of permanent first molars Preoperative preparation Techniques for the removal of primary teeth Postoperative instructions
  19. 19. PRINCIPLES Avoid injury to soft tissues such as the tongue, lips, gingiva and cheeks. Avoid injury to underlying developing permanent teeth and other hard tissues such as bone and adjacent or opposing teeth. Use radiograph to determine  Size and shape of roots.  Amount and directions of root resorption.  Position and stage of developing of underlying permanent tooth.  Any pathology
  20. 20. PRINCIPLES1. The oral cavity is small and there is greater difficulty in gaining access to the field of operation.2. The jaws are in process of growth and development
  21. 21. 3. The dentition is in continuous state of change with eruption and resorption of primary teeth and eruption of permanent teeth taking place at the same time.4. The bone structure more liable than adult bone.
  22. 22. INDICATION FOR EXTRATION OF DECIDUOUS TEETH Badly carious can not be restored.
  23. 23.  Acute pathologic involvement Chronic pathologic involvement for orthodontic purpose.
  24. 24.  Over retained primary teeth preventing eruption of permanent successor. Supernumerary teeth
  25. 25.  The ankylosed deciduous tooth. The impacted tooth. In traumatic injury to teeth if vertical fracture occur.
  26. 26. CONTRAINDICATIONS FOR EXTRACTIONS OF TEETH IN CHILDRENS Acute oral infection
  27. 27.  Blood diseases Uncontrolled diabetes mellitus. Acute systemic infections. Teeth in irradiated bone.
  28. 28. PRE - OPERATIVE PREPARATION OF THE PARENT AND CHILD PARENT- 1 PARENTAL CONSENT BEFORE THE PROCEDURE. 2 INSTRUCT THE PARENT NOT TO DICUSS WITH THE CHILD WHAT THE DENTIST WILL DO.
  29. 29.  CHILD- 1 ARMAMENTARIUM SHOULD BE KEPT BEHIND THE CHAIR. 1. NEVER HOLD THE NEEDLE IN FRONT OF CHILD ALWAYS HIDDEN BY FINGERS.
  30. 30. 2 BEFORE GIVING THE LA, EXPLAIN TO THE CHILD THAT SENSATION OF PINCHING OR AN ANT BITING MAY BE FELT.3 CHILD REALIZES THE DIFFERENCE BETWEEN PRESSURE AND PAIN.4 EXPLAIN THE SENSATION OF NUMBNESS TO CHILD.
  31. 31. EXTRACTION TECHNIQUEPOSITION OF THE PATIENT AND THE OPERATOR
  32. 32. Techniques for the removal of primary teethUpper forceps
  33. 33. RotationMaxillary Incisors
  34. 34.  ,vl Delivery to labialMaxillary Incisors
  35. 35. Right Left
  36. 36. FirstMaxillary Molars
  37. 37. Counter clock wiseMaxillary Molars
  38. 38. -Techniques for the removal of primary teeth Lower forceps
  39. 39. Mandibular incisors
  40. 40. !Contraindicated in Primary Teeth!
  41. 41. The child is instructed to hold betweenhis lips a small"cotton roll until his lips "wake up
  42. 42.  The children should reminded not to bite lips after mandibular block anesthesia Light meal with no hard food is recommended.

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