Principles of Exodontia

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Anaesthesia & Exodontia
Third Year

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Principles of Exodontia

  1. 1. According to American Society of Anesthesiology ((ASA Patients Classified into ASA I; ASA II; ASAIII ;ASA IV & ASA V 20/01/14
  2. 2. ASA I Healthy, normal patient Physiologically able to tolerate the stress Without psychological problems No treatment modifications are indicated 20/01/14
  3. 3. ASA II Mild systemic disease Can perform normal activity without experiencing distress Healthy patient with more extreme anxiety May need modification in treatment 20/01/14
  4. 4. ASA III Severe systemic disease Limited activity but not incapacitated Need stress reduction method during dental treatment May need to alter treatment 20/01/14
  5. 5. ASA IV Has an incapacitating disease that is life threatening Patient is in distress at rest No elective dental therapy Emergency treatment should be in hospital setting 20/01/14
  6. 6. ASA V Moribund patient - not expected to live 24 hours with or without operation 20/01/14
  7. 7. Uncomplicated Exodontia Simple Extraction Closed extraction Conventional extraction Intra-alveolar extraction 20/01/14
  8. 8. Indications for removal of teeth • Sever caries • Pulpal necrosis not amenable to • • • • • • endodontic treatment Sever periodontal disease with excessive bone loss Orthodontic reasons Malopposed or malpositioned teeth Supernumerary teeth Cracked teeth Preprosthetic extractions 20/01/14
  9. 9. Indications for removal of teeth • Impacted teeth • Teeth associated with • • • • pathologic lesions Preradiation therapy Teeth involved in jaw fractures Esthetics Economics 20/01/14
  10. 10. 20/01/14
  11. 11. Contraindications for the removal of teeth • Systemic contraindications • Local contraindications 20/01/14
  12. 12. Systemic contraindications • Uncontrolled or poorly controlled medical conditions: diabetics, Leukemia , cardiac disease ;end stage renal disease • Severe bleeding diathesis as hemophilia ,or platelet disorder • Pregnancy is a relative contraindication? Safe in the second trimester • Patients on special medications: corticosteroids, immunosuppressive, or chemotherapy 20/01/14
  13. 13. Local contraindications • Post-irradiation • Tooth in tumour mass • Tooth in Facture line • Sever pericoronitis • Acute infection and acute dento-alveolar abscess 20/01/14
  14. 14. Patient assessment • Level of co-operation • Medical history • Choice of anaesthesia 20/01/14
  15. 15. Level of co-operation • All patient to be consented for dental extraction and the procedure explained to them • Most patients are co-operative and can be treated under LA • Conscious sedation and GA should be considered in the following conditions: • Irreconcilable dental phobia • Handicapped patients • Young children below the age of reason • Long procedure • Contraindication to LA 20/01/14
  16. 16. Medical history • Patient medical history has to be thoroughly evaluated e.g.: Bleeding problems Immunocompromised patients Ischemic heart disease, cardiac infarction Infective endocarditis Patients with previous radiotherapy to the jaws • Others • • • • • 20/01/14
  17. 17. Choice of anaesthesia Judged by: Medical history and Level of co-operation a. Local anaesthesia( LA):  Simple procedures (30-45min)  Single operative site  Accessible areas b. General anaesthesia (GA):  Complicated procedures  Multiple operative sites  Difficult accessibility 20/01/14
  18. 18. Clinical Examination .The tooth to be extracted is examined Teeth misplaced palatally or lingually , rotated , inclined or single standing teeth .in occlusion , are all potentially difficult Certain teeth have abnormal root formation, particularly the upper and lower third .molars . Heavily filled and dead teeth 20/01/14
  19. 19. Clinical evaluation of teeth for removal • Mobility of tooth • Roots • Surrounding bone • Condition of the crown • Access to tooth • Neighboring vital structures • Radiographic examination 20/01/14
  20. 20. Radiographic Examination The dental radiographs reveals the following : 1-Abnormal number, shape or pattern of roots 2-Caries extending into the roots 3-Fracture,resorption, ankylosis or hypercementosis of the roots 4-Approximation of maxillary sinuses; nasal cavity or neurovascular 20/01/14 canal
  21. 21. Requirements of Pre-extraction Radiograph A-It should show the whole root structure B-It should show the bone investing C-It should show the relation to any important anatomical structure Types of Radiograph : A-Intra-oral radiograph B-Extra-oral radiograph 20/01/14
  22. 22. • Mobility of the teeth • Roots configuration: • Numbers • length • width • ankylosis • hypercementosis • resorption • Surrounding bone: • Bone level • Bone density • Bone pathology 20/01/14

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