Pediatric exodontia requires behavior modification techniques, careful consideration of the child's development and medical history, and use of small extraction forceps and elevators to remove primary teeth while minimizing trauma. Extraction of natal or neonatal teeth requires special precautions due to risk of hemorrhage. Complications from untreated infections or conditions like ankyloglossia may require oral surgery in children.

1. Exodontia in Pediatric Dentistry
Dr. Anjana G
Reader
Department of
Pediatric Dentistry

2. Exodontia – General rules
 Behavior Modification
 Communication with the parent
 Radiographs
 Successful procedure inflicting
minimum pain & trauma
 Consider the underlying tooth
bud
Specific Injection Sites for C
Specific Injection Sites for C
Maxilla
Maxilla
•
• Apices of primary anterior teeth a
Apices of primary anterior teeth a
depth of
depth of mucobuccal
mucobuccal fold.
fold.
•
• Inject at depth of
Inject at depth of mucobuccal
mucobuccal fold
fold
•
• Short or extra
Short or extra-
-short needle.
short needle.

3. Factors to be considered in
Pediatric Exodontia
 Extremely uncooperative patient
 Level of parent awareness
 Degree of root resorption
 Presence of Habits
 Aesthetics and speech
 Presence of other complicating factors
eg: mental retardation, Systemic diseases etc.

4. Armamentarium
 Pediatric Extraction forceps for primary teeth
 Smaller periosteal elevators
 Use of heavy elevators & cow horn forceps
contraindicated

6. Rationale for Extraction
 Cellulitis (Acute Infection)
 Chronic pulpal involvement
 Gross Carious involvement (Non restorable
tooth)
 Over retained primary tooth
 Ankylosed primary tooth (submerged tooth)

7. Rationale for Extraction
 Supernumerary tooth
 Impacted tooth
 Natal tooth/ Neonatal tooth
 #ed or traumatized primary tooth

8. Natal / Neo natal Tooth
 Riga-Fede is a condition caused by the natal or
neonatal tooth rubbing the ventral surface of
the tongue during feeding and causing
ulceration.
 Failure to diagnose and properly treat this
lesion can result in dehydration and inadequate
nutrient intake for the infant.

9. Natal / Neo natal Tooth
 Treatment should be conservative,consisting of
smoothing rough incisal edges or placing resin
over the edge of the tooth to round it.
 If the tooth is not excessively mobile or causing
feeding problems, it should be preserved and
maintained in healthy condition

10. Natal / Neonatal Tooth
 Close monitoring is indicated to ensure that the
tooth remains stable.
 If conservative treatment does not correct the
condition, extraction is the treatment of choice.
 An important consideration when deciding to
extract a natal or neonatal tooth is the potential
for hemorrhage.

11. Natal / Neonatal Tooth
 Extraction is contraindicated in newborns due to
risk of hemorrhage.
 Unless the child is at least 10 days old,
consultation with the pediatrician regarding
adequate haemostasis may be indicated prior to
extraction of the tooth.
From the immunological and hematological point
of view the best time for extraction was
calculated to be 10 - 25 days of birth.

12. Contraindications of Extraction
Acute systemic infections
 Glomerulonephritis
 Congenital heart disease
 Rheumatic fever
 Rheumatic Heart disease
REGIMENS OF CHEMOPROPHYLAXIS
NEEDED

13. Blood diseases
 Hemophilia
 Leukemia
 Other blood dyscrasias
Team should include a hematologist

14. Uncontrolled Diabetes Mellitus
Extractions and oral surgical procedures avoided
due to
 Poor wound healing
 Extreme post surgical pain
 Recurrent hemorrhages.

15. Irradiated bone
 Extractions should be completed before
radiation therapy
 Development of osteomyelitis due to osseous
avascularity contraindicates extractions in
irradiated bone.

16. Presence of acute infection
 ANUG
 Acute herpetic stomatitis
 Acute dentoalveolar abscess
 Other acute oral infections
Extractions are contraindicated till elimination of
infection to avoid extreme patient discomfort
and chances of wound infection.

17. Exodontia -Precautions

18. Precautions
 Always record a complete medical history.
 Explain the sensation of LA to child after
administering LA.
 Give sufficient time for LA to act.
 Reassure the child regarding the pressure &
extraneous noise of the forceps, elevators etc.
 Always support the mandible and stabilize the
head.

19. Precautions
 Take support from the interdental bone while
elevating
 Do not damage the underlying tooth bud
 Be cautious about tooth aspiration
 Always compress the socket
 Always apply a folded sterile gauze pad over
the socket with pressure

20. Exodontia - Techniques

21. Primary Incisors & Canines
 Use a small periosteal elevator to reflect the
gingiva and luxate slightly
For mandibular anteriors:
 apply and maintain firm apical pressure
 Support the mandible with free hand
 Gently tilt lingually and labially
 Rotate along the long axis and deliver through
path of least resistance

22. Primary Incisors & Canines
For maxillary anteriors
 Engage the forceps on the tooth
 Apply and maintain apical pressure
 Initial luxative movement towards the palate
 Then labial gently and carefully
 Rotate along the long axis only in one direction
 Rotate continuously in one direction delivering
it along the rotation.

23. Primary Molars
 Use a small periosteal elevator to reflect the
gingiva
 Luxate the tooth slightly with the elevator

24. Mand. Molars
Engage the forceps on the clinical crown with application
of apical pressure
Support the mandible with the free hand
Luxate buccally and hold there for few seconds for buccal
cortical plate expansion.
Turn the luxating force lingually and hold their for cortical
expansion
When the tooth is mobile sufficiently, deliver the tooth
using slow firm continuous pressure.

25. Max. Molars
 Engage the crown with the forceps with
application of firm apical pressure
 Luxate buccally first and hold
 Luxate palatally and hold
 Continue alternate movements pausing briefly
between each one.
 Deliver the tooth palatally or buccally as it
becomes mobile enough.

26. Management of Fractured Primary
Tooth Roots
 Removing the root tip may cause damage to the
succedaneous tooth, while leaving the root tip may
increase the chance for postoperative infection and
delay eruption of the permanent successor.
 If the root is very small, located deep in the socket,
situated in close proximity to the permanent successor,
or unable to be retrieved after several attempts, it is
best left to be resorbed.

27. Diseases and disorders that require
oral surgery in Children
 Periodontal disease
 Oral trauma & Fractured teeth
 Caries & Odontogenic infections
 Unerupted and impacted teeth
 Supernumerary teeth eg. mesiodens

28. Diseases and disorders that require
oral surgery in Children
 Oral lesions in the newborn such as Epstein's pearls,
dental lamina cysts, Bohn's nodules, and congenital
epulis (Neumann's tumor)
 Eruption cysts
 Mucocele
 Oral structural anomalies such as maxillary frenum,
mandibular labial frenum, mandibular lingual
frenum/ankyloglossia, natal and neonatal teeth etc