The document outlines the American Society of Anesthesiology (ASA) patient classification system from Class I to V based on a patient's physiological status and ability to tolerate medical treatment. It also discusses factors to consider for dental extractions such as indications and contraindications, patient assessment including medical history and cooperation level, clinical evaluation of teeth, and pre-extraction radiographic examination to properly evaluate root structure and surrounding bone.

1. According to American Society
of Anesthesiology
((ASA
Patients Classified into
ASA I; ASA II; ASAIII ;ASA IV
& ASA V
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2. ASA I
Healthy, normal patient
Physiologically able to tolerate the stress
Without psychological problems
No treatment modifications are indicated
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3. ASA II
Mild systemic disease
Can perform normal activity without
experiencing distress
Healthy patient with more extreme anxiety
May need modification in treatment
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4. ASA III
Severe systemic disease
Limited activity but not incapacitated
Need stress reduction method during dental
treatment
May need to alter treatment
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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
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6. ASA V
Moribund patient - not expected to live 24
hours with or without operation
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7. Uncomplicated Exodontia
Simple Extraction
Closed extraction
Conventional extraction
Intra-alveolar extraction
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8. Indications for removal of teeth
• Sever caries
• Pulpal necrosis not amenable to
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endodontic treatment
Sever periodontal disease with
excessive bone loss
Orthodontic reasons
Malopposed or malpositioned
teeth
Supernumerary teeth
Cracked teeth
Preprosthetic extractions
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9. Indications for removal of teeth
• Impacted teeth
• Teeth associated with
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pathologic lesions
Preradiation therapy
Teeth involved in jaw
fractures
Esthetics
Economics
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11. Contraindications for the
removal of teeth
• Systemic contraindications
• Local contraindications
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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
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13. Local contraindications
• Post-irradiation
• Tooth in tumour mass
• Tooth in Facture line
• Sever pericoronitis
• Acute infection and acute
dento-alveolar abscess
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14. Patient assessment
• Level of co-operation
• Medical history
• Choice of anaesthesia
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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
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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
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•
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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
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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
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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
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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
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canal

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
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22. • Mobility of the teeth
• Roots configuration:
• Numbers
• length
• width
• ankylosis
• hypercementosis
• resorption
• Surrounding bone:
• Bone level
• Bone density
• Bone pathology
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