Tooth extraction involves using various instruments like forceps and elevators to remove teeth by applying forces that leverage the tooth from its socket, with the type of force applied depending on the tooth's location in the mouth. Extractions are usually done to remove severely decayed, infected, fractured, or impacted teeth. Proper technique and postoperative care like applying pressure to stop bleeding and a soft food diet are important for healing.

1. Tooth Extraction
Simple Technique
Dr. Md. Nazmul Hassan Bin Khair
BDS (DU)

2. Definition
Extraction:
Extraction can be defined as a painless removal of
the whole tooth or tooth root with minimal trauma
to the investing tissue.

3. Types
1. Intra-alveolar extraction: The blades of the
forceps are forced down the periodontal
membrane between the tooth root & bony socket
wall.
2. Trans-alveolar extraction: This method of
extraction comprises the dissection of a tooth or
root from the bony attachment.

4. Indication
 Severly carious teeth where endodontic treatment
are not possible.
 Teeth with non-vital pulp where acute or chronic
pulpitis when root canal treatment can not be
indicated.
 Severe periodontitis where excessive bone loss.
 Third degree mobile teeth
 Malposed teeth
 Impacted & Unerrupted teeth
 Supernumery teeth.
 Retained desiduous teeth.
 Teeth with fractured root.
 Teeth directly or indirectly involving cyst & tumour.

5. Contraindication
 Local
 Acute oral infection- ANUG, Herpetic
gingivostomatitis
 Pericoronitis
 Acute maxillary sinusitis
 Osteoradionecrosis area

6.  Systemic
 CVS Diseases-
 Sub acute bacterial endocarditis
 Ischemic heart disease
 Hypertension
 CCF
 Valvular disease
 Blood dyscrasias
 Haemophilia
 Purpura
 Severe anemia
 Leukaemia
 Scurvy

7.  Uncontrolled DM
 Thyrotoxicosis
 Viral hepatitis
 Severe Jaundice
 Kidney disease- Nephritis, Renal failure
 Vit-K deficiency
 Radiation therapy
 Epilepsy
 AIDS
 Syphilis

8. Instruments Required
 Local anaesthetic solution with or without adrenaline
 Curved elevator
 Straight elevator
 Cryer
 Forceps
 Curettor
 Normal saline
 Disposable syringe
 Cotton rolls
 Suturing materials

9. Basic necessity of extraction
 Adequate access
 Comforatable patient
 Adequate oral opening
 Proper retraction of the tissue by assistant
 High volume suction
 Patient Preparation
 Comforatable, mentally & physically
 Alleviation of fear, assurance
 Informed consent
 Minimum amount of draping
 Rinsing with antiseptic mouth wash.

10. Surgeon’s & Assistant’s Preparation
 Wearing of protective eye glass
 Wearing mask
 Wearing surgical cap
 Wearing gloves

11. Chair Position For Extraction
 MAXILLARY Extraction
 The chair should be tipped backward and maxillary
occlusal plane is at 60 degrees to the floor.
 The height of the chair should be patient’s mouth
is at or below the operator’s elbow level
 MANDIBULAR Extraction
The patient should be positioned in a more
upright position.
The occlusal plane is parallel to the
floor.
The chair should be lower than
for extraction of maxillary teeth.

12. Operator’s Position
 For all maxillary teeth and anterior with left
mandibular teeth - the dentist is to the
front and right of the patient.
 For the posterior right mandibular teeth-
the dentist is positioned behind and
to the right of the patient .

14. Mechanical Principles In Extraction
1. Lever Principle of First order
 3 basic components- Fulcrum, Effort, Load.
 Fulcrum is between effort and load.
 Maximum advantage is when effort arm
is longer than load arm.
 Used in forceps along with wheel and
axle and in elevators.

15. 2. Wedge Principle
 Here 2 movable inclined planes with a base on
one end and blade on other end.
 Effort is applied to the base of the plane and
resistance has its effect on slant side.
 Used to split, expand or displace the portion
that receives it.
 Elevators used to luxate tooth when
applied between mucoperiosteum and
surface of tooth.

16. 3. Wheel and Axle principle
 Effort is applied to circumstance of wheel which
turns the axle so as to raise the weight.
 Greater the diameter of wheel more is the
mechanical advantage.
 When one root of a multiple-rooted
tooth is let in the alveolar process, the pennant-
shaped elevator is positioned in the socket and
turned.
 The handle then serves as the axle and the tip
of the triangular elevator acts as a wheel and
engages and elevates the tooth root from the
socket.

17. Rules of Using Forceps
 Catch the root not the crown
 Parallel to the long axis of the tooth.
 Initial movement.
 Deep grip.
 Firm grip.
 Principle movement.
 Final movement.

18. Principles Of Forceps Use

19. Forces applied for different teeth
 MAXILLARY:
 Incisors: labial-lingual-labial with mesial rotation.
 Cuspids: labial-lingual-labial with mesial rotation.
 First premolar: buccal-palatal-removal in buccal
direction.
 Second premolar: buccal-palatal-removal in buccal
or palatal direction.
 Molars: buccal-slight palatal and distal rotation.

20.  MANDIBULAR:
 Anteriors: labial-lingual-slight mesial to distal
force and removal in labial direction.
 Premolars: buccal with slight mesio-distal
rotation.
 Molars: buccal-lingual and removal in buccal
direction.
 Third molars: buccal pressure and removal in
buccal or lingual direction.

21. Postoperative instructions after a tooth
extraction
 Day of surgery
 Keep gauzes in the mouth for an hour or two by
maintaining a firm pressure and replace them every
half-hour, as needed.
 Always keep your head elevated.
 Apply ice on the cheek at regular intervals (20
minutes every hour).
 Blood-tinged saliva is a normal postoperative effect.
 Limit your physical efforts and don’t forget to rest.
 Do not dislodge the blood clot that has formed in the
tooth socket because it helps to heal.

22.  Do not eat anything until the bleeding has stopped.
 Avoid drinking through a straw.
 Do not rinse your mouth or spit.
 Avoid smoking or drinking alcohol.
 Do not eat hard foods.
 Avoid brushing your teeth near the extraction site for the first
72 hours.
 Pain
 If you are experiencing some pain, take the medication that has
been prescribed to you.
 If you were prescribed antibiotics for this treatment, continue
to take them for the specified time period, even if the
symptoms go away.
 Diet
 Only eat soft foods and cold liquids on the day of the
extraction. Resume your usual diet as soon as you are able to.

23.  From the next day and until complete healing
 Rinse your mouth three times a day with warm water and salt
(2 ml or 1/2 tsp of salt in 250 ml or 1 cup of water).
 Brush and floss every day to remove plaque and ensure better
results in the long term.
 Avoid brushing near the extraction site for the first 72 hours.
 Avoid eating hard foods (nuts, candies, ice).
 You may experience pronunciation difficulties and an increased
amount of saliva. Everything should come back to normal within
a week.
 Bruising may appear on the skin. It will disappear after five to
seven days.
 You may have difficulty opening your mouth. It should come
back to normal after four to five days.
 If after three days the pain increases instead of decreasing, call
us.

24. COMPLICATIONS
 increased bleeding or slow clotting of the
extraction site
 swelling
 redness
 discomfort or pain
 difficulty chewing
 dry socket
 infection

25. References
 Text Book of Oral and Maxillofacial Surgery 3rd edition, Dr.
Neelima Anil Malik
 Peterson, L. J. Contemporary Oral and Maxillofacial
Surgery, 4th ed. Amsterdam Elsevier Science. 2002. ch.7
 The Extraction of Teeth by- GEOFFREY L HOWE
 Sweedan, O. A. Textbook of Oral and Maxillofacial v, 1st
ed., 2009
 Fragiskos D. Fragiskos Oral Surger. 2007
 Carmen Scheller BASIC GUIDE TO DENTAL INSTRUMENTS
 Wikipedia