PEDIATRIC EXODONTIA
PREPARED BY
HIMANKA NEOG
BDS 4TH YEAR
ROLL NO.: 14
CONTENTS

INTRODUCTION

INDICATION

CONTRAINDICATION

PREOPERATIVE PREPARATION OF THE PARENTS & CHILD

TECHNIQUE

FORCEPS & ELEVATORS

LOCAL INFILTRATION

NERVE BLOCKS

PRINCIPLE OF EXTRACTION

EXODONTIA TECHNIQUE

OPERATIVE COMPLICATION

POST-OPERATIVE CARE
INTRODUCTION

An ideal extraction is
“The painless removal of the entire tooth or the remaining portion of the tooth with
minimal trauma to the investing tissues, so that the wound heals uneventfully & no postoperative prosthetic problem is created.”
- Geoffrey L. Howe
INDICATIONS
1.
Teeth that are hopelessly carious and not restorable
2.
When the primary teeth interfere in the normal eruption and alignment in their permanent
successors.
3.
When there is a sinus opening through the mucoperiosteal membrane overlying the root
4.
When radiograph shows the evidence of periapical pathogenesis with very poor prognosis.
5.
When the root is fractured as a result of trauma, with subsequent development of infection.
6.
When rudimentary supernumerary teeth (e.g.,mesio-dens ) are found in radiograph preventing
the eruption of permanent teeth or causing their malalignment.
CONTRAINDICATIONS
A.
Absolute : Central Haemangioma. May cause uncontrolled bleeding
A-V malformation.
A.
Relative:
When some precautions have to be taken.
1.
Local:
Acute celulitis
ANUG.
1.
Systemic: Uncontrolled Diabetes Melitus
Hypertersion.
Bleeding disorders.
Cardiovascular diseases.
Liver disorders
Patients on lang-term steroid therapy
Teeth that have undergane radiation [6 months – 1year]
PREOPERATIVE PREPARATIONS OF THE
PARIENTS & CHILD

PREPARING THE PARENTS
A)
The Dentist must have a parental consent before the procedure is performed on a minor.
B)
Instruct the parent not to discuss with the child what the dentist will do, rather let the dentist do it.
C)
The parents choice of words can be poor which can un intentionally make the child fearfull,

PREPARING THE CHILD
A)
The 8 to 10 years old who needs teeth removed should have a working through period. This age
extraction when they are told 4 to days 7 prior to the procedure. However the younger children
of appointment about the procedure.
B)
Try containing the armamentarium for the removal of teeth should be kept behind the chair.
C)
Never hold the needle infront of child, it should always hidden with a finger. Before giving the LA
sensation of pinching or a ant biting
D)
Explain the sensations of numbness so that the child is prepared for it.
TECHNIQUE FOR REMOVING THE
PRIMARY TEETH

POSITION OF THE OPERATOR
A)
For the maxillary teeth extraction the operating area should be almost
level and the angulation should be 45 degree.
B)
For the mandibular teeth extraction mandibleshould be at the level of
operator and the angulation should be 90 degree
C)
For the 1st 2nd and 3rd quadrant extraction we stand at around 8 O'
only for the 4th quadrant we go to the 12 O’ clock position.
CHILDREN’S TOOTH EXTRACTION
FORCEPS
ELEVATORS
NERVE SUPPLYING TO MAXILLARY TEETH
NERVE SUPPLYING TO MANDIBULAR
TEETH
LOCAL INFILTRATION
1.
NERVE ANASTHETIZED: Free nerve endings
2.
AREA ANASTHETIZED: Immediate area of infiltration
3.
ANATOMICAL LANDMARKS: No specific landmarks.
4.
TECHNIQUE: In most instance a 1 inch, 25 gauzeneedle will be inserted
subcutaneously and a skinwheal raised.In subsequent injections the dentist
through the skin wheal, fanning out into the desired areas, which will produce
anesthesia of the localized superficial area. In case of infection the
should be anesthetized to permit incision and drainage
PRINCIPLE OF EXTRACTION

In routine practice the following three time mechanical extraction should be followed
1)
Expansion of the socket: The extraction of a tooth requires the separation of its attachment to
of its attachment to the alveolar bone via the crystal and principle fibers of the PDL which
involves a process of expansion of alveolar socket. This is achieved by using the tooth as the
dialating instrument with the help of forcep to permit the removal of thetooth.
2)
Use of Lever and Fulcrum: This basic principles is used with elevators that force a tooth or
force a tooth or root out of the socket along the path of least resistance
3)
The Insertion of a Wedge: This is done between the tooth rootsurface and the bony socket
the bony socket wall to help the tooth to rise in its socket.
EXODONTIA TECHNIQUE
1)
The forcep technique- closed method
2)
The elevator technique- Open
3)
Transalveolar technique-Open Method
4)
Odontotomy
THE FORCEP TECHNIQUE

It is the most commonly used method for the extraction of teeth. But it should not be
used in difficult cases eg. Tooth with hyper cementoid root or tooth with deformity of
the roots. Proper use of this technique involves the application of several basic
principles.
1)
The beaks of the selected forceps should be sealed as farapicaly as possible without
compression of the soft tissues after reflecting the cervical gingiva
2)
The placement of the beak of the forcep should be as parallel as possible to the long
axis of the tooth
3)
The application of the excessive force should be avoided so that the fracture of the
alveolar process or tooth it self doesn’t occur.
ELEVATOR TECHNIQUE

This technique is used in two ways
1)
Elevator as a Lever: In this case the alveolar crest serve as fulcrum the area of the
area of the compressed bone should be removed with a file or rongeur to reduce the
postoperative pain and infection. This method is used for the removal of whole or nearly
whole roots
2)
Elevator as wedge: This principle is used for the removal of small root tips by way of
tips by way of displacement.

3) Wheel and Axel Principal:It is a modified form of lever
principle.Effort is applied to the circumference of a
wheel which turn the axle so as to raise a weight.E.g.
Crossbar elevator

Mechanical advantages = 4.6
TRANSALVEOLAR METHOD (OPEN-VIEW
TECHNIQUE)

This method is used where roots are inaccessible to routine removal by
forceps or by an elevator, when they can't be luxated with simple
forceps or when the roots are covered by bone.
ODONTOMY

In this method, the extraction procedure maybe simplified by cutting a
tooth apart, eg. In multirooted deciduous or permanent teeth with
divergent roots, where crown is decayed.
OPERATIVE COMPLICATIONS

Fracture of the tooth.

Injuries to adjacent teeth.

Fracture of the alveolar bone.

Fracture of the tuberosity.

Extraction of wrong teeth.

Root displaced in the sinus.

Maxillary sinus perforation.

Root displaced in the submandibular space.

Injury to the inferior alveolar nerve.

Hemorrhage and hematoma.

TMJ trauma.

Gingival and mucosal laceration.

Damage to permanent successor.
POST OPERATIVE CARE
Parent is instructed to keep a check on the status of cotton so that the child does not swallow it
inadvertently.

Patient is instructed to keep the cotton for 30 minutes to 1 hour and avoid spitting out.

It is best to give cold food stuff like ice-cream to children to aid in clot formation.

Explain the effect of anesthesia will keep the area numb for a specific time so as to avoid lip or cheek
biting, especially in childrenIn case of pediatric exodontia it is best to allow the child to be seated in
the dental chair for at least 10 minutes before discharging him so as to avoid any shock symptoms.

Advise parents to keep children under close supervision that particular day and avoid sports of heavy
nature.

Parents should use alternate methods to distract the child so as to avoidhis attention towards the
wound.
THANK YOU