Definition
Surgical procedures includes Simple tooth
extractions, Surgical removal of teeth or Soft
tissue lesions.
Special consideration
• Preoperative evaluation
* Medical history
* Dental evaluation
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* Being prepared to treat any emergency situation
Child management
Growth and development
Developing dentition
Degree of parental concern
Exodontia
An ideal extraction is the painless removal of the
whole tooth or remaining root or tooth portion with
minimal trauma to the investing tissues, so that the
wound heals uneventfully and no future problems
are created.
Indications for Tooth Removal
Broken down teeth with
periapical lesions / cellulitis
Indications……
Carious/ fractured non
restorable tooth
Indications……
Supernumerary teeth
Indications……
Over retained primary
teeth
Submerged (ankylosed)
teeth
Indications……
Natal or Neonatal Tooth
Relative Contraindications
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Acute Oral Infection as stomatitis or herpetic stomatitis
Congenital heart disease, rheumatic fever
Blood Diseases as hemophilia or leukemia
Uncontrolled Diabetes Mellitus
Renal disease
After radiotherapy
Oh ….Noo…….oo!!!
Professionals
It is important that the principles & techniques
of removing teeth are understood by all those in
the dental profession who would pick up a pair
of extraction forceps.
Principles of Exodontia in Pediatric
Dentistry
• Differences between primary and permanent teeth
that modify extraction procedures:
Size and shape of primary teeth - alveolar bone
• Recommended instruments
• Care of soft tissues
• Topical and profound local anesthesia
 Discuss with the parents the causes of extraction
 Preoperative as well as postoperative instructions
 Informed consent
 Minimize anxiety and fear of patients to injections, wound
pain, anesthetic action .
 Describing the procedure Tell -Show- Do, avoid the use of
technical words .
 Explain to the child what sensation may be experienced
(digital pressure)
Techniques of Exodontia
• Patient position
Chair is positioned about 45" to the floor during
extraction of the upper teeth and at about 90°
for lower teeth
• Operator position
- Working hand ( dominant)
- Non-working hand ( non- dominant)
Working hand
Non-working hand
Retracts soft tissue allow visibility and access
Protects tissues if instrument slips
Provides resistance to the extraction force on the
mandible  prevent dislocation
Provides ‘feel’ to the operator
Upper Primary Anteriors
operator stands in front of patient + patient’s
mouth just below the operator’s shoulder.
Apply forceps beaks to the root, using clockwise
and anticlockwise rotation about the long axis
Lower Primary Anteriors
* Similar position for upper teeth + patient’s
mouth just below the operator’s elbow.
*Same manner as their upper counterparts with
rotation about the long axis using lower primary
anterior or root forceps
Upper Primary molars
• widely splayed roots considerable expansion
of socket is required
• Upper primary molar forceps are applied to the
roots with initial movement palatally , Continued
with buccal directed force  delivery of tooth
Lower Primary Molars
Those teeth are removed by bucco-lingual
expansion of the socket. After it is loosened, a
counterclockwise rotation delivers the tooth
from the socket.
removing lower right teeth the operator
stands behind the patient.
Soft tissue surgeries
Cysts on apex
caused by trauma
Abnormal
frenum
Post- extraction Instruction
• Bite down on gauze 20-30 minutes, do not
chewing the gauze (Do not disturb the clot)
• After surgery  ice pack
• Eat soft and cool foods
• If there is stitches rinse with mouth wash,
day after surgery
• Seek medical attention if pain after 48 hours
or abnormal bleeding
Post -operative Complications
• Aspiration or swallowing of teeth or roots may
occur, especially under general anesthesia
with the mouth forced open
• Post-operative hemorrhage
Complications…….
• self inflicted trauma
• Dry socket rarely happens
within children