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Dental surgery
1.
2.
3. A TOOTH EXTRACTION (also referred to
as exodontia) is the removal of a tooth from the
mouth. Extractions are performed for a wide
variety of reasons, including tooth decay that has
destroyed enough tooth structure to render the
tooth non-restorable. Extractions of impacted or
problematic wisdom teeth are routinely
performed, as are extractions of some
permanent teeth to make space for orthodontic
treatment.
4. TYPES OF EXTRACTION
Simple extractions are performed on teeth that are
visible in the mouth, usually under local anesthetic,
and require only the use of instruments to elevate
and/or grasp the visible portion of the tooth.
Typically the tooth is lifted using an elevator, and
using dental forceps. rocked back and forth until
the periodontal ligament has been sufficiently
broken and the supporting alveolar bone has been
adequately widened to make the tooth loose enough
to remove. Typically, when teeth are removed with
forceps, slow, steady pressure is applied with
controlled force.
5. Surgical extractions involve the removal of teeth
that cannot be easily accessed, either because they
have broken under the gum line or because they
have not erupted fully. Surgical extractions almost
always require an incision. In a surgical extraction
the doctor may elevate the soft tissues covering the
tooth and bone and may also remove some of the
overlying and/or surrounding jawbone tissue with a
drill or osteotome. Frequently, the tooth may be
split into multiple pieces to facilitate its removal.
Surgical extractions are usually performed under
a general anaesthetic.
6. POST-EXTRACTION HEALING
Following extraction of a tooth, a blood clot forms in
the socket, usually within an hour. Bleeding is common
in this first hour, but its likelihood decreases quickly as
time passes, and bleeding has usually stopped after 24
hours. The raw open wound overlying the dental socket
takes about one week to heal. Thereafter, the socket
will gradually fill in with soft gum tissue over a period of
about one to two months. Final closure of the socket
with bony remodelling can take six months or more.
8. HISTORY
Historically, dental extractions have been used to treat a variety
of illnesses, as well as a method of torture to obtain forced
confessions. Before the discovery of antibiotics, chronic tooth
infections were often linked to a variety of health problems, and
therefore removal of a diseased tooth was a common treatment
for various medical conditions. Instruments used for dental
extractions date back several centuries. In the 14th century, Guy
de Chauliac invented the dental pelican, which was used through
the late 18th century. The pelican was replaced by the dental
key which, in turn, was replaced by modern forceps in the 20th
century. As dental extractions can vary tremendously in
difficulty, depending on the patient and the tooth, a wide variety
of instruments exist to address specific situations.
10. In Europe, from the Middle Ages
all the way until the 19th
century, dental procedures were
performed by either general
doctors or even barbers. Most
of the time these barbers would
keep their dentistry practice
simple, restricting themselves to
tooth extractions linked with
tooth infection and the
lessening of pain. The thought
of cutting hair and pulling out
teeth is a rather interesting one
though.
11. Before the 18th century, this often involved tying a string
around the tooth; a drum might be played in the
background to distract the patient, getting louder as the
moment of extraction grew nearer.
To advertise their services as ‘tooth-pullers’, many barber-
surgeons hung rows of rotten teeth outside their shops. In
1727, the poet John Gay, wrote:
His pole, with pewter basins hung,
Black, rotten teeth in order strung,
Rang’d cups that in the window stood,
Lin’d with red rags, to look like blood,
Did well his threefold trade explain,
Who shav’d, drew teeth, and breath’d a vein.
12. Dentistry, as we understand it
today, did not emerge as a
licensed profession until the end
of the 19th century. That said,
one need not suffer in the past
with a toothache as long as a
barber-surgeon was at hand. For
little cost and a lot of pain, the
rotten tooth could be extracted
and put on display in front of the
barber’s shop.
13. MODERN INSTRUMENTS
Tooth extraction forceps
Tooth Extraction Forceps are primary instruments
to remove the tooth from the socket. The main
function of forceps is expansion of the bony socket by
the wedge shaped beaks of the forceps and movement
of tooth with the forceps. Forceps are also used to pull
out the tooth from the socket.
Forceps look like tweezers and have a firm grip
which allows the dentist to exert sufficient force. The
forceps allow the tooth to be held firmly and yet the
dentist will be able to move it back and forth before it
is plugged out.
14.
15. Mandibular Extraction Forceps
The tooth needs to be pulled out from the
roots and for that the forceps are just the
rightly designed instruments. They can also
maneuver themselves into any part of the
mouth in the most effortless of ways. If the
dentist wants to perform a non-surgical
simple tooth extraction or closed or intra-
alveolar tooth extraction then they will
certainly need forceps.
16.
17. Dental Elevators
In case of teeth that are deeply entrenched and embedded in
the gums then the use of the forceps is just not enough. In
that case what is needed are Dental Elevator tools that need
to be used along with the forceps. Dental Elevator tools can
act as levers and these are put between the tissues and in
between the teeth. Elevators are used for luxation of teeth.
Elevators are frequently used to mobilize the teeth.
The main function of dental elevators is to luxate multirooted
teeth prior to forceps application. They are used to luxate and
remove the teeth which can’t be engaged by the beaks of the
forceps like the impacted teeth, malposed teeth or badly
carious teeth. Dental elevators can also be used to remove
fractured root stumps or apical tooth tips.
18.
19. Scalpels for incision in case of Surgical
Tooth Extraction
In case of surgical tooth extraction which is also
known as open tooth extraction, apart from dental
elevators and forceps, instruments are required for
giving incision and bone cutting. In case of surgical
tooth extraction, tooth is damaged to such an extent
that nothing is visible above the gums. For giving
incision that is for making cut on the soft
tissues, scalpel is used. Scalpel is used to cut directly
through gum tissue down to the bone. Scalpel has 2
parts that are blade and blade handle. After giving
the incision, flap is raised to expose the tooth.
20.
21. Chisel and osteotomes for cutting or splitting
bone in Surgical Tooth Extraction
Chisels are unibevelled instruments for cutting the
bone and osteotomes are bibevelled instruments
which split the bone. Chisels are used to remove
chips of bone in case of surgical tooth extractions
and to split the tooth in difficult tooth
extractions.
22.
23. Mallet
It is made of steel, lead or wood and is
similar to a hammer. It is used for giving
controlled taps on the chisel or
osteotome.
24.
25. Dental drill and burs for splitting tooth
and bone cutting
It is a quicker method of bone removal by drilling the
bone at high speed. Burs are rotary instruments that
cut the bone. They are made of either stainless steel
or carbide. They are available in different
lengths, shapes and sizes. They aid in bone removal
or splitting the tooth during surgical removal of
teeth. Hand piece and burs can also be used to round
off the sharp margins after tooth extraction.
Irrigation should be done during drilling with copious
amount of saline solution. There should be as less
damage to the alveolar bone during the surgical
tooth extraction as possible.
26.
27. Rongeur Forceps, Bone file, Bone cutter
Rongeur Forceps are used to nibble sharp
bony margins after simple or surgical tooth
extraction. Rongeur forceps have curved
handles and have spring action. Bone file as
the name suggests is used to smoothen any
bony margins present in the surgical field.
Bone cutter is similar to Rongeur forceps
and is used to trim sharp bony margins after
tooth extraction.
28.
29. Sutures or stitches after tooth extraction
procedure
Stitches are given to approximate the margins. The two basic
types of suture materials are resorbable suture material which
the body is capable of breaking down easily and the non-
resorbable sutures. Resorbable suture material includes
gut, polyglycolic acid and copolymer of glycolic and lactic acid.
Non-resorbable suture material includes silk, nylon, polyester
and polypropylene sutures. Non-resorbable sutures can be
monofilamentous, multifilamentous or can be both.
30.
31. Suction apparatus, Suction tubing
and Suction tip
Suction apparatus, Suction tubing and suction
tip are used to maintain a clear surgical field
during surgical tooth extraction.
32.
33.
34. The ability to control pain is a
critical part of all dental procedures.
Throughout history, dental
professionals have used a variety of
methods for dental procedures, from
herbal remedies to local anesthetics
and nitrous oxide, to create a
comfortable and trusting environment
for the patient.
35. With pain-dulling practices
starting as early as 2250 BC, the
evolution of dental anesthesia has
come a long way to help make
some of the most invasive oral
procedures possible.
36. 2250 BC: A Babylonian clay tablet reveals the
remedy for pain of dental cavities. The cement
that was used was made by mixing henbane
seed with gum mastic.
37. 1000 BC: In India, wine is used to produce
insensibility.
38. 1540: Valerius Cordus of Germany
introduces synthesized sweet vitriol, now
more commonly known as ether.
39. 1564: Ambroise Pare of France obtains local
anesthesia by compression of nerves.
40. 1779: Humphry Davy announces the
anesthetic properties of nitrous oxide and
notably calls it laughing gas.
42. 1844: After demonstrating nitrous to Dr.
Horace Wells, traveling showman Gardner
Colton gives nitrous oxide to Wells and
another dentist, Dr. Riggs, for wisdom tooth
extraction.
43. 1846: Dr. Horace Wells demonstrates the use
of nitrous oxide for tooth extraction. Since the
patient claimed he still felt pain during the
experience, it was not considered a successful
demonstration.
50. 1931: The American Association of Nurse
Anesthetists (AANA) is organized by Agatha
Hodgins.
51. 1942: Curare, an arrow poison once used by
South American Indians, is first used and
starts the “Age of Anesthesia.”
South American Indian
preparing curare
52. 1943: Lidocaine is synthesized and used as a
dental anesthetic in minor surgery.
55. 1981: Forane is approved for general use in
the United States.
56. 1990: Propofol (Diprivan) Sedative, a hypnotic
is introduced into clinical use in the United
States after showing success in Europe for
many years.
Dental surgery is any of a number of medical procedures that involve artificially modifying dentition, in other words surgery of the teeth and jaw bones.
Extractions are often categorized as "simple" or "surgical".
Infection:The dentists may opt to prescribe antibiotics pre- and/or post-operatively if they determine the patient to be at risk.Prolonged bleeding: usuallynapakagat cotton or napakaon ice creamThe dentist has a variety of means at their disposal to address bleeding; however, it is important to note that small amounts of blood mixed in the saliva after extractions are normal, even up to 72 hours after extraction. Usually, however, bleeding will almost completely stop within eight hours of the surgery, with only minuscule amounts of blood mixed with saliva coming from the wound. A gauze compress will significantly reduce bleeding over a period of a few hours.Swelling:kis.anaga swell anggngabotan due to injury of soft and hard tissuesOften dictated by the amount of surgery performed to extract a tooth (e.g. surgical insult to the tissues both hard and soft surrounding a tooth). Generally, when a surgical flap must be elevated (i.e. and the periosteum covering the bone is thus injured), minor to moderate swelling will occur. A poorly-cut soft tissue flap, for instance, where the periosteum is torn off rather than cleanly elevated off the underlying bone, will often increase such swelling. Similarly, when bone must be removed using a drill, more swelling is likely to occur.Bruising: Bruising may occur as a complication after tooth extraction. Bruising is more common in older people or people on aspirin or steroid therapy. It may take weeks for bruising to disappear completely.Sinus exposure and oral-antral communication: This can occur when extracting upper molars(and in some patients, upper premolars). The maxillary sinus sits right above the roots of maxillary molars and premolars. There is a bony floor of the sinus dividing the tooth socket from the sinus itself. This bone can range from thick to thin from tooth to tooth from patient to patient. In some cases it is absent and the root is in fact in the sinus. At other times, this bone may be removed with the tooth, or may be perforated during surgical extractions. The doctor typically mentions this risk to patients, based on evaluation of radiographs showing the relationship of the tooth to the sinus. It is important to note that the sinus cavity is lined with a membrane called the Sniderian membrane, which may or may not be perforated. If this membrane is exposed after an extraction, but remains intact, a "sinus exposed" has occurred. If the membrane is perforated, however, it is a "sinus communication". These two conditions are treated differently. In the event of a sinus communication, the dentist may decide to let it heal on its own or may need to surgically obtain primary closure—depending on the size of the exposure as well as the likelihood of the patient to heal. In both cases, a resorbable material called "gelfoam" is typically placed in the extraction site to promote clotting and serve as a framework for granulation tissue to accumulate. Patients are typically provided with prescriptions for antibiotics that cover sinus bacterial flora, decongestants, as well as careful instructions to follow during the healing period.Nerve injury: This is primarily an issue with extraction of third molars, but can occur with the extraction of any tooth should the nerve be close to the surgical site. Two nerves are typically of concern, and are found in duplicate (one left and one right): 1. the inferior alveolar nerve, which enters the mandible at the mandibular foramen and exits the mandible at the sides of the chin from the mental foramen. This nerve supplies sensation to the lower teeth on the right or left half of the dental arch, as well as sense of touch to the right or left half of the chin and lower lip. 2. The lingual nerve (one right and one left), which branches off the mandibular branches of the trigeminal nerve and courses just inside the jaw bone, entering the tongue and supplying sense of touch and taste to the right and left half of the anterior 2/3 of the tongue as well as the lingual gingiva (i.e. the gums on the inside surface of the dental arch). Such injuries can occur while lifting teeth (typically the inferior alveolar), but are most commonly caused by inadvertent damage with a surgical drill. Such injuries are rare and are usually temporary, but depending on the type of injury (i.e. Seddon classification: neuropraxia, axonotmesis, & neurotmesis), can be prolonged or even permanent.Displacement of tooth or part of tooth into the maxillary sinus (upper teeth only). In such cases, almost always the tooth or tooth fragment must be retrieved. In some cases, the sinus cavity can be irrigated with saline (antrallavage) and the tooth fragment may be brought back to the site of the opening through which it entered the sinus, and may be retrievable. At other times, a window must be made into the sinus in the Canine fossa--a procedure referred to as "Caldwell-Luc".Dry socket (Alveolar osteitis) is a painful phenomenon that most commonly occurs a few days following the removal of mandibular (lower) wisdom teeth. It typically occurs when the blood clot within the healing tooth extraction site is disrupted. More likely, alveolar osteitis is a phenomenon of painful inflammation within the empty tooth socket because of the relatively poor blood supply to this area of the mandible (which explains why dry socket is usually not experienced in other parts of the jaws). Inflamed alveolar bone, unprotected and exposed to the oral environment after tooth extraction, can become packed with food and debris. A dry socket typically causes a sharp and sudden increase in pain commencing 2–5 days following the extraction of a mandibular molar, most commonly the third molar. This is often extremely unpleasant for the patient; the only symptom of dry socket is pain, which often radiates up and down the head and neck. A dry socket is not an infection, and is not directly associated with swelling because it occurs entirely within bone – it is a phenomenon of inflammation within the bony lining of an empty tooth socket. Because dry socket is not an infection, the use of antibiotics has no effect on its rate of occurrence. The risk factor for alveolar osteitis can dramatically increase with smoking after an extraction.Bone fragments: Particularly when extraction of molars is involved, it is not uncommon for the bones which formerly supported the tooth to shift and in some cases to erupt through the gums, presenting protruding sharp edges which can irritate the tongue and cause discomfort. This is distinguished from a similar phenomenon where broken fragments of bone or tooth left over from the extraction can also protrude through the gums. In the latter case, the fragments will usually work their way out on their own. In the former case, the protrusions can either be snipped off by the dentist, or eventually the exposed bone will erode away on its own.Trismus: Jaw joints and chewing muscles may become sore after tooth extraction and it may become difficult for patient to open the mouth.Loss of a tooth: If an extracted tooth slips out of the forceps, it may be swallowed or inhaled. The patient may be aware of swallowing it, or they may cough, which suggests inhalation of the tooth. The patient must be referred to for a chest Xray in hospital if a tooth cannot be found. If it has been swallowed, no action is necessary as it usually passes through the alimentary canal without doing any harm. But if it has been inhaled, an urgent operation is necessary to recover it from the airway or lung before it causes serious complications such as pneumonia or a lung abscess.
The Dental Pelican was a tool developed in the 14th century by a French doctor named Guy de Chauliac. It was made in resemblance of a pelican’s beak and was the most popular tool used for tooth extraction until the late 18th century.The next tool that came about tried to get its design from door keys and was therefore known as a “Dental Key or Tooth Key.” A dentist would use the handle to twist the tooth out of its socket like the turning of a key in a door.
