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ePaper created 2016-04-19, 11:44:05 | version 1.38.0
28 ortho 1 2016 Avoiding common problems in tooth extractions Author: Dr Kamis Gaballah, UAE The last two decadeshaveseensignificantadvances in restorative techniques and materials for dentistry. The latter, along with com munity-based preventive measures that aim to reduce the incidence of caries, have resulted in many patients living with functional teeth for a longer period. Yet, extraction of teeth forms the considerable bulk of the workload in oral surgeries owing to several factors, including the late presentation of patients with advanced dental dis- ease, the presence of symptomatic impacted teeth, suchasthirdmolars,andtheneedtoextractteethfor orthodontic or orthognathic treatment. The extraction of teeth varies greatly based on the type of patient who is undergoing the procedure. For example, elderly patients with significant co-morbid- itiesandonacomplexcombinationofmedicationsas compared with young healthy individuals render the procedurecomplicatedandrequiremuchmoreprepa- ration with modifications during and after patient management.Additionally,extractionscanrangefrom asingle,fullyeruptedtoothwithfavourablemorphol- ogy to multiple misaligned, impacted teeth or teeth withchallengingmorphology.Localanatomy,suchas tooth proximity to the nerve, maxillary sinus and tu berosity, also plays a significant role. These variations usually dictate who is to perform the extraction, as manygeneralpractitionersdealwithlesscomplicated cases of dental extraction in individuals regarded as healthy patients and may not feel comfortable oper- ating on medically complex patients. Complex extraction cases have been linked to a higherrateofpostoperativecomplications;therefore, a cautious and systematic approach should be ad- optedthatincludesadetailedpreoperativeassessment to predict the potential difficulties that might arise during extraction. The documentation of all compli- cating risk factors along with their potential postop- erativemorbiditiesiscrucialandshouldbeincludedin the informed consent. In the following article, other useful tips will be provided that are not usually in- cludedintraditionaltextbooksorlecturenotestohelp general practitioners to perform safer extractions. During clinical examination, it has been proven usefultoobservethepatient’sbuild.Tallandmuscular individuals tend to have a long ramus with a higher mandibular foramen, and this increases the possibil- ity of failure of the inferior dental nerve block proce- dureif the former is not taken into account when de- termining the height of the injection site. This can be © Komsan Loonprom /Shutterstock | trends & applications tooth extractions 12016