Indications】
1.Caries Severe and extensive caries of teeth and cannot be effectively treated and utilized.
2.Apical disease Periapical lesion, can not be cured by root canal treatment, apical resection and other methods.
3. Periodontal disease Advanced periodontal disease, periodontal bone tissue has been mostly destroyed, the tooth is extremely loose.
4, hidden cracked teeth, root longitudinal fracture and traumatic molar root fracture.
5, dental trauma such as root fracture and fracture line with the oral cavity, difficult to treat and use.
6, intra-dental resorption teeth with excessive absorption or penetration of the pulp chamber wall.
7.Embedded tooth When causing pain or pressure absorption of adjacent teeth, it can be extracted if the adjacent teeth can be retained.
8.Obstructed tooth If pericoronitis or root resorption or decay of adjacent teeth often occurs.
9.Extra teeth: If the neighboring teeth have late eruption or misaligned eruption, root resorption or crowding.
10.Fused teeth and bifid teeth The fused teeth and bifid teeth in the milk teeth should be extracted if they prevent the eruption of the succeeding permanent teeth. Fused and duplex teeth in the permanent dentition should be removed or retained according to the specific situation.
11. Retained milk teeth should be extracted if they interfere with the eruption of permanent teeth. The milk teeth in the adult dentition may be retained if the permanent teeth below are congenitally missing or if the permanent teeth are blocked from erupting.
12.Misaligned teeth can cause soft tissue trauma and cannot be corrected by orthodontic methods.
13.Treatment needs Teeth that need to be reduced for orthodontic treatment; teeth that need to be extracted for denture repair; teeth that need to be extracted before radiation treatment for malignant tumors; teeth involved in cysts or benign tumors, etc.
14. Teeth involved in fractures Teeth involved in bone fractures or alveolar bone fractures should be removed or retained according to the need for trauma treatment and the condition of the teeth themselves.
Contraindications
1.Heart disease
Most patients with cardiovascular disease can tolerate tooth extraction or can have their teeth extracted under cardiac monitoring. The following conditions should be considered as contraindications.
(1) Those with a recent history of myocardial infarction. If tooth extraction is necessary, a thorough examination by a specialist and close cooperation are required.
(2) Those with recent frequent angina pectoris.
(3) Those with cardiac function grade III-IV or symptoms such as telangiectatic breathing, cyanosis, jugular venous anger, swelling of lower limbs, etc.
(4) Heart disease combined with hypertension, blood pressure ≥ 24/14.7kPa (180/110mmHg).
(5) Those who have a history of III or II degree II atrioventricular block, double bundle branch block, A-S syndrome.
2.Hypertension
WHO defines blood pressure ≥ 21.3/12.7kPa (160/95mmHg) as hypertension. Patients with blood pressure higher than 21.3/13.3kPa (160/100mmHg) who need to have their teeth extracted should be supervised or in cooperation with an internist, depending on the situation.
3. Hematologic diseases
(1) Anemia: those with hemoglobin below 80g/L (8g/d1) and hematocrit below 0.30
(2) Leukopenia and granulocyte deficiency: avoid extraction if peripheral blood leukocytes <4×109/L (4,000/mm3), absolute granulocyte count <1×109/L (1,000/mm3) and neutrophils <1×109/L (1,000/mm3). If the white blood cell count is (3~4) × 109/L, the tooth extraction can be considered after the corresponding treatment.
(3) Leukemia: Acute leukemia is a contraindication to tooth extraction. For chronic leukemia in stable stage after treatment, if tooth extraction is necessary, the patient should cooperate with the specialist and pay attention to the prevention of infection and bleeding.
(4) Malignant lymphoma: If tooth extraction is necessary, it should be done in cooperation with relevant specialists and only after the treatment is effective and the condition is stable. Tooth extraction should be considered as contraindicated in highly malignant cases.
(5) Bleeding disorders: In primary thrombocytopenic purpura, teeth should not be extracted in the acute stage. In chronic phase, tooth extraction should be performed when the platelet count is higher than 100×109/L (100×103/mm3); if the platelet function is good and the count is above 60×109/L (60×103/mm3), tooth extraction can be considered, if necessary, in cooperation with a specialist. If tooth extraction is necessary in patients with hemophilia, plasma factor VIII should be supplemented. and wait until its concentration increases to 30% of normal before proceeding.
4. Diabetes mellitus
Tooth extraction can be performed if the patient is under local anesthesia, can eat after surgery, and has a blood sugar control of 8.88 mmol/L (160 mg/dl) or less. If the condition is not controlled and serious, tooth extraction should be postponed. For those who receive insulin therapy, tooth extraction should preferably be performed 1 to 2 hours after breakfast.
5. Hyperthyroidism
If the disease is not effectively controlled, the resting pulse is above 100 times/min and the basal metabolic rate is above +20%, tooth extraction is considered contraindicated.
6.Renal disease
All types of acute kidney diseases should be suspended.
7. Hepatitis
Tooth extraction should be suspended during acute hepatitis. In chronic hepatitis, tooth extraction should be done with caution if the liver function is significantly impaired, and adequate amount of vitamin K and vitamin C should be given 2-3 d before tooth extraction for abnormal liver function, and other hepatoprotective drugs should be given and continued after surgery, and local hemostatic drugs should be added during surgery.
8. Pregnancy
Dental extraction during pregnancy should be done with caution. It is safer to perform tooth extraction during the 4th, 5th and 6th months of pregnancy.
9. Menstrual period
Tooth extraction should be postponed during menstruation.
10.Acute period of oral and maxillofacial infection
Acute inflammatory period should be decided carefully according to the specific situation. If the tooth is highly loosened and extraction helps drainage and inflammation limitation, it can be extracted under antibiotic control. In case of corrosive necrotizing gingivitis and acute infectious stomatitis, tooth extraction should be suspended.
11.Malignant tumor
If the affected tooth is located in a malignant tumor or has been involved by the tumor, it should be removed together with the tumor in general. The extraction of the affected tooth located in the radiotherapy irradiated area should be taken with caution.
12.Long-term anticoagulant treatment
Tooth extraction should be cautious for long-term use of anticoagulant drugs. Anticoagulant drugs should be suspended before surgery. Careful hemostatic measures should be taken intraoperatively and postoperatively for those who must have teeth extracted.
13. Long-term treatment with adrenocorticosteroids
Extractions in such patients should be performed in cooperation with a specialist.
14.Neuropsychiatric disorders
Patients with uncooperative neuropsychiatric disorders should be extracted with caution. Extractions should be performed under general anesthesia if necessary. Patients with epilepsy should pay attention to the possibility of intraoperative seizures and be prepared accordingly when extracting teeth.
15. Other
Other reasons should not be used for tooth extraction.
Precautions]
1. After tooth extraction, check whether the extracted tooth is complete, whether the number of roots matches, and whether there is any tear in the gum, if 1. Probe the alveolar sockets with a scraping spoon, and scrape out foreign bodies (tartar, debris, etc.) or granulomas, etc., if any.
2. The extraction sockets should be reset by applying finger pads with gauze or cotton balls to make buccolingual lateral pressure. If there is a fracture of the alveolar bone wall, it should be reset by compression. If the fracture piece has been free and detached from the periosteum, it should be removed.
3.Overly high alveolar septum, bone ridge or alveolar bone wall should be trimmed.
4.When multiple teeth are extracted and the gingival margin is free and turned out, it should be sutured.
5.The surface of the tooth extraction wound should be placed with sterilized gauze and cotton rolls and discarded after 20~30min of biting. Patients with bleeding tendency should be observed for more than 30min before leaving the hospital.