Anesthesia and steps of tooth extraction
I. Pre-operative preparation for tooth extraction
1.Receive patients with enthusiasm and kindness.
2. After receiving the medical record, do a good job in checking matters, medical history inquiry and local examination. These include checking the name, age, tooth position and diagnosis; asking whether there are any systemic contraindications.
3.Briefly explain to the patient the general process and reaction of local anesthesia and surgery, possible problems, and seek the patient’s active cooperation.
4. Adjust the chair position, head position and lighting. When extracting maxillary teeth, the maxillary coaptation plane is 45° to the ground, the maxilla is higher than the operator’s elbow joint, and it is better to be flush with the shoulder; when extracting mandibular teeth, make the patient open wide, the mandibular coaptation plane is parallel to the ground, and the mandible is lower than the operator’s elbow joint or flush with it.
5. Ask the patient to rinse the disinfectant solution in the oral cavity.
6.Place sterile small square towel.
7.According to the position of the extracted tooth and the condition of the tooth, prepare the local anesthetic drug and the extraction instruments and place the instrument tray on the tray.
8. Put on the mask, wash and soak the hands and put on the sterile gloves.
II. Steps and methods of tooth extraction operation
1. Ask the patient to open his mouth, adjust the light, and the operator stands on the right side of the patient.
2. Disinfect the mucosa of the injection site with 1% tincture of iodine.
3.Inject the anesthetic according to the reasonable local anesthesia method, please check the anesthetic again before injection, check whether the anesthetic is yellowed, there are no impurities, etc. After the needle is required to draw back no blood and then push the injection and observe the patient’s face while injecting, the speed of pushing the drug should not be too fast.
4, the injection is completed, waiting for the anesthesia to take effect, and should always observe whether the patient has fainting and other side effects.
5.Once the anesthetic becomes effective (3-5 minutes), the gingival margin of the extracted tooth can be disinfected with 1% tincture of iodine.
6. After checking the tooth position, use the gingival separator to separate the gingiva: insert the gingival separator from the gingival sulcus to separate the gingival tissue attached around the neck of the tooth to avoid tearing the gingiva when extracting the tooth.
7. When placing the dental forceps or using the dental jaws first, it is required that
(1) Check the tooth position again before placing the dental forceps, place the beak of the dental forceps accurately on the labiolingual or buccolingual side of the affected tooth, make the beak of the forceps rock slowly in the direction of the long axis of the tooth, and pull out the tooth with outward traction as the looseness of the tooth increases. If the root of a single tooth is tapered, it can be extracted with a slight rotational force. If the root of a single tooth is flattened (e.g.) and multiple teeth, rotational force should be avoided, and it is advisable to pull out the tooth in the direction of root curvature, otherwise it is easy to break the root.
(2) Use of dental jaws: Insert the jaws between the root and the alveolar bone with the groove of the jaws facing the root surface, protect the adjacent teeth with the left hand, hold the jaws with the right hand, and use the alveolar bone as the fulcrum to gradually loosen the tooth from the near-medium or far-medium part by using leverage and rotational force.
(3) Do not use violence when extracting dislocation.
(8) Extraction of broken roots: First, the number and distribution of the roots of each tooth should be understood. Different methods should be adopted according to different situations when extracting broken roots. If the edge of the broken root is exposed between the alveolar bone, the root should be extracted. If the broken root is located in the alveolar fossa or the site is very deep, use a bone chisel to remove part of the periapical bone wall to form a gap, then insert a root jaw or root tip jaw to pull out the broken root for multiple teeth with broken roots still gathered together, use a bone chisel to split the joint into several single roots and then remove them separately. Remove the broken root and suture the mucoperiosteal flap and gingiva.
9. Routinely check whether the extracted tooth is complete and whether there are broken roots after tooth extraction. Use a scraping spoon to scrape the granulation tissue and foreign material in the alveolar sockets, and scratch the trauma to fill the sockets with oozing blood.
10. Then press the gum of the buccal (lip) and lingual side of the tooth with a finger to reset it. For larger extraction trauma, the gingiva must still be sutured.
11.Place a small piece of gauze or cotton roll on the extraction wound and make the patient bite down gently.
12.Wipe clean the patient’s blood around the mouth.
13.Tell the patient to take precautions after tooth extraction and prescribe antibacterial, anti-inflammatory and anti-swelling drugs according to the patient’s specific condition.
14.Write up the medical record and sign it.