Date: 26th Dec. 2017
Dental extractions are a part and parcel of everyday dental practice. Many a times, both dentists and patients face unpleasant situations while getting extractions done. This article discusses the various problems a dentist may encounter during an extraction procedure and how they can be avoided or dealt with.
1. Local Anaesthesia Not Working
Prior to extracting teeth, administering local anaesthesia is mandatory. However, local anaesthesia does not work in some instances, and the patient experiences no numbness. This can create a big problem for the dentist as he or she will not be able to go ahead with the procedure. Below listed are some reasons why this can occur:
a. Acidic Environment
If the patient arrives for the procedure with swelling and pain, it is prudent not to extract the tooth immediately. Before the procedure can be done, the source of the pain and swelling must be diagnosed. Once medication has been prescribed and the discomfort eased, the extraction procedure can be carried out. The patient will be more comfortable and the anaesthesia will act swiftly if he or she isn’t experiencing swelling and pain.
If the patient has cellulitis and is feeling feverish, then the dentist must decide if:
-The patient can be handled in the clinic as an OPD patient; or
-Does the patient require to be referred to a nursing home for admission and subsequent treatment by an oral surgeon. In this case, the surgeon will first rapidly control the cellulitis.
Once the cellulitis is under control, tooth extraction can be performed.
b. Pulp Tissue in the Canals
In certain cases, the patient experiences profound anaesthesia. So, once the dentist checks for numbness, he or she proceeds to extract the tooth. However, the patient may experience severe pressure and discomfort. This can be due to the presence of vital pulp which has not been completely anesthetized. Once the pulp is anesthetised with an intra-pulpal injection, the patient experiences relief and the extraction can be performed smoothly.
c. Patient Requires an Alternative Drug for Local Anaesthesia
Sometimes, even after taking utmost precautions and following all protocols, the patient is not satisfied with the level of numbness. In such cases, it is prudent to use an alternative drug that provides deeper anaesthesia. This assures profound anaesthesia and hence, a successful procedure.
2. Limited Mouth Opening
Any procedure in dentistry in which the patient has a limited mouth opening can be a very difficult. This could be because of various reasons like increased infection in the area preventing the patient from opening his or her mouth wider. There could also be pathologies like oral SMF due to which there is limited mouth opening.
What you can do to deal with this situation:
– If infection is the reason for trismus, the infection must be treated before going ahead with the extraction.
-If OSMF is the reason, then referral to an oral surgeon for cutting of the fibrous bands and immediate extraction would be a good option.
-If the patient genuinely has a limited mouth opening, then use of elevators, luxators, etc. as compared to forceps would be helpful.
3. Fainting During the Procedure
This is one of the most common problems while extracting teeth. Due to fear or low sugar, the patient may faint in the chair. The best way to avoid this is to always ask the patient if he has eaten before extraction as he will be unable to eat for 2-3 hours post extraction. If the patient faints despite eating something before the procedure, then standard protocol for management of syncope must be followed.
4. Tooth Breaking While Extracting
Sometimes while extracting multirooted teeth, the root breaks inside the socket. To avoid this problem, the best way is to have pre-operative x-rays before the extraction and luxating the tooth sufficiently before using forceps.
If a root piece is broken in the socket, first reassure the patient and then proceed to stop the bleeding. Then, using a magnifying mouth mirror locate the root piece. Subsequently, luxators or elevators must be used judiciously to loosen the root piece and then complete its retrieval. Sometimes before doing this, a selective osteotomy can be performed to achieve access to the root piece.
There are many other problems while extracting teeth which will be discussed in the next part of this article.
1. Textbook of oral surgery by Neelima Malik
2. Textbook of oral surgery by Kapoor
Dr. Shawn D'souza
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