Exodontics Extraction of the tooth When Persistent deciduous

Exodontics �Extraction of the tooth When? � Persistent deciduous teeth � Prognosis of a tooth is grave � Client prefers low cost method of treatment � Anesthesia is contraindicated in patient �Possible complications: Anesthetic factors Hemorrhage Iatrogenic trauma

Instruments: Periosteal Elevators and Luxators �Goal is to weaken the PDL Instrument is placed in between tooth and bone Tool is rotated slightly, held, and then rotated in the opposite direction and held Tooth is separated from its gingival attachments and is removed in one piece �Index finger is extended to working end Minimizes iatrogenic soft tissue trauma

Winged Elevators

Extraction Prep �Pre and post radiographs �Regional nerve block Delivered to specific nerves to block an entire region of mouth ______ 0. 5% and/or ______ 2% Time of effect? �Instruments needed: Dental luxator/elevators Extraction forceps Small suture and needle drivers Sx: High speed hand piece/burs, scissors, curettes, scalpel, and root tip elevators if fx

Endodontics �Performed when there is disease of the pulp Pulp is the vital part of the tooth, should not be exposed to bacteria of the mouth � Can lead to ______ and _______ �Common indication is fracture More invasive and expensive route than extraction � Which � Why teeth are commonly fractured? is this painful? � What instrument is used to determine pulp exposure?

Endodontics Endodontic disease requires treatment 1. Root canal therapy Removal of pulp with a dental bur, shape with H-files or Kfiles, disinfect with diluted bleach, dry with paper points, fill canal with Gutta Percha, and place protective seal. Requires pre and post radiographs 2. Vital pulp therapy When tooth is alive and can be saved Immature teeth or recent trauma

Oronasal Fistulas (ONF) �Holes formed between mouth and nasal cavity, usually secondary to PDL destruction. �Tooth becomes mobile and eventually falls out, leaving a communication between oral and nasal cavities. Which teeth commonly affected? �CS: sneezing, and persistent, usually single sided, nasal discharge with or without bleeding. �Treatment includes surgery to close fistula.

Oronasal Fistula

Tooth Resorption �Destruction of tooth structures �Lesions usually found clinically in the _____ region Easily hidden by gingiva Which instruments help find these lesions sooner? �Actually begin break down in the root structures… How can we find this earlier? �Idiopathic disease Vitamin D levels? �Extraction required “Cervical neck lesions”

Gingival Hyperplasia �Thickening or over growth of gingival tissue �Not a malignant condition. How do we confirm this? �May be caused by periodontal disease �Overgrowth of gingiva can increase sulcus depths, forming pseudopockets �Treatment: Remove tissue if needed More prophylactic cleanings

Trauma �Jaw Fractures Most common type is _______ separation �Left and right mandibles separate from each other at the symphysis �Require rigid fixation for ~3 -4 weeks Ex. Cerclage wire, tape (puppies) Tape muzzles- stabilize fracture until Sx Adhesive side up! Loose enough to allow tongue to move between incisors allows eating of slurry

Client Education �Start young! Inform client of periodontal disease during vaccination process Distribute pamphlets or brochures �Explain home care oral hygiene techniques Brushing with dentrifices or gels Rinses/wipes Water additives Dental treats �Mention acceptable bones and chews

Home Care Instructions �BRUSH, BRUSH! �Start with water, work towards ______ �Begin caudal and buccal, work towards incisors

Brushing Techniques Stillman Technique: Sweep in a coronal direction *When is this used? Bass Technique: Bristles go into the sulcus

Client Education Once routine dental cleanings begin: (2 -3 years of age) �Discuss the procedures actually performed and: Any complications Medications given or needed � Ex. Local anesthetics, antibiotic, etc Diet changes (temp. or long term) � Prescription needed? �Any follow-up procedures needed Prepare estimates �Give date of return �Helpful websites: https: //www. aaha. org/ http: //vohc. org/index. htm

Prescription Diets Available