MOUTH BREATHING

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Oral Surgy In Children
N.A.GH
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Definition

• Surgical procedures includes Simple tooth
  extractions, Surgical removal of teeth or Soft
  tissue lesions.

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Special consideration

• Preoperative evaluation
• Medical history
• Dental evaluation
• Being prepared to treat any emergency
  situation
• Child management
• Growth and development
• Developing dentition
• Degree of parental concern

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Exodontia

• An ideal extraction is the painless removal of
  the whole tooth or remaining root or tooth
  portion with minimal trauma to the investing
  tissues, so that the wound heals uneventfully and
  no future problems are created.

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Indications for Tooth Removal

• Broken down teeth with periapical lesions /
  cellulitis

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Indications

• Carious/ fractured non restorable tooth

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Indications
Supernumerary teeth
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Indications
Over retained primary teeth
Submerged (ankylosed) teeth
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Indications
Natal or Neonatal Tooth
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Relative Contraindications

• Acute Oral Infection as stomatitis or herpetic
  stomatitis
• Congenital heart disease, rheumatic fever
• Blood Diseases as hemophilia or leukemia
• Uncontrolled Diabetes Mellitus
• Renal disease
• After radiotherapy

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Oh .Noo.oo!!!
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PREEXTRACTION PREPARATION

• Professionals
• It is important that the principles techniques
  of removing teeth are understood by all those in
  the dental profession who would pick up a pair of
  extraction forceps.

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Principles of Exodontia in Pediatric Dentistry

• Differences between primary and permanent teeth
  that modify extraction procedures
• Size and shape of primary teeth - alveolar
  bone
• Recommended instruments
• Care of soft tissues
• Topical and profound local anesthesia

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Parent Preparation

• Discuss with the parents the causes of extraction
  
• Preoperative as well as postoperative
  instructions
• Informed consent

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Child Preparation

• Minimize anxiety and fear of patients to
  injections, wound pain, anesthetic action .
• Describing the procedure Tell -Show- Do, avoid
  the use of technical words .
• Explain to the child what sensation may be
  experienced
• (digital pressure)

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Techniques of Exodontia

• Patient position
• Chair is positioned about 45" to the floor during
• extraction of the upper teeth and at about 90
• for lower teeth

• Operator position
• - Working hand ( dominant)
• - Non-working hand ( non- dominant)

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Working hand
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Non-working hand

• Retracts soft tissue? allow visibility and access
• Protects tissues if instrument slips
• Provides resistance to the extraction force on
  the mandible ? prevent dislocation
• Provides feel to the operator

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Upper Primary Anteriors
operator stands in front of patient patients
mouth just below the operators shoulder. Apply
forceps beaks to the root, using clockwise and
anticlockwise rotation about the long axis
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Lower Primary Anteriors

• Similar position for upper teeth patients
  mouth just below the operators elbow.
• Same manner as their upper counterparts with
  rotation about the long axis using lower primary
  anterior or root forceps

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Upper Primary molars

• widely splayed roots? considerable expansion
• of socket is required
• Upper primary molar forceps are applied to the
• roots with initial movement palatally ,
  Continued
• with buccal directed force ? delivery of tooth

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Lower Primary Molars

• Those teeth are removed by bucco-lingual
  expansion of the socket. After it is loosened, a
  counterclockwise rotation delivers the tooth from
  the socket.
• removing lower right teeth the operator stands
  behind the patient.

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Soft tissue surgeries
Cysts on apex caused by trauma
Abnormal frenum
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Post- extraction Instruction

• Bite down on gauze 20-30 minutes, do not chewing
  the gauze (Do not disturb the clot)
• After surgery ? ice pack
• Eat soft and cool foods
• If there is stitches? rinse with mouth wash, day
  after surgery
• Seek medical attention if pain after 48 hours or
  abnormal bleeding

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Post -operative Complications

• Aspiration or swallowing of teeth or roots may
  occur, especially under general anesthesia with
  the mouth forced open
• Post-operative hemorrhage

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Complications.

• self inflicted trauma
• Dry socket rarely happens within children

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THANK YOU