Oral Surgery in Children

Oral Surgery in Children

1. Special consideration before surgical procedures

   • I. Preoperative evaluation
   • II. Behavioral consideration
   • III. Growth & dev
   • IV. Developing dentition

2. Indication of exodontia

   • 1. Non restorable tooth -> carious/fractured 2. Severely broken tooth w periapical lesion/cellulitis 3. Over retain primary teeth 4. Infected remaining root 5. Supernumery tooth 6. Ankylosed tooth which its successor present 7. Impacted / malformed tooth 8. Traumatized primary tooth that disturb the permanent one 9. Natal / neonatal tooth

3. Relative contraindication

   • 1. Acute oral infection 2. Congenital heart ds. 3. Bleeding disorder 4. Uncontrolled DM 5. Acute renal inflammation 6. Teeth remained in irradiated bone

4. Difference between primary & permanent teeth that modify extraction procedures

   • I. Size
     • Smaller in all dimension
     • Small mouth
   • II. Shape
     • Crown = bulbous
     • Root = divergent/splayed
     • furcation = more cervically
   • III. Supporting St.
     • alveolar bone = more elestic
     • jaw = continuos growing

5. Preoperative preparation

   • Parent prep
     • 1. Tell them why extraction
     • 2. Describe the procedure & pre/post operative instruction
     • 3. Consent must taken from parent
   • Child prep
     • 1. Min anxiety & fear
     • 2. Describe the procedure
     • 3. Tell what he will feel

6. Extraction techniques for primary teeth

   • Patient & operator position
   • Non-working hand
     • 1. Retract soft ts & allow visibility 2. Protect ts. from ins slip 3. Hold mandible (resistance to force) 4. provide 'feel' to operator
   • Extraction of ANTERIOR primary teeth
     • Maxi
       • Root -> single & conical shape
       • Just rotational movement
     • Mandi
       • Root -> single & conical shape
       • Rotational movement --> alternate labial & lingual movement
   • Extraction of 1st primary molar
     • Maxi
       • Root --> widely splared
       • Thus need socket expension (to avoid fracture)
       • Initial luxation bucally --> alternating buccel-palatel motion
     • Mandi
       • motion => same with maxi above
       • need support from non-working hand to protect TMJ against injury
   • Management of fractured primary molar root
     • If clearly visible
       • remove by elevator/ root tip pick
     • If small & deep position
       • Left to be resorbed
     • DON'T blind investigation the socket
       • avoid damage to permanent successor
   • Ankylosed teeth
     • some easy
     • some need section of tooth / flap
       • Divide tooth half bucco-lingually, till depth of floor of chamber. Then remove bone at buccal aspect. Then split using elevator. Then remove each part by forcep

7. Post-operative care

   • Child instruction: 1. Bite gauze for 30 min (avoid lip biting) 2. Tell him that he will get a new tooth 3. Light meat with no hard food on the day of extraction ............................. Parents instruction: 1. Explain why cotton roll is used & slight oozing blood from socket is no prob. 2. Not ask the child about how painful the area is 3. Dentist prescribe analgesic & antibiotic if extensive surgery is done

8. Principle of exodontia in pediatric

   • 1. Pre-extraction radiograph 2. Avoid soft ts. injury 3. Adequate TA & profound LA 4. Explain to the children (Tell-Show-Do tech) 5. Use pead forcep 6. Place palatal/lingual beak first then labially 7. Keep apical firm pressure on tooth 8. Alert --> prevent tooth swallow 9. Avoid injury to permanent bud 10. Separated epi. attachment firstly using currette 11. Extend the gauze pack extraorally

9. Post-Extraction complication

   • 1.Aspiration / swallow of tooth/root 2. Post-O hemorrhage 3. Tooth fractured 4. Dry socket (rare) 5. Damage permanent successor 6. Lip bitting