Oral Surgery: Recommendations For Primary Care

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This article focuses on how to perform extractions safely, predictably, and with minimal harm to hard and soft tissues. All these measures improve extraction patients’ experience.

1. Patient Preparation

Tooth extractions can usually be done without complications, but patients must be prepared. Underestimating tooth extractions can lead to shame and medico-legal penalties.

  • Examine the risks of tooth extractions in patients with cardiovascular or hepato-renal disease, diabetes, immunosuppression, and concomitant blood thinners or anti-resorptive drugs.
    • Discuss a patient’s health concerns with their GP.
    • Perform a complete clinical assessment to determine tooth access, arch position, crown condition, and surrounding restorations at risk during tooth extraction. Consider a periradicular radiograph to identify anatomical issues.
    • Share decision-making to gain patient consent. Reassuring patients is important, but it’s also important to manage expectations, explain potential hazards, and avoid over-promising.
    • Use a surgical safety checklist to prevent erroneous tooth extractions.

2. Select Appropriate Instruments

Forceps, luxation, and elevators remove teeth. Preparing all needed instruments seems wise. Extra equipment is time-consuming and stressful during surgery. It may affect cross-infection control because instruments must be removed from drawers and gloves changed frequently. Patients may think dentists are struggling because they need extra devices.

3. Prioritize Access

Any surgical procedure, including tooth extractions, requires good access and vision. This requires proper operator and patient positioning, retraction of soft tissues (lips, cheeks, tongue), and excellent lighting. We’ve seen doctors exploit a mechanical disadvantage to approach a patient and ignore poor soft tissue retraction and illumination, especially during difficult extractions. This attitude complicates the procedure and increases the dentist’s and patient’s stress and irritation. Clear access to the operation site requires optimal placement, soft tissue retraction, unobstructed light, and effective suction.

4. Use Your Instruments Correctly

Despite wide variations in the difficulty of tooth extractions in clinical practice and the different procedures used by practitioners, it is generally advantageous to start with luxation. Unless ankylosed, periodontal ligament fixes teeth in the alveolar bone. Luxation can be used as peristomes to cut periodontal filaments with minimal force. Using luxation correctly can make tooth extractions easy. Next, Coupland’s elevators are used to lift the tooth by engaging the cementoenamel junction on the buccal face. Rotating the elevator’s long axis raises the tooth along its withdrawal route. Finally, the right forceps can displace and deliver the tooth.

5. Provide Appropriate Post-Extraction Management

After tooth extraction, healing requires several steps:

  • Don’t insert a bite pack after tooth extraction. If necessary, smooth the socket walls with a bone file or rose-head surgical bur. Using saline irrigation and suction, clean the socket to reduce microbial load. These steps promote extraction socket healing.
    • Ensure hemostasis before discharging the patient, and never send a bite pack. A ten-minute bite on a pressure pack over the extraction socket stops bleeding.
    • Post-extraction advice on pain control, postoperative bleeding, dental hygiene, diet, and things to avoid (smoking, alcohol, heavy exercise). Active spitting/rinsing must be avoided for at least 24 hours after extractions to prevent dislodging the blood clot, preventing healing, and possibly causing alveolar osteitis.
    • Provide an emergency contact number for complex extractions.

If you’re looking for the best oral surgeons in Los Angeles, you can’t go wrong with any of the options on this list. All of these surgeons are highly skilled and experienced, and they will be able to provide you with the care and treatment you need. Whether you need a simple procedure or something more complex, you can rest assured that you’ll be in good hands with any of these surgeons.

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