Diagnosis of extraction

Nikhil marah, textbook of paediatric dentistry, ch 62 paediatric extraction

These are common indications for tooth extraction. Here's a refined list for clarity:

Teeth affected by advanced caries and its sequelae
Teeth affected by periodontal disease
Extraction of healthy teeth to correct malocclusion
Over-retained teeth
Trauma to the teeth or jaws causing dislocation (avulsion)
Extraction for esthetic reasons
Extraction for prosthodontic reasons
Impacted and supernumerary teeth
Extraction of decayed first or second molars to prevent impaction of third molars
Teeth involved in a fracture line
Teeth involved in tumors or cysts
Tooth as foci of infection
Teeth affected by crown, abrasion, attrition, or hypoplasia
Teeth affected by pulpal lesions (e.g., pulpitis, pink spot, pulp polyp)
Teeth in the area of direct therapeutic irradiation.

These are contraindications to tooth extraction. Here is a refined list for clarity:

Presence of acute oral infections such as necrotizing ulcerative gingivitis or herpetic gingival stomatitis
Pericoronitis (especially if a difficult surgical procedure involving bone removal is anticipated)
Extraction of teeth in previously irradiated areas (allow at least 1 year for maximal recovery of circulation to the bone)
Relative systemic contraindications to tooth extraction:
Uncontrolled diabetes
Acute blood dyscrasias
Untreated coagulopathies
Adrenal insufficiency
General debilitation for any reason
Myocardial infarction (wait for a 6-month period)

Neelima Anil malik,textbook of oral maxillofacial surgery,ch 18 exodontia

Indications for tooth extraction include:

Severe Caries (49% of cases): When endodontic treatment is not possible due to technical or economic reasons.
Severe Periodontal Disease (41% of cases): When the teeth are not salvageable by periodontal therapy.
Severe Attrition, Abrasion, Erosion: Significant wear of teeth that cannot be restored.
Acute/Chronic Pulpitis or Pulpal Necrosis: Due to trauma or infection, where the tooth cannot be treated by endodontic methods.
Teeth with Necrosed Pulp and Periapical Lesions: Not treatable by endodontic treatment.
Over-Retained Deciduous Teeth: Blocking the eruption of permanent teeth.
Supernumerary Teeth: Extra teeth that cause issues with normal dental development.
Malposed Teeth: Causing constant trauma to soft tissues or prone to caries due to cleaning difficulties.
Impacted Teeth: Teeth that are unable to properly erupt through the gum.
Tooth in the Fracture Line: Extraction is done if the fractured tooth is a source of infection, has a root fracture, or interferes with fracture reduction or healing.
Teeth Involved in Pathology: Such as cysts or tumors.
Teeth with Poor Prognosis in Therapeutic Radiation: To prevent osteoradionecrosis or radiation caries prior to radiation therapy for oral malignancies.
Teeth with Vertical Fracture or Cracked Tooth Syndrome: A painful condition where extraction is necessary.
Prophylactic Extraction: To prevent issues in cases like endocarditis, rheumatic fever, prior to cataract surgery, etc.
Orthodontic Treatment Considerations: For therapeutic extractions, malposed teeth, crowding, or serial extractions.
Prosthetic Purpose: When teeth interfere with the stability or construction of full or partial dentures.
Supraerupted Teeth: Teeth that have vertically extruded due to the absence of an opposing tooth.
Teeth Causing Chronic Trauma to Soft Tissues: Such as constant cheek biting or ulceration on the lateral border of the tongue.
Orthognathic Surgical Procedures: Upper third molars are extracted in Le Fort I osteotomy, lower third molars in sagittal split osteotomy, and premolars in anterior subapical osteotomy procedures.

Contraindications for dental extractions include:

Systemic Contraindications: - Cardiovascular issues (e.g., unstable angina, recent myocardial infarction) - Blood disorders (e.g., anemia, leukemia) - Uncontrolled diabetes or hypertension - Severe renal disease - Liver disease (e.g., cirrhosis) - Bleeding disorders - Respiratory issues (e.g., asthma, COPD) - Long-term corticosteroid or immunosuppressive therapy

Physiologic Contraindications: - Pregnancy (particularly in the first and last trimesters) - Menstruation (due to stress and potential for excessive bleeding) - Extreme old age

Absolute Contraindications: - Recently irradiated areas - Recent myocardial infarction - Areas of central hemangioma or AV malformations - Malignant tumor sites

Relative Local Contraindications: - Acute periodontal or gingival infections (e.g., ANUG) - Acute abscesses or cellulitis - Acute pericoronitis

Exodontia practice,abhay N datakar

Periodontal Disturbances¶

Periodontal issues are a leading cause of dental extraction in India. The decision to extract a tooth involves evaluating the success of periodontal therapy, the patient's attitude towards preserving the tooth, and economic and time factors. A tooth may need to be extracted if there is more than 40% loss of periodontal support, even if the patient wishes to save it.

Dental Caries¶

For teeth extensively damaged by caries, extraction may be necessary if conservative treatments fail due to technical reasons or patient non-cooperation. Sharp margins from carious teeth can cause mucosal ulcers, and multiple carious teeth can impair oral hygiene, necessitating their removal.

Pulp Pathology¶

Extraction is indicated when endodontic therapy is not feasible or if the tooth has pulpal pathology.

Apical Pathology¶

Teeth unresponsive to conservative measures for apical pathology, due to technical or systemic factors, should be extracted before the pathology worsens and affects adjacent teeth.

Orthodontic Reasons¶

Teeth may require extraction during orthodontic treatment for: - Therapeutic Extractions: To create space for realigning malposed teeth. - Malposed Teeth: When realignment is difficult. - Serial Extraction: During mixed dentition, to prevent malocclusion and ensure proper eruption of permanent teeth.

Prosthetic Considerations¶

Extraction of certain teeth may be needed to improve the design and success of partial dentures. However, caution is required when patients request the extraction of remaining teeth for complete dentures to prevent bone atrophy and loss of denture stability.

Impactions¶

Impacted teeth that cause facial pain, periodontal issues, TMJ problems, cysts, or pathological fractures should be carefully evaluated for extraction.

Supernumerary Teeth¶

Malpositioned or unerupted supernumerary teeth that cause malocclusion, periodontal issues, facial pain, or esthetic problems should be extracted unless their retention is advantageous.

Tooth in the Line of Fracture¶

Teeth in the line of fracture should be extracted if they are a source of infection, fractured themselves, or interfere with fracture reduction or healing.

Teeth in Relation to Bony Pathology¶

Teeth involved in cyst formation, neoplasm, or osteomyelitis should be evaluated for extraction. If there is a chance to guide the tooth to normal occlusion, conservation should be considered.

Root Fragments¶

Root fragments may remain asymptomatic but can cause issues like recurrent ulceration, bony pathology, or facial pain. Small fragments can be left alone with periodic observation, but larger fragments should be removed, especially in medically compromised patients.

Teeth Prior to Irradiation¶

Before irradiation for oral carcinomas, only teeth that cannot be maintained in sound condition should be extracted to avoid osteoradionecrosis or radiation caries.

Focal Sepsis¶

Teeth that appear sound but are foci of infection, as indicated by radiological evaluation, should be extracted, especially if underlying systemic disorders exist.

Esthetics¶

Teeth may need to be extracted for esthetic reasons, such as for marriage or job opportunities, followed by immediate prosthetic restoration.

Economic Considerations¶

If economic constraints prevent conservative treatment, extraction may be necessary, with the final decision left to the patient's discretion.

Contraindications¶

Certain systemic and local factors may contraindicate extraction, either relatively or absolutely. Conditions like uncontrolled diabetes, cardiac problems, leukemia, renal failure, and liver disorders are absolute contraindications. Conditions like controlled diabetes, hypertension, steroid therapy, pregnancy, bleeding disorders, and medically compromised states are relative contraindications that require careful evaluation and management before extraction. Active infections and recently irradiated patients also require special considerations to prevent complications.