Extraction of the Teeth

by Frank Colyer

(2) Destruction of its membranous connections with, and dilatation of, the socket.

(3) Removal of the tooth from the socket.

In the initial stage the first step is the application of the blades, and, in this connection, care must be taken to see that the points pass between the gum and the tooth, and also that they are applied parallel with the long axis of the root. It is, as a rule, best first to apply the blade on the side of the tooth most obscured from view, and then lightly to close the other upon the opposite side. The blades should then be forcibly pressed upwards or downwards, as the case may be, in the direction of the apex of the root; a slight rotary or wriggling motion will often be found of assistance in the process. This “pressing” movement should be continued until a firm hold of the root has been obtained—a point of great importance, as upon it the successful removal of the tooth in a large measure depends. The handles should next be firmly closed, so as to give the blades a good grip, and the amount of pressure applied should be such, that when movement has commenced the blades do not ride upon the surface of the root. The amount of pressure to be applied must naturally vary according to the character of the tooth to be removed, and the resistance offered by the alveolar process. The thumb placed between the handles of the forceps, as previously pointed out, should counteract the pressure applied to the root and prevent crushing, which, should it occur, may make the subsequent removal very difficult.

The second stage—the destruction of the membranous attachments and dilatation of the socket—is accomplished by employing force in either a rotary or a lateral direction. The movement to be employed depends upon the form of the root or roots to be removed and the resisting strength of the surrounding hard structures, and at this point it need only be remarked that rotary motion is alone admissible in the case of teeth possessing a single conical root.

The final stage is carried out by exerting extractive force in the direction of the long axis of the tooth, and also in that of least resistance; the latter is determined by a knowledge of the anatomy of the alveolar border, and by the sensation conveyed to the hand through the forceps.

The removal of a tooth with a straight elevator is accomplished in the following manner. The blade, with the flattened surface towards the tooth to be removed, is inserted between the root and the alveolus, the instrument being kept as far as possible parallel with the anterior surface of the crown. The blade is then forced downwards so as to reach the root at as low a point as possible; the handle of the elevator is then rotated away from the direction in which the tooth is to be removed. This has the effect of both raising the tooth in its socket and displacing it in the required direction. One such movement of the instrument rarely suffices for the removal of a tooth, a second, and sometimes a third grip, each time nearer to the apex of the root, having to be obtained.

The method of using a curved elevator will be described in dealing with the removal of the roots of lower molar teeth.

The wound resulting from the removal of a tooth is a lacerated one, and heals by “granulation.” The socket immediately after the operation becomes filled with coagulated blood, which is eventually replaced by granulation tissue, followed at a later period by the formation of loose cancellous bone.

A varying amount of absorption of the alveolar border always follows the removal of a tooth, the continuity in the surface of the gum being restored by ordinary cicatricial fibrous tissue.

The wound is best treated by keeping the parts carefully cleansed as far as possible from all foreign matter, and for this purpose an antiseptic mouth-wash[3] should be used several times a day. From the wound resulting from the extraction of an upper tooth the discharge drains away in a natural manner owing to the orifice being the most dependent part. From the wound caused by the removal of a lower tooth such is not the case, and should suppuration take place the socket must be frequently syringed with some antiseptic solution, and if necessary, packed.