Extraction of the Teeth - Frank Colyer

(a) Undue Resistance of the tooth and alveolus.—Considerable resistance to our efforts to remove a tooth at times occurs. This is naturally most often, though by no means always, met with in those of strong physique. Teeth isolated are always firmer than those in series; this is accounted for by a consolidation of the bone around them. Experience will act as a guide, and it is to a certain extent possible, after a little observation, to gather from the general appearance of a tooth if it will give more than normal trouble in removal. Should undue resistance be met with, steady attempts to move the tooth slightly in different directions should be made and persevered with; if this precaution is not taken and too much force is used in any one direction, fracture of the tooth or alveolus is sure to result. It may, perhaps, be found impossible to remove the tooth; when this is the case it is best to dismiss the patient and to make a fresh attempt two or three days later; the tooth will then probably be loose, as a result of the inflammation which has been set up by the previous attempt at extraction, and can be easily removed.

The causes of undue resistance are:—

(i.) Abnormal density of the alveolar process.

(ii.) Divergent and twisted roots.

(iii.) Alteration in the shapes of the roots brought about by periodontal inflammation (exostosis).

(b) Fracture of the tooth.—The principal causes of this accident are:—

(i.) The use of badly fitting forceps.

(ii.) The use of unnecessary or wrongly applied force in attempting to loosen the tooth in its socket.

A tooth having been fractured, the patient should be made to rinse the mouth until the bleeding has ceased, the socket should be dried with cotton-wool, and the position and edge of the root defined with a probe before attempting to remove the fractured portion. It is neglect of these steps that so often leads to failure to remove the remaining portion of a fractured root. Too many attempts to remove a fractured root should not be made; if a second endeavour proves fruitless, the patient should be dismissed and a fresh attempt, if necessary, made after a period of one or two days, as the tooth will probably then be looser from inflammatory trouble, moreover, the hæmorrhage having ceased, it will be possible to obtain a clearer view of the root. Before, however, dismissing the patient, an anodyne mouth wash should be prescribed, and the pulp if exposed touched with carbolic or nitric acid. The lower third of a root may generally be left without fear of unpleasant consequences; but it is always well to inform the patient when any portion of a tooth is allowed to remain in the jaw, as such knowledge may be of assistance should any trouble arise at a subsequent date.