Extraction of the Teeth

by Frank Colyer

Treatment.—In fracture of small portions of the alveolar process, no special treatment is called for except that all loose fragments should be removed. When the fracture is of a more extensive character, the fragments must be retained in position by a suitable form of splint, a description of which will be found in most works on dental surgery.

(b) Necrosis of the alveolus may result from extraction and is generally the result of undue violence or of some septic process occurring in the wound. The treatment to be followed consists of the use of antiseptic and deodorant mouth washes; the necrosed bone when quite separated from the living tissue should be removed with a pair of suitable forceps.

(c) Dislocation of the mandible.—The use of too much force in extracting a lower tooth and not at the same time counteracting the force by supporting the chin, may lead to unilateral or bilateral dislocation of the mandible. This accident may also be brought about by forcing the mouth open too much with a Mason’s gag during the administration of an anæsthetic. It may likewise occur without the employment of undue force in those who have previously met with or are liable to dislocation.

Reduction may be brought about by placing the thumbs, carefully wrapped in a napkin, on the molar teeth and the palmar surfaces of the fingers below the chin. If downward pressure is then made with the thumbs, and upward pressure with the fingers, the condyles of the mandible will generally pass back easily into the glenoid cavity. In cases where more difficulty than this is experienced, the patient should be placed in a recumbent position, and corks should be inserted between the back teeth. Upward pressure should then be applied on the under surface of the chin. It is advisable, after reduction, for the patient to wear a four-tailed bandage for about a week.

(d) Forcing a root into the antrum.—This accident occurs mostly in connection with the extraction of the second upper bicuspid root and buccal roots of the first upper permanent molar. If a root has been so dislocated into the antral cavity as to still partly remain in its socket, the best course to pursue is to leave it alone and not to attempt removal as the attempt might only result in complete dislocation of the root into the antrum. The socket should be kept quite clean by the continual use of antiseptic washes. As a rule the root gives rise to no subsequent trouble.

When a root has been forced completely into the antrum, the latter should be enlarged and the antral cavity thoroughly syringed. For this purpose it is well to use an aural syringe of five or six ounce capacity. The rationale of this form of treatment is that the root may pass out with the return current from the antrum. If this treatment fails, an attempt may be made to remove the root with a little scoop of gutta-percha fixed on to a flexible wire. When it cannot be removed in this manner, the cavity should be thoroughly irrigated with an antiseptic solution and the root left alone, as it will in all probability become encysted and not give rise to any subsequent trouble. If, however, the patient has a history of epitheliomatous disease of the jaws further attempts should be made to remove it. A case where a tooth was forced into the antrum in a patient with a family history of epithelioma of the jaw is recorded in the Transactions of the Odontological Society, vol. ii., page 15, old series.

(e) Forcing a tooth into an abscess cavity.—This accident may occur; if it does, it requires similar treatment to the accident just described in connection with the antrum.

(f) Trismus.—Inability to open the mouth naturally renders extraction of the teeth more difficult than usual. When, however, the closure is the result of inflammatory trouble in connection with the lower molars, an anæsthetic should be given and the mouth opened forcibly with a Mason’s gag. If the trismus is the result of tonic contraction of the muscles closing the jaw, ether should be used in order to overcome the resistance of the muscles, as nitrous oxide would not have the desired effect.

(3) DIFFICULTIES, COMPLICATIONS AND SEQUELÆ IN CONNECTION WITH THE SOFT TISSUES.

(a) Extensive laceration of the gum.—In cases where a tooth has given rise to much trouble in removal, the soft tissues naturally suffer, but apart from this they may be severely lacerated when the gum is more than usually adherent to a tooth. This is most frequently seen in the removal of the lower third molar, but it is also sometimes met with in the removal of loose teeth. When the gum is found more than usually adherent the tooth should be left in the socket until the gum attachment has been divided with a pair of scissors or a lancet. Continued attempts to remove the tooth with the forceps before the gum has been divided will only lead to undue laceration.