L1 Questions, Notes

• Roots can exceed the limit of 3 teeth at the same time
• Clinic Rules
  • simple uncomplicated patients
• In terms of antiplatelet, more modern ones are fine (i.e. dabigatran)
• E block referal discussed ⇐ save this
  • Even in terms of emergency, referrals have to be made in titanium

Assessing Complexity

Think about the patient as a person, how mobile they are etc

Patient related factors

• Systemic
• Psychological
  • can deal with long appointments
  • can tolerate exos

Tooth Related Factors

• curvature
  • avoid severe dilaceration
• Hypercementosis
  • if you trace out the PDL apically it sort of “balloons”
• Ankylosis

Case 1 : 35 and 36

• Patient on Prolia

Why is it difficult to extract these teeth?

• 35 crown might break
  • apical bulbosity
• 36
  • looks ankylosed

How to tell if tooth looks ankylosed

Consent

• Talk to patients in a way they can understand
  • Gives a script on “the way I do it slide
• “Procedure specific risks slide”
  • use that advice also when it looks like you can damage the tooth next door

Correct Site Checklist tool

• found in eform dialogue box
• “Dental Surgery Safety Checklist Tool “

Case 2

• Patient referred to eblock
• took back and forth with patient and referrer to create a full clearnace

Local Anesthesia

• amount of adrenaline needs convertion or is written on the side of packet

Exam

MCQs coming from the “Local Aneasthetic consideratoins slide”

• Take a look at therapeutic guidelines version 4
• They will ask questions and know
  • thought process and where referencing information from

• Read instructions from manufacturer
  • read from the ARTG website
  • if you click on product information you get the up to date and latest instructions
• When LA choice matters
  • when you know they need a lot of LA, pick something that you can give more of!
    • most of the time its not a problem unless you’re extracting lke 5 + teeth

Considerations

What to make sure is anesthetized

• Tooth
• Surrounding bone
• Circumferential gingival tissues

When patient is still in pain

use the 1 OW rule

• if they say ow once, you make sure its not ust pain
• again and you have to consier other techniques

Lower First Molar and Mylohyoid cross innervation

• get rid of this by giving half a carpule lingually

Mechanics of Taking Teeth out

• lever
  • This is what the elevator helps to do
    • leans on the alveolar bone and lift it out
• Wheel and axle
  • effort applied circumferentially
  • used often in retained roots

Basic Armamentarium

• Simple teeth you’ll get away with 2 instruments
  • something to luxate with and something to “wiggle it” with
• Coupland elevator / chisel
  • coupland used genreally for rotating and lifting out teeth

Luxation

• Don’t luxate palatally/ lingually
  • if you slip you’ll lacerate teh floor of mouth or palatal artery
  • if you use buccal side that can’t happen

Forceps