Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
4 CE credits
This course was
written for dentists,
dental hygienists,
and assistants.
A Peer-Reviewed Publication
Written by Bach T Le, DDS, MD, FICD
With Lucas A Hardy, DMD and Robert Ryan Goos, DMD
Educational Objectives
Upon completion of this course, the clinician will be able
to do the following:
1. Explain a complete preoperative assessment
2. Evaluate the level of difficulty of the proposed procedure
3. Apply the basic surgical techniques required
4. Manage certain complications that may arise, including root tip retrieval
Abstract
Atraumatic dental extraction requires a complete preoperative assessment of the patient prior to surgery. The clinician
must know the patients medical status, and assess the level of
difficulty of the extraction. During the extraction procedure,
basic atraumatic surgical techniques must be followed and the
clinician must be prepared to manage complications should
they arise.
Introduction
Almost daily, each dentist may deal with some aspect of
oral surgery in his or her practice. It may be a single tooth
extraction, an infection, the extraction of third molars, or a
biopsy. In this article, we will focus on extractions. For any
practitioner, whether a general dentist or a dental specialist, the most important aspect of any surgical procedure is
the preoperative assessment. This assessment begins with
a thorough medical history and physical examination. An
accurate medical history is important to help the practitioner decide whether a patient is able to undergo a surgical
procedure. Included in this exam are the patients chief
complaint, history of chief complaint, medical history, and
review of systems.
Chief Complaint
Every patient should be asked to state his or her chief complaint. This should be transcribed into the patients chart
in his or her own words. This will aid the practitioner in
establishing a diagnosis and developing a treatment plan
to fit each individual patient.
Medical History
Dentists are trained in basic and preclinical medical sciences and have a responsibility as health care providers to
take a thorough medical history to screen their patients
for any medical problems that may preclude them from
undergoing a surgical procedure. There are many health
2
Review of Systems
The review of systems is a systematic method of determining symptoms of each organ system. These questions
should be based upon positive answers obtained from the
health questionnaire. This review will give the practitioner
an idea of the severity of the disease and guide him or her
when making treatment decisions (i.e. do the procedure,
consult physician, refer to specialist). When in doubt about
the patients medical history, the dentist should consult the
patients physician.
After careful review of the patients health history,
the clinician should focus on the physical evaluation. The
physical exam of the oral surgery patient should begin with
vital signs (BP, pulse). This information will establish a
baseline for each patient for future visits as well as screen
the patient for any potential medical problems. The physical
exam of the dental patient will focus on the head and neck
region with emphasis placed on the oral cavity. Once the
physical exam is completed, the clinician should evaluate all
the information and can then assign the patient an American
Society of Anesthesiologists (ASA) classification of physical status. The clinician should consider obtaining medical
clearance for those patients ASA III and above. An example
of an ASA II vs ASA III patient, respectively, is one with
controlled hypertension or diabetes vs a patient with uncontrolled hypertension or diabetes.
Radiographic Evaluation
The size and shape of the roots of the tooth being extracted must also be taken into account. Teeth with long,
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Figure 5
Figure 8
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Figure 11
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Conclusion
Proper preoperative evaluation is important to avoid
complications due to health problems. A full assessment
will help the practitioner avoid difficulties. With the
ability to replace extracted teeth with dental implants,
careful thought and planning must be taken when planning an extraction at a future implant site. Using proper
instrumentation and knowing when to refer, are both very
important aspects of efforts to give a patient the best possible outcome.
Course References
1. Peterson L, Ellis E, Hupp J, Tucker M, Contemporary Oral and
Maxillofacial Surgery, 3rd ed. St. Louis Mosby 1998:797
2. Little J, Dental Management of the Medically Compromised
Patient 6th ed. 2002:736
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Authors Profile
Bach T Le, DDS, MD, FICD
Dr. Le has extensive education and experience in both
dentistry and medicine. He attended USC School of
Dentistry and graduated Omicron Kappa Upsilon. He
attended medical school with advanced standing at
Oregon Health Sciences University. An internship in
General Surgery was completed at Cedars-Sinai Medical
Center in Los Angeles. Following this, Dr. Le completed
a residency in Oral and Maxillofacial Surgery at Oregon
Health Sciences University.
Dr. Le has presented many scientific abstracts and
lectures nationally as well as internationally. In addition, Dr. Le has numerous medical journal articles and
medical textbook chapters published or submitted for
publication in various peer-review journals in diverse
areas including trauma, implant dentistry, and facial
reconstructive surgery.
Dr. Le is a Diplomate of the American Association of
Oral & Maxillofacial Surgeons, the American Dental Society of Anesthesiologist, and the International Congress of
Oral Implantologists. Dr. Le also holds Fellowship in the
International College of Dentists and the International Association of Oral & Maxillofacial Surgeons. Dr. Le is currently Assistant Professor of Oral & Maxillofacial Surgery
at the USC School of Dentistry and Assistant Director of
Residency Education at LAC-USC Medical Center.
Lucas A Hardy, DMD
Chief Resident, University of Southern California/ Los
Angeles County Medical Center
Robert Ryan Goos, DMD
Chief Resident, University of Southern California/ Los
Angeles County Medical Center
Disclaimer
The authors of this course have no commercial ties with the
sponsors or the providers of the unrestricted educational
grant for this course.
Reader Feedback
We encourage your comments on this or any PennWell
course. For your convenience, an online feedback form is
available at www.ineedce.com.
Questions
1. The most important aspect of any
surgical procedure is:
a. Setting up the treatment room.
b. Discussing financial arrangements.
c. The preoperative assessment.
d. None of these are important.
ANSWER SHEET
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Requirements for successful completion of the course and to obtain dental continuing education credits: 1) Read the entire course. 2) Complete all
information above. 3) Complete answer sheets in either pen or pencil. 4) Mark only one answer for each question. 5) A score of 70% on this test will earn
you 4 CE credits. 6) Complete the Course Evaluation below. 7) Make check payable to PennWell Corp.
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Educational Objectives
4. Manage certain complications that may arise, including root tip retrieval
Course Evaluation
Please evaluate this course by responding to the following statements, using a scale of Excellent = 5 to Poor = 0.
1. Were the individual course objectives met? Objective #1: Yes No
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10. If any of the continuing education questions were unclear or ambiguous, please list them.
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11. Was there any subject matter you found confusing? Please describe.
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12. What additional continuing dental education topics would you like to see?
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INSTRUCTIONS
All questions should have only one answer. Grading of this examination is done
manually. Participants will receive confirmation of passing by receipt of a verification
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Completing a single continuing education course does not provide enough information
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2008 by the Academy of Dental Therapeutics and Stomatology, a division
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