I'm a pedodontist...and I suck at doing extractions!

[dancesingfloss]

Hi all,

I'm a practicing pediatric dentist (went to residency) and I am horrible at doing primary teeth extractions! Obviously, those ones that are about to exfoliate are not my problem, but it's the one with the roots.

I've tried several methods and each time I do it, I feel like I inflict pain onto my patients. I've infiltrated, given pdl injections. I've used septo. I've elevated, I've not elevated. I've tried to slowly twist with the forceps and just quickly pull out the tooth. I'm kind of at a loss as to what would make the extractions painless. I realize that kids often mistake pressure for pain in the case of extractions, but what are you techniques in making the process more comfortable for your kiddos?

Any advice would be much appreciated.

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[Screwtape]

Flood the heck out of them and get them out of there as quickly as possible. What age range are you talking?

 

[eh384]

NITROUS, Septocaine infiltrations, and gentle buccal/lingual movement with forceps. The only time I ever elevate is when you have ectopic eruption of the max 6's and you have half an upper second molar left.

 

[dancesingfloss]

Flood the heck out of them and get them out of there as quickly as possible. What age range are you talking?

Probably when I work on the kids like 5-8, mostly. I tried recently to extract fast without elevating...yea, that didn't end up going too well. I mean, I got the tooth out fine and easily but the kid was not happy.

 

[ElectraOnAzalea]

My technique is nitrous!!!, making sure it's completely numb, always elevating and then lifting the tooth out with a forcep after its very wiggly. I also talk the kid though the procedure.

1. "I'm going to push around on your tooth to make sure it's sleepy!" While I'm using the periosteal. Making sure they are completely numb.

2.) "I'm going to use my tooth dancer now! You may feel some big pushes so help me by breathing through your nose when I push!" Then I count down and use my luxator to get the tooth pretty loose.

3.) "one more big push now, take a big breath!" Then I lift it out with the forcep

 

[Screwtape]

I'll second the nitrous. I also never tell the kid when I'm actually gonna pull it. I just say I have to do three tests before to make sure the tooth is ready to come out (periosteal, elevator, forceps). The less the kid sees/knows the less likely they are gonna act up. As long as they are numb.

 

[dancesingfloss]

If I'm doing an extraction, I use nitrous. The last time I even had a kid sedated with chloral, versed and vistaril and he still freaked out.

I used lido that time though. My boss gives an infiltration for upper and blocks/infiltration for lower teeth with lido when doing the ext, but doesn't give any pdl or palatial injections for uppers. Some other people I've talked to give just that with septo.

I'm confused because I usually give half-3/4 carp of lido so they should be pretty numb. I'm thinking it's my technique, but not sure.

 

[Wax n Relax]

How long do you wait to extract after you have given local? Im assuming you're giving local and then doing some exams on other kids while the local is kicking in? Some kids just lose their mind because of the pressure, but most should not. I usually wait at least ~10 min for local to sit in prior to extracting.