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Medical Forum / General / Dentistry / November 2004dental extractions--rate of complications..
I'm in very good health (In my early 50s), am an RN, know pretty well how to take care of myself..but have --apparently--neglected my teeth ...have been told by two reputable specialists ("suggested" is a better word for it)..that #15 be extracted--just had a root canal done, ...but the crown fits poorly, creating a large gap....and little bone available.. will probably not have an implant there...(*18 will need extraction eventually).....What is the complication rate on extractions.? Do I need o see an oral surgeon for what I presume to be a simple extraction? Browing variious sites on Google, for example, gives me pause: (there's things like "cavitations" and such. I'd rather avoid the costs of a oral surgeon...my pocketbook right now is a consideration. Yet, want to avoid getting more entangled...with dental problems in the long run. Please give suggestion, or a site i can read (in terms on problems and complications of dental extractions, and whether or not extractions generally go quite routinely, given good post-op care and good health... thanks. Ruth > I'm in very good health (In my early 50s), am an RN, know pretty >well how to take care of myself..but have --apparently--neglected [quoted text clipped - 8 lines] >things like "cavitations" and such. I'd rather avoid the costs of a >oral surgeon...my pocketbook right now is a consideration. Forget cavitations .... its not accepted nor established in the dental literature. Joel M. Eichen DDS > Yet, want to avoid getting more entangled...with dental problems >in the long run. Please give suggestion, or a site i can read (in terms >on problems and complications of dental extractions, and whether >or not extractions generally go quite routinely, given good post-op >care and good health... Sounds like your tooth is loose ... is it? If it is not loose then keep it. If it is loose, it will come right out. Barbers used to remove teeth, in Morocco, shamans remove teeth, so for American dentists its a piece of cake Joel M. Eichen DDS >thanks. > >Ruth Let's put it another way - if you needed heart surgery, will you be thinking with your pocket book then? Nuff said. It's always better to pay a little more in the beginning to spare future problems. Even oral surgeons can't say with complete accuracy that an extraction will be simple or surgical - what if the crown snaps off and they have to flap your gums, remove some bone for a gripping point? You can never tell. On a side note, being an RN, I'm assuming you have dental insurance (every RN I know does). Why have you neglected your teeth? The best way to "avoid getting more entangled...with dental problems in the long run" is to maintain your periodic checkups - that's when small problems are taken care of before they come big problems - like now. Hope all goes well.  SignatureShad Lewis www.WyomissingSmiles.com > I'm in very good health (In my early 50s), am an RN, know pretty > well how to take care of myself..but have --apparently--neglected [quoted text clipped - 18 lines] > > Ruth ...................... > It's always better to pay a little more in the beginning to spare future > problems. Even oral surgeons can't say with complete accuracy that an > extraction will be simple or surgical - what if the crown snaps off and > they have to flap your gums, remove some bone for a gripping point? You > can never tell. Shad, when the crown snaps off, the rest of the extraction is usually easier. BTW, do you like DT? >> I'm in very good health (In my early 50s), am an RN, know pretty >> well how to take care of myself..but have --apparently--neglected [quoted text clipped - 18 lines] >> >> Ruth > ...................... > > [quoted text clipped - 6 lines] > Shad, when the crown snaps off, the rest of the extraction is usually > easier. ??? How is this possible? If you can section the tooth, perhaps this is true, but in general, what do you mean? Thanks SP > BTW, do you like DT? SignatureNot a real Addy, yet >> Shad, when the crown snaps off, the rest of the extraction is usually >> easier. [quoted text clipped - 4 lines] >SP >> BTW, do you like DT? I agree with this. FIRST, I tell the patient that the crown may break, but not to worry. I am prepared for that. The patient who is nervous is the largest deterrent for proper tooth removal! ONE EXAMPLE: A cowhorn forceps for a lower first molar is very easily placed, with no crown in place. Squeezing the handles on occasion, elevates the root right out of the alveolus, on other occasions, splits the roots into two sections. A standard elevator can usually lift out the mesial root, while the distal root is a simple East-West Elevator job. Or the root can be luxated out of its socket. BOOM! Five minutes ...... after good anesthesia of course! Joel Joel >. A standard elevator can usually >lift out the mesial root, while the distal root is a simple East-West [quoted text clipped - 3 lines] > >BOOM! Five minutes ...... after good anesthesia of course! I usually take out the distal root first. -- W_B wubbabubbazG@RBAGEyahoo.com Take out the G'RBAGE >>. A standard elevator can usually >>lift out the mesial root, while the distal root is a simple East-West [quoted text clipped - 5 lines] > >I usually take out the distal root first. OK. I take the mesial out first and then place an East-West elevator down into the mesial socket to engage the distal root at the apex. A flick of the wrist and its out. My rationale The distal root is more cured than the mesial and therefore is more vulnerable to my elevator, than doing it the reverse way. Joel >>I usually take out the distal root first. > >OK. I take the mesial out first and then place an East-West elevator >down into the mesial socket to engage the distal root at the apex. A >flick of the wrist and its out. good technic. I take the distal root out then elevate the mesial root distally into the socket, sometimes removing the septum. -- W_B wubbabubbazG@RBAGEyahoo.com Take out the G'RBAGE I put the elevator between the 2 and whichever comes out first is it................... ares > I usually take out the distal root first. > [quoted text clipped - 3 lines] > wubbabubbazG@RBAGEyahoo.com > Take out the G'RBAGE I knew those other techniques did not quite describe mine. :-) Fawks > I put the elevator between the 2 and whichever comes out first is > it................... > ares > >> Shad, when the crown snaps off, the rest of the extraction is usually > >> easier. [quoted text clipped - 4 lines] > >SP > >> BTW, do you like DT? FWIW, *I* flip through the mag, but I don't waste any time on the Web with them... I never figured out how to do it quickly like JME does. I will say that in the November 2004 issue (that I just received on Friday) they were talking about the safe removal of upper wisdom teeth. There are some pretty big guns (OMFS proffesors, etc) contributing to the article (and certainly even more on the thread). There were some good points that were made (as in using a finger to stabilize the tuberosity, etc). I'm not really looking forward to breaking off the tuberosity with the tooth. Also, they do describe products from time to time that are interesting; like the Isolite, the below mentioned Luxators, etc. If you get the DT mag, flip thru it before you chuck it, if only to see what they're pushing on us this month... For you all, it's just adverts... for me, there are a few concepts that are interesting to think about. > I agree with this. FIRST, I tell the patient that the crown may break, > but not to worry. I am prepared for that. The patient who is nervous [quoted text clipped - 4 lines] > elevates the root right out of the alveolus, on other occasions, > splits the roots into two sections. True... the cowhorn was not a forceps that I mastered. I do have one with the curved handle... I should give it another chance.... <Ahem...> truth be told, I often use a 74N to remove roots for lower molars... I go right-handed for right sided roots, and left-handed for left sided roots. I feel more stable this way and the other hand is stabilizing the mandible. This is done in the standing position, with myself at about 4 o'clock wrt the patient's midline (12 o'clock). > A standard elevator can usually > lift out the mesial root, while the distal root is a simple East-West > Elevator job. By 'east-west', do you mean Cryers, Potts and Warwicks? And while we are on the subject, is it worth it to get a couple of luxators? > Or the root can be luxated out of its socket. > > BOOM! Five minutes ...... after good anesthesia of course! > > Joel Thanks SP SignatureNot a real Addy, yet >> >> Shad, when the crown snaps off, the rest of the extraction is usually >> >> easier. [quoted text clipped - 9 lines] >will say that in the November 2004 issue (that I just received on >Friday) they were talking about the safe removal of upper wisdom teeth. What I like about their mag is that its less mainline than the others ,,, but its slipping. The articles have key buzzwords that are reinforced on the facing page ~ the full page ad for what is being touted. Joel >There are some pretty big guns (OMFS proffesors, etc) contributing to >the article (and certainly even more on the thread). There were some [quoted text clipped - 40 lines] >Thanks >SP >Also, they do describe products from time to time that are interesting; >like the Isolite, the below mentioned Luxators, etc. If you get the DT >mag, flip thru it before you chuck it, if only to see what they're >pushing on us this month... For you all, it's just adverts... for me, >there are a few concepts that are interesting to think about. Here is an example. Howard Farran sent me the 59 forms he uses in his office ...... a ZIP file .... He also has the method for his periodontal treatment, fees, rationale, etc. He is kind of upfront with his information, although he sees me as "the most annoying poster!" He's been talking to Jan I guess. Joel >Here is an example. Howard Farran sent me the 59 forms he uses in his >office ...... a ZIP file .... I would like to have that zip file. -- W_B wubbabubbazG@RBAGEyahoo.com Take out the G'RBAGE > I feel more stable this way and the other hand is stabilizing the >mandible. GOOD! Extremely important! Joel (TMJ damage is possible). >> A standard elevator can usually >> lift out the mesial root, while the distal root is a simple East-West >> Elevator job. >> >By 'east-west', do you mean Cryers, Potts and Warwicks? And while we are >on the subject, is it worth it to get a couple of luxators? I suggest you buy the full set of 4. .. Stephen Mancuso, D.D.S. Troy, Michigan, USA Writing on a tablet PC,so forgive me if the PC misreads my poor handwriting. > >> A standard elevator can usually > >> lift out the mesial root, while the distal root is a simple East-West [quoted text clipped - 5 lines] > I suggest you buy the full set of 4. > .. thanks... sp SignatureNot a real Addy, yet >> >on the subject, is it worth it to get a couple of luxators? >> >> I suggest you buy the full set of 4. >> .. >thanks... >sp What set ? Gee, getting information out of you guys is like pullin' teeth. -- W_B wubbabubbazG@RBAGEyahoo.com Take out the G'RBAGE > >> >on the subject, is it worth it to get a couple of luxators? > >> [quoted text clipped - 9 lines] > -- > W_B ..... Really???? What do you use to open a dictionary; A Seldin elevator and a number 1 forceps??? ... ;-) If you still have the November edition of DentalTown magazine, there's a photo of a set of SDI Luxators. The poster recommends getting the 2mm and 3 mm gray handled and the blue re-curved one. I don't know what a re-curved luxator is. BTW: are these things anything like periotomes? Thanks SP SignatureNot a real Addy, yet Speaking for myself, I usually use a mouse. ;-) Fawks > ..... Really???? What do you use to open a dictionary; A Seldin elevator > and a number 1 forceps??? ... ;-) >> >> >on the subject, is it worth it to get a couple of luxators? >> >> [quoted text clipped - 21 lines] >Thanks >SP Similar but better. These have a nice handle to push with and very sharp tips .. Stephen Mancuso, D.D.S. Troy, Michigan, USA Writing on a tablet PC,so forgive me if the PC misreads my poor handwriting. > Similar but better. These have a nice handle to push with and very > sharp tips > .. > Stephen Mancuso, D.D.S. > Troy, Michigan, USA Thanks SP SignatureNot a real Addy, yet >>> >on the subject, is it worth it to get a couple of luxators? >>> [quoted text clipped - 6 lines] > >Gee, getting information out of you guys is like pullin' teeth. A full set of Luxators. one narrow tip straight, one narrow tip offset, one each with wide tip. a set of 4 .. Stephen Mancuso, D.D.S. Troy, Michigan, USA Writing on a tablet PC,so forgive me if the PC misreads my poor handwriting. >>What set ? >> [quoted text clipped - 4 lines] >.. >Stephen Mancuso, D.D.S Any particular brand ? -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com Only one brand is made. Used to be Whaledent, now is SDI Signature~+--~+--~+--~+--~+-- Stephen Mancuso, D.D.S. Troy, Michigan, USA .................................................... This posting is intended for informational or conversational purposes only. Always seek the opinion of a licensed dental professional before acting on the advice or opinion expressed here. Only a dentist who has examined you in person can diagnose your problems and make decisions which will affect your health. ...................... > >>>What set ? [quoted text clipped - 13 lines] > Take out the G'RBAGE > wubbabubbazG@RBAGEyahoo.com >>By 'east-west', do you mean Cryers, Potts and Warwicks? And while we are >>on the subject, is it worth it to get a couple of luxators? > >I suggest you buy the full set of 4. >.. >Stephen Mancuso, D.D.S. Four what ? -- W_B wubbabubbazG@RBAGEyahoo.com Take out the G'RBAGE > >>By 'east-west', do you mean Cryers, Potts and Warwicks? And while we are > >>on the subject, is it worth it to get a couple of luxators? [quoted text clipped - 4 lines] > > Four what ? Luxators.... SP SignatureNot a real Addy, yet > > ONE EXAMPLE: A cowhorn forceps for a lower first molar is very easily > placed, with no crown in place. Squeezing the handles on occasion, > elevates the root right out of the alveolus,> > Joel I should be so lucky........... ares >> ...................... >> > [quoted text clipped - 12 lines] >SP >> BTW, do you like DT? Once the Crown snaps off you section the roots apart, insert your Luxator and out comes each will. The roots now come out along their own path of extraction and divergent roots do not matter. .. Stephen Mancuso, D.D.S. Troy, Michigan, USA Writing on a tablet PC,so forgive me if the PC misreads my poor handwriting. > Once the Crown snaps off you section the roots apart, insert your > Luxator and out comes each will. The roots now come out along their > own path of extraction and divergent roots do not matter. > .. > Stephen Mancuso, D.D.S. ok, thanks sp SignatureNot a real Addy, yet >>> Shad, when the crown snaps off, the rest of the extraction is usually >>> easier. [quoted text clipped - 10 lines] >.. >Stephen Mancuso, D.D.S Sometimes I snap the crown off on purpose. Tell the patient before you do this. "this tooth is going to break and you will hear a noise" -- W_B wubbabubbazG@RBAGEyahoo.com Take out the G'RBAGE > >>> Shad, when the crown snaps off, the rest of the extraction is usually > >>> easier. [quoted text clipped - 14 lines] > Tell the patient before you do this. > "this tooth is going to break and you will hear a noise" I will do this, if the zray shows nice, separated roots that can be easily worked individually. I usually do the sectioning with a bur on the highspeed, though. How do you break it predictably otherwise? Thanks SP SignatureNot a real Addy, yet >> >>> Shad, when the crown snaps off, the rest of the extraction is usually >> >>> easier. [quoted text clipped - 20 lines] >Thanks >SP Severely decayed molars just take a quick snap of the forcep. I usually luxate the tooth first with elevators (34s my personal fave, or a 301 in tight spots, a 77R is nice too) For sectioning I use a 45 degree high speed with a 702 surgical length. -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com >>> >>> Shad, when the crown snaps off, the rest of the extraction is usually >>> >>> easier. [quoted text clipped - 26 lines] > >For sectioning I use a 45 degree high speed with a 702 surgical length. Ever try a 1702 bur? .. Stephen Mancuso, D.D.S. Troy, Michigan, USA Writing on a tablet PC,so forgive me if the PC misreads my poor handwriting. >>For sectioning I use a 45 degree high speed with a 702 surgical length. > >Ever try a 1702 bur? >.. >Stephen Mancuso, D.D.S. No, what is the difference ? -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com >>>For sectioning I use a 45 degree high speed with a 702 surgical length. >> [quoted text clipped - 3 lines] > >No, what is the difference ? Same shape and size but end-cutting. .. Stephen Mancuso, D.D.S. Troy, Michigan, USA Writing on a tablet PC,so forgive me if the PC misreads my poor handwriting. >>>>For sectioning I use a 45 degree high speed with a 702 surgical length. >>> [quoted text clipped - 4 lines] >>No, what is the difference ? >Same shape and size but end-cutting. Will give it a try. -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com >>>>>For sectioning I use a 45 degree high speed with a 702 surgical length. >>>> [quoted text clipped - 6 lines] > >Will give it a try. The 702 sure looks end cutting to me. -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com I'd say dry sockets are more common than rare. Then some people might bleed extra or others might get some bone poking through during healing. I see many complications but most aren't calamaties. ares > Let's put it another way - if you needed heart surgery, will you be thinking > with your pocket book then? Nuff said. [quoted text clipped - 35 lines] > > > > Ruth > I'm in very good health (In my early 50s), am an RN, know pretty > well how to take care of myself..but have --apparently--neglected > my teeth ...have been told by two reputable specialists ("suggested" > is a better word for it)..that #15 be extracted I'm no dentist but I have had 5 teeth extracted over the years with no problems and usually less pain than for a regular filling. You could always take the x-ray to another dentist and ask him if he thinks it would be a difficult extraction. >I'm no dentist but I have had 5 teeth extracted over the years with no >problems and usually less pain than for a regular filling. Patients always tell us this ... either I am excellent with extractions or lousy with fillings! Joel Cavitations are hokey pokey let-me-steal-your-money stuff. Forget about them. Complication rate for middle aged black females who smoke is higher risk for dry sockets. That risk assessment is 20 years old and could be outdated by now. Higher risks for dry sockets in other smokers, but not as high. That part is current. Beyond that, no big deal unless you have serious health problems. Don't worry about it. If you GP does extractions, this would probably be a piece of cake for him/her. Signature~+--~+--~+--~+--~+--. Stephen Mancuso, D.D.S. Troy, Michigan, USA .................................................... This posting is intended for informational or conversational purposes only. Always seek the opinion of a licensed dental professional before acting on the advice or opinion expressed here. Only a dentist who has examined you in person can diagnose your problems and make decisions which will affect your health. ...................... > > I'm in very good health (In my early 50s), am an RN, know pretty [quoted text clipped - 19 lines] > > Ruth >Cavitations are hokey pokey let-me-steal-your-money stuff. Forget about >them. I agree 100%. One problem though .... BOUQUOT! He is not a charlatan. Joel >Complication rate for middle aged black females who smoke is higher >risk for dry sockets. That risk assessment is 20 years old and could be [quoted text clipped - 3 lines] >problems. Don't worry about it. If you GP does extractions, this would >probably be a piece of cake for him/her. "Aware" patients such as nurses, I find, sometimes have more complications simply because they can't stop messing with the extraction site. They want to 'doctor' it by squirting who knows what in there with a syringe and rinsing ten times a day and poking around with a toothpick trying to keep it clean. The best thing generally is NOT to rinse for 24 hrs to preserve the blood clot that forms and don't go poking around in there. Just leave it alone and it will heal fine. Now this is all for a routine extraction so you may be instructed to do otherwise if it turns out to be a surgical extraction. > Cavitations are hokey pokey let-me-steal-your-money stuff. Forget about > them. Complication rate for middle aged black females who smoke is higher [quoted text clipped - 39 lines] > > > > Ruth >"Aware" patients such as nurses, I find, sometimes have more complications >simply because they can't stop messing with the extraction site. They want [quoted text clipped - 5 lines] >may be instructed to do otherwise if it turns out to be a surgical >extraction. Good points. I always say, "LEAVE-e-e-e-e-e it alone!!" >> Cavitations are hokey pokey let-me-steal-your-money stuff. Forget about >> them. Complication rate for middle aged black females who smoke is higher [quoted text clipped - 40 lines] >> > >> > Ruth >(there's >things like "cavitations" and such. They don't exist. NICO is bogus. Any competent General Dentist should be able to do a routine extraction. I abhor the term 'simple extraction'. If it was so simple, anyone could do it. -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com |
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