Ease Of Extraction And The Presence Of Impacted Teeth

The extraction of teeth is a potentially traumatic experience. The decision to extract should be made with an awareness of the risks of treatment, including the psychological impact of the procedure. The General Dental Council in its guidance to dentists of professional and personal conduct makes it clear that dentists who refer patients for general anaesthesia must make it clear what justification there is for the procedure. The duties of the treating dentist include a thorough and clear explanation of the risks involved as well as the alternative methods of pain control available. The use of general anaesthesia is usually considered in dealing with unerupted teeth, first molars, multiple extractions in four quadrants and specific phobias.

If teeth are impacted or ectopically positioned, extraction of an erupted tooth can guide the path of eruption of the impacted tooth and obviate the need for minor oral surgery. For example, the impaction of a lower second premolar may be relieved by the removal of the first premolar or first molar, which only requires local analgesia and is less traumatic than the removal of the impacted tooth (Fig. 3). In Figure 4, eruption of the upper second premolars resulted in severe resorption of the roots of the upper first molars. Extracting these molars would be fairly atraumatic and allow the second premolars to erupt into the mouth. Similarly, if unerupted permanent canines are palatally positioned judicious removal of the deciduous canines can improve the path of eruption of the permanent teeth and may help to avoid lengthy orthodontic treatment.13

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