<unk> s could be categorized into non-surgical (simple) and surgical, depending on the type of tooth to be removed and other factors. A<unk>  x-ray image (radiograph) showing the shape and number of roots of the molars which cannot be observed in the mouth directly. Assessment and special investigations A comprehensive history taking should be performed to find out the pain history of the tooth, patient's medical history and history of previous difficult<unk> s. The tooth should be assessed clinically i.e. checked visually by the dentist. Pre-extraction radiographs are not always necessary but are often taken to confirm the diagnosis and hence appropriate treatment plan. Radiographs also help in visualising the shape and size of roots which are beneficial in planning the<unk> . All this information will aid the dentist in foreseeing any difficulties and hence prepare appropriately. Obtaining consent from patient In order to obtain permission from patient for<unk>  of tooth the dentist should explain; other treatment options available, what is involved in the<unk>  procedure, the potential risks of the procedure and the benefits of the procedure. The process of gaining consent should be documented in clinical notes. Mark Roback, a Navy dentist from the Military Sealift Command (MSC) hospital ship , speaking to his patient through an interpreter, informs her about the injection he is giving. Giving local anaesthetic Before<unk> g a tooth, the dentist would deliver local anaesthetic to ensure the tooth and surrounding tissues are numb before they start the<unk> . There are several techniques to achieve numbness of the tooth including * infiltration - injection containing local anaesthetic is delivered into the gum near the root tip of the tooth to be extracted. This allows the local anaesthetic to penetrate through the bone, eventually reaching the nerve bundle of the tooth to be extracted. * nerve block - injection containing local anaesthetic is delivered to an earlier branch of a nerve. For example, the inferior alveolar nerve block can be used to anaesthetise all the lower teeth. The two most commonly used local anaesthetics in the UK are lidocaine and articaine. Prior to injection, topical anaesthetic gel or cream, such as lidocaine or benzocaine, can be applied to the gum to numb the site of the injection up to a few millimetres deep. This should reduce the discomfort felt during the injection and thus help to reduce patient anxiety.<unk>  forceps. Removal of tooth During<unk> , multiple instruments are used to aid and ease the removal of the tooth whilst trying to minimally traumatise the tissues to allow for quicker healing.<unk>  forceps are commonly used to remove teeth. Different shaped forceps are available depending on the type of tooth requiring removal, what side of the mouth (left or right) it is on and if it is an upper or lower tooth. The beaks of the forceps must grip onto the root of the tooth securely before pressure is applied along the long axis of the tooth towards the root. Different movements of the forceps can be employed to remove teeth. Generally, while keeping downwards pressure attempts to move the tooth towards the cheek side (buccal) and then the opposite direction (palatal or lingual) are made to loosen the tooth from its socket. For single, conical-rooted teeth such as the incisors, rotatory movements are also used. A ‘figure of eight’ movement can be used to extract lower molars.<unk>  luxators. Instruments used are summarised below: + Name Type of Instrument Use Area of use Unique features Luxator Luxator Tear PDL around tooth Anywhere Sharp blade Coupland Elevator expand socket and lift Anywhere Numbered 1-3 from most narrow to wide Warrick James Elevator Expand socket and lift tooth Anywhere Right left and straight Cryers Elevator Expand socket and lift tooth Anywhere Right and left with sharp tips Upper straight Forcep Remove teeth Upper canine to canine Straight handle Upper anterior Forcep Remove teeth Upper anteriors and premolars Upper molar Forcep Remove teeth Upper 1st/2nd/3rd molars One pointed end to engage buccal furcation Upper bayonet Forcep Remove teeth Upper 3rd molars Curved handle and tip to reach 3rd molars Upper root Forcep Remove teeth Upper retained/fractured roots Narrow tips Cowhorn Forcep Remove teeth Lower molars Thin tips to engage furcation of broken down molars Lower anterior Forcep Remove teeth Lower anteriors and premolars 90 degree bend handle lower molar Forcep Remove teeth Lower 1st/2nd/3rd molars 2 beak tips to engage furcations Lower root Forcep Remove teeth Lower retained/fractured roots Narrow tips to engage roots In terms of operator positioning when removing a tooth, the patient is placed more supine when<unk> g and upper and more upright when<unk> g a lower. This is to allow direct vision for the operator during the procedure. A right handed operator will stand to the front of the patient and to their right when removing any upper teeth or lower left teeth. However, they will stand behind the patient and to the right when<unk> g a lower right tooth.<unk>  elevators can be used to aid removal of teeth. Various types are available that have different shapes. Their working ends are designed to engage into the space between the tooth and bone of the socket. Rotatory movements are then made to dislodge the tooth from the socket. Another similar looking but sharper instrument that can be used is a luxator; this instrument can be used gently and with great care to cut the ligament between the tooth and its boney socket (periodontal ligament). Achieving haemostasis Biting down on a piece of sterile gauze over the socket will provide firm pressure to the wound. Normally this is sufficient to stop any bleeding and will promote blood clot formation at the base of the socket. The source of any bleeding can either be from soft tissues (gingiva and mucosa) or hard tissue (the bony socket). Bleeding of soft tissues can be controlled by several means including suturing the wound (stitches) and/ or using chemical agents such as tranexamic acid, ferric sulphate and silver nitrate. Bony bleeding can be arrested by using haemostatic gauze and bone wax. Other means of achieving haemostasis include electrocautery.
Dental extraction
Orthognathic surgery
Glossectomy
Dental implant
Dental vibration appliance
Uvulopalatopharyngoplasty
Surgery for temporomandibular joint dysfunction
Crown lengthening