week, my patient presented to dental clinic for the extraction of tooth #12. As
this was my first planned extraction, I was a bit anxious. The instruction I
had to go off of was a vague, old PowerPoint. I thought to myself, how crazy is it that I am really allowed to
perform such invasive procedures? I consulted with the faculty beforehand
to calm my nerves and to get some tips. Overall, the procedure went smoothly.
I’ll share my experience step by step in the hope this will assist other dental
students in their first extraction.
examination revealed a carious tooth #12 with class III mobility and horizontal
and vertical bone loss on radiographic imaging. The patient’s medical and
dental history were reviewed; no contraindications to treatment were
identified. Vitals were taken. The treatment plan, risks, and benefits were
reviewed with the patient, and the patient consented to treatment.
the patient’s soft tissue surfaces were cleaned and dried using gauze. Topical
anesthetic (benzocaine) was applied to both the palatal and buccal mucosa in
preparation for local anesthesia. I anesthetized #12 using local infiltration of
both the buccal and palatal soft tissue surfaces. I used two thirds of a
carpule of 2% Septocaine (34 mg) with 1:100K epinephrine (0.017 mg) on the
buccal and the remaining third was injected palatally. A bite block and
posterior pharyngeal curtain were inserted to prevent aspiration. The overhead
light and patient were positioned at a 60-degree angle, providing good visualization
and access of the field. If I were to work on the mandibular teeth, I would
position the occlusal plane parallel to the floor.
used a periosteal elevator to help release the soft tissue around the tooth. I
then positioned a straight elevator between the tooth and the bony wall socket,
my finger placed along the shaft of the elevator. I rotated the elevator along
its long axis to help luxate the tooth. The #150 extracting forceps was
positioned as far apically as it could be seated. I knew that the further
apically I could seat the forceps, the less risk I would have fracturing the
crown from the root. The beaks were parallel to the long access of the tooth. The
tooth was displaced by applying pressure buccally, then palatally, and
coronally. Pressure was applied by moving my trunk and hips instead of my
elbow. Once the tooth was loose, a rotary, figure-8 movement was used to remove
the tooth from the socket. Excessive force should be avoided. The surgical
curette was used to remove any granulation tissue, and the site was irrigated.
No bone filing or suturing was necessary.
patient tolerated the procedure without any complaints or discomfort. The
patient was asked to bite down on a piece of moistened gauze at the extraction
site and post-op and pain management instructions were given. A one-week
follow-up appointment was scheduled. I answered all patient’s questions and
they were dismissed.
I think that my first extraction went smoothly. However, the tooth was pretty
mobile to begin with so I’m sure that had a lot to do with it. I anticipate
more struggle in the future when dealing with more stubborn teeth. Despite my
nerves, I followed protocol, listened to my instructors, and I now have an
additional experience under my belt. I will be sure to walk into the next surgical
procedure with a bit more confidence.