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My First Extraction

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    Last 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. 

    Oral 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. 

    Next, 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. 

    I 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. 

    The 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.

    Overall, 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.