Extraction Setup

• Basic kit
• Extraction kit
• Surgical suction 
• Surgical handpiece & bur 
• Forceps
• Blood pressure cuff
• Consent form
• Post-Op instructions
• Ligaget + purple needle  
  
• Jaw rest – Dr. Bryant only
• Gloves for Dr. 
• 2×2 gauze
• Slow speed suction 
• Air/water tip 
• Syringe + needle + anesthetic
• Bib clips
• Safety glasses 

Extraction Procedure (1/3)

1. Seat patient & introduce yourself. Place bib on Patient. Go over the procedure as well as what the patient should expect and the benefit they should gain by having the tooth removed, including how the space can be filled by either an implant, a bridge or a partial. Treatment plan if not done prior to this appointment.
2. Have patient sign the Tooth Extraction Consent Form. Take patient’s blood pressure and note it in the chart as well as on the Tooth Extraction Consent Form. 
3. Place topical. Open up everything, prepare for the procedure. Notify the Doctor that the patient is seated and any other pertinent information.
4. Doctor comes in to anesthetize the patient.  Then lets the anesthetic soak in so they are numb for the procedure. Go over K Trac report and get signatures on consent forms. After a few minutes ask the patient if they are feeling numb and let the dr. know more is needed, if necessary.
5. Doctor may start with a ligament separator or use the luxator to begin stretching the fibers that hold the tooth. Hand the small elevator to the dr. to continue loosening the tooth by helping the fibers release their grip on the root to make the tooth mobile.
6. Hand the doctor the forceps so the dr. may grasp the tooth to continue removing it & to safely hold it once it is removed. Take the tooth in gauze from the Dr. & place it behind the patient. Ask if pt. wants tooth. For children the tooth is always cleaned up in peroxide & placed in a plastic tooth necklace taped so it cannot fall out & get lost so the tooth fairy can save it for all eternity.

Extraction Procedure (2/3)

7. Hand the doctor some folded gauze to place over the socket. The patient then closes and bites on the gauze. The pressure & tight seal aids in the formation of a good solid blood clot. The clot is essential to the patient’s comfort.
8. The clot serves for several purposes. 1. it seals the hole in the patient to keep them from bleeding. 2. the clot keep them comfortable over the next 2 weeks by covering the bone so it is not tender from everything ate, drank and just air from breathing. 3. It provides a matrix for bone cells to grow into and begin healing after a couple weeks.
9. Chart and watch the patient to make sure they are not sucking on the gauze. *Any suction will pull on the clot and keep it from setting up. This keeps a leak in the clot so the patient just keeps bleeding. Take the filled out chart up front so they may get the next appointment ready, get the patient’s fee for this appointment & their estimated cost for the next appointment.
10. Give the patient their oral homecare instructions and go over Instructions with patient.
11. Ask the patient to open so you may check the clot.  It should look kind of fibrous and be oozing but not a flowing hole of liquid. If the gauzes is less than ½ blood soaked then place it back just the way it set before being moved (it is better to not change the gauze too many times as each time a new dry one is placed on the clot it will remove a little more clot which is what we want to leave). If it is more than ½ soaked then replace it with a fresh one. Hand the patient the written home care instructions and their take home gauze pack. Instruct them in how to remove & place the gauze in so it tightly seals the hole when they stay closed upon it.

Extraction Procedure (3/3)

12. Review pain medications usually Ibuprofen 800 mg (4 of the OTC 200mg tablets) every 4 – 6 hours unless they are pregnant. Since Ibuprofen is an anti-inflammatory medication it may take 4 – 8 hours before they really feel the medicine working so they must take 3 doses of the medicine before deciding how well it works. The anti-inflammatory inhibits formation of the last 6 – 8 hours once formed. So Ibuprofen works best when taken before the pain is excruciating. The patient may also have Tylenol #3 which provides a drowsiness side effect which is nice when you lay down to sleep and once all is calm you notice your tooth.  Or they may have Norco 5 which doesn’t have as much of the drowsiness (but less stomach upset for some).
13. Chart appointment in patient’s chart. Make any changes or adjustments to the patient’s appointment in the computer and add your name in the assistant field if not already there, then complete the appt. in the computer.
14. Be prepared to schedule pt.’s next appt. & treatment plan any changes to pt.’s current treatment plan. Have Front Desk call in RX when prescribed.
15. Inform the patient of what their next appointment will be, ask if the patient has any questions, & escort the patient to the front desk so they can check out.

Extraction Charting

Reason for treatment (decay, fracture, perio, non-restorable, abscess/necrosis)

Reviewed medical history. Discussed pros and cons towards extraction. Discussed possible complications of extraction including postoperative discomfort, infection, damage to adjacent teeth and structures, prolonged bleeding, permanent or temporary paresthesia, sinus complications, the possibility of a small fragment of tooth being left in, broken jaw, and the need to see a specialist at their own expense.

Patient understands procedure that tooth will be permanently removed and complications may occur. Patient signed informed consent. 

Lacerated PDL with ligament separator

Elevated tooth and forceps used to extract crown and roots

Sutures placed. Patient informed that sutures will dissolve on their own.

Pain medication: OTC Advil, OTC Tylenol, T3, Norco 5

Post-op instructions given verbally and written. Patient informed to bite firmly on gauze for 1 hr. Included discussion about taking medication as directed. It is normal to experience some post-operative discomfort but to call immediately if bleeding or pain becomes severe.