Exodontia (Oral Extraction)
Quality radiographs, oral examination, and advanced imaging (computed tomography) if necessary. Ensure that exodontia remains the only means of controlling the problem and improving the quality of life.
• Apply the molar spreaders to the interdental space caudal to the affected tooth. Slowly apply force to drive the wedges together. NOTE: This takes time and should not be rushed. The handles of the instrument can be taped together to reduce operator fatigue. This stage can take up to 20 minutes or longer (Figure 1).
• DO NOT APPLY MOLAR FORCEPS UNTIL THE TOOTH IS DEMONSTRABLY LOOSE. At this stage, the alveolus will be bleeding readily and “squishing” sounds can be heard when the tooth is manually grasped and rocked.
• Apply molar extraction forceps (Figure 3). Insert fulcrum to allow the handles of the instrument to be moved toward the occlusal surface of the tooth. DO NOT ROCK THE INSTRUMENT IN A DORSOVENTRAL DIRECTION. If molar forceps application has occurred at the correct time, pressure against the fulcrum will result in elevation of the tooth from the alveolus as a single, intact unit. (Figure 4).
• Pack alveolus if necessary. A variety of products are available, such as iodine-soaked gauze and plaster of Paris. The author currently recommends a Silastic pack (Splash Putty Pak, regular putty, firm setting (European distributor: EMDAR BV, El Arnhem, The Netherlands; North American distributor: Discus Dental Inc., Culver City, CA).