12 Exodontics (Extractions)
When you have completed this chapter, you will be able to:
• Define exodontic and describe indications for this type of treatment.
• Discuss legal concerns related to performance of tooth extractions by veterinary technicians.
• List the instruments used for performing dental extractions and describe the function of each.
• Describe the procedure for removal of a single-rooted tooth.
• Describe the procedure for removal of a multirooted tooth.
• List and describe potential complications to tooth extraction.
Although the object in veterinary dentistry is to save teeth, extraction often becomes necessary. Exodontics is the branch of dentistry that involves the extraction of teeth. This chapter’s intent is to familiarize the reader with indications, equipment, and techniques for exodontia. It is not a substitute for proper hands-on training given by experts to those legally authorized to do so.
Indications for Exodontics
Exodontics is indicated when the tooth cannot be salvaged or the client is unable or unwilling to perform home care. The client should be consulted for authorization before any teeth are extracted. In addition to becoming upset with the extra fees, clients may respond emotionally to their pets’ loss of teeth. Alternative types of treatment should always be discussed. Staff members must always remember that extraction is final.
The Technician and Extractions
With regard to extraction, laws vary from state to state. In all states, if extraction by someone other than a veterinarian is permitted, the extraction must be performed under a veterinarian’s supervision. Some state regulations are contradictory. For example, in some states, registered veterinary technicians are permitted to perform extractions. However, the law forbids registered veterinary technicians from performing surgery. Many extractions are surgical (e.g., when teeth are split or flaps performed). This presents a conflict for the technician. Further, there may be insurance issues concerning whether the veterinarian can allow unauthorized individuals to perform procedures for which they are not authorized by law or regulation to do. The safe position, if allowed by state law and the veterinarian, is for the technician to perform only nonsurgical extractions such as removal of extremely mobile teeth.
The American Veterinary Dental College (AVDC), which represents board-certified veterinary dental specialists throughout the world, has evaluated the duties of the veterinarian, registered veterinary technician, and nonlicensed individuals in practice. As a result, the AVDC developed a position statement stipulating that only veterinarians should provide extraction services (Box 12-1).
Box 12-1
American Veterinary Dental College (AVDC) Position Statement Regarding Veterinary Dental Healthcare Providers
The American Veterinary Dental College (AVDC) developed this position statement as a means to safeguard the veterinary dental patient and to ensure the qualifications of persons performing veterinary dental procedures.
Primary Responsibility for Veterinary Dental Care
The AVDC defines veterinary dentistry as the art and practice of oral health care in animals other than man. It is a discipline of veterinary medicine and surgery. The diagnosis, treatment, and management of veterinary oral health care is to be provided and supervised by licensed veterinarians or by veterinarians working within a university or industry.
Who May Provide Veterinarian-Supervised Dental Care
The AVDC accepts that the following health care workers may assist the responsible veterinarian in dental procedures or actually perform dental prophylactic services while under direct, in the room supervision by a veterinarian if permitted by local law: licensed, certified or registered veterinary technician or a veterinary assistant with advanced dental training, dentist, or registered dental hygienist.
Operative Dentistry and Oral Surgery
The AVDC considers operative dentistry to be any dental procedure which invades the hard or soft oral tissue including, but not limited to, a procedure that alters the structure of one or more teeth or repairs damaged and diseased teeth. A veterinarian should perform operative dentistry and oral surgery.
Extraction of Teeth
The AVDC considers the extraction of teeth to be included in the practice of veterinary dentistry. Decision making is the responsibility of the veterinarian, with the consent of the pet owner, when electing to extract teeth. Only veterinarians shall determine which teeth are to be extracted and perform extraction procedures.
Dental Tasks Performed by Veterinary Technicians
The AVDC considers it appropriate for a veterinarian to delegate maintenance dental care and certain dental tasks to a veterinary technician. Tasks appropriately performed by a technician include dental prophylaxis and certain procedures that do not result in altering the shape, structure, or positional location of teeth in the dental arch. The veterinarian may direct an appropriately trained technician to perform these tasks providing that the veterinarian is physically present and supervising the treatment.
Veterinary Technician Dental Training
The AVDC supports the advanced training of veterinary technicians to perform additional ancillary dental services: taking impressions, making models, charting veterinary dental pathology, taking and developing dental radiographs, performing non surgical subgingival root scaling and debridement, providing that they do not alter the structure of the tooth.
Tasks that May Be Performed by Veterinary Assistants (Not Registered, Certified, or Licensed)
The AVDC supports the appropriate training of veterinary assistants to perform the following dental services: supragingival scaling and polishing, taking and developing dental radiographs, making impressions and making models.
Tasks that May Be Performed by Dentists, Registered Dental Hygienists, and Other Dental Healthcare Providers
The AVDC recognizes that dentists, registered dental hygienists and other dental health care providers in good standing may perform those procedures for which they have been qualified under the direct supervision of the veterinarian. The supervising veterinarian will be responsible for the welfare of the patient and any treatment performed on the patient.
The AVDC understands that individual states have regulations that govern the practice of veterinary medicine. This position statement is intended to be a model for veterinary dental practice and does not replace existing law.
Adopted by the Board of Directors April 1998; revised October 1999 and September 2006. Courtesy American Veterinary Dental College (AVDC) at www.AVDC.org.
Instruments for Exodontics
A variety of instruments are used for extractions (Box 12-2). Dental elevators are used to engage teeth and raise them from the root socket. Extraction forceps grasp the tooth and remove it from the socket. Spring-loaded forceps are recommended (Figure 12-2). Another useful forceps is a root removal forceps (Figure 12-3).
Box 12-2
Instruments for Exodontics
Surgical extraction: Scalpel handle with blade (11 blade, 15c)
Periosteal elevator: Molt No. 2 (small patient) or Molt No. 4 (large patient)
Burs: Tapered crosscut bur, No. 701L for sectioning multirooted teeth
Dental elevators: 301SS, 301S, 301, 34
Winged elevators: 1-6 (7-10 are available for larger patients)
Root tip picks: Miltex 76, HB 11, Heidbrink
Irrigation solution: Sterile saline, dilute chlorhexidine solution
Periodontal scissors to release flap
Resorbable suture with swaged needle
Bone implant material: Consil (Nutramax Laboratories, Edgewood, MD)
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