Exodontia: When and Why

Dental extraction or exodontia is a common practice in any dental clinic. Despite significant advances in preventive and restorative dentistry, exodontia is still a necessary surgery. It is usually done to treat painful teeth, which cannot be restorable. The extraction method becomes more laborious and complex as the average age rises. This article provides a general overview of exodontia, the history of exodontia, and Indications for Exodontia.

What is Exodontia?

Exodontia is the surgical removal of a tooth from a socket in the alveolar bone. It is a complicated treatment in and of itself since the dental surgeon must work in an oral cavity constrained by the patient's lips and cheeks. Furthermore, the movement of the tongue and jaw complicates the operation. Saliva is another component that affects the process. The oral cavity interfaces with the pharynx, communicating with the larynx and esophagus. There is always a risk of aspiration or deglutition of the extracted tooth. As a result, exodontia must be performed with caution and under basic surgical principles.

Aside from the dental surgeon's ability and practical abilities, the patient's participation is also critical to successful tooth extraction. Misinformation, myths, worry, pain phobia, previous exodontia experiences, and trust in the operator all influence the patient's participation. A dental surgeon must have a calm, compassionate, and comforting demeanor to acquire the patient's confidence. The empathic aspect of the doctor must be supplemented with sound patient management and pharmacokinetic concepts. This combination aids in reducing the patient's anxiety and apprehension of the treatment.

Exodontia, also known as tooth extraction, is the painless removal of an entire tooth or tooth root with minimal stress to the investing tissues, allowing the bone to heal normally and preventing postoperative prosthetic problems.

History of Exodontia

The concept of how extractions were done in the eleventh century is unsettling. The patient's head was held between the operator's knees, the soft tissue was cut with a sharp scalpel, and the tooth was pulled out in a single direction. A red-hot iron was frequently used to cauterize the wound, and a repellant mouthwash was suggested.

Historically, dental extractions were used as a preventative and curative treatment for various ailments. Exodontia was the recommended treatment before the discovery of antibiotics. Dentistry was not a separate profession at the time, and barbers, also known as 'barber surgeons,' extracted teeth. They used to advertise their services as tooth pullers by hanging rows of decaying teeth outside their businesses. Multiple instruments like forceps, pelicans, keys, screws, and elevators were used in various geographical places.

Indications of Exodontia

Teeth extraction can be either preventative or therapeutic. The following are the causes of exodontia.

  1. Dental Caries: Caries-damaged teeth that cannot be saved by any conservative or endodontic therapy.
  2. Pulp Pathology: Endodontic therapy cannot treat pulpal necrosis or any other pulpal condition.
  3. Severe Periodontal Disease: Periodontally weakened teeth with mobility and irreversible periodontal tissue loss.
  4. Periapical Pathology: In cases where all periapical pathological reparative therapies have failed to prevent the spread of infection.
  5. Orthodontic Reasons: There are a few circumstances in which a tooth must be extracted during orthodontic therapy. Malposed teeth: Misaligned teeth that cannot be reoriented inside the proper arch shape with orthodontic therapy. Making Space: Making room to correct misaligned teeth. Premolars are often extracted in such circumstances. Serial Extractions: A few deciduous teeth are extracted sequentially throughout the mixed dentition stage to avoid malocclusion in permanent dentition as the kid grows.
  6. Pre-prosthetic Extractions: Total extraction for complete denture fabrication (removable or implant-supported) or extraction of a few undesired teeth to improve the design and stability of a removable partial denture.
  7. Fractured Teeth: Teeth that have been fractured and cannot be saved.
  8. Root Fragments: Root fragments can cause recurring ulcerations under dentures, the development of bone diseases, and numbness if they are adjacent to a nerve. However, very few asymptomatic root pieces can be left alone, but the patient must be monitored regularly.
  9. Supernumerary teeth: Supernumerary teeth can be malpositioned or impacted. They are predisposed to malocclusion, discomfort, periodontal disruption, diseases, and, in some cases, aesthetics. It must be extracted if there is no benefit to keeping a supernumerary tooth.
  10. Retained Deciduous Teeth: Deciduous teeth that have been retained after exfoliation.
  11. Impacted Teeth: Teeth that have become impacted in the jaw and are causing discomfort to the patient or those discovered accidentally and are commencing specific pathological alterations within the bone.
  12. Tooth extraction in fracture line: Tooth extraction in fracture line has long been contentious. Previously, all teeth in the fracture line were removed, but a more conservative approach is recommended. Teeth in the fracture line should be extracted if they are a source of infection at the fracture site, the tooth is damaged, or their retention in the fracture line may interfere with fracture reduction or healing.
  13. Teeth linked to pathologies: Teeth implicated in cyst formation and linked to other pathologies such as tumors, osteomyelitis, or neoplasms.
  14. Teeth in the radiation firing line: Historically, preventive extractions were performed before radiation therapy. This procedure was carried out due to the consequences of radiation, such as bone vascularity loss and radiation caries, which increased the likelihood of osteoradionecrosis. However, due to technological advancements, it is no longer routinely practiced.

To learn more about the indications, contraindications, steps, armamentarium, and techniques of interalveolar and trans-alveolar extraction, click on the link to check the details of the “Basics of Exodontia” Series of lectures on the docMEP app.

Checkout the details here: https://www.docmep.com/Basic_Endodontics2/Basics_of_Exodontia/91