Oral extractions in the field: when and how

Oral extractions is a procedure that follows several steps, nevertheless, always is important to ensure good anatomy and pathology knowledge, as well as managing different techniques for a good case selection and succes rate.

In this lecture we will review decisión making for extractions in the field, as well as common indications, complications and techniques.

One of the most common causes for dental extraction is apical infection (62%) that can be produced in maxilary teeth by anachoresis (51%), infundibular caries, periodontal spread, displastic teeth, fracture and pulp exposure. Even if there is a incisor, canine or cheek teeth involved it needs to be confirmed by radiology. Clinically in pulpitis we can observed under mirror or endoscope pulpar exposures of different levels from small changes in secondary dentin until food trapped inside. Fractures can be classified if they compromised or not sensitive tissue, and must be carefully assesed. Periodontal disease also is well known like a possible extraction indication in advanced cases not responding to conservative therapies.

Intraoral technique has an outcome around 80%, and for a good procedure will be likely to have a good amount of clinical crown. Complications are reported from 6-20%. So case selection for extraction at the field is very sensitive especially in cheek teeth. If the CT doesnt have a good clinical crown could be a good reason for referral, because it will need advanced extraction procedures and post-operative cares. Nevertheles (in this autor opinión) most of the incisor and canines extractions can be performed at the field with minimal complications.

The most common complication are alveolar sequestration, retention of fragments, damage to adjacent teeth, damage to mandibular/maxilary nerves or parotid duct, chronic sinusitis and oro-antral fistular among others.

Post alveolar manage is a very crucial step and also should be take in consideration for procedures at the field, specially with preexisting complications, location of the horse, and kind of technique used. For a standard procedure should be necessary at least 2 examinations every 10-15 days for ensure good granulation and alveolar care, including lavage, packing change and/or curetagge if needed.