15.5 ORAL SURGERY
15.5.0 Introduction
This section deals with dental extractions and minor oral surgical procedures for
children. The procedures described are those that can be performed under local
anaesthesia with or without sedation (normally inhalational) or day-stay general
anaesthesia in healthy children. Oral surgery procedures that require in-patient
facilities, other than the treatment of severe infection, will not be considered in this
text.
15.5.1 Exodontia
Differences between primary and permanent teeth
- Size. Primary teeth are smaller in every dimension compared with their permanent
counterparts. Although the roots of primary teeth are smaller than those of the
permanent dentition they do form a proportionately greater part of the tooth. - Shape. The crowns of primary teeth are more bulbous than the crowns of
permanent teeth. The roots of primary molars are more splayed than the roots of
permanent molar teeth. The furcation of primary molar roots is positioned more
cervically than in the corresponding permanent teeth. - Physiology. The roots of primary teeth resorb naturally, whereas in the permanent
dentition resorption is normally a sign of pathology. - Support. The bone of the alveolus is much more elastic in the younger patient.
These differences mean that there are some modifications to extraction techniques in
children. The types of forceps employed for the removal of primary teeth differ from
that used for the removal of permanent teeth. The beaks and handles are smaller. In
addition, to accommodate the more bulbous crown, the beaks are more curved in
forceps designed for the removal of primary teeth.
The wide splaying of primary molar roots means that more expansion of the socket is
required for the extraction of primary teeth. The more elastic alveolus of the younger
patient allows this to be achieved.
Due to the relatively cervical position of the bifurcation in primary molars it is
injudicious to use forceps with deeply plunging beaks (such as the adult cowhorn
design) as these could damage the underlying permanent successors. This is especially
so with the lower primary molars.
As primary roots are resorbed it is often preferable to leave small fragments in situ if
the root fractures. When part of a fractured root is visible then it should be removed.
Blind investigation of primary sockets should not be performed as there is a danger of
damaging the underlying permanent successor. Similarly, blind investigation of the
distal root socket of first permanent molar teeth must not be carried out in children
with unerupted second molars, as unintentional elevation of the second molar can
occur.