antiseptic mouthwash. The problem of self-inflicted trauma in anaesthetized areas is
stressed at this stage.
PAIN RELIEF
Simple analgesics are usually required, but aspirin must be avoided in those under 12
years of age due to its association with Reye's syndrome. Paracetamol elixir (120
mg/5 ml four times daily for those under 6 years of age; 250 mg/5 ml four times daily
for children aged 6-12 years) is ideal. The patient is given a review appointment but
should return sooner if there are any problems with bleeding, excessive pain, or
swelling. A telephone number for contact in an emergency must be provided.
REVIEW
The patient should be reviewed 1 week after surgery, at which stage resorbable
sutures may have disappeared. The surgical site should be examined for undue
swelling, the area of local anaesthesia examined for evidence of self-inflicted trauma,
and the patient questioned about any residual altered sensation.
It is often necessary to reinforce good oral hygiene at this stage.
POSTEXTRACTION PROBLEMS
Fortunately, postextraction problems are rare in children. Dry socket does not seem to
occur after the removal of primary teeth but it can affect older children following
permanent molar extractions, although the incidence is not as great as in adults. Local
measures such as irrigation and dressing with a sedative pack, plus the prescription of
an analgesic are sufficient. Postoperative haemorrhage is an occasional problem with
children and can be impressive following multiple extractions under general
anaesthesia. Usually pressure applied with gauze or a handkerchief is effective. If not,
sutures with or without haemostatic gauze must be used. Severe blood loss is very
rare, but if this occurs it is important to exclude a systemic cause to ensure subsequent
treatment can be performed safely.
1048H
Fig. 15.21 The non-working
hand supports the tooth for
extraction and reflects the soft
tissues.