Problems peculiar to the child patient
A number of problems peculiar to the child patient will affect the way in which
extractions are carried out. The following should be considered:
(1) natal and neonatal teeth;
(2) infraocclusion of teeth;
(3) fusion/gemination of two teeth;
(4) damage to the permanent successor;
(5) dislocation of the mandible.
NATAL AND NEONATAL TEETH
Most neonatal teeth (85%) are found in the mandible. About 5% of these are
supernumeraries. Their management is discussed in 1042HChapter 13.
INFRAOCCLUSION
Surgical division is sometimes necessary to remove these teeth (1043HChapter 13).
FUSION/GEMINATION (CONNATION)
Such teeth may not lend themselves to forceps extraction due to their unusual coronal
shape. Elevators are usually employed, with or without tooth division and bone
removal, to effect extraction.
DAMAGE TO PERMANENT SUCCESSOR
This may occur if forceps with large beaks are used or during root elevation.
DISLOCATION OF THE MANDIBLE
It is very easy to dislocate a child's mandible during extractions under general
anaesthesia (when the muscles are relaxed) unless adequate support is provided by the
'non-working' hand. This is because the articular eminence is not as pronounced in
young patients as in adults. It is essential to verify that dislocation has not occurred
before the patient is allowed to regain consciousness.
15.5.2 Extraction techniques
PATIENT POSITION
The child should be seated in a dental chair reclined about 30° to the vertical for
extractions under local anaesthesia. Under general anaesthesia the patient is usually
supine. When removing upper teeth under local anaesthesia the operator stands in
front of the patient, with a straight back and the patient's mouth at a level just below
the operator's shoulder. A right-handed operator removes lower left teeth from a
similar position in front of the patient, except that the patient's mouth is at a height
just below the operator's elbow. When removing teeth from the lower right the right-
handed operator stands behind the patient with the chair as low as possible to allow
good vision. When performing extractions in the supine patient under general
anaesthesia the patient's mouth is usually at a level just below the operator's elbow.
Once again, lower right teeth are removed from behind, with all others being
extracted by the operator standing in front of the patient. It does save time during
general anaesthesia if teeth can be removed ambidextrously as all teeth can be