extracted with the operator standing in front of the patient. The removal of primary
teeth with the non-dominant hand is not difficult to master and is a useful skill to
acquire.
The non-working hand
The sections below describe the instruments and technique used by the operator's
working hand. The 'non-working' hand also has important roles to play (1044HFig. 15.21):
- It retracts soft tissues to allow visibility and access.
- It protects the tissues if the instrument slips.
- It provides resistance to the extraction force on the mandible to prevent dislocation.
- It provides 'feel' to the operator during the extraction and gives information about
resistance to removal.
Order of extraction
When performing multiple extractions in all quadrants of the mouth (especially if
under general anaesthesia) the order of extraction is as follows:
- Symptomatic teeth are extracted before 'balancing extractions' on the opposite side.
- Lower teeth are extracted before upper teeth (to eliminate bleeding interfering with
the surgical field). - If there are symptomatic teeth in all quadrants right-handed operators should begin
with lower right extractions. This minimizes the number of changes of position of the
surgeon, which will reduce general anaesthetic time.
UPPER PRIMARY AND PERMANENT ANTERIORS
When these teeth are in a normal position in the dental arch they should be removed
by applying the forceps beaks to the root and then using clockwise and anticlockwise
rotations about the long axis (the action one would employ when using a screwdriver).
In older children some additional buccal expansion may be required for the removal
of the permanent upper canine. When removing primary upper anteriors, upper
primary anterior or upper primary root forceps are used; for the permanent maxillary
anteriors upper straight forceps are employed.
Malpositioned permanent upper anteriors are frequently encountered and
modifications to technique must be employed. Labially placed upper lateral incisors
and canines have very little buccal support and are easily removed, either by using
straight forceps applied mesially and distally and using a slight rotatory movement as
described earlier or by the use of elevators. The most useful elevators under these
circumstances are the straight and curved Warwick James and Couplands. The
straight elevators are applied along the length of the mesial and distal surfaces of the
root and directed in a rotatory manner towards the apex (1045HFig. 15.22). The mesiobuccal
and distobuccal surfaces are used alternately, although in many instances the tooth