92 F. D. Fragiskos

Fig. 5.42 a, b. Removal of the root tip using an endodontic file. After the endodontic file enters the root canal, the root tip is drawn upwards by hand (a), or with a needle holder (b)

Fig. 5.43. Curettage of the socket after tooth extraction for removal of the periapical lesion

Fig. 5.44. Root, together with firmly attached lesion at tip of root, right after extraction

5.6

Postextraction Care of Tooth Socket

After extraction of the tooth, the bottom of the socket is curetted (as long as the tooth is nonvital) with a periapical curette, to remove any periapical lesion from the area (Fig. 5.43). Curetting must be done carefully, because if any remnants of granulation tissue remain in the socket, there is a chance they will develop into a cyst, because a large percentage contain epithelial cells. Sometimes the lesion is firmly attached to the root tip of the tooth and is extracted together with the tooth (Fig. 5.44). Even in this case, the socket must be inspected, but only in the apical region. When the lesion is large and the entire lesion cannot be removed through the socket alone, then surgery is required.

Afterwards, and only if considered necessary (e.g., there are sharp bone edges), the alveolar margin is smoothed using rongeur forceps or a bone file, and then the lingual and buccal plates are compressed using finger pressure. This is done to restore the expansion of the socket caused by the extraction, and also for initial control of hemorrhage. Hemostasis is also aided by the patient applying pressure on gauze placed over the socket for 30–45 min.

5.7

Postoperative Instructions

After finishing the surgical procedure, oral and written instructions are given to the patient, concerning exactly what to do in the next few days. These instructions normally include the following:

Chapter 5 Simple Tooth Extraction

93

ΟRest: After surgery, the patient should stay at home and not go to work for 1 or 2 days, depending on the extent of the surgical wound and the patient’s physical condition.

ΟAnalgesia: Take a painkiller (but not salicylates, aspirin), every 4 h, for as long as the pain persists.

ΟEdema: After the surgical procedure, the extraoral placement of cold compresses (ice pack wrapped in a towel) over the surgical area is recommended.

This should last for 10–15 min at a time, and be repeated every half hour, for at least 4–6 h.

ΟBleeding: The patient must bite firmly on gauze placed over the wound for 30–45 min. In case bleeding continues, another gauze is placed over the wound for a further hour.

ΟAntibiotics: These are prescribed only if the patient has certain medical conditions or inflammation (see Chaps. 1 and 16).

ΟDiet: The patient’s diet on the day of the surgical procedure must consist of cold, liquid foods (pudding, yogurt, milk, cold soup, orange juice, etc.).

ΟOral hygiene: Rinsing the mouth is not allowed for the first 24 h. After this, the mouth may be rinsed with warm chamomile or salt water, three times a day for 3–4 days. The teeth should be brushed with a toothbrush and flossed, but the patient should avoid the area of surgery.

ΟRemoval of sutures: If sutures were placed on the wound, the patient must have them removed a week later.

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