Indication and Contraindication of Tooth Extraction
EXODONTIA
Ideal Tooth Extraction: Painless tooth removal of its Socket with minimum trauma to surrounding tissue (Bone & soft tissue), insuring healing without or minimum delayed complication.
Indications of Teeth Extraction:
- Severe Caries and/or much worn or abrasion: that can’t be treated.
- Severe Periodontal Disease: Excessive bone loss affecting ½ of roots or bifurcation, irreversible tooth mobility “Grade III”, advanced periodontitis with sever, deep pockets and periodontal abscess. that can’t be treated.
- Teeth Involved with Pulpal Pathology (Pulpal Necrosis): that not approachable to endodontic treatment.
- Teeth Involved with Apical Pathology (Teeth Associated with Pathologic Lesions): periapical granuloma, periapical abcess, periapical radicular cyst, and tooth not response to endo or endo-surgery treatment.
- Teeth Involved in Jaw Fractures (Teeth in the Fracture Line): interfere with fracture reduction or become infected.
- Pre-Prosthetic Extractions
- Pre-Radiation Therapy
- Orthodontic Reasons
- Malopposed Teeth
- Impacted Teeth
- Cracked Teeth
- Supernumerary Teeth: are usually impacted and should be removed. May interfere with eruption of succedaneous teeth and has the potential for causing their resorption and displacement.
- Economics (Financial Issues)
Contraindications of Teeth Extraction:
The contraindications are divided into two groups: (1) systemic (2) local.
A. Systemic Contraindications:
1. Cardiac Diseases (coronary heart diseases):
* Patients with any of a variety of severe uncontrolled cardiac diseases should also have their extractions deferred until the disease can be brought under control.
* Patients who have had a recent myocardial infarction.
2. Severe myocardial ischemia, such as unstable angina pectoris.
3. Severe, uncontrolled cardiac dysrhythmias.
– Uncontrolled Hypertension: Patients who have malignant hypertension should delay extractions because persistent bleeding, acute myocardial insufficiency, and cerebrovascular accidents are more likely to occur as a result of stress caused by the extraction.
– Uncontrolled Diabetes: increases the risk of infection in the wound and spreading in the surrounding tissue.
4. Pregnancy: Relative contraindication. Second (Middle) trimester is the safest. (3rd )(supine hypotension, venacava syndrome).
5. Toxic Goitre (Thyroid Storm) (Thyroid Crisis) (Thyrotoxic Crisis): Acute Life-threating complication of hyperthyroidism when thyroid gland release a large amount of thyroid hormone in a short amount of time due surgical trauma and excessive stress causing Heart Failure.
6. Patients on Steroid Therapy or (Addison’s Disease): condition where the adrenal glands do not produce enough cortisol): A physician’s opinion must be taken. Otherwise, the normal precaution would be to safely double the dose of steroid, one or two days prior to extraction and to continue one or two days postoperatively. Then, the dose must be tapered gradually to the usual dose. Otherwise, the patient is liable to exhibit adrenal crisis due to stress.
7. Blood Dyscrasias (Disorders):
A. Anemia: Extreme care is needed to avoid significant drop in bold count.
B. Leukemia: The potential complications are infection as a result of nonfunctioning white cells and excessive bleeding as a result of an inadequate number of platelets.
C. Hemorrhagic Purpura: There is low Platelet levels or dysfunction, increase the risk of prolonged bleeding, hematoma formation and infection at extraction site.
D. Hemophilia: may lead to uncontrolled bleeding and potentially life threating bleeding.
B. Local Contraindications
1. ACTIVE INFECTIONS:
– Acute gingival infection (ANUG).
– Acute Maxillary Sinusitis.
– Acute Periapical Abscess or Cellulitis.
– Acute Pericoronitis.
2. Patients Receiving Bisphosphonates.
3. Teeth located within an area of malignant tumor: it could potentially disseminate cells and accelerate metastatic process.
4. Extraction of Teeth in recently Irradiated Patients: increase risk of Osteoradionecrosis “Bone death due to radiation”, extraction lead to bone damage, poor healing, or necrosis.