Introduction

A common complaint many dental patients experience is persistent pain and discomfort from a decayed tooth. This issue can often lead to the need for surgical extraction, particularly when conservative treatments like fillings or root canals are not viable. In this blog post, we’ll take a closer look at the surgical extraction of the lower left third molar (tooth 38) in a patient experiencing pain, food lodgment, and decay.

Patient Complaint

The patient presented with a complaint of pain in the lower left back tooth (tooth 38) for the past 15 days. The pain was aggravated by food lodgment, which the patient reported as a recurring issue in the affected region. Upon examination, a decayed third molar was observed, and an OPG (Orthopantomogram) radiograph was advised to evaluate the complete position and condition of the tooth.

The radiograph revealed the tooth’s position and extent of decay, confirming the need for extraction due to its poor prognosis and the patient’s symptoms.

Diagnosis

The diagnosis was a severely decayed, horizontally impacted lower left third molar (38). The horizontal positioning of the tooth made it difficult for the patient to maintain proper oral hygiene, which contributed to the pain and food lodgment.

Treatment Plan

Given the state of the tooth, a surgical extraction under local anaesthesia was recommended. The procedure involved several key steps to ensure tooth removal was done safely and efficiently.

Step-by-Step Surgical Extraction of Tooth 38

  1. Preoperative Assessment: Before beginning the procedure, the patient was thoroughly assessed, ensuring no contraindications to local anaesthesia. A sterile environment was prepared, and the patient was positioned comfortably.
  2. Local Anesthesia: Local anaesthesia was administered to the patient to ensure complete numbness of the area surrounding the tooth. This step is crucial for minimizing discomfort during the procedure. The anaesthesia was injected around the inferior alveolar nerve, the buccal nerve, and the lingual nerve, ensuring that the entire area was adequately numbed.
  3. Incision: Once anaesthesia took effect, a careful incision was made along the buccal (outer) aspect of the tooth to expose the underlying bone and tooth. The incision was planned to minimize tissue trauma and facilitate optimal access for tooth removal.
  4. Bone Guttering: Bone guttering was performed on the buccal and distal aspects of the tooth. Bone guttering refers to the removal of small amounts of bone around the tooth to allow for better access and to reduce the risk of damaging surrounding tissues. This step was necessary due to the tooth’s horizontal positioning, which required additional bone removal to ease its extraction.
  5. Tooth Luxation: Using specialized dental luxators, the tooth was luxated (loosened) from its socket. Luxators are designed to gently separate the tooth from the surrounding bone and periodontal ligament. This process requires careful handling to avoid fracture of the surrounding bone.
  6. Extraction: After loosening, the tooth was successfully removed. Given the tooth’s difficult position, the extraction required careful manipulation to ensure it was removed without causing unnecessary damage to the adjacent structures.
  7. Irrigation: After the tooth was removed, the surgical site was thoroughly irrigated with sterile saline. This step is important for removing any debris, blood clots, and bacteria from the extraction site, reducing the risk of infection.
  8. Suturing: Once the site was cleaned, the incision was closed using resorbable sutures. Suturing is necessary to promote healing by closing the wound and minimizing the risk of infection or complications. In this case, a simple interrupted suture technique was used to secure the tissue.

Postoperative Care and Instructions

After the surgical procedure, the patient was given specific postoperative care instructions to ensure a smooth recovery:

  • Pain Management: Over-the-counter pain medications were prescribed to manage any discomfort following the surgery.
  • Antibiotics: Antibiotics were prescribed to prevent any potential infections.
  • Swelling Management: The patient was advised to apply ice packs to the affected area in intervals to help reduce swelling during the first 48 hours after surgery.
  • Oral Hygiene: The patient was instructed on proper oral hygiene techniques, avoiding the surgical site, and rinsing gently with warm salt water after 24 hours to reduce the risk of infection.
  • Follow-up: A follow-up appointment was scheduled in a week to remove the sutures (if non-resorbable) and ensure proper healing.

Conclusion

Surgical extraction of a decayed and horizontally impacted tooth like tooth 38 requires a detailed and careful approach to ensure a successful outcome. By performing the procedure step-by-step starting with local anaesthesia and ending with suturing the surgical site we can effectively alleviate the patient’s symptoms and ensure proper healing.

Although the extraction procedure may sound complicated, with modern techniques and proper planning, it is a routine part of dental practice that provides significant relief to patients suffering from tooth pain and food lodgment. As always, the key to a successful recovery lies in the patient’s adherence to postoperative care instructions and regular follow-up visits with their dentist.

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