10 steps to successful tooth extraction

Dental extractions are considered an everyday procedure in veterinary dentistry, but they should not be taken lightly! The reasons, why the tooth needs to be removed, are several.

Dental extraction is a surgical procedure associated with several possible complications. Before attempting a dental extraction, a diagnosis (based on clinical examination and dental radiographs) should be made, the right set of equipment and materials ready, and the surgeon equipped with skills. Moreover, dental extractions require patience and time!

1. Rinse the oral cavity with an antiseptic

Rinsing the oral cavity with an antiseptic before any procedure will reduce the bacterial load in the mouth, and therefore reduce the bacteremia (amount of bacteria pushed in the bloodstream during the procedure), as well as in the aerosol.

2. Perform charting on a tooth-by-tooth-basis and obtain (full-mouth) dental radiographs

We cannot emphasize enough the importance of a detailed oral examination and dental radiographs in establishing the correct diagnosis and treatment plan.

3. Perform local nerve blocks as indicated

Local nerve blocks will help reduce the sensation of pain and will therefore help in decreasing the amount of general anaesthetic needed as well as reduce the need for post-operative analgesics.

4. Perform periodontal treatment

Just as a cat spay without shaving and preparing the skin before the procedure would never be performed, the same goes for oral surgery in a grossly contaminated oral cavity. Besides, some teeth may require just basic periodontal therapy to return to health.

5. Cover surgical field and get on sterile surgical gloves

Dental extraction is a surgical procedure and as such should be performed using an aseptic technique to reduce the risk of wound infection. Covering the surgical field will also help with focus, protect the animal’s eyes and keep hair and dirt out of the surgical field.

6. Open a gingival or mucoperiosteal flap as indicated

Local flap is created when performing surgical extraction to allow access to the underlying bone and tooth root(s). The flap needs to be designed appropriately, which requires knowledge of the local anatomy not to compromise adjacent vital structures. Several types of flaps can be created, but all should be full-thickness flaps. I am a big user of triangle flaps.

7. Section multirooted teeth and perform alveolotomy as indicated

After reflection of the flap, alveolotomy (partial removal of the alveolar bone to gain access to the tooth roots) is performed with a bur on a high-speed handpiece with coolant. Multi-rooted teeth must then be sectioned through the furcation(s) to separate the roots.

8. Elevate and/or luxate the root until ready to remove with extraction forceps

Roots are then luxated and/or elevated with appropriate and sharp instruments, which severe the periodontal ligament (tooth attachment to the bone) and enable removal of the root(s). The tooth/root is delivered with extraction forceps only once it is very mobile. It’s not pulling teeth…

9. Obtain post-operative dental radiographs to confirm complete removal of roots

One of the most common complications during tooth extraction is root fracture. Make sure the alveolus (tooth socket) is empty, clean and filled with a healthy blood clot before suturing the wound otherwise the extraction of the tooth is not completed!

10. Suture the flap

Perform alveoloplasty (smoothen any sharp bony edges) and suture the wound edges. Fine suture material (5-0, monofilament, absorbable) and no tension!

If you have noted any problems with your animal, please consult your veterinarian.

Selected references
1. Lommer MJ (2012). Complications of extractions. In: Verstraete FJM, Lommer M, eds. Oral and maxillofacial surgery in dogs and cats. Saunders Elsevier, Edinburgh: 153-159.
2. Lommer MJ (2012). Principles of exodontics. In: Verstraete FJM, Lommer M, eds. Oral and maxillofacial surgery in dogs and cats. Saunders Elsevier, Edinburgh: 97-114.
3. Lommer MJ (2012). Special considerations in feline exodontics. In: Verstraete FJM, Lommer M, eds. Oral and maxillofacial surgery in dogs and cats. Saunders Elsevier, Edinburgh: 141-152.
4. Lommer MJ, Tsugawa AJ, Verstraete FJM (2012). Extraction of multirooted teeth in dogs. In: Verstraete FJM, Lommer M, eds. Oral and maxillofacial surgery in dogs and cats. Saunders Elsevier, Edinburgh: 131-139.
5. Lommer MJ, Verstraete FJM (2012). Simple extraction of single-rooted teeth. In: Verstraete FJM, Lommer M, eds. Oral and maxillofacial surgery in dogs and cats. Saunders Elsevier, Edinburgh: 115-120.
6. Moore JI, Niemiec B (2014). Evaluation of extraction sites for evidence of retained tooth roots and periapical pathology. J Am Anim Hosp Assoc 50(2):77-82.
7. Terpak CH, Verstraete FJM (2012). Instrumentation, patient positioning and aseptic technique. In: Verstraete FJM, Lommer M, eds. Oral and maxillofacial surgery in dogs and cats. Saunders Elsevier, Edinburgh: 55-68.
8. Tsugawa AJ, Lommer MJ, Verstraete FJM (2012). Extraction of canine teeth in dogs. In: Verstraete FJM, Lommer M, eds. Oral and maxillofacial surgery in dogs and cats. Saunders Elsevier, Edinburgh: 121-129.
9. Tsugawa AJ, Verstraete FJM (2012). Suture materials and biomaterials In: Verstraete FJM, Lommer M, eds. Oral and maxillofacial surgery in dogs and cats. Saunders Elsevier, Edinburgh: 69-78.