What should be taken into consideration when extracting impacted teeth in pediatric patients?
It is not always possible to complete dental treatments under clinical conditions by overcoming children’s prejudices and fears, and in patients where surgical procedures such as impacted tooth extractions need to be planned, it becomes much more difficult for the child patient to comply with the treatment.
Problems or some diseases during the period when teeth develop in the bone can cause deficiency or excess in the number of teeth. Teeth called ‘supernumerary teeth’, which are formed as an extra tooth outside the normal tooth row, can be seen in both the milk tooth row and the permanent tooth row. Stating that the first time they meet with pediatric patients is usually due to toothache, Pediatric Dentist Nurgül Demir reminded that most of the patients were reluctant due to the anxiety of the toothache they experienced and worried about the stories they heard from their friends. Dt. Demir stated that most patients come to the clinic with fear caused by previous dental treatment appointments. Nurgül Demir added that for this reason, the most appropriate treatment method is anesthesia.
Noting that the so-called “supernumerary teeth” are mostly formed in the upper incisor area, Pediatric Dt. Nurgül Demir said, “These extra teeth, which we can see as erupted next to the incisors in the mouth, may continue to develop within the bone and may remain buried. For supernumerary teeth, which we often see in pediatric patients; the dental films we take during routine dental checks or the first examination of our patients who apply to our clinics due to complaints such as toothache, tooth fractures caused by trauma, and tooth discoloration are diagnostic. Most of the time, we detect the presence of supernumerary teeth through clinical examination or radiological evaluation in our patients who apply for a different complaint.”
It is important not to be late in treatment
“Extra teeth that continue to develop within the bone; It may cause gaps in the permanent tooth row, position and eruption disorders, and delays in tooth eruption; over time, it may cause cyst formation in the area, damage to adjacent tooth tissues, pain and swelling,” warns Nurgül Demir. “As a result of the complete examination of the pediatric dentist and detailed evaluation of the dental film, the supernumerary tooth planned to be extracted; it should be taken at the ideal time, with a correct treatment plan and by an ‘oral, dental and maxillofacial surgeon’ who has experience in surgical procedures in pediatric patients. After the procedure, it is very important for the patient to follow up the tooth eruption and alignment with regular checks and periodic films. Early diagnosis and treatment of impacted supernumerary teeth is very important in terms of preventing tooth gaps that may occur in the future, tooth eruption delays, tooth alignment disorders, cystic problems, regional infections and damage to healthy tooth tissues in the immediate neighbourhood.”
Answering the question, How is the Decision Made on General Anesthesia in Supernumerary Tooth Extraction? Nurgül Demir listed the factors as follows;
-In cases where the level of fear and anxiety is very high in the presence of dentist phobia or uncontrollable nausea reflex.
-In special cases caused by some systemic diseases that prevent our patient from complying with the procedures performed in the chair, and in our patients with special needs.
-For our pediatric patients who can tolerate limited time and certain procedures in the dentist’s chair, we need to plan impacted tooth extractions mostly while they are asleep.
-Taking into account the patient’s age, general health condition, dental treatments to be performed and planned treatment duration; treatment should be performed according to the guidelines of the American Association of Pediatric Dentists.
-Planning is made with the anesthesiologist for the procedure planned to be performed under general anesthesia under operating room conditions.
-The medical history of every patient for whom treatment planning will be done under anesthesia should be questioned first. If there is any health problem that is being monitored, the anesthesia decision should be made in consultation with the relevant medical doctor.