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Minor Oral Surgery in Children

Introduction

The mouth, also referred to as the oral cavity, is the first part of our digestive system. It receives food, mixes it with saliva and begins the process of digestion here. The oral cavity includes the teeth, tongue and saliva secreted from salivary glands.

In order to learn more about Minor Oral surgery in Children, it is necessary to understand the normal anatomy of the oral cavity.

Normal Anatomy

Oral cavity consists of the following structures:

• Lips and cheeks: These structures form the boundaries of the oral cavity.

• Palate: This is the roof of the oral cavity and is made up of a hard palate and soft palate.

• Tongue: It helps in manipulating food to form a bolus and is used in speech. The tongue surface is covered with papillae which contains taste buds.

• Labial Frenum: This is a fold of tissue seen in the center of the upper and lower lip. It attaches the lips to the gums.

• Lingual Frenum: This is a thin strip of tissue that runs from the floor of the mouth to the undersurface of the tongue.

• Salivary glands: These glands produce saliva which contains enzymes that digest carbohydrates. Saliva also moistens the food and lubricates the mouth.

• Teeth: There are 20 teeth in children. The tooth structure is made up of:

 Crown: The visible part of the tooth projecting above the gums is the crown.

 Root: It is that part of the tooth that is embedded inside the jawbone.

 Enamel: The hardest outermost part of teeth is the enamel. It is white in color and is made of calcium hydroxyapatite.

 Dentin: It lies below both the enamel and cementum layer of tooth and is softer than enamel.

 Cementum: This layer contains very small fibers called periodontal ligament fibers which help in anchoring the teeth to the bone.

 Gingiva: This is the gums and is the part of the oral cavity that covers the root portion of all the teeth.

What is minor oral surgery?

Minor oral surgery consists of oral surgical procedures of short duration which are carried out under local anesthesia.

Many of the oral surgical procedures in children are similar to that in adults since the basic principles are no different.

Types of Minor Oral Surgery

The minor oral surgical procedures undertaken in children are:

• Extraction of primary teeth

• Frenectomy

• Treatment of infections

Extraction of Primary teeth (baby teeth):

This is the removal of the whole tooth or its root, with as less injury as possible. It is done with the help of small forceps that are specially designed for the small mouth. Anesthesia is given so the child feels no pain during the procedure.

Frenectomy:

This is a procedure which involves the removal of the tissue fold that connects the lips or tongue to the jawbone. There are two primary locations in the mouth where the frenum is found — under the tongue and underneath the center of the upper lip. Sometimes the frenum is attached too high on the gums, causing space between the two upper front teeth. Or the frenum is attached too close to the tip of the tongue. In either case, a frenectomy is performed surgically to prevent interference in mouth development.

Treatment of infections:

Dental infections such as acute dental abscess, chronic dental abscess and chronic apical periodontitis may require minor oral surgery. Your oral surgeon makes an incision over the infected tissue and drains the pus.

Extraction-Indications:

The conditions in which the baby teeth need to be removed are:

• Decayed teeth which cannot be restored

• Severe gum disease

• Abscessed tooth

• Retained baby teeth

• Fractured teeth which cannot be repaired

Extraction –Contraindications:

The baby teeth should not be removed if the child is having:

• Acute stomatitis

• Acute necrotizing ulcerative gingivitis

• Bleeding disorders

• Patients on anticoagulant therapy

Frenectomy-Indications:

A Frenectomy may be indicated in the following situations:

• Gum inflammation that persists even after root planning and good oral hygiene measures

• An area of gum recession that is progressive

• Midline diastema (gap) that is present even after the permanent canines have erupted

• Ankyloglossia (tongue tied)

Extraction technique

Extraction of Upper front teeth (incisors):

The upper incisor teeth have single, conical roots. Therefore, rotational movement is used to remove these teeth.

• After adequate local anesthesia is obtained, the soft tissue attachment of the tooth is separated with a periosteal elevator.

• The tooth to be removed is gripped firmly with the forceps.

• Rotational movements are given to extract the tooth.

Extraction of Upper Molar teeth:

• After local anesthesia and soft tissue separation is done, the tooth is gripped with a universal maxillary forceps.

• First, a palatal movement is given followed by slow buccal and palatal motion.

Extraction of Lower front Teeth(incisors)

• These teeth have single roots, so rotational movements are used to remove them.

Extraction of Lower Molar teeth

• When extracting lower molar teeth, the lower jaw is supported to prevent injury to the TMJ.

• The tooth is gripped firmly with lower molar forceps, and alternate buccal and lingual movements are used to remove the teeth.

Post-operative care:

 The child is told to bite down firmly on the gauze-pad placed over the extraction socket.

 The child is told about the anesthetic effect that will persist for an hour or so and also advised not to bite on that area.

 Medications are prescribed to relieve pain.

Labial Frenectomy

Technique:

The abnormal maxillary frenum can be treated by frenectomy procedure which includes the following steps:

1. A field block anesthesia is given.

2. The frenum is engaged with a hemostat.

3. The frenum is incised along the upper and lower surface of the hemostat and the triangular portion of tissue is removed.

4. Bleeding is controlled with gauze sponge and the area is covered with a periodontal pack.

5. The pack is removed after two weeks and healing occurs.

 The frenum is incised along the upper and lower surface of the hemostat and the triangular portion

 The abnormal maxillary frenum can be treated by frenectomy, it includes:

Lingual Frenectomy

Technique:

• A transverse incision is made between the undersurface of the tongue and floor of the mouth, and the tissue is removed.

• The wound is closed with sutures.

Post-operative care

 Your surgeon will advise you on analgesic medicines to relieve pain.

 You should gargle with warm saline or mouthwash to maintain good oral hygiene.

Treatment of infections

Acute dental abscess:

All acute infections require immediate treatment, observation and follow up for the condition to resolve.

• The abscess is incised and drained to relieve pressure.

• The tooth from which the infection is caused is treated endodontically in the subsequent visits.

• Plenty of fluids and analgesics are advised.

Chronic dental abscess:

In case of neglected pulp disease in primary teeth, chronic dental abscess may result.

There are two options to treat this:

• The teeth may be saved by draining the pus through the root canal.

• Extraction of the diseased tooth and prescribing antibiotics.

Although every effort is made to educate you on Minor Oral Surgery in children, there will be specific information that will not be discussed. Talk to your Dentist or Pedodontist about any concerns you have about Minor Oral Surgery in children.

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