Thoughts in exo clinic

So the other day I was rostered in the extraction clinic, my first one of this for the year which means it was the first time extracting teeth other than perio teeth for about 3 months. Below are some thoughts that I had during the day:

- I probably broke the roots on about 3 teeth that day and I felt no panic or at least a lot less than if the same thing had happened fresh out of uni. Successful exodontia doesn't involve having straight forward procedures all day every day but requires the skills and knowledge to manage complications and surprises as they come. I dug these roots out with different methods: elevation, root picks and endo files. Some advice I would give to a fresher grad is that you will break plenty of roots, don't be surprised when it happens.  If something happens that you don't expect, step back, take a deep breath and plan out what you will do next.
-Most of the appointment is talking, the fastest part is often the extraction itself. 10 minutes of talking i.e consent, 10 minutes of local anaesthesia then the actual procedure, 20 minutes of suturing, haemostasis, post operative instrumetions and rebooking.
-Preplanning is very important in dentistry. This is significantly important in exodontia as you want to know the medical history, indications, risks and possible complications before you start. The risks are higher in extrations so the planning must be of a higher quality to compensate.
-Extractions are based on simple mechanics. Find out which direction the tooth wants to come out and apply pressure in that direction. When you apply force, the aim is to expand the bone, severe the PDL attachment and move the tooth in the direction you want it to. Elevation applies force in one direction and forceps apply multi-directional force. When force is applied, the force can be transmitted to the PDL, bone, surrounding teeth. Outcomes can either be extraction of the tooth or something breaking i.e tooth or bone. If the force applied is going to be excessive to the tooth or bone and there is risk of fracture, you must perform procedures to make the force required for extraction less i.e sectioning, bone removal or tooth removal.
-Many dentists find fear in extractions as they can be perceived as unpredictable but patients experience this fear too; the fear of pain and the unknown. Our patient management skills need to be high for these appointments to be successful and we need enough time in the appointment to do this.
-I have always seen extractions as something that is brutal and unrefined and therefore haven't enjoyed them in the past but I have seen how extractions can be done well and aren't a matter of applying brute force.
-The only situation where the method in which you remove a tooth doesn't matter is if you didn't care if the patient survived or not afterwards. In reality, everything matters from start to finish i.e diagnosis, treatment planning, consent, local anaesthesia, sectioning, luxation, elevation, forcep removal, suturing, post op and review. The patient may not want an implant at the moment but this may change in the future. besides, dentures rely on good height and shape of ridge for stability so implants shouldn't be your only consideration. Traumatic extractions can damage the surrounding teeth and interproximal bone as well as increase post operative pain and swelling and delay healing.