This young lady presented with this deteriorated (necrotic) asymptomatic (didn’t hurt) lower left second molar. This tooth could have been restored had the patient received appropriate dental care a while back. But for whatever reason (fear, cost, etc.) she put off therapy and now needed the remains extracted. So, other than going to an oral surgeon, how does a general dentist perform this therapy. Well, with experience and continuing education, the general dentist (me) starts by administering the appropriate local anesthetic. Normally, I would utilize septicaine via infiltration adjacent to the tooth. However, since the bone surrounding this second molar is thick, I decided to administer carbocaine 3 % via a mandibular block injection (septicaine is contraindicated for block injections).

When the anesthesia became effective, I utilized bur # 1 to remove the remaining crown portion of the tooth. Then I needed to have good visualization. I administered xylocaine with 1:50,000 epinephrine via local infiltration to obtain homeostasis. This along with working with two good assistants (to provide access and good suctioning) and high powered magnification allowed me to see the two roots. I then utilized bur # 2 to separate the roots and perform minimal bone resection. I needed to reflect a small mini-flap from the buccal-mesial area to gain access to the hidden mesial root. I utilized a root tip elevator to remove both roots . Due to the minimal flap reflection, sutures were not required. The area was compressed with hydrogen peroxide soaked gauze.

Moist gauze was placed over the extraction site and the patient was instructed to keep pressure on this until the bleeding stopped. Post operative directions were reviewed and dispensed along with a supply of gauze. The patient was given two Advil analgesics. A follow up call that night found the young lady doing well with no need for a more potent analgesic. Antibiotics are generally over utilized and most times, not necessary for these cases.