My name is Lily Robson, and I am a final year BSc Dental Hygiene and Therapy student at the University of Liverpool. One key moment of my training was the first time I extracted a primary tooth from a child, as it was an eventful day!

The Scene

This session was an inhalation-sedation clinic for paediatric patients who were pre-cooperative and required care. We provide them with “happy air” to help them relax, allowing us to perform the required procedures.

Going into the session, I was already slightly nervous, as unlike usual clinics where you are with multiple members of your year, this time it was just me, a paediatric specialist as my tutor, and a qualified dental nurse in a single room. So, the pressure to perform was already mounting!

Although feeling apprehensive, I was also excited and eager to undertake my first extraction on a primary molar. Especially since the child would be a lot calmer and receptive to treatment because of the gas. However, when the patient arrived, this was not the case. The child claimed he did not want sedation, instead opting to undergo the extraction without.

So, with the patient sat back in the chair, Dad sat next to them holding the young child’s hand, my tutor and nurse next to me ready to guide me, I was prepared to give the local anaesthetic, thinking, actually, this might go a lot smoother than I was expecting. Especially considering the patient hadn’t had any gas to relax them. However, as the needle started to get closer, the patient reared away and refused to proceed with the treatment.

This interaction initiated a 45-minute long back-and-forth between the patient, their father and us, trying to persuade them to accept this much-needed treatment. It was challenging and required the use of many persuasive techniques, whilst also maintaining an empathetic approach.

As the exchange went on, I felt my confidence growing. Repeatedly talking through the procedure with the child helped put me at ease. Finally, the patient accepted the local anaesthetic from my tutor, and so the start of the extraction could begin.

With anticipation, I went in, positioned myself correctly to provide stability, and started loosening the tooth. At each second, I was constantly asking myself, “Am I doing this correctly?”, “Is this the right angle?”, all whilst the patient is starting to become distressed, and is nearly biting me. But, with my tutor’s guidance, I proceeded.

And just as quickly as we started, with the forceps in my hands and a firm grip on the tooth, I removed it all in one go!

The outcome

I felt relieved, but also proud of myself for persisting with the treatment, despite my mounting nerves. The patient, however, was crying and being comforted by his father, and I had deep sympathy for him. Having a tooth extracted is unpleasant at any age, let alone as a young child.

Reflecting on this experience has taught me that being quick yet efficient is key, especially in children’s cases, to minimise discomfort. Going forward, it gave me an understanding of what to anticipate in the future, whether that be regarding instrument handling, correct pressure and techniques, or handling patient responses.

Advice for the future?

To anyone approaching their first time, although you may be nervous, be prepared, remain calm and collected, don’t be afraid to ask for help, and expect to possibly be met with a few tears!

Remember, at the end of the day, you’re helping to improve the oral health of a child, and that’s an incredibly rewarding experience to be part of!

Member spotlight: My first paediatric extraction

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