Dental Forceps

Part of Dentistry

Design, improvisation, and use of dental forceps for tooth extraction — the primary instrument of surgical dentistry in low-resource settings.

Why This Matters

Dental forceps are the fundamental extraction instrument. Unlike elevators, which loosen teeth by prying at the socket, forceps grip the tooth and control its removal through specific movements that expand the bony socket and deliver the tooth without fracturing the root or injuring surrounding structures.

In a world with limited dental equipment, understanding forceps design allows fabrication of functional instruments from available metal, and understanding use allows safe extractions that would otherwise be attempted with inadequate tools, causing avoidable complications.

A well-designed and properly used pair of dental forceps is safe, predictable, and relatively fast. Improvised techniques using non-dental instruments — pliers, general-purpose gripping tools — are far more likely to cause root fracture, soft tissue damage, and prolonged procedures with increased infection risk.

Anatomy of Dental Forceps

All dental forceps share the same fundamental anatomy:

Handles: Two parallel handles that the operator grips. Design allows palm-grip (squeeze from sides) or finger-grip depending on the specific forceps type.

Hinge (joint): Connects the two arms; allows the beaks to open and close.

Beaks (blades): The working ends that grip the tooth. Beak design varies dramatically by tooth type and arch position.

Beak Design by Tooth Type

Upper straight forceps (No. 1 pattern): Straight handles and beaks, for upper anterior teeth (incisors, canines). Beaks are narrow, pointed, and parallel.

Upper molar forceps: Beaks angulated upward to reach back of mouth; one beak has a pointed projection to fit into the furcation (fork between roots) of upper molars — this “cowhorn” design distinguishes upper right from upper left molar forceps.

Lower straight forceps: Beaks turned downward at an angle to the handles, allowing work on lower teeth. Used for lower anteriors and premolars.

Lower molar forceps (cowhorn): Both beaks have pointed projections fitting the lower molar furcation; used for a squeezing and rocking motion.

Fabricating Improvised Forceps

Full dental forceps can be fabricated by a skilled blacksmith or metalworker:

Material Requirements

• High-carbon steel or spring steel — strong enough not to deform during use, slightly flexible
• Minimum 5 mm thickness for beaks; 6–8 mm for handles
• Smooth internal surfaces on beaks — rough surfaces damage the tooth and don’t grip well

Fabrication for Upper Anterior Teeth (Simplest Design)

1. Forge two identical blanks: Each approximately 180 mm long, 8 mm wide, 5 mm thick
2. Shape handles: Knurl or texture surface for grip
3. Taper and shape beaks: Narrow end, curved to follow root curvature, smooth inner surfaces
4. Drill hinge hole at 40% of total length from beak end (not center)
5. Assemble with pivot pin (bolt and nut, or machined pin with peened end)
6. Adjust tension: Beaks should close smoothly with moderate hand pressure; too tight makes control difficult, too loose provides inadequate grip

Functional Alternatives

When custom forceps are not available:

• Heavy-duty pliers with modified tips: Grind inner surfaces of plier jaws smooth; round off corners to avoid tissue damage; use for lower anterior extractions only
• Ring-handled dissection forceps: Not ideal but functional for anterior teeth
• Modified pliers with protective covers: Wrap beak surfaces with thin lead sheet or leather to improve grip without point contact on tooth

Avoid: Standard household pliers, vice grips, and locking pliers — these grip poorly on round tooth surfaces and generate uncontrolled forces leading to fracture.

Proper Extraction Technique with Forceps

Positioning

• Patient reclined (not fully flat — allows operator control)
• Operator position: in front for upper teeth, to the side for lower teeth
• Lighting: directed into mouth, unobstructed view or mirror view

The Grip

Grip the tooth below the gumline if possible — at or below the cemento-enamel junction:

1. Use elevators to loosen and slightly elevate the tooth first (see Loosening Methods article)
2. Slide forceps beaks below gumline, one on buccal (cheek) side, one on lingual/palatal (tongue/palate) side
3. Advance apically (toward root tip) as far as possible without forcing
4. Close beaks firmly — firm grip without squeezing so hard the tooth fractures

The Motion

Tooth removal requires socket expansion through specific movements:

For single-rooted teeth (anteriors, lower premolars):

1. Buccal pressure (toward cheek) — hold 5–10 seconds
2. Lingual/palatal pressure (toward tongue/palate) — hold 5–10 seconds
3. Repeat, gradually increasing range of motion
4. When mobility felt, add rotational component (twist slowly)
5. Deliver with outward traction when socket sufficiently expanded

For multi-rooted teeth (molars):

1. Buccal-lingual rocking motion only — rotation will fracture roots
2. More force required; socket expansion takes longer
3. Progressive rocking over 1–3 minutes
4. Deliver buccally (toward cheek) when mobility achieved

For upper molars (three roots):

• Buccal pressure expands the socket around the three roots
• Palatal root is largest and most apically placed — may need to be separated if tooth fractures

Recognizing Complications During Extraction

• Resistance that does not yield after 2–3 minutes of controlled force: Stop. The tooth may be ankylosed (fused to bone), roots may be curved unusually, or roots may be fracturing. Re-assess.
• Sound of cracking: Root fracture occurring — reposition beaks lower and continue carefully; fractured root will need separate retrieval
• Excessive bleeding: See Post-Extraction Care article
• Patient reports electric pain or numbness spreading to lip: Instrument contacting nerve — stop and reposition

After successful delivery, examine the extracted tooth: roots should be intact and complete. Any root missing from the extracted specimen remains in the socket and must be retrieved.

Maintenance of Forceps

After each use:

1. Remove all blood and tissue with brush and water before drying
2. Check hinge for smooth action; lubricate pivot with thin oil
3. Check beak surfaces for damage (chips, deformation)
4. Sterilize by boiling or dry heat before reuse
5. Store in clean, dry condition — instrument cases or wrapped in clean cloth

Maintain sharpness of any pointed beak features with small files. Dull or damaged beaks grip poorly and damage teeth during extraction.