A dental extraction (also referred to as tooth extraction, exodontia, exodontics, or informally, tooth pulling) is the removal of teeth from the dental alveolus (socket) in the alveolar bone. Extractions are performed for a wide variety of reasons, but most commonly to remove teeth which have become unrestorable through tooth decay, periodontal disease or dental trauma, especially when they are associated with toothache. Sometimes wisdom teeth are impacted (stuck and unable to grow normally into the mouth) and may cause recurrent infections of the gum (pericoronitis). In orthodontics if the teeth are crowded, sound teeth may be extracted (often bicuspids) to create space so the rest of the teeth can be straightened.
Tooth extraction is usually relatively straightforward, and the vast majority can be usually performed quickly while the individual is awake by using local anesthetic injections to eliminate painful sensations. Local anesthetic blocks pain, but mechanical forces are still felt. Some teeth are more difficult to remove for several reasons, especially related to the tooth's position, the shape of the tooth roots and the integrity of the tooth. Dental phobia is an issue for some individuals, and tooth extraction tends to be feared more than other dental treatments like fillings. If a tooth is buried in the bone, a surgical or trans alveolar approach may be required, which involves cutting the gum away and removal of the bone which is holding the tooth in with a surgical drill. After the tooth is removed, stitches are used to replace the gum into the normal position.
Immediately after the tooth is removed, a bite pack is used to apply pressure to the tooth socket and stop the bleeding. After a tooth extraction, dentists usually give advice which revolves around not disturbing the blood clot in the socket by not touching the area with a finger or the tongue, by avoiding vigorous rinsing of the mouth and avoiding strenuous activity. Sucking, such as through a straw, is to be avoided. If the blood clot is dislodged, bleeding can restart, or alveolar osteitis ("dry socket") can develop, which can be very painful and lead to delayed healing of the socket. Smoking is avoided for at least 24 hours as it impairs wound healing and makes dry socket significantly more likely. Most advise hot salt water mouth baths which start 24 hours after the extraction.
The branch of dentistry that deals primarily with extractions is oral surgery ("exodontistry"), although general dentists and periodontists often carry out tooth extraction routinely since it is a core skill taught in dental schools. Periodontists are performing more and more extractions, since they often follow up and place a dental implant.
Surgical extraction of an impacted molar
The most common reason for extraction is tooth damage due to breakage or decay. There are additional reasons for tooth extraction:
Extractions are often categorized as "simple" or "surgical".
Simple extractions are performed on teeth that are visible in the mouth, usually under local anaesthetic, and require only the use of instruments to elevate and/or grasp the visible portion of the tooth. Typically the tooth is lifted using an elevator, and using dental forceps, rocked back and forth until the periodontal ligament has been sufficiently broken and the supporting alveolar bone has been adequately widened to make the tooth loose enough to remove. Typically, when teeth are removed with forceps, slow, steady pressure is applied with controlled force.
Surgical extractions involve the removal of teeth that cannot be easily accessed, for example because they have broken under the gum line or because they have not erupted fully. Surgical extractions almost always require an incision. In a surgical extraction the doctor may elevate the soft tissues covering the tooth and bone and may also remove some of the overlying and/or surrounding jawbone tissue with a drill or osteotome. Frequently, the tooth may be split into multiple pieces to facilitate its removal.
Studies have shown that there is a correlation between consumption of anticoagulant drugs after dental extractions and the amount of bleeding. In one such review, oral anticoagulants were prescribed to multiple subjects, all of whom were undergoing dental surgery. 89 out of 990 subjects (9%) had delayed postoperative bleeding, and 3.5% of these cases were not controlled by local measures (‘serious cases’). Other studies have reported greater numbers of patients with minor post-operative bleeding. However, it is difficult to standardise bleeding as the definitions used to categorise the extent of the bleed tend to differ from study to study. However, the majority of studies concur that there is little risk of a major bleed if a patient is regularly consuming oral anticoagulants at the time of a simple dental extraction.
For simple extractions, therapeutic anticoagulation can be continued, as the bleeding risk is not high and the risk of a thromboembolism caused by a temporary withdrawal from the anticoagulant is much higher than that of a serious bleed following the extraction However, for complex extractions (3 or more teeth or multiple adjacent teeth), the risk of bleeding is higher, and the dentist should consult the patient’s doctor. Patients undergoing a course of treatment using anticoagulants should notify their dentist when organising the procedure. An individual treatment plan should be drawn up for the patient, and the patient’s doctor should be contacted to confirm the anticoagulant being used, and the dose type. The patient’s INR should also be taken into account. When the patient has an INR of 4.0 or over, they should be referred to a specialist  The risk of haemorrhage is increased in the elderly (especially after post-surgical dental extractions) as they are more susceptible to dental caries and periodontal diseases. This should also be taken into account by the dentist. Studies found that rivaroxaban impose a high risk of bleeding when compared to the other oral anticoagulants, in contrast to Dabigatran, which was found to have fewer postoperative bleeding incidents.
To increase the effectiveness of oral anticoagulant drugs, bleeding risks can be further minimized by the usage of collagen sponges and sutures and rinsing 5% tranexamic acid mouthwash four times a day.
Overall, patients utilizing long-term anticoagulant therapies such as warfarin or salicylic acid do not need to discontinue its use prior to having a tooth extracted. The extraction should be performed utilizing the least traumatic extraction procedures and patients should make sure to tell their dentist or oral surgeon about any medications they may take before the procedure.
Antibiotics can be prescribed by dental professionals to reduce risks of certain post extraction complications. There is evidence that use of antibiotics before and/or after impacted wisdom tooth extraction reduces the risk of infections by 70% and lowers incidence of dry socket by one third. For every 12 people who are treated with an antibiotic following impacted wisdom tooth removal, one infection is prevented. Use of antibiotics does not seem to have a direct effect on manifestation of fever, swelling or trismus seven days post-extraction. In the 2013 Cochrane review, 18 randomized control double-blinded experiments were reviewed and after considering the biased risk associated with these studies, it was concluded that there is moderate overall evidence supporting the routine use of antibiotics in practice in order to reduce risk of infection following a third molar extraction. There are still reasonable concerns remaining regarding the possible adverse effects of indiscriminate antibiotic use in patients. There are also concerns about development of antibiotic resistance which advises against the use of prophylactic antibiotics in practice.
Immediately following the removal of a tooth, bleeding or just oozing very commonly occurs. Pressure is applied by biting on a gauze swab, and a thrombus (blood clot) forms in the socket (hemostatic response). Common hemostatic measures include local pressure application with gauze and the use of oxidized cellulose (gelfoam) and fibrin sealant. Dental practitioners usually have absorbent gauze, hemostatic packing material (oxidized cellulose, collagen sponge) and suture kit available. Sometimes 30 minutes of continuous pressure is required to fully arrest bleeding. Talking, which moves the mandible and hence removes the pressure applied on the socket, instead of keeping constant pressure, is a very common reason that bleeding might not stop. This is likened to someone with a bleeding wound on their arm, when being instructed to apply pressure, instead holds the wound intermittently every few moments. Coagulopathies (clotting disorders, e.g. hemophilia) are sometimes discovered for the first time if a person has had no other surgical procedure in their life, but this is rare. Sometimes the blood clot can be dislodged, triggering more bleeding and formation of a new blood clot, or leading to a dry socket (see complications). Some oral surgeons routinely scrape the walls of a socket to encourage bleeding in the belief that this will reduce the chance of dry socket, but there is no evidence that this practice works.
The chance of further bleeding reduces as healing progresses, and is unlikely after 24 hours. If the bleeding occurs beyond 8 –12 hours, this situation is then referred as post-extraction bleeding. The blood clot is covered by epithelial cells which proliferate from the gingival mucosa of socket margins, taking about 10 days to fully cover the defect. In the clot, neutrophils and macrophages are involved as an inflammatory response takes place. The proliferative and synthesizing phase next occurs, characterized by proliferation of osteogenic cells from the adjacent bone marrow in the alveolar bone. Bone formation starts after about 10 days from when the tooth was extracted. After 10–12 weeks, the outline of the socket is no longer apparent on an X-ray image. Bone remodeling as the alveolus adapts to the edentulous state occurs in the longer term as the alveolar process slowly resorbs. In maxillary posterior teeth, the degree of pneumatization of the maxillary sinus may also increase as the antral floor remodels.
1. Primary prolonged bleeding
This type of bleeding occurs during/immediately after extraction because true haemostasis has not been achieved. It is usually controlled by conventional techniques such as applying pressure packs or haemostatic agents onto the wound.
2. Reactionary bleeding
This type of bleeding starts 2 to 3 hours after tooth extraction as a result of cessation of vasoconstriction. Systemic intervention might be required.
3. Secondary bleeding
This type of bleeding usually begins 7 to 10 days post extraction and is most likely due to infection destroying the blood clot or ulcerating local vessels.
There is no clear evidence from clinical trials comparing the effects of different interventions for the treatment of post-extraction bleeding. In view of the lack of reliable evidence on this topic, Clinicians must use their clinical experience to determine the most appropriate means of treating this condition, depending on patient-related factors. When dental practitioner is deciding on how to control post-extraction bleeding, many other factors have to be taken into account:
If on examining the patient, the blood pressure is below 100/60 and the heart rate is over a 100bpm, a hypovolaemic shock should be suspected and the patient should be sent to hospital for IV blood transfusion.
Post-extraction bleeding interventions can be categorized into two main groups:
(i) Surgical interventions
(ii) Non-surgical haemostatic measures
(iii) Combination of both
2. Systemic interventions
This is important for patients who have systemic cause for bleeding. Usually, local haemostatics do not work well on limiting their bleeding because they only result in temporary cessation of bleeding. Antibiotics can be prescribed to manage any bleeding associated with a spreading infection.
There are specific factors that need to be accounted for when considering nerve injury after removal of mandibular third molars (bottom wisdom teeth). Position of the molars is an important risk factor with regards to inferior alveolar nerve injuries. Horizontally-impacted molars pose a higher risk of nerve injury, as the depth of the impacted molar is increased. Furthermore, the most important factor for inferior alveolar nerve-injury prediction is the proximity of the root tips to the mandibular canal.
Many drug therapies are available for pain management after third molar extractions including NSAIDS (non-steroidal anti-inflammatory), APAP (acetaminophen) and opioid formulations. Although each has its own pain relieving efficacy, they also pose adverse effects. According to Dr. Paul A Moore and Dr. Elliot V. Hersh, Ibuprofen-APAP combinations have the greatest efficacy in pain relief and reducing inflammation along with the fewest adverse effects. Taking either of these agents alone or in combination may be contraindicated in those who have certain medical conditions. For example, taking ibuprofen or any NSAID in conjunction with warfarin (a blood thinner) may not be appropriate. Also, prolonged use of ibuprofen or APAP has GI and cardiovascular risks. There is high quality evidence that ibuprofen is superior to paracetamol in managing postoperative pain.
Socket preservation or alveolar ridge preservation (ARP) is a procedure to reduce bone loss after tooth extraction to preserve the dental alveolus (tooth socket) in the alveolar bone. At the time of extraction a platelet rich fibrin (PRF) membrane containing bone growth enhancing elements is placed in the wound or a graft material or scaffold is placed in the socket of the extracted tooth. The socket is then directly closed with stitches or covered with a non-resorbable or resorbable membrane and sutured.
Atraumatic extraction is a novel technique for extracting teeth with minimal trauma to the bone and surrounding tissues. It is especially useful in patients who are highly susceptible to complications such as bleeding, necrosis or jaw fracture. It can also preserve bone for subsequent implant placement. Techniques involve minimal use of forceps, which damage socket walls, relying instead on luxators, elevators and syndesmotomy.
Following dental extraction, a gap is left. The options to fill this gap are commonly recorded as Bind, and the exact choice is agreed between dentist and patient based upon several factors.
|Bridge||Fixed to adjacent teeth||Drilling usually required on one or both sides of the gap if conventional bridge (average lifespan about 10 years). Conservative bridge (average lifespan about 5 years) preparation may cause minimal damage to adjacent teeth. Expensive and complex treatment, not suited to all situations, e.g. large gaps in the back of the mouth Alveolar bone will still resorb, and eventually a gap may show under bridge.|
|Implant||Fixed to jawbone. Maintains alveolar bone, which would otherwise undergo resorption. Usually a long term lifespan.||Expensive and complex, requiring specialist. May involve other procedures such as bone grafting. Relatively contra-indicated in tobacco smokers.|
|Denture||Often a simple, quick and relatively cheap treatment compared to bridge and implant. Not usually any drilling of other teeth required. It is far easier to replace several teeth with a denture than place multiple bridges or implants.||Denture is not fixed in mouth. Over time worsens periodontal disease unless there is good level of oral hygiene, and may damage soft tissues. Potential for slightly accelerated resorption of alveolar bone compared to no denture. Potential for poor tolerance in persons with over-sensitive gag reflex, xerostomia, etc.|
|Nothing (i.e. not replacing the missing tooth)||Often the choice due to cost of other treatment or lack of motivation for other treatments. Part of a shortened dental arch plan, which revolves around the fact that not all teeth are required to eat comfortably, and only the incisors and premolars need be preserved for normal function. This is usually the choice taken if the reason of dental extraction is due to impacted wisdom teeth or orthodontics because of limited space.||The alveolar bone will slowly resorb over time once the tooth is lost. Potential esthetic concern. Potential for drifting and rotation of adjacent teeth into the gap over time.|
Historically, dental extractions have been used to treat a variety of illnesses. Before the discovery of antibiotics, chronic tooth infections were often linked to a variety of health problems, and therefore removal of a diseased tooth was a common treatment for various medical conditions. Instruments used for dental extractions date back several centuries. In the 14th century, Guy de Chauliac invented the dental pelican, which was used through the late 18th century. The pelican was replaced by the dental key which, in turn, was replaced by modern forceps in the 19th century. As dental extractions can vary tremendously in difficulty, depending on the patient and the tooth, a wide variety of instruments exist to address specific situations. Rarely, tooth extraction was used as a method of torture, e.g. to obtain forced confessions.
Until the early 20th century in Europe, dental extractions were often made by traveling dentists in town fairs. They sometimes had musicians with them playing loud enough to cover the cries of pain of the people having their teeth extracted. In 1880 in Pyrénées-Orientales (France), one of these traveling dentists claimed to have extracted 475 teeth in one hour.
was a common year starting on Saturday of the Gregorian calendar and a common year starting on Thursday of the Julian calendar, the 1842nd year of the Common Era (CE) and Anno Domini (AD) designations, the 842nd year of the 2nd millennium, the 42nd year of the 19th century, and the 3rd year of the 1840s decade. As of the start of 1842, the Gregorian calendar was
12 days ahead of the Julian calendar, which remained in localized use until 1923.1842 in science
The year 1842 in science and technology involved some significant events, listed below.Alveolar osteitis
Alveolar osteitis, also known as dry socket, is inflammation of the alveolar bone (i.e., the alveolar process of the maxilla or mandible). Classically, this occurs as a postoperative complication of tooth extraction.
Alveolar osteitis usually occurs where the blood clot fails to form or is lost from the socket (i.e., the defect left in the gum when a tooth is taken out). This leaves an empty socket where bone is exposed to the oral cavity, causing a localized alveolar osteitis limited to the lamina dura (i.e., the bone which lines the socket). This specific type is known as dry socket and is associated with increased pain and delayed healing time.Dry socket occurs in about 0.5–5% of routine dental extractions, and in about 25–30% of extractions of impacted mandibular third molars (wisdom teeth which are buried in the bone).Aminocaproic acid
Aminocaproic acid (also known as ε-aminocaproic acid, ε-Ahx, or 6-aminohexanoic acid) is a derivative and analogue of the amino acid lysine, which makes it an effective inhibitor for enzymes that bind that particular residue. Such enzymes include proteolytic enzymes like plasmin, the enzyme responsible for fibrinolysis. For this reason it is effective in treatment of certain bleeding disorders, and it is marketed as Amicar. Aminocaproic acid is also an intermediate in the polymerization of Nylon-6, where it is formed by ring-opening hydrolysis of caprolactam.Coupland’s elevators
Coupland’s elevators (also known as chisels) are instruments commonly used for dental extraction. They are used in sets of three each of increasing size and are used to split multi-rooted teeth and are inserted between the bone and tooth roots and rotated to elevate them out of the sockets.
The instruments were designed by Doctor Douglas C W Coupland who qualified as a Dental Surgeon in Toronto in 1922 and spent most of his career practising dentistry in Ottawa where he specialised in dental extraction.
Coupland designed the instruments in the 1920s; they were manufactured by the Hu-Friedy company and sold from the early 1930s initially as sets of eight or twelve which were later reduced to three.
Coupland also designed a set of dental suckers with interchangeable tips. He died in 1936 after only 13 years of clinical practice.Dental key
The dental key is an instrument that was used in dentistry to extract diseased teeth. Before the era of antibiotics, dental extraction was often the method of choice to treat dental infections, and extraction instruments date back several centuries.Dental surgery
Dental surgery is any of a number of medical procedures that involve artificially modifying dentition; in other words, surgery of the teeth, gums and jaw bones.History of general anesthesia
Attempts at producing a state of general anesthesia can be traced throughout recorded history in the writings of the ancient Sumerians, Babylonians, Assyrians, Egyptians, Greeks, Romans, Indians, and Chinese. During the Middle Ages, which correspond roughly to what is sometimes referred to as the Islamic Golden Age, scientists and other scholars made significant advances in science and medicine in the Muslim world and Eastern world.
The Renaissance saw significant advances in anatomy and surgical technique. However, despite all this progress, surgery remained a treatment of last resort. Largely because of the associated pain, many patients with surgical disorders chose certain death rather than undergo surgery. Although there has been a great deal of debate as to who deserves the most credit for the discovery of general anesthesia, it is generally agreed that certain scientific discoveries in the late 18th and early 19th centuries were critical to the eventual introduction and development of modern anesthetic techniques.
Two major advances occurred in the late 19th century, which together allowed the transition to modern surgery. An appreciation of the germ theory of disease led rapidly to the development and application of antiseptic techniques in surgery. Antisepsis, which soon gave way to asepsis, reduced the overall morbidity and mortality of surgery to a far more acceptable rate than in previous eras. Concurrent with these developments were the significant advances in pharmacology and physiology which led to the development of general anesthesia and the control of pain.
In the 20th century, the safety and efficacy of general anesthesia was improved by the routine use of tracheal intubation and other advanced airway management techniques. Significant advances in monitoring and new anesthetic agents with improved pharmacokinetic and pharmacodynamic characteristics also contributed to this trend. Standardized training programs for anesthesiologists and nurse anesthetists emerged during this period. The increased application of economic and business administration principles to health care in the late 20th and early 21st centuries led to the introduction of management practices such as transfer pricing to improve the efficiency of anesthetists.Medication-associated osteonecrosis of the jaw
Medication-related osteonecrosis of the jaw (MON, MRONJ) is progressive death of the jawbone in a person exposed to a medications known to increase the risk of disease, in the absence of a previous radiation treatment. It may lead to surgical complication in the form of impaired wound healing following oral and maxillofacial surgery, periodontal surgery, or endodontic therapy.Particular medications can result in MRONJ, a serious but uncommon side effect in certain individuals. Such medications are frequently used to treat diseases that cause bone resorption such as osteoporosis, or to treat cancer. The main groups of drugs involved are anti-resorptive drugs, and anti-angiogenic drugs.
This condition was previously known as bisphosphonate-related osteonecrosis of the jaw because osteonecrosis of the jaws correlating with bisphosphate treatment was frequently encountered, with its first incident occurring in 2003. Denosumab, another antiresorptive drug were also related to this condition. Newer medications such as anti-angiogenic drugs have been potentially implicated causing the condition to be renamed as MRONJ; however, this has not been definitively demonstrated.BON was nicknamed "bis-phossy jaw" based on its similarity with phossy jaw. There is no known prevention for bisphosphonate-associated osteonecrosis of the jaw. Avoiding the use of bisphosphonates is not a viable preventive strategy on a general-population basis because the medications are beneficial in the treatment and prevention of osteoporosis (including prevention of bony fractures) and treatment of bone cancers.
It usually develops after dental treatments involving exposure of bone or trauma, or may arise spontaneously. Patients who develop MRONJ may experience prolonged healing, pain, swelling, infection, exposed bone, after dental procedures, though some patients may have no signs/symptoms.Milk sickness
Milk sickness, also known as tremetol vomiting or, in animals, as trembles, is a kind of poisoning, characterized by trembling, vomiting, and severe intestinal pain, that affects individuals who ingest milk, other dairy products, or meat from a cow that has fed on white snakeroot plant, which contains the poison tremetol.
Although very rare today, milk sickness claimed thousands of lives among migrants to the Midwest in the early 19th century in the United States, especially in frontier areas along the Ohio River Valley and its tributaries where white snakeroot was prevalent. New settlers were unfamiliar with the plant and its properties. A notable victim was Nancy Hanks Lincoln, the mother of Abraham Lincoln, who died in 1818. Nursing calves and lambs may have died from their mothers' milk contaminated with snakeroot, although the adult cows and sheep showed no signs of poisoning. Cattle, horses, and sheep are the animals most often poisoned.
Anna Pierce Hobbs Bixby, called Dr. Anna on the frontier, is credited today by the American medical community with having identified white snakeroot as the cause of the illness. Told about the plant's properties by an elderly Shawnee woman she befriended, Bixby did testing to observe and document evidence. She wrote up her findings to share the discovery in the medical world. The Shawnee woman's name has been lost to history.Outline of dentistry and oral health
The following outline is provided as an overview of and topical guide to dentistry and oral health:
Dentistry – branch of medicine that is involved in the study, diagnosis, prevention, and treatment of diseases, disorders and conditions of the oral cavity, maxillofacial area and the adjacent and associated structures and their impact on the human body.Passion gap
Passion gap or Cape Flats smile is a dental modification originating in Cape Flats, Cape Town, South Africa in which people deliberately remove the upper front teeth (maxillary incisors) for fashion and status. The practice is popular among lower class Coloureds and has occasionally been done by White and Chinese South Africans in the area.Pulling Teeth
Pulling Teeth may refer to:
Dental extraction in dentistry
Pulling Teeth (band), a metal band from Baltimore, formed in 2005
"(Anesthesia)—Pulling Teeth", a bass solo by Cliff Burton on the 1983 Metallica album Kill 'Em All
"Pulling Teeth" (song), a song by Green Day from their 1994 album Dookie
Pulling Teeth (album), a 2000 album by Striaght FacedReview of systems
A review of systems (ROS), also called a systems enquiry or systems review, is a technique used by healthcare providers for eliciting a medical history from a patient. It is often structured as a component of an admission note covering the organ systems, with a focus upon the subjective symptoms perceived by the patient (as opposed to the objective signs perceived by the clinician). Along with the physical examination, it can be particularly useful in identifying conditions that do not have precise diagnostic tests.Root extraction
Root extraction may refer to:
Root-finding algorithm, a process for finding roots of polynomials
Methods of computing square roots, a special case of polynomial root finding
Dental extraction, the removal of the roots of teeth
Stump removal, the removal of a tree stump
In linguistics, finding the underlying core form of a word
In genetics, using the root of a hair to evaluate DNA
Determining the fundamental note in a chord, see: root (chord)Socket preservation
Socket preservation or alveolar ridge preservation (ARP) is a procedure to reduce bone loss after tooth extraction to preserve the dental alveolus (tooth socket) in the alveolar bone. A platelet rich fibrin (PRF) membrane containing bone growth enhancing elements is placed in the wound or a bone grafting material or scaffold is placed in the socket of an extracted tooth at the time of extraction. The socket is then directly closed with stitches or covered with a non-resorbable or resorbable membrane and sutured.
After extraction, jaw bone has to be preserved to keep the socket in its original shape. Without socket preservation, the bone quickly resorbs resulting in 30–60% loss in bone volume in the six months after dental extraction. The jaw bone will never revert to its original shape once bone is lost and tissue contour has changed.
The human body reduces the amount of bone that is not sufficiently used with a daily stress; without the strain stimulus, the jaw bone behaves (with or without socket preservation) as if the space occupied by the tooth and periodontal ligament was empty.Un célebre especialista sacando muelas en el gran Hotel Europa
Un célebre especialista sacando muelas en el gran Hotel Europa is an 1897 Venezuelan short film, and the first Venezuelan (and likely South American) film ever produced. It was screened at the Baralt Theatre in Maracaibo on 28 January 1897.
The film shows a renowned surgeon, displaying at the Hotel Europa in Maracaibo, as he pulls teeth from a man.Viridans streptococci
The viridans streptococci are a large group of commensal streptococcal Gram-positive bacteria species that are α-hemolytic, producing a green coloration on blood agar plates (hence the name "viridans", from Latin "vĭrĭdis", green). The pseudo-taxonomic term "Streptococcus viridans" is often used to refer to this group of species, but writers who do not like to use the pseudotaxonomic term (which treats a group of species as if they were one species) prefer the terms viridans streptococci, viridans group streptococci (VGS), or viridans streptococcal species.
These species possess no Lancefield antigens. In general, pathogenicity is low.