Extracting Primary Teeth

Today I extracted #I and #H on a child who has always been difficult. He was screaming the entire time but he was fully anesthetized. He is the type of child who is combative with his parents and always refuses everything in the office. Anyway the screaming was certainly the “blood curdling” type. I have always been taught that if you get in there and have the forceps on the tooth to just get the job done quickly while of course protecting the patient. I also have never had great experience with giving kids long breaks unless I know the kid truly needs it. Afterwards I had a hygienist colleague of mine suggest that I should refer these patients out because the screaming makes everyone in the office uncomfortable and it is a “bad look” for the office. Curious how others go about these difficult primary extractions when patients scream at the top of their lungs.