Short answer: A baby tooth may need to be extracted in cases of advanced decay that cannot be saved with a filling or baby tooth root canal treatment, when an abscess develops, after trauma, and when the baby tooth does not fall out even though the permanent tooth has come in. In most cases the procedure is done quickly under local anesthesia. If the tooth is lost early, a space maintainer may be recommended to preserve room for the permanent tooth. The decision is made after an examination by the dentist.
Baby teeth loosen and fall out on their own when the time comes, which is why many parents are surprised to hear that their child's tooth needs to be extracted. However, baby tooth extraction can be necessary in some cases to protect the child's oral health and help the permanent tooth underneath come in at the right place. In this article we explain when baby teeth are extracted, how you can prepare your child for the process, what to pay attention to on the day of the extraction and afterwards, and why a space maintainer is considered after teeth are lost early.
When is a baby tooth extracted?
A baby tooth is extracted when it is too damaged to be saved with treatment or when it blocks the permanent tooth from coming in. Dentists' general approach is to keep the baby tooth in the mouth as long as possible, until its natural time to fall out, because baby teeth serve chewing, speech and holding space for the permanent teeth. For this reason the decision to extract is made carefully.
The main situations in which baby tooth extraction is considered are:
- Advanced decay: If decay has destroyed most of the tooth and it cannot be saved with a filling or baby tooth root canal treatment (pulpotomy, pulpectomy).
- Abscess and infection: If inflammation has developed around the root and there is a risk of it affecting the permanent tooth bud underneath.
- If the baby tooth does not fall out: If the baby tooth stays in place even though the permanent tooth has started to come in. This is most common in the lower front teeth; the permanent tooth comes in behind the baby tooth, creating the appearance of two rows of teeth.
- Trauma: For teeth that are broken, have a damaged root or have been displaced as a result of a fall or a blow.
- Orthodontic reasons: In cases of severe crowding, to help the permanent teeth come in more evenly, in line with the orthodontist's plan.
There is no need to panic if you notice two rows of teeth in the lower front. If the baby tooth is clearly loose, it may fall out on its own within a few weeks. However, if the baby tooth is firmly in place and the permanent tooth keeps coming up, it is a good idea to have it checked by a dentist.
Preparing for the extraction
The most important step in preparing a child for an extraction is explaining the process in simple, honest language that does not frighten them. Children pick up on adults' anxiety very easily. The language used at home directly affects the experience at the clinic.
A few practical tips for parents:
- Instead of phrases like "it won't hurt at all" or "you're going to get a shot", choose gentle and accurate wording such as "the dentist will put your tooth to sleep and then take out the sick tooth".
- Do not use the dentist as a punishment or a threat.
- Try not to talk about your own negative dental experiences in front of your child.
- Try to book the appointment at a time when your child is rested and has eaten.
- Tell the dentist about any medications your child takes, their allergies and past illnesses.
At the clinic, pediatric dentists usually use the "tell, show, do" approach. The instruments to be used are first explained to the child, then shown, and then the procedure begins. This method lets the child know what to expect and helps them keep a sense of control.
The extraction process
In most cases, baby tooth extraction is a simple procedure completed quickly under local anesthesia. The roots of baby teeth dissolve as the permanent tooth comes in, so extracting teeth that are close to their natural time to fall out is usually easy.
- Topical numbing: A numbing gel may first be applied to the gum so the needle is felt less.
- Local anesthesia: The tooth and the area around it are numbed. The child may feel pressure at this stage, but the aim is for them not to feel sharp pain.
- Extraction: The tooth is gently removed with special instruments. The procedure often takes a few minutes.
- Controlling the bleeding: A sterile gauze pad is placed on the extraction site, and the child is asked to bite on it.
For very young children, children with intense anxiety or special needs, and cases where many treatments are needed at the same time, sedation or general anesthesia may be considered. These methods are carried out with appropriate equipment and an anesthesiologist; which child needs them is determined by examination.
Aftercare following the extraction
In the first hours after the extraction, the main goals are to protect the blood clot at the extraction site and to make sure the child does not bite their numb lip or cheek. When these two points are taken care of, healing usually proceeds smoothly.
- Gauze: Make sure the child bites on the gauze for the time the dentist recommends, usually 20-30 minutes.
- Numbness period: The effect of the anesthesia can last a few hours. During this time the child may bite their lip, cheek or tongue without noticing. It is important not to give them food and to keep an eye on them until the numbness wears off.
- Eating: Once the numbness has worn off, lukewarm or cold soft foods can be given. On the first day, very hot, hard and crunchy foods are avoided.
- Oral hygiene: Toothbrushing continues the same evening; only the extraction site is gently skipped. On the first day, vigorous rinsing and spitting are avoided.
- Pain: In most children pain is mild. If needed, a pain reliever recommended by the dentist and suited to the child's age and weight can be used.
You should contact the dentist if the bleeding does not stop with gauze, if facial swelling keeps increasing, if there is a fever, or if the child complains of increasing pain a few days later.
In the days after the extraction, it is very common for children to keep probing the gap with their tongue, and this usually decreases on its own. A whitish appearance may form at the extraction site in the first days; this is a natural part of the healing tissue and is usually not a sign of infection. Still, if you notice a bad smell, discharge or swelling in the area, it is advisable to have it checked by the dentist.
Space maintainers after early tooth loss
When a baby tooth is extracted long before its natural time to fall out, an appliance called a space maintainer may be recommended to preserve the gap. This is because the neighboring teeth can drift into the gap left by the baby tooth over time, and the permanent tooth coming in underneath may not find enough room to erupt. This can later mean crowding, impacted teeth and the need for more extensive orthodontic treatment.
Space maintainers generally fall into two groups:
- Fixed space maintainers: They consist of a band cemented to the neighboring tooth and a thin wire extending into the gap. The child does not need to put it in or take it out.
- Removable space maintainers: They are plate-shaped; sometimes an artificial tooth can also be added in place of the missing tooth. The child needs to wear it regularly.
Not every early tooth loss requires a space maintainer. The dentist decides by looking at which tooth was lost, the child's age, how soon the permanent tooth underneath will come in and the space available in the mouth. Children with a space maintainer should be brought in for regular check-ups; the appliance is removed when the permanent tooth starts to come in.
Monitoring the development of the teeth and jaws during childhood also helps plan any orthodontic treatment that may be needed later more easily. You can read about approaches that can be used during this period on our Invisalign First for children page.
When should you take your child to the dentist?
If you notice darkening on your child's tooth, a pimple-like swelling on the gum, pain while eating or two rows of teeth in the lower front, the examination should not be postponed. We have gathered other questions parents frequently ask on our frequently asked questions page. At our polyclinic in Oran, Çankaya, the decision to extract a child's tooth is made only after options for saving the tooth have been considered, and in discussion with the parents.
Frequently asked questions
What happens if a baby tooth does not fall out on its own?
If the baby tooth does not fall out even though the permanent tooth has started to come in, the permanent tooth may erupt in a different position, most often behind the baby tooth. If the baby tooth is loose, waiting a few weeks may be enough. If it is not loose or stays in place for a long time, the dentist assesses whether extraction is needed.
Is it OK to pull a loose baby tooth at home?
In most cases it causes no problem for a child to wiggle a very loose tooth that is about to fall out with their tongue or finger until it comes out. However, forcing the tooth out with a string or an instrument can leave a piece of root behind, cause bleeding and create fear. For teeth that are only slightly loose, it is better to consult a dentist.
A decayed baby tooth will fall out anyway, so does it need treatment?
Yes, in most cases it does. As decay progresses, it can lead to pain, abscesses and eating problems; the infection can also affect the permanent tooth bud underneath. In addition, a baby tooth that is lost early can cause the loss of the space needed for the permanent teeth to come in.
Will a space maintainer bother my child?
Children usually get used to a space maintainer within a few days. In the first days they may play with it with their tongue or have a slight foreign-body sensation. With fixed space maintainers, it is important to avoid sticky and hard foods and to clean around the appliance well.
