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Baby tooth extractions, or pediatric tooth extractions, are the surgical removal of teeth. This is a common pediatric dentistry procedure for children. Tooth extraction is typically necessary after a child's tooth becomes damaged due to an injury, disease, or severe tooth decay.
Front teeth are more simple extractions compared to primary (baby) molars because they have a single root, rather than multiple roots. Baby molars are the most common dental extractions because they are more prone to decay (cavities).
Common reasons for primary tooth extractions include:
Primary teeth easily fall victim to tooth decay, which typically results in extractions. Cavities commonly form on a child’s molars because baby tooth enamel is more fragile than permanent (adult) teeth, which makes them prone to decay. Additionally, children often do not follow complete dental health care practices.
Untreated decay in baby teeth can also lead to more serious oral health conditions or diseases. For example, when a baby tooth becomes infected, bacteria can spread to other teeth and may affect developing adult teeth.
If a primary tooth is extracted due to severe decay, adult teeth can also move into the open space at the extraction site, which leads to crooked or crowded teeth.
A child’s primary teeth can become damaged from trauma or an injury, including accidents, falls, or failed dental restorations. If a baby tooth is chipped, cracked, or completely detached from the socket, pain and increased sensitivity are common symptoms.
Depending on the severity of the damage, pediatric pulp therapy (baby root canal) or a full-coverage crown may be able to save the tooth. Often times, the tooth has to be removed and replaced with a space maintainer until the adult tooth grows in.
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Gingivitis causes inflammation in the gingival tissues and results in bleeding, redness, and swelling of the gum tissue. If gingivitis is left untreated, pediatric periodontal disease (PD) can develop later on. PD is a serious oral condition that affects the gums and jawbone.
Severe cases can lead to loose teeth, receding gums, and severe bleeding. Tooth extractions are typically necessary if the teeth do not fall out on their own.
When third molars partially grow in or get stuck under the gums, they are considered impacted wisdom teeth. Dentists recommend extractions to reduce the chance of disease and jaw misalignment.
If your child shows early signs of an impacted tooth or teeth at a young age, the teeth are often removed to prevent future oral health problems. These problems can include gum disease, cavities, and root resorption.
Over-retained baby teeth refer to teeth that have loosened, but then tighten back into the gums, preventing the eruption of permanent teeth. Dentists typically recommend extracting these teeth to allow for the proper eruption of adult teeth.
If the primary teeth are not removed, dental crowding commonly develops, which is a condition that occurs when there is not enough space for teeth to grow in.
Adult teeth can also begin growing in above the over-retained primary teeth, which leads to misaligned teeth and the need for orthodontic treatment, such as braces, later on. The teeth most commonly removed for orthodontic reasons are the first premolars, which are located next to the canines.
Before most dental procedures, dentists or oral surgeons take x-rays of your child's teeth and mouth to predict any possible complications. The radiographs examine the position of the tooth roots and the surrounding bone structure.
Primary tooth extractions are typically carried out under local anesthesia, which is a safe membrane-stabilizing drug that does not result in a loss of consciousness.
The local anesthetic is injected into the child's mouth, which numbs the area and eliminates pain. The numbness is temporary and will only last a few hours.
Sedatives may also be used in combination with anesthesia for children with high anxiety levels or fear of needles. Depending on the patient’s preference, the drugs can be taken orally, intravenously (IV), or through inhalation (nitrous oxide).
General anesthesia is typically not used for children, though some dentists may offer it.
After the administration of local anesthesia, the dentist removes the tooth using small instruments. As the tooth is being removed, they will carefully ensure the bone around the tooth is not damaged.
After extraction, the tooth socket is covered with sterile gauze, and pressure is applied for about 20 minutes. Stitches may also be necessary depending on the patient’s needs.
When a primary molar is removed or lost prematurely, space maintainers are placed to ensure the child’s adult tooth grows in correctly. These orthodontic devices prevent the migration of adjacent teeth, depending on the number of teeth present and the patient’s mouth size.
If there is a sufficient amount of space present to allow for the eruption of a permanent tooth, a space maintainer is typically not necessary.
Moderate pain may occur after surgery. Within a few days, life can return back to normal. To help reduce pain and symptoms, a dentist may recommend:
Medications — anti-inflammatory pain medications, such as Ibuprofen, and antibiotics may be prescribed or purchased over-the-counter to reduce pain after surgery and speed up the recovery process.
Ice Packs — icing the outside of the jaw helps reduce inflammation and pain throughout the healing process.
Soft Foods — to increase comfortability, patients should eat softer foods for a few days post-surgery, such as cooked vegetables, mashed potatoes, and smoothies. Also, do not let your child drink from a straw or spit vigorously for about a week post-op. These actions can dislodge the blood clot that forms after the extraction procedure and may require additional dental care.
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Ahlin, Jeffrey H. Maxillofacial Orthopedics: a Clin. Approach for the Growing Child. Quintessence Publ., 2003.
Lee, Benjamin. Things You Should Know about Teeth the Complete Guide to Dental Health and Beauty. AuthorHouse, 2007.
Nowak, Arthur J. Pediatric Dentistry: Infancy through Adolescence. Elsevier, 2019.
Phulari, Basavaraj Subhashchandra. Orthodontics: Principles and Practice. Jaypee, The Health Sciences Publisher, 2011.