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Extraction of a primary tooth is the surgical removal of a baby tooth. A child's tooth may require extraction if it is severely damaged from an injury or decay. This procedure is commonly performed for both the front and back teeth.
However, extractions of the front tooth are simpler since these teeth only have one root, unlike the molars, which have multiple roots.
It is important not to delay or avoid extractions if your dentist deems them necessary. Even though most baby teeth eventually fall out on their own, the permanent tooth buds can be permanently damaged without treatment. Infection from the baby teeth can also spread to the brain or heart.
Common reasons for primary dental extractions include:
Primary teeth can easily fall victim to tooth decay since the enamel, or covering, of the teeth is thinner than in permanent teeth. In addition, children may have a high sugar diet or poor oral hygiene, making their teeth more prone to decay.
If the decay is deep or large enough, the tooth may not be saveable and may need to be extracted.
Untreated decay in baby teeth can lead to more serious oral health conditions and diseases. For example, the bacteria can spread when a baby tooth becomes infected, which can cause permanent damage to the developing adult teeth and life-threatening infections.
If a primary tooth is extracted due to severe decay, the other teeth can shift into the open space at the extraction site, leading to crooked or crowded teeth.
A child’s primary teeth can become damaged from trauma or an injury, including accidents or falls. Pain and sensitivity are common if a baby tooth is chipped, cracked, or detached from the socket due to such an injury.
Depending on the severity of the damage, pediatric pulp therapy (baby root canal) or a full-coverage crown may save the tooth. Sometimes, the tooth must be removed and replaced with a space maintainer until the adult tooth grows in. For example, if the tooth develops a pimple by the gums.
Over-retained baby teeth refer to teeth that have not fallen out on their own at the appropriate age. Dentists typically recommend extracting these teeth to allow for the proper eruption of adult teeth.
If the primary teeth are not removed, problems in the bite can occur. Adult teeth can also begin growing above the over-retained primary teeth, leading to misaligned teeth and the need for orthodontic treatment later on.
Gingivitis causes inflammation in the gingival tissues. It 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, though it is rare in the absence of a systemic or congenital issue.
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.
There are more rare cases that may necessitate the removal of baby teeth. Sometimes, people are born with extra baby teeth due to a systemic issue or just because. These extra baby teeth may need to be removed to allow permanent teeth to grow normally.
In other cases, the teeth have abnormal shapes (such as when two teeth are fused into one) and may not fall out on their own. In these cases, the baby teeth may also need to be removed.
The extraction procedure typically consists of five steps:
Before most dental procedures, dentists or oral surgeons will take a thorough dental and medical history, check the mouth, and take x-rays of your child's teeth to predict any possible complications. The radiographs depict the number and position of the tooth roots and the surrounding bone.
Primary tooth extractions are typically carried out under local anesthesia, which is a safe drug that does not result in a loss of consciousness.
First, a topical gel is applied, and then the local anesthetic is injected into the child's mouth, which numbs the area. The numbness is temporary and will only last a few hours but cannot eliminate the sensation of pressure.
Sedatives may also be used with local anesthesia for children with high anxiety levels or a fear of needles. Depending on the parents’ preference, the drugs can be taken orally, intravenously (IV), or through inhalation (nitrous oxide).
General anesthesia is typically used as a last resort because it comes with the biggest risks.
After the administration of local anesthesia, the dentist removes the tooth using surgical 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 30 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 into the socket.
If there is a sufficient amount of space present to allow for the eruption of a permanent tooth, or if the permanent tooth is going to erupt shortly, a space maintainer is typically not necessary.
Mild to moderate pain may occur after surgery. Within a few days, life can return to normal. To help reduce pain and symptoms, a dentist may recommend:
Anti-inflammatory pain medications, such as Ibuprofen, may be prescribed or purchased over-the-counter to reduce pain after surgery and speed up recovery. Antibiotics may be prescribed in special circumstances.
Icing the outside of the jaw helps reduce inflammation and pain throughout the healing process.
Children should eat softer foods for a few days post-surgery to increase comfort, including cooked vegetables, mashed potatoes, and smoothies.
Also, it is important to avoid drinking from a straw or spitting vigorously for about a week post-op. These actions can dislodge the blood clot that forms after the extraction procedure and may require additional treatment.
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