Baby Tooth Extractions: Overview
Tooth extractions, which is the surgical removal of teeth, is typically necessary after teeth are damaged due to an injury, disease, or decay. Front teeth are easier to extract than molars because they have a single root, rather than multiple roots. Although, baby molars are the most common tooth extractions because they are more prone to decay.
When Do Children Need Tooth Extractions?
Common reasons for primary tooth extractions include:
Primary teeth easily fall victim to tooth decay, which typically results in extractions. In addition, cavities commonly form on a child’s molars because baby tooth enamel is more fragile than permanent teeth, which makes them prone to decay.
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 permanent teeth. If a primary tooth is extracted due to severe decay, permanent teeth can also move into the open space, which leads to crooked or crowded teeth.
Trauma or Injury
A child’s primary teeth can become damaged from trauma or an injury, including accidents, falls, or failed dental restorations (such as cavity fillings or crowns). 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, a root canal or full coverage crown may be able to save the tooth. However, often times the tooth has to be removed and replaced with a space maintainer until the permanent tooth grows in.
Gingivitis causes inflammation in the gingival tissues and results in bleeding, redness, and swelling. 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.
Impacted Wisdom Teeth
When third molars partially grow in or get stuck under the gums, they are considered impacted wisdom teeth. So, dentists recommend extractions to reduce the chance of disease and jaw misalignment. If children show early signs of impacted teeth at a young age, they are often removed to prevent future problems later on. For example, these problems may 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 permanent 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.
Additionally, permanent 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 next to the canines.
Tooth Extraction Procedure
Step 1 — Radiograph (x-ray)
Before most dental procedures, dentists take x-rays of your teeth and mouth to foresee any possible complications. The radiographs examine the position of the tooth roots and the surrounding bone structure.
Step 2 — Local Anesthesia Administration
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. Dentists inject local anesthesia into the mouth, which numbs the area and eliminates pain. The sensations associated with it are temporary and 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).
Step 3 — Tooth Removal
After the administration of local anesthesia, the dentist removes the tooth using small instruments. In addition, as the tooth is being removed, they carefully ensure the bone around the tooth is not damaged.
Step 4 — Stitches
After extraction, the dentist covers the tooth socket with sterile gauze and applies pressure for about 20 minutes. Stitches may also be necessary depending on the patient’s needs.
Step 5 — Space Maintainer
When a primary molar is removed or lost prematurely, space maintainers are placed to ensure the child’s permanent tooth grows in correctly. They prevent the migration of adjacent teeth, depending on the number of teeth present and the patient’s dental arch length. If there is a sufficient amount of space present to allow for the eruption of a permanent tooth, a space maintainer typically isn’t 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 drugs, such as Ibuprofen, and antibiotics may be prescribed to reduce pain after surgery and speed up the recovery process.
Ice — icing the outside of the jaw helps reduce inflammation and pain.
Soft Foods — to increase comfortability, patients should eat softer foods for a few days post-surgery, such as cooked vegetables, mashed potatoes, and smoothies.