Why should a baby tooth be extracted?

Why should a baby tooth be extracted?

There are a handful of reasons a tooth might need to be extracted.

  • Decay/Infection: If your dentist determines that he/she cannot restore the tooth because of severe decay or infection. 
  • It is a baby tooth that is not falling out on its own: In some cases, the adult teeth do not come in directly underneath the baby tooth, leaving part of the root. 
  • To help with orthodontic/braces: The dentist might be working with an orthodontist to come up with a long term plan for your child's tooth alignment. This can include removing adult teeth to allow for enough room for the other teeth to erupt.

What happens on the day of the extraction?

Depending on your child's age, anxiety and dental needs, some form of sedation might be suggested for your child.

  • Minimal sedation (nitrous oxide, aka laughing gas): This is a commonly used anesthetic to help relax children in a dental office. This sedation method helps calm and relax the patient, so they are more likely to sit and have a positive experience in the dental chair. It will not typically put the child to sleep and will not be effective for very difficult patients. 
  • Moderate sedation: This is a slightly deeper level of sedation. These medications can be given either orally (a liquid or pill) or intravenous (IV). With moderate sedation, the child will go into a "twilight" like sleep. But typically, they should not be 100%  asleep with this method. This may be an excellent option for children who are not calm enough for minimal sedation, but do not need deeper forms of sedation such as general anesthesia. This can also be a much more cost-effective option than general anesthesia. 
  • Deep Sedation: This can include general anesthesia. In this situation, your child would be asleep. This can be a great option if other forms of sedation are not going to be sufficient. This might also be the only safe form of sedation if the child has other medical conditions. Make sure to discuss your child’s medical history with your dentist to make sure you are finding the best option for your child. 

What does it feel like to have a tooth extracted?

Unless the child is deeply sedated, they are going to feel some pressure as the tooth is extracted even if they are completely numb. There are many verbal and distraction techniques that your dentist can use to help guide your child’s behavior through the procedure.

One of them is called "tell, show, do." Just like it sounds, first I tell the patient what I will do. Then I show them and finally, I actually do the actions I discussed. This simple method can be very helpful to help the patient get used to what will happen before you jump into the procedure.  

What do you need to do after the extraction?

The best post-extraction instructions will vary depending on the difficulty and type of extraction as well as the patient’s medical history. Below, I want to review some of the most common situations and questions patients ask me.

Will I need an antibiotic after an extraction?

Possibly, depending on the severity of the infection and your child's medical history, your dentist might prescribe an antibiotic.

What is one of the biggest things that will slow down my healing?

The suction motion from a straw, sports bottle or sippy cup can lead to loss of the blood clot that is forming where the tooth used to be. This will cause the healing process to slow down, increase pain, and possibly cause a dry socket.

Packing gauze

Your dentist will give you some little cotton squares called packing gauze. The goal of the packing gauze is to put some pressure on the extraction site to allow the blood clot to stabilize. They may call them "2 by 2s" or "4 by 4s" these nicknames tell you how large the squares are (2 cm or 4 cm). All you need to do is fold over the gauze and have the child bite onto it. You will check this gauze every 30 minutes. If it is still pink or red, replace it and recheck it in another 30 minutes. If the gauze just looks wet from their saliva then the blood clot is firm and stable. At this point, the packing gauze is no longer needed.

What should I do if my child will not keep the gauze in their mouth?

Depending on the location of the extraction, age of the child, and temperament of the child, this can be difficult. In this situation, I like to give the parent the larger "4 by 4s" discussed above. This allows for a portion of the gauze to hang outside the mouth while the child puts pressure on the extraction site. This allows the parent the hold the other end in place.

If your child is extremely defiant about keeping the gauze in place, please contact your dentist. They can discuss options with you based on your specific situation.

What is the most common factor parents overlook after an extraction?

One thing many parents overlook is how to keep your child comfortable after being numb. Some children have a habit of trying to suck in their upper lip while it is numb. This constant pressure against the front teeth can cut into the back of the lip. This can cause severe swelling and pain after the patient is no longer numb.

It is vital to keep a close eye on the patient after treatment to make sure they are not chewing or picking at their lips.

Bonus tip: I always like to remind my patients that it is normal for it to feel fat and funny. For some kids, when you say it will feel this way for two hours, they cannot fully grasp what two hours feels like. I like to break things down into movies or show lengths. This could mean they will be numb for one movie or three TV shows.

The closer you follow your dentist post-extraction instructions the better your child will recover after treatment.

Should your child return to school after an extraction?

If the child was only minimally sedated or had no sedation during the extraction there should be no problem going to school the next day. For deeper levels of sedation, please discuss it with your dentist to determine how much activity will be appropriate for your child after treatment. 

Do I need to do anything about the gap where the tooth used to be after a extraction?

It is common to need a space maintainer after a baby tooth is extracted. This is a custom device your dentist or a dental lab will create to help prevent the other teeth from tipping or drifting into where the tooth used to be. This will stay in place until the child's adult tooth is ready to come in, and then the space maintainer can be removed.

There are two major types of space maintainers. Unilateral (one side) bilateral (both sides). The unilateral space maintainer is typically used when a single tooth is extracted. A bilateral space maintainer is used if a unilateral cannot be used.

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