At smiles+grins pediatric dentistry, our primary goal is to SAVE teeth, but there are instances when an extraction is required. There are several reasons why teeth may need to be removed: Some teeth are extracted due to extensive and severe decay and some teeth may need to be pulled due to a lack of space in the jaw for erupting permanent teeth.

Extractions Due to Tooth Decay & Trauma

Sometimes it may be necessary to remove a primary tooth due to the severity of tooth decay. When the size of a cavity is so big that a traditional white filling may not hold and a baby crown won’t support the remaining tooth structure, extracting it might be the only solution. If a cavity (caries) has spread into the nerve and nerve treatment is not done in time, the nerve gets infected and may become necrotic (“dead nerve”). At that point, depending on several factors, the tooth may be ‘unrestorable’ and need to be pulled to avoid further damage and pain.

Trauma to a tooth (most commonly, front upper incisors), can cause severe fractures leading to an unrestorable tooth. In those cases, extractions may be indicated as well.

Space Maintainers

Often after tooth extractions, the empty space left behind can lead to a change in the tooth alignment and occlusion. Teeth tend to shift into empty spaces near them and opposing teeth may overgrow since there is no opposing tooth. These changes can lead to malocclusion and cause grinding, headache and jaw pain.

Depending on the tooth that was removed and the dental age of the child, different space maintainers exist for different circumstances. As part of the treatment plan, Dr. G will always diagnose if a space maintainer is recommended.

Over-Retained Baby Teeth

Everybody has a different amount of space in their jaws, determined by their diet habits early on and genetics. Sometimes, when the jaw does not have adequate space, the permanent teeth erupt and try to fit in unaligned with the rest of the teeth. This can be of concern because it is the growth of the permanent teeth through the jaw that breaks down the roots of baby teeth and allow them to fall out naturally. If the permanent teeth are coming in unaligned with its predecessor tooth, that primary tooth may not fall (exfoliate). This can lead to an increase in pain/pressure, gingival (gum) issues and malocclusion. In these instances, extracting the primary tooth may open up enough space for the permanent tooth to shift into its natural position.

After Tooth Extractions

After tooth extraction, some bleeding is to be expected for several hours. Your child will leave our office biting on gauze pads. We recommend biting on the gauze for 15 minutes, then throwing that gauze away and rolling up new gauze for another 15 minutes. If bleeding or oozing still persists, sucking on anything cold, like ice cubes or ices, or placing moistened tea bag over the area and biting firmly for 20 minutes will help.

Once the blood clot forms (bleeding has stopped) it is important to not disturb or dislodge the clot: So avoid spitting, rinsing vigorously, sucking on straws, or smoking for the first 24 hours after the extraction. It is also recommended to limit vigorous physical activity for the next 24 hours, as this can cause the blood clot to come out.

Depending on which local anesthetic was used, your child’s mouth will be numb for approximately two to four hours. If possible avoid eating during this time to prevent your child from biting his/her cheek or lip. If your child is starving and must eat, feed them soft and bland foods. If they bite their cheeks or lips, they may develop a traumatic ulcer and a swollen lip or cheek that takes 7-10 to heal. Such trauma from biting the lips and cheeks looks like a white/cream patch- this is not an indication of an infection but usually the body healing.

Because some discomfort is expected, you may give your child acetaminophen (Tylenol®) or ibuprofen (Motrin®, Advil®) before the numbness wears off and AVOID giving aspirin to your child. Follow the instructions on the bottle for dosing based upon your child’s age/weight. If antibiotics are prescribed, continue to take them for the indicated length of time even if signs and symptoms of infection are gone.

After bleeding has stopped, encourage fluids to help avoid dehydration. Cold soft foods (e.g., ice cream, gelatin, oatmeal, pudding, yogurt) are ideal the first day. Until the area has healed, avoid foods such as nuts, sunflower seeds, and popcorn that may get lodged in the surgical areas- these can lead to gingival infections.

The teeth should be brushed and flossed softly and avoid putting pressure with the tooth brush at the surgery site.

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