Dental Extractions: When Are They Necessary in Children?

Keeping teeth in the mouth is usually best. But there are situations that require dental extractions in children. Learn more about them.
Dental Extractions: When Are They Necessary in Children?
Vanesa Evangelina Buffa

Written and verified by the dentist Vanesa Evangelina Buffa.

Last update: 17 February, 2023

In dentistry, most of the time, professionals prioritize keeping the teeth in the mouth. However, there are particular situations in children in which dental extractions are necessary. Today, we’ll tell you about them.

Each of the teeth in children’s mouths, both primary and permanent, has a specific role. For this reason, it’s best to preserve and take care of each element so that it can fulfill its function.

But as we were saying, there are particular situations that require the removal of a tooth from the mouth. It’s a pediatric dentist who makes this decision in order to achieve better oral health.

When a dentist has to remove a tooth from the mouth, this can be a situation of fear and anxiety in children. Find out when dental extractions are necessary for children and how you can accompany your child if they need one.

When are dental extractions necessary in children?

As we mentioned before, keeping teeth in the mouth is always the first option in dentistry. The loss of a tooth affects the harmony and esthetics of the smile, has repercussions on oral functions, and can cause space problems due to the mobilization of the remaining elements.

However, when the persistence of the tooth becomes a health risk or alters the harmony of the rest of the dentition, dental extractions will be necessary in children. The intervention is performed when, after evaluating other therapeutic alternatives, there’s no other option but to remove the problematic tooth or teeth.

These are some of the situations that may lead the pediatric dentist to recommend dental extractions in children.

Very advanced cavities

Cavities are one of the most common reasons for dental extractions in children. Decayed teeth, if not treated in time, can cause extensive destruction of hard tissues and severe damage to the deeper areas of the mouth.

The progression of the disease can cause pain and infection in the tooth and surrounding tissues. In the case of milk teeth, the pathology can put at risk the correct development of the definitive tooth that’s forming inside the bone.

When the cavities are very advanced and most of the dental tissues have been lost, there’s a great infection that can’t be reversed with a root canal or the development of the definitive teeth is at risk, the pediatric dentist will indicate a dental extraction. By removing the damaged element, the other structures are preserved and major complications are prevented.

After the extraction, rehabilitation alternatives are sought according to the age of the child in order to restore the appearance and function of the teeth. If the tooth to be extracted is temporary, a space maintainer is placed to preserve the site for the eruption of the definitive element in the future.

Find out more: Mouthguards for Children

Dental trauma

A crying toddler.
Children, especially at school age, are susceptible to trauma involving the teeth.

Sometimes, blows to the teeth can cause fractures and damage that can’t be solved with root canals and crowns. In addition, in baby teeth, there’s a risk of damaging the germ of the definitive element that’s forming inside the bone.

In these cases, it’s best to remove the tooth fragments and look for a prosthetic rehabilitation according to the age of the child. This way, oral health is preserved, complications are prevented, and lost functions and esthetics are recovered.

The persistence of baby teeth

Another reason for dental extractions in children is the persistence of baby teeth that fail to fall out naturally on their own. The permanence of temporary teeth affects the positioning of their definitive successors and alters the alignment of the entire bite.

In these cases, removing the baby tooth or teeth helps the definitive elements to be positioned in their corresponding places in the dental arch. This way, extraction prevents dental malposition and bite problems.

As part of orthodontic treatment

Dental extractions performed on children can be part of orthodontic treatment. In this type of therapy, the position is usually conservative, but there are situations in which the space in the jaws isn’t sufficient and the removal of some teeth can achieve this.

In children who have a very narrow jaw or very severe dental crowding, the extraction of some teeth allows the orthodontist to obtain the space needed to align the other elements of the arch. The professional indicates exodontia when it’s not possible to reverse the malocclusion with other methods.

In general, the tooth that’s usually extracted is the first or second premolar. However, depending on the clinical case, the orthodontist may indicate the extraction of some other element.

In some cases, the extraction of deciduous teeth helps to change an abnormal eruption pattern in the permanent teeth. If the angulation at which the permanent teeth erupt isn’t correct, removing some temporary teeth helps to avoid further damage or problems.

What are dental extractions in children?

An Asian dentist examining an Asian boy's mouth while he sits on his Asian mother's lap.
It’s important to have highly qualified personnel when performing dental extractions.

Dental extractions in children, also called extractions, require a previous preparation of the child. This prevents the situation from being traumatic and producing fears and resistance in the future.

Talking to the child about the procedure to be performed, as well as explaining and showing what’s going to be done, helps to reduce the tension that the surgery generates. It’s important to respect their time and accompany them with patience in the moment of preparation prior to the intervention.

At the time of exodontia, it will be necessary to apply local anesthesia so that there’s no pain during the intervention. In some children, this step can be combined with some type of sedation to relax the child and prevent fear or anxiety.

Letting the child know that you’re with them, holding their hand, or bringing some of their favorite toys can also help them to be calmer during the procedure.

Depending on the type of tooth to be extracted and the severity of the case, the tooth can be removed by two processes:

  • Simple extraction: This is the most common. It consists of separating the tooth from the gum, loosening it, and moving it with special instruments such as syndesmotomes and elevators. Then, the tooth is taken with tweezers called “forceps” and removed from the mouth.
  • Surgical extraction: This is used in more complex cases where a simple extraction isn’t possible, such as broken teeth below the gum line or teeth that haven’t finished erupting. In these cases, the gum is cut and separated and material is removed from the bone to expose the tooth and then removed with specific instruments. Sometimes it’s fragmenting the tooth and extracting it in parts is necessary.

At the end of the procedure, the dentist makes stitches when necessary and places a gauze in the mouth for the child to bite on for a few minutes. In addition, they’ll give the parents indications on the necessary care for the recovery of the tissues.

How to care for children after dental extractions

After the surgical intervention, there are some steps that should be taken so that the tissues in your child’s mouth heal and recover. Here are some tips that will help you care for and accompany your child after a tooth extraction:

  • Bite the gauze for 30 minutes and then discard it. Make sure your child doesn’t swallow it or move it from its place.
  • Avoid having your child rinse their mouth or brush their teeth in the first 24 hours after the extraction.
  • Don’t use straws or sippy cups.
  • Offer soft, cold foods such as yogurt, cool soups, fruit purees, and ice cream.
  • Avoid exposure to heat.
  • Don’t play sports or games that involve a lot of physical activity.
  • Take the medication prescribed by the pediatric dentist: It’s common for the professional to prescribe an anti-inflammatory for pain and, in cases of infections, antibiotics.
  • Remind the child not to touch the extraction area.
  • If the child’s face swells, ice can be applied intermittently to the area to reduce swelling and pain.
  • If stitches are used, it will be necessary to visit the dentist’s office in 7 days to have them removed.
  • Follow the dentist’s recommendations and return to scheduled check-ups.

Accompany the child

Although dental extractions in children may frighten little ones and worry their parents, sometimes they’re the most convenient option. Evaluating all the doubts, accompanying your child before, during, and after the procedure, and following the dentist’s instructions will make the experience more pleasant for everyone.

All cited sources were thoroughly reviewed by our team to ensure their quality, reliability, currency, and validity. The bibliography of this article was considered reliable and of academic or scientific accuracy.

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This text is provided for informational purposes only and does not replace consultation with a professional. If in doubt, consult your specialist.