Definition and Overview

Pediatric tooth extraction refers to the removal of teeth among those in pediatric age. This age can significantly vary depending on countries, but in the United States, it’s 0 to 21 years old.

Despite being covered with enamel, which is the hardest substance in the body, the teeth can be damaged due to a wide variety of reasons including trauma, injuries, gum infection, and dental caries, among others. The dentist job is to ensure that the teeth remain healthy and in cases of dental problems, his priority is to save the damaged tooth as much as possible. However, in certain cases, removing the teeth becomes the best and only option.

Who Should Undergo and Expected Results

Pediatric tooth extraction becomes a necessity in cases of:

  • Severe tooth decay – One of the biggest challenges in oral care is caries or tooth decay. If dental attention is sought immediately, the affected tooth can be easily saved using fillings and in more severe cases, root canal therapy. However, if the damage is beyond repair, the dentist may not have any other option but to pull it out.

  • Baby teeth – Also known as milk teeth or deciduous teeth, the baby teeth are the first set of teeth to appear. They start to develop during pregnancy but begin showing by around six months. They help in oral cavity development and are replaced by permanent teeth starting at around six or seven years old. Usually, baby teeth become loose and easier to remove on their own. But sometimes when the permanent teeth are about to erupt and the baby teeth have not fallen yet, they may have to be removed by the dentist to prevent possible dental problems.

  • Orthodontics – Teeth misalignment should be corrected as soon as possible as it can affect the bite and overall function of the oral cavity among children. In some cases, teeth may have to be removed to allow enough space for the remaining teeth to move in.

  • Impacted wisdom teeth – Also known as third molars, wisdom teeth can become impacted or unable to erupt. This may result in infection and inflammation, which can cause a lot of pain and damage to the nearby teeth. Because of their location, their extraction is recommended and this is performed through minor oral surgery.

How Does the Procedure Work?

The procedure starts with a thorough consultation with the dentist. As most children are often anxious about dental visits, the consultation is often used to establish a good relationship with the child and to gain his trust. Parents are also provided with instructions on how to prepare the child for the procedure. This is followed by x-ray exams that give the dentist a clear picture of not just the affected tooth but also its root and the gums surrounding it. Through this, the dentist will be able to identify the best solution to the problem.

As for the actual procedure, children may have to be provided with sedative, depending on their anxiety level. It’s important that the dentist is patient and is able to adjust himself to the emotional and mental state of the child.

A local anesthesia is administered prior to the tooth extraction to numb the area and minimize discomfort. In the case of surgery, such as the removal of an impacted wisdom tooth, general anesthesia may be applied.

For simple tooth extractions, a dental tool called elevator is used to loosen the tooth from its socket before it is pulled out using a pair of forceps. Bleeding is expected but should resolve on its own within 24 hours after the procedure. In the case of wisdom tooth extraction, the gums surrounding the tooth will be cut open, making the tooth visible to the dentist. In some cases, the affected tooth is broken into pieces, especially if it’s covered with bones, before it is pulled out. The wound is then sutured closed and the patient is advised to take antibiotics for about 5-7 days to avoid infection. The patient is also expected to make a follow-up after a week or so for the removal of the sutures and for the dentist to check if the would is healing properly.

Possible Risks and Complications

Children can develop the same complications as adults such as discomfort, pain, and bleeding. Sometimes the gums can also become infected.

The child’s experience can also have an emotional and mental impact, with some becoming traumatized by the whole experience and avoiding dental visits later in life.

References:

  • Douglas JM, Douglass AB, Silk HJ. A practical guide to infant oral health. Am Fam Physician. 2004;70:2113-2120.

  • Dental caries. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 304.

  • Touger-Decker RJ. Position of the American Dietetic Association: oral health and nutrition. J Am Diet Assoc. 2007;107:1418-1428.

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