Tooth extractions in children


Milk teeth differ from permanent ones. They have a thinner enamel layer, and their root system is less developed. As a result, they are prone to rapid development of cavities, which destroy the tissue. In some cases, it becomes necessary to extract these teeth because therapeutic treatments fail to address the issue adequately.

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Indications for the extraction of milk teeth

Pediatric tooth extraction - 1

The transition from milk teeth to permanent ones is a natural process. Their roots gradually dissolve, the crowns become loose, and then fall out on their own. However, there are situations where it becomes necessary to extract milk teeth. These include:

  1. Advanced-stage cavities that cannot be addressed by removing affected tissues and filling;
  2. Destruction of the tooth unit due to injury;
  3. Reluctance of a loosened crown to fall out, especially if it causes discomfort to the child;
  4. Eruption of a permanent tooth in a place where a milk tooth has not yet fallen out;
  5. Identification of a fistula, cyst, or signs of periodontitis;
  6. The need to form a correct bite in accordance with orthodontist's recommendations.

When Permanent Teeth are Extracted

In some cases, it becomes necessary to remove permanent teeth, but this is only done for serious reasons. The most common causes include:

  • Advanced or complicated cavities that cannot be managed with therapeutic methods;
  • Severe inflammatory processes accompanied by mobility of the crown;
  • Fracture of the tooth root or its crown part;
  • The emergence of supernumerary units disrupting the integrity of the dental row;
  • Orthodontic treatment, for example, to correct the bite or make space for erupting teeth;
  • Presence of an unerupted tooth that cannot develop further.

The decision to extract is made by the dentist based on diagnostics and after consultation with other specialists.

Types of Anesthesia

Tooth extraction is a painful procedure. A loose milk tooth ready to fall out can be removed without pain and usually doesn't require anesthesia. In all other cases, anesthesia is necessary. We use drugs that are completely harmless to the child's body. There are several options for anesthesia, and the choice depends on the individual characteristics of the young patient.

Local Anesthesia

Modern dentistry uses the following methods of local anesthesia:

  • Topical – the doctor applies the drug to the tissue surface. It provides a short-term numbing effect and is used before an injection or the removal of a loose tooth;
  • Infiltration – the doctor injects into the gum mucosa to numb the tissues surrounding the tooth;
  • Block – used to block the nerve trunk innervating the vascular-nerve bundle of the tooth to be removed;
  • Intraligamentary – the anesthetic is injected into the tissues between the cement of the root and the socket.

In pediatric dental treatment, two-stage anesthesia is often used: topical numbing of the area where the doctor then makes an injection.

General Anesthesia

Drugs are administered intravenously or through a mask. Under general anesthesia, the child is completely relaxed and does not feel pain. General anesthesia is applied considering the specifics of a child's body. It may be required in the following cases:

  • The patient is under 2-3 years old;
  • Complex extraction is required;
  • The child is extremely scared of the upcoming procedure and may have uncontrolled panic attacks;
  • Several teeth need to be removed;
  • Complex inflammatory processes in the oral cavity;
  • The child has an allergy to pain medications;
  • Presence of neurological disorders.

General anesthesia is recommended for dental extractions in children with cerebral palsy and epilepsy. Otherwise, they may get injured due to seizures, spasms, uncontrollable movements.


The child is in a state resembling sleep, maximally relaxed but still able to respond to the doctor's words. Sedation is usually performed by inhalation – inhaling gas through a mask. Sedation can be combined with anesthesia to achieve maximum effect.

Typically, a drug based on nitrous oxide is used. It does not cause allergies or addiction and is quickly eliminated from the body.

Contraindications for the Use of Anesthesia

Pediatric tooth extraction - 2

Tooth extraction with anesthesia is conducted after an examination and consultation with an anesthesiologist. The specialist must rule out contraindications, which include:

  • Acute infectious diseases;
  • Recent vaccinations;
  • Inflammation of the oral mucosa – stomatitis, gingivitis;
  • Diseases of the ENT organs and the cardiovascular system;
  • Individual intolerance to the components included in the drugs used for anesthesia.

Types of Procedure

Tooth extraction in children is generally a straightforward procedure. However, there can be specific nuances in different situations.

Extraction of a Milk Tooth

This is the most common operation. In most cases, two-stage anesthesia is used. The dentist:

  • Applies a gel with a freezing effect on the gum mucosa;
  • Makes an injection at this spot with a safe and effective anesthetic.

During this, the dentist distracts the child with conversation, so the child doesn't focus on the dentist's manipulations or the tools being used. Typically, it's enough to hook the tooth with a special instrument and extract it with gentle, rotating movements.

Extraction of a Loose Tooth

This procedure is used if a loose tooth doesn't fall out on its own but is hindering the eruption of a permanent tooth or is causing discomfort to the child. It's possible to manage without anesthesia or to use a topical gel with a freezing effect. After numbing, the dentist easily extracts the tooth from the gum.

Extraction of a Supernumerary Tooth

The roots of such teeth often are not fully formed, which simplifies extraction. They are removed if they:

  • Have erupted outside of the main dental row;
  • Are pressing on existing teeth, displacing them;
  • Are damaging soft tissues, causing inflammation;
  • Affect speech articulation – this is possible, for example, when they erupt on the side of the palate.

Before extraction, the dentist performs two-stage anesthesia.

How the Procedure is Conducted

Pediatric tooth extraction - 3

It's important that the child feels calm. Therefore, before the extraction, the dentist, together with the parents, explains what will be done and why.

After establishing rapport with the young patient, the dentist:

  • Examines the oral cavity;
  • Takes an X-ray to assess the root positioning;
  • Chooses the optimal anesthesia option if required.
  • The extraction is performed in a specially equipped office. Parents can be present with their child. Typically, the dentist follows this procedure:
  • Administers anesthesia;
  • Waits for the anesthesia to take effect;
  • Extracts the tooth using an instrument, employing gentle rotating movements.
  • The procedure takes 10-15 minutes.

After the extraction, the dentist treats the socket. They also advise the parents on oral care, answer questions, and schedule a follow-up visit to ensure there are no complications or adverse side effects.

Post-Extraction Recommendations for Children

A child's postoperative wound heals faster than an adult's. However, to avoid potential complications, certain rules and recommendations should be followed.

  1. Do not drink for 30 minutes after the procedure – a blood clot should form in the socket to protect the wound and stimulate further healing, and liquids can interfere with its formation.
  2. Do not eat for 2 hours after the procedure – for the same reason and because the anesthesia is still in effect, and the child may accidentally bite their lip or cheek without feeling it.
  3. Do not rinse the mouth for 3 days after extraction – to avoid disturbing the blood clot in the socket. You can use mouth baths with warm solutions recommended by the doctor.
  4. Avoid hard, excessively hot, or overly cold food for 24 hours after the extraction.

You can brush your teeth the next day after the extraction, but be careful not to disturb the wound.

If the child feels pain after the anesthesia wears off, you can give them a painkiller.

The healing process usually takes 5-7 days. If it takes longer or complications arise, inform the dentist immediately.

AESTHETE Dental Clinic in Dubai, UAE, located on Bluewaters Island, is at your service. Dear parents, if your child requires dental treatment and extraction, bring them to us. Our doctors are professionals with extensive practical experience. They easily establish contact with children, perform all procedures quickly, without pain and discomfort. If anesthesia is required, we will select a suitable harmless option.

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