Tooth extraction refers to painless removal of tooth or tooth roots with minimum trauma to the investing surrounding tissues so that the extraction socket wound heals uneventfully without any post-operative complications. A child doesn’t know what to expect during tooth extraction and anticipation of surgery itself exacerbates the apprehension of the child. Child will often consider the tooth extraction procedure to be scary and will worry that the tooth extraction procedure will hurt. Pedodontist who is children specialist dentist can reduce the anxiety and apprehension level of the child by educating the child. Pedodontist spends considerable time in attaining level of cooperation from the child in dental operatory. If the baby tooth can be saved, then emphasis should be laid on saving the tooth and not removing the tooth. People think that baby teeth are of no use and get their children’s baby tooth removed when they can be saved. Baby teeth guide the adult teeth in correct position and prevent crowding of adult teeth on eruption.

Causes of Tooth Extraction in Children

1.    Dental extraction is done in children if the tooth is decayed to the point that tooth can’tbe restored.

2.    If the tooth is fractured or is involved in jaw fractures, then the tooth is indicated for dental extraction.

3.    If the baby deciduous teeth are interfering with the eruption of permanent adultsuccessor, then extraction of baby teeth is done.

4.    If there are over retained baby teeth present, then baby teeth extraction is done.

5.    If teeth are involved with dental cysts and dental tumors, then teeth are removed. 

6.    In case of impacted teeth and supernumerary teeth, dental extraction is done.

7.    Primary teeth with furcation involvement are indicated for dental extraction.

8.    In case of severe Periapical infection of baby tooth, tooth extraction is indicated.

9.    Tooth extraction may be done for braces treatment. In case of crowding of dental arch, dentist may extract one or more teeth to create space for shifting the teeth.  Some of the baby milk teeth are removed in child if crowding is likely to occur when the deciduous baby teeth are replaced with permanent adult teeth.  

Planned Tooth Extraction is carried out to create room for the adult permanent teeth to come and for proper alignment of the adult teeth. It may also avoid the need for braces treatment later on.

Prior to Tooth Extraction Procedure in Children

To determine severity of damage, an x-ray of tooth is taken. If tooth can’t be restored, then new appointment is given to the child for tooth extraction procedure. An antibiotic may also be given to the patient to reduce the infection.

If the child is very nervous and anxious about the tooth extraction procedure, then anti-anxiety medication may be given to the child. It is typically to be taken at night before the tooth extraction.

Pain Prevention

For the prevention of tooth extraction pain, local anesthesia shot, topical anesthesia for numbing the area, IV conscious sedation or general anesthesia may be given to the child. The method adopted for pain prevention depends on patient’s preference, age and health of the child, comfort level of the dentist and the procedure which is used for tooth extraction. In children, less of anesthesia is required as compared to the adults. As few as possible pain meds should be given to the child. Pain meds if given before the tooth extraction procedure can cause blood clotting difficulties.  

Procedure for Tooth Extraction

After numbing the tooth, dental elevator and dental forceps are used to luxate the tooth and remove the tooth from the socket. If shot is given to the child for pain prevention, then the child will only feel some pressure during tooth removal and no pain. This procedure is done in case of simple tooth extraction in which the tooth is visible in the mouth.

 
Extraction of Baby Deciduous Lower Molar

If the tooth is impacted or is not visible above the gum line, then surgical tooth extraction is done in child. Conscious sedation or general anesthesia may be given to the child before surgical tooth extraction.  Nitrous oxide also called laughing gas or stronger sedation may be given to the patient through IV. In case of surgical tooth extraction, gum tissue is removed to pull the tooth out.

Tooth Extraction of Baby Deciduous Teeth

Baby tooth is easier to remove from the socket. The roots of the baby tooth are mostly resorbed and are short which makes it easy to remove them.  There is little or no discomfort.

Adult Permanent Tooth Extraction in Children

In children, adult tooth extraction is done for dental braces treatment if there is severe crowding of dental arch or in case of dental cyst or tumour involvement to the tooth. Extraction of teeth in children for braces treatment should be avoided if possible. Space can also be gained in children by use of palate expansion, guided growth or by use of head gears. If tooth extraction is to be done for braces treatment in children, then wisdom teeth or the bicuspids are commonly removed. They are removed after giving local anesthesia shot and will not cause much of pain.

Tooth Extraction Aftercare in Kids

Child has to firmly bite on the gauze pack to stop the bleeding. If bleeding is profuse after tooth extraction, then gauze pack needs to be changed after every 20-30minutes till the time blood clot forms. Ice can be applied to reduce the swelling on child face and soft diet is recommended to the child during the first 24 hours after tooth extraction. Milkshakes, smoothies, jellies and apple sauce can be given to the child.  Child should not spit forcefully after tooth extraction and should keep his mouth as clean as possible during the healing period. Pain meds may be prescribed to the child. Child can do warm saline rinses 24 hours after toothextraction. If dissolvable stitches are given to the child, then they will dissolve in 2 weeks.  If non-dissolvable stitches are given, then they have to be removed after 1 week. Child can do salt water rinses a day after tooth extraction.

If there is severe fever or if swelling persists for longer time, then it can be because of infection. Dentist should be called immediately in such a situation.

If baby teeth are removed because they are not restorable and the baby tooth extraction is done too early, then space maintainers should be given to the child. Fixed or removable space maintainers can be given to the child.  Baby teeth are important as they guide the adult teeth to correct place and if they are removed prematurely, then it can lead to crowding of the adult teeth.

Who performs Tooth Extraction in Children

A general dentist can perform tooth extraction in children. If the child is quite anxious and nervous, then Pedodontist who is specialist in children dentistry should perform the tooth extraction. Pedodontist will spend considerable time in attaining cooperation from child in dental operatory and will reduce the fear, anxiety and apprehension of the child by educating the child. If baby tooth extraction is done too early, then fixed or removable space maintainers have to be given to the child. If tooth extraction is performed by a general dentist and space maintainer is required after that, then a Pedodontist is consulted.

Cost of Tooth Extraction in Children

Simple tooth extraction in children will cost $50-$90. If sedation or general anesthesia is given to the child for tooth extraction, then it will cost even more. Dental insurance companies will pay 70-80% of the dentist’s fees. If space maintainers are given to the child after tooth extraction, it will cost around $200-$400 depending on the place, dentist and type of space maintainer (Unilateral or bilateral, Fixed or removable space maintainer) Dental insurance companies may or may not cover the cost of space maintainers.