There are times when it is necessary to remove a tooth. Sometimes, a baby tooth has misshapen or long roots that prevent it from falling out as it should, and the tooth must be removed to make way for the permanent tooth to erupt. Other times, a tooth may have so much decay that it puts the surrounding teeth and jaw at risk. Infection, orthodontic correction, or problems with a wisdom tooth can also require removal of a tooth.
If it is determined that your child’s tooth needs to be removed, your pediatric dentist may extract the tooth during a regular checkup or may schedule another visit for this procedure. The root of each tooth is encased within the jawbone in a “tooth socket,” and the tooth is held in that socket by a ligament. In order to extract a tooth, the dentist must expand the socket and separate the tooth from the ligament holding it in place. While this procedure is typically very quick, it is important to share with your dentist any concerns or preferences for sedation; we want to make sure your child is as comfortable as possible.
The day after your child’s extraction:
- No drinking with straws
- No vigorous rinsing and spitting
- A soft diet is recommended; no eating of popcorn, pretzels, pizza, crackers, or any food with sharp edges
- If your child has any discomfort, give a children’s dose of Advil® or Tylenol®
- If your child experiences swelling, apply a cold cloth or an ice bag and call our office
Space Maintenence
If your child’s tooth has come out too soon because of decay or an accident, it is important to maintain the space to prevent future space loss and dental problems when permanent teeth begin to come in. Without the use of a space maintainer, the teeth that surround the open space can shift, impeding the permanent tooth’s eruption. When that happens, the need for orthodontic treatment may become greater.
Types of Space Maintainers
Space maintainers can be made of stainless steel and/or plastic, and can be removable or fixed (cemented to the teeth).
Removable
A removable space maintainer looks much like a retainer with plastic blocks to fill in where the tooth is missing. If your child is older and can reliably follow directions, a removable space maintainer can be a good option.
Fixed
Fixed space maintainers come in many designs.
A band-and-loop maintainer is made of stainless steel wire and held in place by a crown or band on the tooth adjacent to the empty space. The wire is attached to the crown or loop and rests against the side of the tooth on the other end of the space.
A Nance appliance has a very specific function and can be used to expand or rotate the upper molars, or to hold molars in place. The most common use is as a space maintainer to prevent upper molars from drifting forward.
A lingual arch is used on the lower teeth when the back teeth on both sides of the jaw are lost. A wire is placed on the lingual (tongue) side of the arch and is attached to the tooth in front of the open space on both sides. This prevents the front teeth from shifting backwards into the gap.
In the case of a lost second primary molar prior to the eruption of the first permanent molar, a distal shoe may be recommended. Because the first permanent molar has not come in yet, there is no tooth to hold a band-and-loop space maintainer in place. A distal shoe appliance has a metal wire that is inserted slightly under the gum and will prevent the space from closing.
Caring for Your Child’s Space Maintainer
There are four general rules for taking care of your child’s appliance.
- Your child should avoid sticky foods, including candy and chewing gum.
- Encourage your child not to push or tug on the space maintainer with the fingers or tongue.
- Keep your child’s space maintainer clean through effective brushing and flossing.
- Your child should continue to see the pediatric dentist for regular dental visits.