Extraction vs filling of kids's milk tooth.

choosing between extraction and filling or conservation is a very common decision that both dentists and patients have to take every day. With adults the decision making is much more easier, if the tooth is restorable and the patient can pay for the treatment then we simply conserve the tooth. If the patient is a child then the process of decision making is much more harder as many factors affect the selection of the treatment plan that the dentist have to follow.

1-Child’s age:

This factor is very important as it well judge the cooperation of the child during treatment process so the cooperative patient is giving more chance to the success of lengthy treatments like filling or even root canal when uncooperative patient may drive the dentist to extraction.

2- The time left for the tooth to come out or shedding:

The dentist here estimate the time left for the milk tooth in the mouth by considering the normal eruption time averages and also the eruption time variations of your kid. Some kids tend to change their teeth earlier of later than normal and this should be taken in consideration when the dentist calculate the estimated of the milk tooth left.

if the dentist estimated that the permanent tooth needs only 6 months or less to come out then it would be better not to waste money and time in filling or root canal.

We have to know that premature extraction of the milk teeth will result in less effective chewing also may cause malalignment or crowding in the permanent teeth which will need an expensive orthodontic treatment after that.

3-General medical state of the child:

If the child suffer from generalized medical illness this may change the treatment plan dramatically. For example if the kid suffers from cardiac disease or the immunity of the child is compromised for any reason like uncontrolled diabetes etc. The recurrence of infection here should be avoided so extracting the affected tooth with a antibiotic coverage may be better than performing deep filling or root canal treatment that may fail and cause recurrence of infection.

In other cases if the child suffers from diseases that affect blood coagulation (like hemophilia ) then the extraction should be avoided and we should try to conserve the tooth till it fall out or shedd normally to avoid the risk of bleeding after extraction.

4-Parents insistence:

Most of the parents of our patients have a good knowledge about problems of early extraction of milk teeth but sometimes we meet parents who insist in extraction and keep saying “the tooth will fall naturally any way in a year or two why should i spend money on it ” In many of this cases the dentist will just pull the tooth as he feels that the patient is not believing what he say about early extraction.

5-Number of decayed milk teeth:

If the child has only one carious tooth then we should conserve this tooth and his mouth clean. But if we have extensive caries allover the mouth sometimes we have to sacrifice some teeth to keep the treatment plan affordable and realistic. The very common decision here is to extract the first milk molar and conserve the second milk molar as the first milk molars tend to cause less problems when extracted early.

6-The degree of tooth destruction:

simply some teeth are too late to be fixed

7-position of the tooth:

Although loss of first incisor will have less effect on permanents alignment, loss of canines or molars will lead to more problems especially in patient with a crowding susceptibility .

8-orthodontic consecrations:

Many times the orthodontist can give an order of early extraction or insist on keeping a tooth that may require lengthy treatment to avoid serious orthodontic problems in the future.

last thing we have to say that early extraction of deciduous teeth can cause really bad problems in permanents alignment or even affect the child’s chewing and psychology. so take your time to think before pulling the tooth