Short answer: A baby tooth is pulled in cases such as severe decay, an abscess, an injury that cannot be saved, or when it blocks the path of the permanent tooth coming in. Losing a tooth too early can let neighboring teeth drift into the gap and leave too little room for the permanent teeth; for this reason the dentist may recommend a space maintainer when needed.
When do baby teeth fall out on their own?
Baby teeth usually start to fall out at around six to seven years of age. The lower and upper front incisors go first, while the baby molars mostly make way for permanent teeth between ages ten and twelve. Timing differs from child to child; being a few months early or late is usually considered normal. The root of the permanent tooth dissolves the root of the baby tooth, and the tooth becomes loose and falls out.
In which cases is a baby tooth pulled?
- Severe decay that cannot be treated: When the structure of the tooth is damaged beyond saving.
- Abscess or infection: When there is inflammation at the root or in the gum, because the infection can affect the permanent tooth bud underneath.
- Injury: For teeth broken by a fall or a blow that cannot be treated.
- A baby tooth that does not fall out: When the permanent tooth has come in beside it but the baby tooth has stayed in place (the “double row of teeth” appearance).
- Orthodontic need: To reduce crowding or to make way for permanent teeth that are coming in, depending on the dentist’s plan.
The decision to extract is made by evaluating the child’s age, the condition of the tooth and the development of the permanent tooth beneath it together. In some cases an X-ray may be needed.
Why does early loss matter?
A baby tooth works like a “place holder” for the permanent tooth that will replace it. If it is lost too early, neighboring teeth may tilt or drift toward the gap, and the opposing tooth in the other jaw may grow longer. As a result, the space for the permanent tooth narrows, and problems such as crowding, impaction or eruption in the wrong position become more likely. We covered this topic in more detail in our article on baby tooth decay and space maintainers.
What is a space maintainer?
A space maintainer is a small appliance that preserves the gap left by a baby tooth lost too early. It comes in fixed and removable types and stays in place until the permanent tooth comes in. It is not necessary after every early loss; the child’s age, the tooth that was lost and how long remains before the permanent tooth erupts are taken into account. The decision belongs to the dentist.
What should you pay attention to after extraction?
- Not picking at the area or pushing it with the tongue during the period the dentist specifies
- Staying away from hot and hard foods for a short time
- Continuing to brush the other teeth while keeping the extraction site gently clean
- Contacting the dentist if there is swelling, prolonged bleeding or fever
To learn about the risk of crowding after early loss and orthodontic follow-up, you can read our dental crowding page, and for the signs, our article on crowding in children.
Extraction or treatment?
Baby teeth should not be neglected on the grounds that they will fall out anyway. In teeth where decay has not advanced or reached the nerve, a filling may be chosen, and for deeper decay, root canal-like treatments suitable for baby teeth may be preferred. The aim is to keep the tooth in the mouth until its natural time to fall out, whenever possible. Extraction is chosen when treatment would not work or when infection threatens the permanent tooth.
How do you explain it to the child?
- Use simple, honest language, with phrases such as “We need a dentist’s help to keep your tooth healthy.”
- Avoid frightening details and negative stories.
- If the child has questions, answer them calmly and give them the chance to get to know the dentist.
- After the procedure, support the child with encouraging words.
When should a check-up be arranged?
If you see swelling in a baby tooth, a blister on the gum, pain when biting or fever, you should see the dentist without waiting. Teeth that break or move out of place after a fall should also be evaluated without delay. Regular check-ups help to notice the risk of space loss early and save time for a space maintainer or orthodontic follow-up if needed.
Follow-up after a space maintainer
After a space maintainer is fitted, the child needs to come to check-ups regularly. The eruption of the permanent tooth is monitored, and the appliance is removed when it is time or renewed if necessary. Because a space maintainer can be damaged by sticky and hard foods, it is recommended to watch the child’s eating habits and to contact the dentist without delay if it becomes damaged or loose. Oral care must also be kept up carefully, because plaque can build up more easily around the appliance.
Frequently asked questions
Is it right to pull a loose baby tooth at home?
If the tooth is very loose and the child is not uncomfortable, waiting for it to fall out on its own is usually enough. Rather than trying to pull it by force, it is safer to monitor it and consult the dentist without squeezing the tooth.
Does the permanent tooth come in right away when a baby tooth is pulled?
No. The eruption time of the permanent tooth depends on the development of its root; this can take months. For this reason a space maintainer may come up in the case of very early loss.
What happens if a decayed baby tooth is pulled without being treated?
Not every cavity requires extraction. Whether the tooth can be treated is evaluated first; for teeth that cannot be saved, extraction is carried out and a plan is then made to hold the space.
How do you find out what suits you?
The information here is general; the right plan for your child is determined through an examination and the dentist’s evaluation. At our clinic in Oran, Çankaya, Ankara, we go through your questions together. For appointments and directions, you can see our contact page.
