When Should Baby Teeth Be Pulled?

Pulling a perfectly healthy baby tooth… Why would you even consider this? Interestingly, it can be an incredibly important step in preventing orthodontic problems. We always recommend the most conservative treatment option and often opt to wait and see if your child’s mouth will develop naturally. However, for some kids, extracting a baby tooth that won’t come out on its own can eliminate or minimize future orthodontic treatment. Let’s talk about when this may be the best option and what to expect.


When is it beneficial to extract a baby tooth?


Sometimes if a baby tooth (primary tooth) has extensive damage from an injury or too much decay, it cannot be restored. In these situations, it makes sense to pull the tooth to prevent pain and further dental problems.


Other times, orthodontic concerns may lead us to recommend extracting baby teeth. It is not something to recommend lightly, and we will only suggest it as a last resort when leaving the tooth in place will be detrimental to the developing mouth and no other treatment options will work. There are two situations, in particular, that would lead us to consider extracting teeth as an option: severe overcrowding and over-retained primary teeth.


Overcrowding – Many times, other orthodontic treatments can remedy an overcrowded mouth. Braces and palatal expansion are two common treatment methods for this problem. Sometimes, primary teeth contribute to the problem and need to be pulled. Overcrowded teeth are difficult to properly clean and are more prone to cavities and gum disease. When they cause poor alignment, it can lead to a host of other problems, including muscle tension, TMJ disorder, headaches, and tooth enamel that is worn down much faster than normal.


Over-retained primary teeth – This situation is seen when baby teeth are still in the mouth long past the time they should have come out, usually more than a year. Sometimes, these teeth have loosened then tightened back into the gums, which prevents the permanent teeth from coming in properly. If the primary tooth isn’t pulled, the permanent tooth may come in above it, causing very poor alignment and crowding. In addition to crowding and the problems it creates, over-retained teeth can cause tipping of the neighboring permanent teeth, misalignment, cavities, and periodontal problems.


Baby teeth that don’t fall out often cause orthodontic problems, but they can also highlight an existing problem. One example is an ankylosed permanent tooth. Since these teeth are fused to the bone, the primary tooth doesn’t fall out, signaling there is a larger issue at play. Other times, when a baby tooth is in the way, the permanent tooth may try to come in under another permanent tooth, causing it to destroy the tooth in its path.


In many instances, once a primary tooth has been removed the permanent tooth will naturally correct itself over time and not harm nearby teeth. So, as you can see, removing baby teeth at the right time may actually save permanent teeth and protect your child’s mouth from damage.


How does it work? Will my child need to be sedated?


Step 1 - We conduct a thorough exam, usually including x-rays, to determine the root of the problem and be sure that no other treatments will work. Once we have discussed the treatment options with you and answered any questions you may have, we proceed with the treatment plan.


There are two types of tooth extractions: simple and surgical. Removing a primary tooth is usually a simple extraction which is outlined below. A surgical extraction is more common for situations such as impacted wisdom teeth.


Step 2 - We administer local anesthesia. Primary teeth are relatively easy to remove and most children will be just fine having a baby tooth extracted while only using a local anesthetic. This is the same type used while filling a cavity, and it is injected near the tooth then causes temporary numbness to the area.


Some children do need the help of sedation to get through a dental procedure. For these children, we offer nitrous oxide (laughing gas), conscious sedation, or unconscious sedation. Your child’s safety and comfort are our priority, so we will discuss all options with you and proceed with the option that provides the best outcome for your child’s physical and mental wellbeing. If you would like to learn more about the sedation services that we offer, we have discussed them in this article, and if you have further questions we are happy to discuss them with you.


Step 3 – We carefully remove the tooth using small instruments. Extracting a primary tooth is usually a simple procedure that doesn’t take long.


Step 4 – The gum heals then we proceed with any further work that needs to be done. Depending on your child’s mouth, they may simply need to have the tooth pulled, then we will wait and see how the permanent tooth comes in. Other times, extractions are part of a more comprehensive treatment plan that may include a space maintainer, braces, a palatal expander, or other treatment options.


After Care


Depending on your child, they may feel a bit of discomfort or tenderness for a few hours or days after an extraction. There are a few things you can do to help minimize this and allow healing to proceed as quickly as possible.

  • Never let your child eat while their mouth is still numb! This will usually cause them to bite their inner cheeks and tongue, causing pain they would not normally feel.

  • Offer ibuprofen if appropriate.

  • Provide plenty of soft foods for your child to eat for a few days after the procedure. Yogurt, smoothies, soups, scrambled eggs, and soft fruit such as bananas and melons are all great options if your child’s mouth feels tender at all.

  • Drink or suck on cold drinks or soft foods. You can chill small chunks of bananas, melons, or even applesauce and yogurt, and these will provide nutrients while decreasing any discomfort or swelling.

  • Don’t let your child drink from a straw, sippy cup, or thermos that requires them to use a sucking motion. This can cause the healing blood clot to dislodge.

  • Remember to keep brushing and flossing while healing, just be very gentle around the area of extraction. If your child is young, you may want to help for a few days until the area is mostly healed.


A Note About Space Maintainers


We usually want to provide the permanent tooth a chance to erupt normally on its own after a primary tooth is removed. However, in order to do so, it will need space to come in. When there is an empty space in the gum, nearby teeth move to fill in that space more quickly than you would imagine. Luckily, we have options to ensure that the permanent tooth can take its time and still have space to erupt. The appliance used is called a space maintainer.



This image shows the most common type of space maintainer. It is fitted to your child’s tooth and a thin loop of wire keeps the two teeth from drifting toward each other. It is easily removed when the permanent tooth begins to break through the gum tissue.


When Should Baby Teeth Fall Out?


Most parents eagerly anticipate when each baby tooth arrives, but the child is the one eagerly waiting for them to fall out. What happens if a tooth won’t fall out, and how do you know if it has been in too long? Here is a handy chart that shows when each baby tooth should shed.



Each child is different, so this chart includes an age range to account for different developmental rates. If your child still has a primary tooth a year past the range, or you are concerned about a tooth that was loose and has tightened back up or the way a permanent tooth is growing in, please contact us. We are happy to evaluate the situation and ensure your child’s mouth develops in the healthiest way possible.


We hope you have a wonderful Thanksgiving!



At Jungle Roots Children’s Dentistry & Orthodontics, we strive to provide the highest comprehensive pediatric and orthodontic dental care in a unique, fun-filled environment staffed by a team of caring, energetic professionals. We believe the establishment of a “dental home” at an early age is the key to a lifetime of positive visits to the dentist.


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