Expert: Miguel Rodriguez, DDS, MBA - 12/3/2006

Question
Our 3 yr old baby girl has been advised to go for teeth extraction for the front three teeth of the top. We have the following concerns and would appreciate if someone can help us out in the same:

1. She will not be able to sit for the whole process and hence might have to go thru general anesthesia. Is General Anesthesia okay for a 3 yr old? Does it not have any effects after the whole procedure?

2. We have read that removing the teeth may effect the permanent ones and hence some sort of placeholders are kept to avoid this. Can we get some information about the same and like, is it painful, or does it involve another process or are they permanent?

3. The teeth has to be removed due to the decay caused by prolonged breast feeding. Is there another solution besides the extraction by removing the infection or things like that?

4. How much will the whole process will take and till what portion is covered in the Insurance?

Thanks in advance. Would really appreciate if someone can help us out with these issues.

Answer
Ok,I'll address these issues point by point:

1- First, it would be sedation, and not general anesthesia, and the procedure is usually not so long as to require it, though it'll probably require restraining of the girl. An extraction of a front baby tooth takes 2 minutes: one to place the anesthesia, and another one for pulling it out.

2- What you've heard is correct. Losing a baby tooth prematurely will cause the rest to move while attempting to close the gap. Space maintainers are usually cemented on (to avoid having the child lose or swallow it) and are uncomfortable, but not painful.

3- An intrepid odontopediatrician might want to attempt rebuilding the tooth. This would be a hard and long procedure, and whose outcome and durability might not be the desired one, but it is a better option compared to the extraction and spacemaintainer. Nonetheless, if the decay of the baby tooth has created infection at the base of the tooth, extraction is mandatory, since not only has the baby tooth been severely hurt, but also, the infection may affect the forming permanent tooth which lies inside of the bone.

4- Regarding costs and insurance, I have no idea. I live outside of the U.S.