Pediatric Dentistry/Tooth extraction


QUESTION: My daughter is 15 years old. She has two baby teeth in the bottom of her mouth that never had adult teeth under it. The dentist said it happens sometimes where adult teeth never grow. He said some people have these baby teeth for a very long time.

She already has had all her braces and retainer work done.  Well in one of the baby teeth , a cavity developed that started bothering her. We went to the dentist and sure enough there was a cavity.

He told us to have the tooth pulled. Its not the two back molars but the third one in from the backHe said he could fill it but it would probably hurt more and it will just keep happening and eventually get infected. I guess he was saying filling it would be a temp. fix but would have more problems down the road . He sent me to an oral surgeon because he doesn't extract teeth(?)  He said baby teeth are much closer to the bone. I thought adult teeth would be much harder to pull out? He also told me to have them check her wisdom teeth and see about getting both done at the same time.

We had our consultation and the surgeon said he was going to put her under to do it. He said that was the best option. I was kind of shocked since I have had teeth pulled without being put under. I guess it is just to spare her the trauma because he said she would feel him really pulling on her jaw.

The plan (from my dentist) is to make her a retainer to keep the space open so she can have an implant put in when she is older. The surgeon explained the implant process and there is absolutely no way I am going to be able to get her to do this. She has slight anxiety normally and is scared to death of needles. The fact that she has to be put out is making her freak out enough.

I don't even know the cost yet since they didn't tell me.  But the more I think about it, the more I am not understanding.  Why would she need an implant? Couldn't they close the space up or let it close? Would leaving that space be good to let her wisdom tooth come in correctly?

I also am wondering why would they not have pulled the baby teeth before the braces? She has one on the other side that is healthy.  Could they have pulled them and put on braces to close the gaps?  Now if that is an option, I am going to have to pay for more braces.

Is it the right thing to put her under? Should she get the other pulled too? I just have so many questions and this is getting bigger than I anticipated. I thought she could just get the cavity filled like everyone else.

I just need some insight. Thanks so much!!!

ANSWER: Sounds right being you state she has a lot of anxiety that being put under is a good Idea. Especially if you will also be doing the wisdom teeth. It is always best to save retained primary teeth as long as possible. The tooth would have to come out at some time anyways. Placing it in her retainer for now is a good option ,then after age 18 a implant can be done once growth is complete in the jaw. These baby teeth are very brittle at this point and restoring with large restorations usually is not a good option. Best Wishes

---------- FOLLOW-UP ----------

QUESTION: IF the teeth have to come out eventually, why not pull both the baby teeth(one on each side ) and then close the gap with braces?  Or is this not really an option?

I won't be doing wisdom teeth..I have to take baby steps. I can't do it all at once for her. Wisdom teeth wise, they aren't bothering her and it looks like on the xrays they are coming in fairly straight(but I am not a dentist). I don't want to do that if it isn't necessary.

There is no way I am going to get my daughter to do an implant. They explained the process...and it isn't going to happen.  When she is 18 , she also can make her own decisions and she won't do it.  

Thanks again for your input!

If you leave a decayed tooth it can get infected and damage the bone preventing future use of an implant when older. If she is going to be put to sleep, you might as well do all at once. The back tooth this late in the game cannot be closed with braces, you will need to make a partial, bridge or implant to replace. Also if you wait for the wisdom teeth to start bothering her you will have a harder time with the extractions once infected. If she is asleep, she wont remember what happened doing all or just two.

Pediatric Dentistry

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Michael D. Saxe D.M.D.


All questions related to Pediatric Dentistry, Dental Growth, Dental Trauma, First Dental visit, Baby Bottle tooth Decay, Dental Sedation, Etc...


20 years private practice as a Pediatric Dentist, Staff at University Of Nevada School of Dental Medicine, Advanced Education Program in Pediatric Dentistry.

ADA, AAPD, Nevada dental society, Clark County Dental Society, Cal. AAPD, Western society of Pediatric Dentistry, Southern Nevada CFA Team core member.

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Washington University in Saint Louis, Dental School University of Texas Health Science Center San Antonio, residency

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