• Tooth extraction refers to painless removal of
tooth or tooth roots with minimum trauma to
the investing surrounding tissues so that the
extraction socket wound heals uneventfully
without any post-operative complications. A
child doesn’t know what to expect during
tooth extraction and anticipation of surgery
itself exacerbates the apprehension of the
Role of Pedodontist
• . Pedodontist who is children specialist dentist
can reduce the anxiety and apprehension level
of the child by educating the child.
Pedodontist spends considerable time in
attaining level of cooperation from the child in
dental operatory. If the baby tooth can be
saved, then emphasis should be laid on saving
the tooth and not removing the tooth
• . People think that baby teeth are of no use
and get their children’s baby tooth removed
when they can be saved. Baby teeth guide the
adult teeth in correct position and prevent
crowding of adult teeth on eruption.
• . Child will often consider the tooth extraction
procedure to be scary and will worry that the
tooth extraction procedure will hurt
Causes of Tooth Extraction in Children
• 1. Dental extraction is done in children if the
tooth is decayed to the point that tooth can’tbe
• 2. If the tooth is fractured or is involved in jaw
fractures, then the tooth is indicated for dental
• 3. If the baby deciduous teeth are interfering
with the eruption of permanent adultsuccessor,
then extraction of baby teeth is done.
• 4. If there are over retained baby teeth
present, then baby teeth extraction is done.
• Planned Tooth Extraction is carried out to
create room for the adult permanent teeth to
come and for proper alignment of the adult
teeth. It may also avoid the need for braces
treatment later on.
• 5. If teeth are involved with dental cysts and
dental tumors, then teeth are removed.
• 6. In case of impacted teeth and
supernumerary teeth, dental extraction is
• 7. Primary teeth with furcation involvement
are indicated for dental extraction.
• 8. In case of severe Periapical infection of
baby tooth, tooth extraction is indicated.
• 9. Tooth extraction may be done for braces
treatment. In case of crowding of dental arch,
dentist may extract one or more teeth to
create space for shifting the teeth. Some of
the baby milk teeth are removed in child if
crowding is likely to occur when the deciduous
baby teeth are replaced with permanent adult
• To remove teeth that cannot be restored
• To remove teeth that are not necessary to
• To remove potentially problematic teeth
• To remove teeth necessary for orthodontic
• Although permanent teeth were meant to last
a lifetime, there are a number of reasons why
tooth extraction may be needed. A very
common reason involves a tooth that is too
badly damaged, from trauma or decay, to be
repaired. Other reasons include:
Purpose of extraction in children
• Risk of infection. If your immune system is
compromised (for example, if you are
receiving chemotherapy or are having an
organ transplant) even the risk of infection in
a particular tooth may be reason enough to
pull the tooth.
• A crowded mouth. Sometimes dentists pull
teeth to prepare the mouth for orthodontia.
The goal of orthodontia is to properly align
the teeth, which may not be possible if your
teeth are too big for your mouth. Likewise, if a
tooth cannot break through the gum (erupt)
because there is not room in the mouth for it,
your dentist may recommend pulling it.
• Infection. If tooth decay or damage extends to
the pulp -- the center of the tooth containing
nerves and blood vessels -- bacteria in the
mouth can enter the pulp, leading to
infection. Often this can be corrected with
root canal therapy (RCT), but if the infection is
so severe that antibiotics or RCT do not cure
it, extraction may be needed to prevent the
spread of infection.
• Periodontal (Gum) Disease. If periodontal
disease -- an infection of the tissues and
bones that surround and support the teeth -have caused loosening of the teeth, it may be
necessary to the pull the tooth or teeth.
Prior to Extraction Procedure
• To determine severity of damage, an x-ray of
tooth is taken. If tooth can’t be restored, then
new appointment is given to the child for tooth
extraction procedure. An antibiotic may also be
given to the patient to reduce the infection.
• If the child is very nervous and anxious about the
tooth extraction procedure, then anti-anxiety
medication may be given to the child. It is
typically to be taken at night before the tooth
• Apply local anaesthetics to the tooth and oral
structures to make them numb
• Using appropriate instruments to extract the
• Tightly bite on cotton roll or gauze to help
What Dentist must know Before
Having a Tooth Pulled
• Although having a tooth pulled is usually very
safe, the procedure can allow harmful bacteria
into the bloodstream. Gum tissue is also at risk of
infection. If you have a condition that puts you at
high risk for developing a severe infection, you
may need to take antibiotics before and after the
extraction. Before having a tooth pulled, let your
dentist know your complete medical history, the
medications and supplements you take, and if
you have one of the following:
damaged or man-made heart valves
congenital heart defect
impaired immune system
liver disease (cirrhosis)
artificial joint, such as a hip replacement
history of bacterial endocarditis
• Removal of a seriously decayed tooth can
prevent infective endocarditis for some
patients who are suffering from some forms of
Note to be given for parents
• The proper alignment of teeth depends on the
size of the jaw bone. If deciduous teeth are
extracted prematurely, the early loss of
deciduous teeth may have an adverse result in
irregular alignment of permanent teeth.
• Deciduous teeth will shed naturally during the
period of transition from deciduous to
permanent dentition. Even though they are loose,
there is no need to extract the deciduous teeth.
• Never frighten a child by a threat to have their
teeth extracted if they don't behave. It will
cause fear towards dental treatments and the
child will become less cooperative to dental
procedures in the future.
• Points to note after extraction
On the day after extraction:
• Do not rinse your mouth vigorously
• Do not disturb the wound with the tongue or
• Do not do heavy exercise
• Take pain control medication as given by dentist
• Painful and swollen wound after extraction
• Generally, discomfort in the wound will be felt
within few days after the extraction. The level
of discomfort will decrease as the wound
heals. If you follow the dentist's advices to
give your child medications and keep his/her
mouth clean, the wound should gradually
After a Tooth extracted
• Following an extraction, your dentist will send you
home to recover. Recovery typically takes a few days.
The following can help minimize discomfort, reduce
the risk of infection, and speed recovery.
• Take painkillers as prescribed.
• Bite firmly but gently on the gauze pad placed by your
dentist to reduce bleeding and allow a clot to form in
the tooth socket. Change gauze pads before they
become soaked with blood. Otherwise, leave the pad
in place for three to four hours after the extraction.
• Apply an ice bag to the affected area immediately after
the procedure to keep down swelling. Apply ice for 10
minutes at a time.
• Relax for at least 24 hours after the extraction. Limit
activity for the next day or two.
• Avoid rinsing or spitting forcefully for 24 hours after
the extraction to avoid dislodging the clot that forms in
• After 24 hours, rinse with your mouth with a solution
made of 1/2 teaspoon salt and 8 ounces of warm
• Do not drink from a straw for the first 24 hours.
• Do not smoke, which can inhibit healing.
• Eat soft foods, such as soup, pudding, yogurt,
or applesauce the day after the extraction.
Gradually add solid foods to your diet as the
extraction site heals.
• When lying down, prop your head with
pillows. Lying flat may prolong bleeding.
• Continue to brush and floss your teeth, and
brush your tongue, but be sure to avoid the
extraction site. Doing so will help prevent
• If the discomfort persists or has even
worsened , you should take your child to get a
detailed check-up by the dentist.
Extraction of Baby Deciduous Lower
• If the tooth is impacted or is not visible above
the gum line, then surgical tooth extraction is
done in child. Conscious sedation or general
anesthesia may be given to the child before
surgical tooth extraction. Nitrous oxide also
called laughing gas or stronger sedation may
be given to the patient through IV. In case of
surgical tooth extraction, gum tissue is
removed to pull the tooth out.
Tooth Extraction of Baby Deciduous
• Baby tooth is easier to remove from the
socket. The roots of the baby tooth are mostly
resorbed and are short which makes it easy to
remove them. There is little or no discomfort.
What to Expect With Tooth Extraction
• Dentists and oral surgeons (dentists with special
training to perform surgery) perform tooth
extractions. Before pulling the tooth, your dentist
will give you an injection of a local anesthetic to
numb the area where the tooth will be removed.
If you are having more than one tooth pulled or if
a tooth is impacted, your dentist may use a
strong general anesthetic. This will prevent pain
throughout your body and make you sleep
through the procedure.
• If the tooth is impacted, the dentist will cut
away gum and bone tissue that cover the
tooth and then, using forceps, grasp the tooth
and gently rock it back and forth to loosen it
from the jaw bone and ligaments that hold it
in place. Sometimes, a hard-to-pull tooth must
be removed in pieces.
• Once the tooth has been pulled, a blood clot
usually forms in the socket. The dentist will
pack a gauze pad into the socket and have you
bite down on it to help stop the bleeding.
Sometimes the dentist will place a few stitches
-- usually self-dissolving -- to close the gum
edges over the extraction site.
• Sometimes, the blood clot in the socket
breaks loose, exposing the bone in the socket.
This is a painful condition called dry socket. If
this happens, your dentist will likely place a
sedative dressing over the socket for a few
days to protect it as a new clot forms.
When a Dentist should be called
• It is normal to feel some pain after the anesthesia
wears off. For 24 hours after having a tooth
pulled, you should also expect some swelling and
residual bleeding. However, if either bleeding or
pain is still severe more than four hours after
your tooth is pulled, you should call your dentist.
You should also call your dentist if you experience
any of the following:
• Signs of infection, including fever and chills
• Nausea or vomiting
• Redness, swelling, or excessive discharge from the
• Cough, shortness of breath, chest pain, or severe
nausea or vomiting
• The initial healing period usually takes about one to
two weeks. New bone and gum tissue will grow into
the gap. Long-term, however, having a tooth (or teeth)
missing can cause the remaining teeth to shift,
affecting your bite and making it difficult to chew. For
that reason, your dentist may advise replacing the
missing tooth or teeth with an implant, fixed bridge, or