Extraction or root canal for baby teeth?

My two-year-old daughter has dental caries extending to the nerve on the two upper front teeth and dental caries which did not extend to the nerve on the two upper teeth next to the two center teeth. Do you recommend extractions of all four teeth? Or root canal of the two center ones and fillings of the two side ones? What is the risk of anesthesia in a young child? She weighs about 23 lbs, does that exclude using nitrous oxide? Is observation only an option?

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Because your daughter will probably have those front teeth for about four to five more years and because they function for cosmetics, phonetics, and chewing, the ideal treatment would be to do what it takes to save the teeth. I would probably recommend doing "baby" root canals (much less involved than "adult" root canals) on the teeth which need them and fillings on teeth which need them. Small amounts of local anesthesia are fine for children; dosages are based on weight.

If your daughter does weigh about 23 lbs., only slightly more than one cartridge should be used per visit; therefore, it might be prudent to do the work on the front teeth in two or three appointments. A moderate to low amount of nitrous oxide should be all right as well, given your daughter does not have any medical conditions or allergies which would cause a problem with nitrous oxide. I would not just sit back and observe these cavities unless one happens to be extremely small. They will only get worse, and the teeth which already have caries into the nerve could become infected and cause pain.

To help avoid continued trouble with caries, please be sure you are helping your daughter brush at least twice daily and floss at least once daily. Also, keeping an eye on diet is important, and if your water is not fluoridated, discuss with your dentist or pediatrician fluoride supplements for your daughter.

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