How important is saving a baby tooth?

How important is saving a baby tooth, when a permanent tooth will be replacing it? How does a dentist decide whether to save or pull a baby tooth?

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Sometimes saving a baby tooth is very important. When dentists attempt to restore a primary (baby) tooth from trauma, disease, or other conditions, there are several goals. These goals include restoring the tooth for proper function, maintaining the space for the permanent tooth to erupt and keeping the area free from pain and infection. To obtain these goals, careful treatment planning must be considered. Factors that affect treatment planning include location of the tooth, tolerance and cooperation of the patient, condition of pulp tissue within the tooth and the condition of the tooth structure.

If the tooth appears to be "disintegrating" prior to treatment (i.e. much tooth structure is lost due to trauma or decay), then restoring the tooth may not be possible. If the tooth structure loss is not extensive, then restorative options should be considered. If the nerve tissue is exposed, removal of the pulp tissue (nerve and blood vessels within the tooth) will be necessary. Perhaps only the coronal portion of the tooth will need to be removed. This procedure is called a pulpotomy. Sometimes both the coronal and root portions must be removed. This procedure is called a pulpectomy.

Just as with a permanent tooth which has had root canal therapy, these procedures can cause the primary tooth to become more brittle; therefore, the type of restoration needs to be given careful consideration. If the amount of tooth loss is small, a simple filling might suffice, otherwise, placement of a stainless steel crown may be necessary to prevent further deterioration of tooth structure.

The success rates for pulpotomies and pulpectomies can run anywhere from 60 to 98 percent. Failure is generally indicated by persistent swelling, increased bone loss and/or tooth resorption. If this happens, the tooth should be extracted, otherwise, the tooth should remain until the permanent tooth erupts. Root resorption of the treated primary tooth should occur naturally. One exception might be the primary tooth which required treatment as a result of trauma. Trauma can occasionally cause ankylosis (a fusion of the tooth with the bone). In this case, tooth loss would not occur naturally.

If you have a child whose primary tooth was saved but now appears to be disintegrating, please see your dentist. If it is not too late, placement of a stainless steel crown may be helpful. Otherwise the tooth may need to be extracted and replaced with a space maintainer to properly reserve a place for the incoming permanent tooth.

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