Infected cavity in primary molar

My son (8yrs. old) has a cavity in his baby molar. Our dentist said the tooth is dead and he is not going to worry about filling it as it should fall out in the next year. A few months ago the tooth became infected so the dentist gave him antibiotics and said not filling it would allow it to drain. He said if it bothers my son he will just pull it unless we really want to go through filling it.

It has been hurting a lot lately. Especially when he eats sweets. Which is the "lesser of the three evils"? Pull it? Fill it? Leave it alone?

He's a real baby when it comes to pain!

Thanks,
Cindy

Question:

Dear Cindy,

Your dentist did perform the correct treatment for the infection by placing your son on antibiotics and allowing the tooth to drain; now, treatment needs to be completed.

Most primary molars are not lost until about 11 or 12 years of age. Unless your son is early to develop, as may be revealed on radiographs (x-rays), it is likely he will have this tooth for 3 or 4 more years. I would not advise "leaving it alone". My first choice of treatment would be to perform a pulpotomy (a.k.a "baby root canal"). These are much less complicated and easier than root canals on permanent teeth. After this is done, the tooth should have a filling or a stainless steel crown placed. If much tooth structure is missing, I would recommend a stainless steel crown. Generally, this treatment works very well to alleviate further problems. It also saves the primary tooth to help with chewing and to hold the place for the permanent tooth underneath.

If the tooth does become infected again or if it continues to be painful, then I might recommend extracting it and placing a space maintainer. The only two reasons I might not try the pulpotomy and restoration first are: 1) if too much of the tooth structure is missing already; or 2) if the primary tooth is mobile because the permanent tooth is close to erupting.

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