Extraction
Extraction of primary or permanent teeth
Suitable for:
- a primary tooth that is unrestorable or of poor prognosis
- a permanent tooth that is unrestorable or of poor prognosis
Aim: To relieve or avoid pain or infection when alternative management approaches are not feasible or are not in the child’s best interests.
For primary teeth with associated pain (pulpitis with irreversible symptoms) or infection and when alternative management options have been excluded, an extraction should be considered. However, dental extractions with local anaesthesia are potentially traumatic for the child and can leave them with a negative perception of dental care, especially in children where this is an early experience of dental care for them. It is better to avoid an extraction in an emergency situation where a child has little positive experience of dental treatment, and consider delaying until the child’s confidence has been built and they are able to cope with the procedure. The possibility of the child not being brought back for treatment once out of pain should be considered.
Avoid dental extractions with local anaesthesia on a child’s first visit if at all possible.
If the child is in pain (pulpitis with irreversible symptoms), consider dressing the tooth with corticosteroid-antibiotic paste and a temporary dressing.
Where there are signs or symptoms of dental abscess/infection and an extraction is either not possible or better delayed, build up the child’s ability to cope to allow the extraction to be carried out.
- In some cases, local measures to bring infection under control may be appropriate.
- If there are signs or symptoms of systemic involvement or spreading infection, antibiotics may be prescribed.
Balancing extractions in the primary dentition
A balancing extraction is the extraction of a contralateral tooth, performed in order to minimise a centre line shift and maintain symmetry of the developing occlusion.
Orthodontic treatment has generally moved away from techniques based on the extraction of premolars with the use of removable appliances, to fixed appliance therapy. Therefore, there may be more flexibility in the guidance on the indications for balancing extractions.
The benefits of balancing extractions have to be weighed against the risk of causing treatment-induced anxiety through the additional extraction.96
Note that if caries is identified on one side of the mouth, it is quite likely to also be present on the other side, although may be at an earlier stage and more difficult to detect. Therefore, it is particularly important to examine contralateral teeth for disease clinically and with bitewing radiographs.
Consider balancing extractions when:
- one primary canine (C) is to be extracted
- one primary canine (C) has exfoliated prematurely due to eruption of the permanent lateral incisor
- a centre line shift is developing following extraction of one first primary molar (D)
Be aware that balancing extractions are not usually necessary in the following situations:
- loss of primary incisors (As and Bs)
- loss of first primary molars (Ds) unless a centre line shift is developing
- loss of second primary molars (Es)