Dentist Questions Cavities

The dentist has recommended my son’s tooth extraction. Is it the right way to go?

My son is 4.5 years old. His front two teeth have cavities. According to the doctor we will have to extract his front two teeth. Is it the right way to go or is there another option?

30 Answers

Yes there is. Find a dentist that has silver diamine fluoride. It will arrest the decay but it will turn the decay very dark,almost black, but the dentist can place a bonded restorations to hid the color. The current ADA Journal covers the indications for this newer treatment
There are usually options, depending on the size of the cavities. It's often best to keep natural teeth as long as possible. If teeth are removed prematurely, a space maintainer may be necessary. Of course, if decay is close to the nerve, then nerve treatment or extraction may be necessary. If you are unsure, get a second opinion.
Sometimes you can restore the teeth with fillings of "caps," but if the decay has gotten too deep, the teeth can become abscessed (usually noticeable by a small pimple at the gums by the tooth), in which case, the baby tooth should be extracted.
Depending on the size of the decay, the teeth may/can be saved. However if the decay is too large, extraction may be the best option. Without seeing an X-ray, I can’t say for sure.
As your son is 4.5 years old, there is a chance in a year's time, he will lose these teeth anyway. If the teeth have small cavities, the dentist might be able to monitor and only extract them if the teeth become compromised. If the cavities are large, the risk of leaving the teeth there is infection and it might affect the adult teeth that are underneath. If there is any question, I would get a second opinion.

Hope this helps,

Jossi Stokes, DDS
You did not give enough information for an answer. Are they primary or permanent teeth? Does he have decay in other teeth? If they are primary teeth, what is the status of the permanent teeth? Are there radiographs to be seen?
Without an X-ray, it is impossible to answer your question. Please call the office at 718-708-6755 for an appointment and I’ll be happy to take a look and let you know. If we can save the tooth. we will.

It depends on the extent of the decay. His adult front teeth will not erupt until about age 6 for the lowers and around age 6 to 7 for the uppers. So you may want to get a second opinion to see if the teeth can be held onto a little longer with some fillings or even some pulpotomies, if the decay is all the way to the nerve. The longer they can be held onto, the better.
It's reasonable if he's in pain or it doesn't look good. It is very likely he will lose it within the next 2 years so it just depends on how bad it is.
Good afternoon. The answer to your question depends upon the extent of the tooth decay. If there is not enough tooth structure remaining to restore the tooth, extraction may be the only option. However, if there is enough tooth structure remaining (and your son is cooperative enough to allow the treatment to be completed), the teeth may be able to be restored with composite resin or with a crown. If you are unsure of what to do, it may be worthwhile to get another opinion.

Best of luck!
Gary D. Sabbadini, DDS
Without knowing the history, symptoms and x-ray, it is impossible to know

Dr Jensen
It is difficult to say without seeing the x Ray. If the teeth are very broken down and can not be restored, then you have no choice. Extracting them may delay the eruption of the permanent teeth but it not affect their appearance. If they are repairable, it would probably be less traumatic to fix them.
When the decay reaches the pulp restoring the teeth is an option. The upper front teeth would fall out at 7, the lower front teeth at 6. That is quite a while to go without teeth. Placing replacement teeth should be considered. The hole in the front of the mouth will likely alter tongue function in speech and swallowing.
It would depend on the extent of the cavities or how close to two front teeth coming out
They could be filled provided no endodontic therapy is required.
The answer to that question, as is often the case, is "it depends."
If your son's 2 front teeth have small, shallow cavities, then several Silver Diamide Fluoride treatments on those teeth may be enough to slow the progress or arrest those cavities (if he isn't ready to sit still for filling treatment). If your son is cooperative enough for a filling treatment, and those cavities are not extremely deep, then fillings are usually standard practice. If the cavities are so deep that infection and/or inflammation has affected the nerves in those teeth, then extraction is certainly a legit treatment option. Those teeth will be replaced by "adult" versions between 6-7 years of age, but I would recommend a spacer/retainer be worn until those replacement teeth erupt (come through gums) - otherwise the surrounding teeth will crowd-in and block those replacements (an orthodontic problem).
So as you can see, it all depends on the extent/severity of those cavities, and the cooperative/behavioral "readiness" of the young patient.

Hope this perspective helped.

Dr D. Kowalchuk
In most cases I would say yes. Depends on where his adult teeth are on x-ray, but....I would want to know why it required also.
We always evaluate whether there will be enough tooth remaining after removal of all decay. Sometimes the pulp is involved depending on the size of the cavity, and that sometimes doesn't leave enough tooth remaining to function until the permanent teeth erupt. You would hope if there is ample tooth remaining after caries removal, and even possible nerve damage treatment, that you can maintain these primary teeth until arrival of the permanent central incisors. You also don't want to risk damaging the erupting permanent incisors if the caries have caused major loss of tooth structure to the primary incisors, or due to nerve damage as well.
- Dr Chip
Hi, if dental caries got to the nerve then extraction is the best option as permanent front teeth often erupt at 6-7 years old. If caries not that big then doing filling is an option.
It depends on how far the cavity has gone?? If it is too far and there is an infection then yes.
Your dentist has the clinical judgment having examine the child and the tooth and supporting bone if he recommends extraction I'm sure there's a good reason. However if you're in a urban population you might consult the services of a pediatric dentist who can do some heroic things too facilitate your child keeping those front teeth until the permanent teeth the right usually between 7 and 8. So that amount of time justifies some added thinking in terms of weighing the benefits a restoring those teeth as viable space maintainers not to mention efficiency and chewing and speech at a most important stage of development. If you do end up extracting the tea ask your dentist to replace them with a removable Appliance easy to make and it has little Clips to hold on to the T to maintain the space as a secondary alternative to expensive Restorations.
If the teeth are decayed into the nerve, then they should be removed. The risk of an infection can permanently damage the adult teeth. If it is only a cavity, then restoring the tooth is an option. My son lost his front two teeth at age four and the only problem was a delay in the eruption of his permanent teeth when he was six which was not a problem at all.
Obviously, in individual cases the answer may vary, but in general I do not even attempt to fill front teeth of children, because they are the first to fall out, and they almost never cause pain, so unless there is very gross disfigurement, I would leave them be.

It depends, I don’t have the X-ray to evaluate the situation, but if the tooth is going to fall out on its own within the next six months then yes, you could extract the tooth, if not we would advise to fill the teeth. If you are not sure, consult with another dentist.

Thank You,

it depends on the severity. You could always get another opinion to verify your options.
If you need a second opinion, see a pediatric dentist as soon as possible. Dental infections can be serious and even life threatening.
It depends on how deep the cavity is.
There is no harm in seeking a second opinion from a dentist who can see the depth of the cavities and where the big teeth are underneath - how soon they can be expected to come in. Please do not allow your son to drink sugary drinks, especially right before bed. He should not have soda at all. Not only is it horrible for his teeth, it will cause damage to his bones.
If the teeth can be saved, they shouldn't get extracted. He is 4.5 and he won't get his permanent ones for another two years.
Yes, it's ok to extract these two teeth. He is very close to loosing them naturally anyway. They are changed between five to seven years of age, to give room to his adult teeth to erupt. No need for an appliance to keep the space.